Barriers and facilitators to the implementation of the collaborative method: reflections from a single site

Newton, Phillip J.; Davidson, Patricia M.; Halcomb, Elizabeth; Denniss, A. Robert

doi:10.1136/qshc.2006.019125

Cited by 38 publications

(37 citation statements)

References 31 publications

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“…The need for an improvement infrastructure has been confirmed by others 5 8 20 30 31 49–51. One might ask, ‘Is there a firewall between top-down and bottom-up approaches to QI?’ Studies suggest that clinicians often think that quality is their personal responsibility, and do not take into account the complexity and contributions of the system 18 52.…”

Section: Discussionmentioning

confidence: 84%

Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members

Brandrud

Schreiner

Hjortdahl

et al. 2011

BMJ Quality & Safety

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A pattern of three success factors for CQI emerges: (1) continuous and reliable information, including measurement, about best and current practice; (2) engagement of everybody in all phases of the improvement work: the patient and family, the leadership, the professional environment and the staff; and (3) an infrastructure based on improvement knowledge, with multidisciplinary teams, available coaching, learning systems and sustainability systems.

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Section: Discussionmentioning

confidence: 84%

Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members

Brandrud

Schreiner

Hjortdahl

et al. 2011

BMJ Quality & Safety

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“…Indeed, it is becoming increasingly recognized that such complex interactions are not uncommon in healthcare [15]- [19]. While there is positive but limited evidence that QICs can result in improved quality of care [20], it is not clear which factors contribute to the effectiveness of teamwork in QICs [21]- [23].…”

Section: Introductionmentioning

confidence: 99%

Team structure and quality improvement in collaborative environments

Manukyan

Eppstein

Horbar

2013

2013 International Conference on Collaboration Technologies and Systems (CTS)

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Teams comprising diverse individuals have been shown to increase the collective creativity in jointly solving problems. However, in contexts where the purpose of collaboration is knowledge diffusion in complex environments, it is not clear whether team diversity will help or hinder effective learning. For example, in organized quality improvement collaboratives (QICs), healthcare institutions exchange information on clinical practices and outcomes with the aim of improving health outcomes at their own institutions. However, what works in one hospital may not work in others with different local contexts, due to non-linear interactions among various treatments and practices. While there is limited evidence that some QICs have resulted in improved care, it is not yet clear what factors contribute to the effectiveness of these team collaborations.In this study, we use an agent-based model to study how different strategies of team formation, including team diversity and size, affect quality improvement in simulated collaborative environments. We show that, in this context, teams comprising similar individuals outperform those with more diverse teams, and that this advantage increases with the complexity of the landscape and level of noise in assessing fitness. Furthermore, we show that larger teams of relatively homogeneous agents perform better than smaller teams, and that effective learning through team collaborations is dependent on the level of knowledge of team members' performance levels. Thus, our results suggest that groups of similar hospitals should collaborate as a single team and openly share detailed information regarding their clinical practices and outcomes. To facilitate this, we propose a virtual collaboration framework that would allow hospitals to efficiently identify potentially better practices in use at other institutions similar to theirs, without any institutions having to sacrifice the privacy of their own data. Our results may also have implications for other types of data-driven diffusive learning, such as in personalized medicine.

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“…For example, many experience a lack of role clarity, and other team members' expectations regarding the pharmacists' responsibilities are frequently unclear. 4,[8][9][10][11] In addition, patients often do not understand the role of the pharmacist in this setting. 9,10,12 Pharmacists are also typically unfamiliar with the roles of other team members, 13 creating difficulties in collaborating successfully.…”

Section: Introductionmentioning

confidence: 99%

Guidelines for pharmacists integrating into primary care teams

et al. 2013

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PRACTICE GUIDELINESPeer-reviewed Guidelines for pharmacists integrating into primary care teams Derek Jorgenson, BSP, PharmD, FCSHP; Dan Dalton, BSc; Barbara Farrell, BScPhm, PharmD, FCSHP; Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC; Lisa Dolovich, BScPhm, PharmD, MSc IntroductionHealth systems are moving toward a more interprofessional approach to primary care. This team-based paradigm has had a significant impact on the role of pharmacists within primary health care systems. Within the past decade, nondispensing clinical pharmacists have been integrated into many Primary Care Trusts in the United Kingdom, 1,2 primary care teams in North America 3-5 and similar practice settings around the world. 6,7 Pharmacists bring value to these teams by improving medication use through individual patient assessments and population-based interventions, providing education and drug information to other team members and implementing system-level practice enhancements. Pharmacists commonly encounter barriers to integrating into these primary care teams. For example, many experience a lack of role clarity, and other team members' expectations regarding the pharmacists' responsibilities are frequently unclear. 4,[8][9][10][11] In addition, patients often do not understand the role of the pharmacist in this setting. 9,10,12 Pharmacists are also typically unfamiliar with the roles of other team members, 13 creating difficulties in collaborating successfully.14-16 During the early stages, pharmacists often depend on other team members to assist in their integration, creating additional work for nurses and physicians.17 Other frequently reported barriers include physician resistance, lack of pharmacist assertiveness, inadequate pharmacist support, lack of space and inadequate pharmacist training. [9][10][11]13,14,[17][18][19][20][21] Many of these barriers to pharmacist integration can be minimized or avoided if pharmacists are prepared. Unfortunately, recent evidence suggests that pharmacists often continue to make the same mistakes and struggle to integrate into these teams, despite the fact that these barriers are well documented in the literature. 22 The purpose of these guidelines is to provide recommendations that will assist pharmacists to successfully integrate into existing primary care teams. MethodsA literature search was performed in OVID Books, MEDLINE, Embase and International Pharmaceutical Abstracts to identify publications related to the experiences of pharmacists in primary care teams. Additional studies were identified from bibliographical reviews of pertinent articles. Relevant articles from the search were selected for detailed review if they contained qualitative or quantitative data related to pharmacists' experiences integrating into primary care teams. Articles were excluded if they were not available in the English language. Two authors (DJ, DD) independently reviewed the relevant articles from the search and made lists of authors' conclusions about how pharmacists could have integrated bet...

show abstract

Barriers and facilitators to the implementation of the collaborative method: reflections from a single site

Cited by 38 publications

References 31 publications

Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members

Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members

Team structure and quality improvement in collaborative environments

Guidelines for pharmacists integrating into primary care teams

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