Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team

Abstract

BackgroundWhile chiropractors are integrating into multidisciplinary settings with increasing frequency, the perceptions of medical providers and patients toward adding chiropractors to existing healthcare teams is not well-understood. This study explored the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting.MethodsThis qualitative analysis was part of a multi-phase, organizational case study designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team. The setting was a 62-bed rehabilitation specialty hospital located in the northeastern United States. Participants included patients, families, community members, and professional staff of the administrative, medical, nursing, and therapy departments. Data collection consisted of audiotaped, individual interviews and profession-specific focus groups guided by a semi-structured interview schedule. Transcripts were imported into a qualitative data analysis program for data analysis. An iterative coding process using thematic content analysis categorized key themes and domains.ResultsSixty participants were interviewed in June 2015, including 48 staff members, 6 patients, 4 family members, and 2 community members. Our analysis generated a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings composed of 5 domains and 13 themes. The central domain, Patient-Centeredness, or the provision of healthcare that is respectful, responsive, and inclusive of the patient’s values, preferences, and needs, was mentioned in all interviews and linked to all other themes. The Professional Qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence. Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting. Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.ConclusionsOur findings provide an expanded view of the qualities that chiropractors might bring to multidisciplinary healthcare settings. Rather than labeling stakeholder perceptions as good, bad or indifferent as in previous studies, these results highlight specific attributes chiropractors might cultivate to enhance the patient outcomes and the experience of healthcare, influence clinical decision-making and interprofessional teamwork, and impact healthcare organizations.Electronic supplementary materialThe online version of this article (10.1186/s12998-018-0200-4) contains supplementary material, which is available to authorized users.

Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study

“…We conducted a longitudinal case study using qualitative methods (interviews, focus groups) as part of a larger research project to evaluate the process and outcomes of adding a DC to the clinical team in a multidisciplinary rehabilitation hospital [ 17 – 19 ]. The Institutional Review Boards of Palmer College of Chiropractic and Crotched Mountain Foundation provided the research ethics approvals for this project.…”

“…This report describes stakeholder outcome expectations expressed during baseline interviews conducted before the implementation of the chiropractic program. The methods for this case study are described in greater detail elsewhere [ 19 ].…”

“…As most interviews were conducted during a single site visit, data analysis followed the completion of all interviews and focus groups. As we have described elsewhere [ 19 ], four coders, including three research assistants overseen by a study investigator (SAS), conducted the qualitative content analysis using an inductive approach [ 21 ]. Team members read the transcripts independently, coded the transcripts, and made written memos or annotations on their analysis process.…”

“…All transcripts were coded over multiple rounds of iterative coding. For this paper, we present themes related to expected outcomes from the chiropractic program only; other findings from the qualitative interviews are presented elsewhere [ 19 ].…”

So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies

“…Another example of chiropractors functioning in interprofessional collaboration was provided by Wirth et al who reported on outcomes and trajectories of patients referred from a surgical department to chiropractic care [8]. In these settings, chiropractors frequently work alongside or in collaboration with other providers, and Salsbury et al reported, based on a qualitative stakeholder analysis, that in order to be successful in multidisciplinary teams, chiropractors should be good clinicians, practice according to evidence, be communicative and be supportive of patient's emotional journeys during care and rehabilitation [9]. Four articles dealt with different elements of chiropractic practice.…”