Commentary: Intraprofessional Collaborative Practice: Strengthening Nursing to Support Health System Transformation.

BackgroundThe ever-evolving healthcare system of today demands physicians who steer their roles as treatment providers, managers and collaborators. Professionals are highly interdependent due to increased complexity of health problems and risk of errors increases with transitions in care. In hospitals, the main workforce is postgraduate residents; therefore, intraprofessional collaboration amongst residents is essential. Several instruments are available to evaluate interprofessional collaboration amongst physicians, nurses and hospital teams but none specifically assessed intra-professional collaborative practices amongst residents working in tertiary care hospitals in multi-disciplinary teams. This study intends to develop and validate an instrument to self-assess intraprofessional collaborative practices in postgraduate residents undergoing residency in multiple specialties at tertiary care hospitals.ApproachThis study on Instrument Development employed mixed method study design executed in two phases. In phase 1, six domains of intraprofessional collaborative practices were identified from literature and 35 items were developed. Fifteen experts participated in qualitative content validation and provided comments. To establish content validity in phase 2, content validity index (CVI) and content clarity average (CCA) were assessed by seventeen experts. Response process validity was established by cognitive interviewing of 5 postgraduate residents. Pilot testing was done on a sample of 407 residents. Cronbach’s alpha was determined, and confirmatory factor analysis established construct validity.ResultsDuring phase 1, items were modified based on qualitative feedback from 15 experts. In round 2, CVI and CCA were determined based on responses of 17 experts. The items having an I-CVI greater than 0.90 were accepted and six items underwent modifications as their I-CVI fell between 0.78 and 0.90. Similarly, four items with a CCA of less than 2.4 were modified to increase clarity. Cognitive interviews of participants on 30 items resulted in the deletion of 1 item and changes in 5 items. The final instrument had 29 items categorized under six constructs. All items had good factor loadings during CFA, so none was deleted. Cronbach’s Alpha α was 0.937.ConclusionIntraprofessional collaborative practices in residents is a valid and reliable self-assessment tool comprising 29 items measuring six constructs. It may be used by residents to assess their collaborative practices and incorporated in curricula to help develop collaborative practices and their assessment during training of postgraduate residents.

Health Systems Need to Transform Data Collection to Advance Health Equity.

To deliver high-quality collaborative care, residents need to be trained across the boundaries of their medical specialty (intraprofessional learning). The current literature does not provide insights into the underlying processes that influence intraprofessional learning. The aim of this study was to gain insight into the processes that occur during intraprofessional workplace learning in residency training, by exploring everyday intraprofessional interactions experienced by residents, with the ultimate objective of improving collaborative practice. We conducted a focused ethnography using field observations and in-depth interviews with residents at an academic children's hospital in the Netherlands. In 2022, nine residents from four different medical specialties were shadowed and/or interviewed. In total, >120 hours of observation and 10 interviews were conducted. Data collection and analysis were conducted iteratively and discussed in a research team with diverse perspectives, as well as with a sounding board group of stakeholders. Residents were involved in numerous intraprofessional interactions as part of their daily work. We identified three themes that shed light on the underlying processes that occur during intraprofessional workplace learning: (1) residents' agency, (2) ingroups and outgroups and (3) communication about intraprofessional collaboration. Collaborative practice offers many intraprofessional learning opportunities but does not automatically result in learning from, with and about other specialties to improve intraprofessional collaborative care. Overarching the identified themes, we emphasise the pivotal role of the resident-supervisor dyad in facilitating residents' engagement in the learning opportunities of complex intraprofessional care. Furthermore, we propose that promoting deliberate practice and shared responsibility in collaborative care are crucial to better prepare residents for their roles and responsibilities in delivering high-quality collaborative patient care.

Background: The United Arab Emirates’ nursing workforce has a remarkable diversity, including a range of cultural, linguistic, clinical, and educational backgrounds. While a source of richness, this diversity poses challenges to effective collaboration among Intensive Care Unit (ICU) nurses. This study aimed primarily to analyze the relationship between nurse collaboration and self‐perceived performance in ICUs. Therefore, the study is significant for its potential to improve collaborative practices within the nursing profession, leading to elevated patient care standards in a diverse and demanding clinical environment.Methods: One hundred and forty‐seven ICU nurses participated in this cross‐sectional study. The “Nurse–Nurse Collaboration Scale” and the “Six‐Dimension Scale for Nursing Performance” were used to collect the study data. Data were statistically analyzed using multiple linear regression with 10 independent variables.Results: The overall mean scores for nurse–nurse collaboration exhibit a statistically significant difference between Arabic and overseas nurses (p = 0.002). Similarly, the total mean scores for perceived job performance also show a significant difference. The standardized beta coefficient indicates that nurse–nurse collaboration is a significant predictor (β = 0.470, p = 0.001) as well as nurse‐to‐patient ratio (β = −0.233, p = 0.003).Conclusion: The study revealed a statistically significant difference in coordination among nurses from different ethnic backgrounds. Better team collaboration and a lower nurse‐to‐patient ratio are two major aspects that nurse administrators can work on to enhance job performance among ICU nurses in the United Arab Emirates, achieving optimal performance in resource deployment and quality of service.Implications for Nursing Practice: This study highlights the intricate dynamics of nursing teamwork within the multicultural ICU settings. Identifying and addressing the nuances of teamwork, alongside the critical factors affecting nurse collaboration and job performance, is vital for improving patient outcomes and fostering a positive work environment.

