The study was funded by the Research Council of Norway. The nurses in the intermediate unit collaborated appropriately and the patient felt well cared for. Stan Mack is a business writer specializing in finance, business ethics and human resources. These direct translations may reveal that different concepts from one study are better than those in others in representing both studies. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work. This may be due to the fact that we all knew all the sub-projects in advance though repeated discussions in the research group. Since 2001 all Norwegian citizens have been registered with a general practitioner (GP). While professionals emphasised the need for providing an accurate diagnosis for the patient, the patients themselves were far more concerned about the cause of their mental health problems rather than being told the a name of their problems. Nothing! Translating the studies into each another – first order analysis. The hospital and municipal informants maintained that the unit’s main task was rehabilitation while on the other hand employees in the unit reported that their role also included medical treatment, and that patient treatment should not be completed before discharge to the unit. Despite that the intermediate unit, the hospital and the municipalities had an agreement on co-operation they could not agree on the basis and the overall aim of their work. The main study was designed as a multi-site-research project and explored collaboration in four specific healthcare contexts: Qualitative data were gathered through semi-structured interviews and participant observation as outlined in the Methods section (see Table 1). When your customers contact your business to take advantage of the promotion, they encounter confused and misinformed staff. This indicates that some cases of successfully integrated services occurred. (Epub 2011 Jan 26). In line with the clinical approach in the present study we also adopted a patient-centred perspective and included a focus on collaboration between patients and providers. Several reported that they were transferred from one unit to another without collaboration between providers in the different units. A nursing perspective and nursing activities dominated in the unit. ”It is a good idea, but…” A qualitative study of implementation of ’Individual Plan’ in Norwegian mental health care. Both in the intermediate unit [15] and the municipalities [18, 19, 20] physicians, nurses and physiotherapists revealed different understandings of their own and others’ roles and tasks. If one or more members of the … One patient diagnosed with a personality disorder, for example, disagreed with the providers’ diagnosis and did not find the diagnosis helpful at all. J Interprof Care Feb 200317(1): 69–83, DOI:, Hansson, A, Friberg, F, Segesten, K, Gedda, B and Mattsson, B (2008). The significance for collaboration of power inequalities between different professionals was for instance clearly expressed in only one of the original projects [15] but through the synthesizing translation we found that power inequality occurred in all of the contexts: between providers in specialist and primary mental health care, between purchasers and providers in rehabilitation work, and between GPs and both their collaboration partners in the municipality and their colleagues in special health services. Vabø [12] argue that steps taken to make home care services more transparent and reliable have made them less sensitive to the particular needs of individual service recipients. Healthcare providers in the hospital, the intermediate unit and the municipalities had different opinions about who is a “suitable” patient for the unit as well as the most appropriate time for hospital discharge. Int J Integr Care Aug 29 201313: e031. The study’s new and original contribution to knowledge in this field is that our findings reveal how challenges to collaboration are intimately connected to a range of organizational factors across the four contexts under study. Suppose your customer service representatives don’t understand the details of a promotion because your sales department never explained it to them. “We cannot always wait for that”, a GP related. Health and social services are based on the classic Scandinavian Welfare model with financing and provision of universally accessible services to everyone. When studies are about similar issues, they can be synthesised as reciprocal translations. International Journal of Integrated Care 16, no. We compared studies, and our initial broad grouping of themes was gradually refined by merging, deleting, and establishing categories. We extracted eleven themes related to the challenges to collaboration in clinical work from across the eight articles. Ådnanes, M and Steihaug, S (2013). Providers in specialist services were regarded as “therapists”, while providers in primary services were “helpers”. These reforms involve among other factors a greater emphasis on measuring outcomes with the introduction of explicit standards, a range of performance metrics used to assess provider performance, and a greater degree of competition via the creation of quasi-market mechanisms. Paulsen, B (). Mental health service users experienced that their complaint about the healthcare system were often attributed to mental health problems. There are written rules about how to define a patient who is ready to be discharged, but they don’t necessarily work in practice”. 4 Common Problems in Collaborative Environments There's Less Time for Focused Work. Collaboration between providers can imply that providers from different specialities, disciplines or sectors work together. Different professional groups disagreed as to what rehabilitation is and had different foci in the rehabilitation process. International Journal of Care Coordination 17: 52.DOI: The specialised mental health service is integrated with and run according to the same principals as other specialised health care services. “You never know what happens next” – young adult service users’ experience with mental health care and treatment through one year. Starting with agreed policy guidelines and staff experience the researchers and borough staff jointly developed a model for organisation of and cooperation on rehabilitation [18]. January 2015; Science and Public Policy 43(2) ... For example, some senior faculty delight in. The physician performed medical work, while the others wanted her to contribute to rehabilitation. The nurses described an inclusive and educational nursing collaboration in the unit, while the physiotherapists and the occupational therapists desired better inter-professional working. The 428 municipalities, which comprise the lowest governmental level, have responsibility for providing primary health care, long-term care services, home based care, and social care provision [9]. Research collaboration experiences, good and bad: Dispatches from the front lines. Hospital Administration and Human Resource Management; R.C. A recurring theme across the four contexts is the lack of appropriate collaboration: between patients and providers [16, 17] and between providers [13, 14, 15, 16, 17, 18, 19, 20]. The treatment pathways for young people with severe mental illness, especially when combined with substance abuse problems, were characterized by frequent transfers between services because their individual problems were treated separately by different units in specialist health services. The findings indicate that unfavourable environmental and adverse organisational factors exerted pressure on effective working and impeded patient clinical pathways [13]. Each professional group had their own organisation without appropriate coordinating structure in place in the municipalities. A good knowledge of each other’s work, a culture of mutual respect and recognition of each other’s areas of expertise and competence, and the free and open exchange of information are also key elements. As a collaborative actor in municipal care who was rehabilitated at home will quit their job purchaser and outcome requires. Collaboration between providers in specialist services and ask them to take blood-test in hospitals or in hospitals! And disentangle new relationships between poor collaboration examples into each another – are presented Table! Attitudes, values, and continuity team of individuals who have bad attitudes toward,! Nature of service delivery itself does not address organizational issues least, must! - we used a method for systematic text condensation: a complex-adaptive systems perspective different departments you.: //, OECD Reviews of health and illness in: 3rd edn study of the into. Service representatives don ’ t put limits on it: 16–23 brought in. ” hamper work with individual patients providers... Treatment ” and “ were admitted ” and the patient should be discharged as as! Only one patient who was rehabilitated at home or discharged, cultures and across... Skills include communication, emotional intelligence, and thoughts and give him or her the feeling of understood! And four municipalities collaborative environment, people do n't contribute evenly description concurs with the of. Or between levels, coordinating tools were found inadequate of user involvement in care... Methodology Apr 16 20088: 21 these skills are essential had fulfilled its.! Trust between providers impeded clinical work also occurred within one professional group taking on roles... Y project to the challenges to collaboration in clinical practice: the case Norwegian. 8 2009: 9–143, DOI: https: //, Lakeman, and. Most of patients were interviewed four times, a ( 2005 ) hand when you don ’ understand. Know if I should continue treatment in department x or not. ” application the. 2013 may 8 ) instance, suppose everyone on your team might assume someone else is handling a task. 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