Tablet Based Asynchronous Communication to Support Integrated Care for Complex Patients
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Abstract
Background: Studies of inter-professional and interdisciplinary teamwork in healthcare indicate that collaboration is a contested process in which parties have to learn to work together. However, the process by which this type of learning is enacted remains poorly understood which has hindered the development of collaboration tools in supporting integrated care.
Objective: This study examines (1) how learning and knowledge exchange processes unfold within and across inter-professional and inter-organizational teams, and (2) identifies what factors contribute to the development of effective communication tools in supporting integrated care of complex patients.
Methods: In depth semi-structural interviews were conducted with a convenient sample of thirteen Community Care Coordinators embedded in multiple interdisciplinary teams of healthcare professionals providing integrated care to patients with complex needs. Interviews were complemented by observations of group meetings and listening-in on patients’ case study group discussions. Results were validated in a focus group of Community Care Coordinators.
Results: The data highlighted that much of what makes integrated care delivery successful or challenging is based on the quality of the inter-professional interaction and the type of social engagement determined by attitudes, preferences, and expectations of the individual providers in the interface. Also how each team member defined and enacted the concept of collaboration and communication in the context of care provisions was important. Interdependence and collaboration among team members generally increased over time as team members recognized the value of others’ knowledge and expertise and became accustomed to drawing on that knowledge in care provisions. Learning occurred through active participation as a collective social process rather than an individual process without points of contact, through four inter-related behaviors: interaction, feedback, reflection, and self-directed learning.
Conclusions: Overall, the data shows that promoting informal non-hierarchical relationships encourages interdisciplinary teamwork, while a shared platform for timely discussions allows for collective learning as a result of being in the loop, and encourages interaction, feedback, and reflection. Our study highlights the limit of both the “best practice approach” and the search for universal solutions to integrated care, independent of context and local contingencies of learning. The results of the study can be used to identify ways to better support healthcare professionals in collaborating for integrated care delivery through asynchronous distributed collaboration tools that facilitate dialogue and learning through knowledge exchange across organizational and professional boundaries.
Objective: This study examines (1) how learning and knowledge exchange processes unfold within and across inter-professional and inter-organizational teams, and (2) identifies what factors contribute to the development of effective communication tools in supporting integrated care of complex patients.
Methods: In depth semi-structural interviews were conducted with a convenient sample of thirteen Community Care Coordinators embedded in multiple interdisciplinary teams of healthcare professionals providing integrated care to patients with complex needs. Interviews were complemented by observations of group meetings and listening-in on patients’ case study group discussions. Results were validated in a focus group of Community Care Coordinators.
Results: The data highlighted that much of what makes integrated care delivery successful or challenging is based on the quality of the inter-professional interaction and the type of social engagement determined by attitudes, preferences, and expectations of the individual providers in the interface. Also how each team member defined and enacted the concept of collaboration and communication in the context of care provisions was important. Interdependence and collaboration among team members generally increased over time as team members recognized the value of others’ knowledge and expertise and became accustomed to drawing on that knowledge in care provisions. Learning occurred through active participation as a collective social process rather than an individual process without points of contact, through four inter-related behaviors: interaction, feedback, reflection, and self-directed learning.
Conclusions: Overall, the data shows that promoting informal non-hierarchical relationships encourages interdisciplinary teamwork, while a shared platform for timely discussions allows for collective learning as a result of being in the loop, and encourages interaction, feedback, and reflection. Our study highlights the limit of both the “best practice approach” and the search for universal solutions to integrated care, independent of context and local contingencies of learning. The results of the study can be used to identify ways to better support healthcare professionals in collaborating for integrated care delivery through asynchronous distributed collaboration tools that facilitate dialogue and learning through knowledge exchange across organizational and professional boundaries.
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