BackgroundModern cancer care requires the development of clinical pathways to enhance coordination, but there are few descriptive studies about the content of coordination activities. More specifically, little is known about hospital discharge coordination, although this is seen as a sensitive phase of clinical pathway.PurposeThe purpose of this study was to identify and quantify the categories of activities performed by nurse navigators for hospital discharge coordination.MethodsPatients supported within the Coordinating Outpatient Care department (COC) at Gustave Roussy (Villejuif, France). Study conducted over two consecutive phases (Feb-September 2014): (1) a qualitative phase to identify the categories of coordination activities (interviews with patients plus, focus groups with nurse navigators—NNs); (2) a quantitative phase to quantify the relative share of each category. The calls received through the telephone platform of COC (made by both patients and primary care providers) were systematically reported (caller; reason for the call; procedure performed) and then analyzed.ResultsQualitative phase: 17 interviews with patients, plus 2 focus groups with NNs. Quantitative phase: 543 calls analyzed. The callers were patients or their relatives (38 %), private nurses (35 %), medical device providers (20 %), and other primary care providers (e.g., pharmacists, family physicians) (7 %). Five categories of coordination activities identified: (F1) Patient monitoring (29 %); (F2) Helping to navigate (24 %); (F3) Managing technical problems (17 %); (F4) Explaining care protocols (16 %); (F5) Collecting and transmitting the patient medical record information (14 %).ConclusionsThe majority of requirements are related to organizational issues (e.g., navigation, lack of information, appointments). Nurse navigators’ training and qualification must therefore combine both clinical and managerial skills.

Objectives Although interprofessional teamwork has been shown to improve patient safety, it is not yet routine practice in most hospital settings. There is also a lack of clarity regarding what teamwork actually means, with terms such as collaboration, coordination, networking and knotworking often being used interchangeably. In this study, we analyse 20 years of qualitative research on interprofessional teamwork in hospital settings and examine what it looks like and the factors influencing it. Methods The literature search included articles published between 1996 and 2016, and articles were included if they examined interprofessional teamwork within a hospital using qualitative methodology. We used meta-ethnographic analysis of eligible primary studies applying reciprocal translation and line of argument synthesis. Results Nineteen articles were included. Interprofessional teamwork was largely absent in acute care and found to be influenced by systems perpetuating power imbalances, organizational practices that interfered with interprofessional interactions, representations of teamwork and leadership. Conclusions Future strategies to improve interprofessional practices should include policies and structural changes to develop healthcare systems that facilitate these practices.

PurposeThe persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France.Design/methodology/approachData were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015–2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations.FindingsDespite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted “patient safety”, a paradoxical injunction to do more with less and conflicting organizational priorities.Originality/valueThis paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.

RéSUMé La reconnaissance de la fonction d’expert auprès des représentants du personnel est un bon analyseur de l’évolution des pratiques syndicales. L’article met en relief les résistances suscitées par cette activité dans le monde militant et l’échec relatif du développement d’une expertise opérationnelle interne aux organisations syndicales. Il pointe le retournement de cette situation grâce à l’externalisation de cette activité par le biais d’organismes autonomes. Le recours à l’expertise se trouve conforté par le caractère instrumental que lui confère son institutionnalisation dans un champ d’activités distinct du monde syndical. Il apparaît aujourd’hui d’autant plus légitime qu’il permet à nombre d’élus de combler certains vides résultant de l’affaiblissement des organisations syndicales.

International audienceCet article cherche à comprendre la fragilité persistante dans la prise en charge syndicale de l’égalité professionnelle au sein des entreprises. Pourquoi, malgré les mesures adoptées au fil des ans pour inscrire cet enjeu dans la négociation collective, les progrès enregistrés n’enclenchent-ils pas un cercle vertueux ? À partir d’entretiens menés auprès de représentants syndicaux de la CFDT, l’article pointe quelques-unes des difficultés – stratégiques, opérationnelles, politiques – pouvant expliquer cette fragilité. Il reprend des éléments d’un rapport commandé par une organisation syndicale, la confédération française démocratique du travail, au moment où celle-ci se pose la question du renouvellement des pratiques syndicales en matière des rapports hommes/femmes