This paper aims to hypothesize that modern health systems are transforming towards what has been called a health ecosystem in complexity-based health care literature. It has been argued that complexity arises from the interconnectedness, which in this paper is equated with knowledge flows between actors. The paper seeks to discuss the possible implications of a health ecosystem approach to health system management. The paper is conceptual in nature but the transition towards a health ecosystem is illustrated with an example of a regional health care system in Finland. The case description and related analysis presented are based on qualitative data gathered by interviewing leading office-holders, by process modeling and by observing management group meetings. Conceptually, a health ecosystem seems to have potential for the system-level analysis of the health care system. The discussion concludes that management of knowledge flows should be a strategic management function for individual health organizations as well as for the wider health system. This study focuses on a Finnish health care system. The operations and structures of health care services and systems vary in different areas and countries. The practical illustration of the health ecosystem provides a reminder that health care systems are dynamic and largely based on interaction between different actors. The approach provides new strategic insights for the development of health care systems by concentrating on interrelationships and knowledge flows. The literature has suggested that the ecosystem metaphor offers useful insights for the development of health care systems. Nevertheless, this approach has not been thoroughly studied so far. This paper makes a contribution by presenting a practical illustration of the framework and in light of this discusses the possible implications for health care management.

The evaluation of the Homeless Older People (HOP) project focused on case management/navigation for unhoused older adults and making connections between major healthcare organizations and housing programs to enhance collaboration in advance of patient discharge. Healthcare systems recognize the impact of social determinants of health (SDOH) on patients since SDOH can negatively impact patients’ health outcomes and self-management abilities. However, healthcare organizations said completing SDOH screening tool can take over 30 minutes. We suggest two screening questions regarding a steady place to stay at night and where they usually sleep to ascertain homelessness. Health systems aren’t structured to address housing issues, making coordination with housing service agencies imperative. When homelessness is indicated, HOP case managers would be notified to collaborate in discharge planning. HIPAA compliance restrictions on healthcare data systems create firewalls that preclude information exchange. Electronic health records systems are not compatible with other entities’ electronic systems, requiring staff to make referrals manually which is often not done. We observed significant differences in approaches among healthcare systems serving unhoused older patients. Some health systems are eager to explore expanding communication channels. A positive trend is healthcare organizations recognize the problem of growing numbers of unhoused older adults who need services beyond their service array. Creating straight-forward protocols for coordination, with input from healthcare stakeholders, could increase collaboration. The protocol would describe who and when to contact for specific admission situations. Easy-to-use communication channels between healthcare systems and HOP case managers can bolster successful discharges.

The future of health professions education: Emerging trends in the United States.

This paper describes a participatory, evidence-based, patient-focused process for advanced practice nursing (APN) role development, implementation, and evaluation (PEPPA framework). Despite the growing demand for advanced practice nurses, there are limited data to guide the successful implementation and optimal utilization of these roles. The participatory, evidence-based, patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing (PEPPA) framework is an adaptation of two existing frameworks and is designed to overcome role implementation barriers through knowledge and understanding of APN roles and environments. The principles of participatory action research directed the construction of the new framework. The process for implementing and evaluating APN roles is as complex and dynamic as the roles themselves. The PEPPA framework is shaped by the underlying principles and values consistent with APN, namely, a focus on addressing patient health needs through the delivery of coordinated care and collaborative relationships among health care providers and systems. Engaging environmental stakeholders as participants in the process provides opportunity to identify the need and shared goals for a clearly defined APN role. The process promotes increased understanding of APN roles and optimal use of the broad range of APN knowledge, skills, and expertise in all role domains and scope of practice. The steps for planning and implementation are designed to create environments to support APN role development and long-term integration within health care systems. The goal-directed and outcome-based process also provides the basis for prospective ongoing evaluation and improvement of both the role and delivery of health care services.

Firmly establishing oral health care professionals’ roles as vaccinators within the health care system

Strengthening healthcare systems has been identified as central to Africa achieving global and regional development targets, including the millennium development goals. Lola Dare and Anne Reeler present case studies on...

The Indian healthcare scenario has been gradually changing in terms of the use of advance healthcare and healthware systems. In accordance with the recent surrounding conditions and increasing health issues rate, accelerate the use of healthware and healthcare system. The growth of healthcare systems in India is obstructed due by lack of medical professionals, hospitals, poor accessibility to medicines, and unavailability of quality healthcare in distant and rural areas. The Internet of Things (IoT) can play a vital role in improving the poor healthcare system in India by providing a proficient, integrated, well connected, patient-centered system. The IoT technology has emerges with various IOT based healthware, medical monitoring system, and smart homes for elderly patients suffering from chronic disease which serves as an efficient solution to qualitative, effective and accessible healthcare system. The present study provides a review of the available healthware and healthcare system in India and their efficacy for healthcare space.

