Facilitators and barriers to communication in rehabilitation services across healthcare levels: A qualitative case study in a Norwegian context

Abstract

Background People experiencing functional decline following injury or illness often need multiple and combined interventions in their rehabilitation processes. This means that collaboration and coordination between the involved healthcare professionals are essential. Interprofessional collaboration has, to a large extent, been explored in previous research, which has indicated the importance of facilitators of communication. Despite efforts in both research and policy, challenges in practice continue, both in the collaboration across specialist and primary levels of healthcare and within primary healthcare. Context-bound research is needed to gain insight into the complexity of these communication challenges. In this study we explore facilitators and barriers to communication in the context of neurological rehabilitation from specialist care at hospital to municipality primary care in a region of Norway. We address the transfer and exchange of relevant patient information between involved healthcare professionals.Methods A qualitative case study design was used to explore the exchange of patient information in the neurological rehabilitation processes for four patients. The data collection included participant observations in communication situations and an exploration of the electronic patient records of the same four patients. Reflexive thematic analysis was used to code and analyse the data, and the theory of practice architecture was used to interpret and structure the findings.Results We found three main barriers to communication: lack of a common understanding and culture for rehabilitation, poor access to written information and unclear authority and responsibilities for sharing information. These barriers are intertwined and influence communication practices.Conclusion The chains of interventions in the rehabilitation process depend on extensive information exchange among many of the health professionals involved, making collaboration complex. The barriers to exchanging relevant patient information need to be acknowledged as well as how informal relations among the involved facilitate the flow of information. More extensive use of joint communication tools may contribute to handling the complexity and to reducing barriers to communication.