Background Hospital length of stay (LOS) is an important indicator of healthcare systems’ performance. Several factors are closely related to LOS, which is characterized by high heterogeneity among countries. This study aims to investigate the 20-year time-trends of LOS and their association with different healthcare systems’ and reimbursement models among 25 European countries. Methods We conducted a 20-year time-trend analysis (2000-2019) using a Weighted Least Squares model for panel data to investigate the association between LOS, healthcare systems’ models (National Health Service, NHS, National Health Insurance, NHI, Social Health Insurance, SHI, and Etatist Social Health Insurance, ESH), reimbursement schemes (Prospective Global Budget, PGB, Diagnosis Related Groups, DRG, and Procedure Service Payment, PSP), and several control variables. Data were extracted from the Eurostat and GBD study databases. Results The analysis showed a generalized reduction of LOS across the 25 countries, ranging from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to the reference category (NHS) (b=−0.6327, p < 0.05). Both DRG (b = 1.2399, p < 0.05) and PSP (b = 1.1677, p < 0.05) reimbursement models were positively associated with LOS when compared to PGB. Conclusions Our results confirmed the downward trend of LOS in the last 20 years among European countries, highlighting the strong influence of the healthcare system model. The results of this study offer insight into the factors influencing healthcare utilization and can inform the design of more efficient and sustainable healthcare systems. Key messages • This study investigated the relationship between HS models, financing, regulation, service provision, reimbursement schemes, and LOS, across 25 European countries in the last 20 years. • This study found a dominant influence of the HS models on LOS. SHI models were associated with shorter LOS compared to National Health Systems, after accounting for several factors.

Over the last 25 years, the health care systems of most high-income countries have experienced extensive--usually market-based--organizational and financial reforms. The impact of these system changes on health equity has been hotly debated. Examining evidence from systematic reviews of the effects of health care system organizational and financial reforms will add empirical information to this debate, identify any evidence gaps, and help policy development. Systematic review methodology was used to locate and evaluate published systematic reviews of quantitative intervention studies (experimental and observational) of the effects on equity in health care access and/or health status of health care system organizational and financial reforms (system financing, funding allocations, direct purchasing arrangements, organization of service provision, and health and social care system integration) in high-income countries. Nine systematic reviews were identified. Private insurance and out-of-pocket payments as well as the marketization and privatization of services have either negative or inconclusive equity effects. The evidence base on the health equity effects of managed care programs or integrated partnerships between health and social services is inconclusive. There were no relevant studies located that related to resource allocation reforms. The systematic review-level evidence base suggests that financial and organizational health care system reforms have had either inconclusive or negative impacts on health equity both in terms of access relative to need and in terms of health outcomes.

Abstracts from theCenter to Advance Palliative Care National Seminar Pathways to Quality Palliative Care<i>November 13–15, 2014</i><i>Orlando, Florida</i>

Born in Pyongyang in 1914, Choe Ung-sok was a physician who lived through the Japanese colonial era (1910-1945), rule by the United States Army Military Government in Korea (USAMGIK; 1945-1948), and national division (1948). Influenced by socialism and social hygiene/social medicine during his studies in Japan, he played the role of representing the socialist camp in the discussions related to the construction of a heath care system immediately following the Liberation (1945). His key arguments were: first, the nationalization of the medical system and the implementation of nationwide programs to eradicate diseases; second, the provision of free medical services through the expansion of social insurance; third, the reeducation of the medical personnel; fourth, the provision of social sciences education to the medical personnel and the reorganization of medicine into preventive medicine; fifth, the nationalization of pharmaceutics; sixth, the laborers' establishment of autonomous medical organs (affordable clinics, medical consumers' unions through cooperatives); and seventh, the reduction of work hours to 6-8 hours, technical improvement, respite from research, and guarantee of economic life for the medical personnel. Influenced by the medical systems of the Soviet Union and Japan, such arguments stood in opposition to the right wing's plan for the construction of a relatively passive health care system at the time but, in the end, failed to be realized in southern part of Korea under the USAMGIK. Subsequently, he defected to northern part of Korea and came to participate in the task of constructing North Korea's health care system. Choe's life and design for a health care system provide examples through which one can confirm the nature of social hygiene/social medicine both during the Japanese colonial era and before and after the Liberation and the contents of the design related to a health care system as held by the socialist faction. In addition, they show that, immediately after the Liberation, there existed a broad spectrum of imagination and arguments concerning the desirable health care system. Following the division of the Korean Peninsula, South Korea witnessed the instatement of a regime that established anti-communism as the state policy and the strong influence of the United States in politics, economy, and culture. The consequent frustration of Choe's design for a health care system and his defection to North Korea frustrated the creation of a National Heath Service (NHS) in South Korea, reinforced the tendency to view NHS and social insurance as "socialist" or "communist" methods, and led to the restriction of the scope of subsequent discussions related to health care system. In conclusion, the course of Choe's life and thought went beyond the life of an individual during a period in which diverse ideologies collided through the Japanese colonial era, Liberation, and national division and symbolically demonstrates one important path of the process of constructing a health care system on the Korean Peninsula.