Collaborating clinicians

Citation

Hurst, K. (2010), "Collaborating clinicians", International Journal of Health Care Quality Assurance, Vol. 23 No. 5. https://doi.org/10.1108/ijhcqa.2010.06223eaa.001

Collaborating clinicians

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 23, Issue 5

Multidisciplinary teamwork is an important component of patient care. Social network analysis (SNA) is emerging as a useful sociological analytical technique, which seems to be an excellent way to investigate and improve teamwork. Laurent Boyer and colleagues capitalise on the method’s ability to explore working relationships among hospital professionals, which coincided with French hospital reorganisations. The authors asked professionals about whom they contacted regarding service issues. Three professional characteristics emerge: centrality; prestige; and cliques. From insights they generated the authors hope to strengthen hospital management, leadership, communication and collaboration. Findings should also extend our outcome measures. Male physicians in influential positions predominate in the three main measures and emerge as natural leaders. Interestingly, findings support middle manager roles, which seem to glue hospital management systems. A bonus is the authors’ robust methodological approach, which is clearly explained and has obvious educational benefits for our readers.

President Obama’s US healthcare reform debate surprisingly drew strong comment from several European providers and users, e.g. responding to the NHS’ “death panels” claim, which makes publications that include detailed commentary on policy and practice timely and important. Although there are similarities among ways European countries organise and fund healthcare, diagnosis, treatment and care systems remain complex areas to understand. Moreover, healthcare reforms add to the complexity. Daniel Simonet’s comprehensive article takes stock. He:

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  summarises UK, France, German, Italian and Swiss healthcare policy and practice;

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  looks at how services evolved from the 1880s;

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  explores service strengths and weaknesses; and

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  offers insights into their future.

What is most valuable about his lengthy analysis is the way readers can understand:

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  service quality (patient and employer satisfaction);

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  service efficiency and effectiveness;

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  funding;

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  market forces and competition;

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  decentralisation;

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  equity;

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  over-supply;

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  managed care;

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  information technology; and

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  workforce planning and development in context.

The author’s conclusions may not be popular with patriotic readers but at least the debate is extended.

We dedicated IJHCQA Volume 20, Number 7 to patient safety owing to the topic’s growing importance. Two things usually happen after special issues are published: downloads increase; and follow-up manuscripts on the same topic arrive. Johan Hellings and colleagues take the latter a step further by writing a follow-up article to the one we published in the special issue. This follow-up article focuses on hospital culture and change management in a patient safety context. Their before-and-after research design is methodologically robust; especially the way authors address psychometric concerns and the way their data are exposed to higher-level statistical analyses. Response rates were good although they varied from hospital-to-hospital and among professional groups – doctors were the poorest responders. The authors’ change management strategy was mainly feeding back findings to hospital staff after the first survey, coupled with staff education and training before re-evaluating. Perceptions about many safety cultures differed between the first and second measurements. Dimensions that differed may not surprise readers; neither will the finding that professionals’ perceptions changed disproportionally after the first survey. Perhaps the most valuable finding is that change management timing is crucial; that is, leaving sufficient time before effects are measured seems an important point that previous literature may have got wrong. Clearly, the authors make great strides but much remains to be done.

Diagnostic accuracy and consequential treatment is a crucially important healthcare process. When applied to recruiting soldiers, additional importance is added owing to screening accuracy’s impact on soldier and consequently his or her fighting unit’s survival. Consequently, quality assuring recruitment screening processes takes on special considerations. Although an unusual topic, few argue its relevancy. But how do you audit military medical recruitment service structures processes and outcomes? Yoram Chaiter and his Israeli colleagues use triangulation to explore military recruitment medical processes – document audit, site inspections and electronic database analyses. They found significant differences among military recruits’ diagnostic codes, which could not be explained geographically. Methods and results are presented clearly and simply, which authors can emulate or apply. Medical history taking and on-site testing process seemed to cause these differences. Consequently, supervising agency initiated staff education and training programmes were recommended and implemented and the authors hope to evaluate their impact later. The authors speculate that their evaluation techniques and results may apply to recruitment in other agencies.

Another important healthcare structure and process is collaboration between general practitioners and specialists especially in health services where GPs are gatekeepers. Collaboration has three important components: oral and written communication, and referral procedures. So how do you measure collaboration so that improvements can be made? Annette Berendsen and her colleagues from The Netherlands follow-up their qualitative studies by developing and testing a questionnaire for measuring collaboration among primary and secondary care doctors. The authors note, surprisingly, that the topic is under researched despite its importance. Drawing on their qualitative work and meagre literature they develop and refine a short questionnaire using factor analysis and related high-level statistics. Initial surveys reveal surprising findings about GP and specialist perceptions. There were differences also between clinician trainer and non-trainer, and between university, general and peripheral hospitals. The authors feel their findings can be used to improve collaboration between primary and secondary health services.

The way clinicians collaborate to improve OPD services significantly affects outpatient efficiency and effectiveness. Strenuous efforts are being made to switch inpatient work to outpatients, but are we transferring work to inefficient areas thereby compounding the problem? Consequently, Fergal Donnellan and his Irish colleagues report a simple and elegant study that set out to reduce unnecessary OPD attendance, which the authors remind us is the commonest hospital clinical contact. Their idea was simple – senior clinicians review OPD appointments two-weeks before patients were due to attend, ruling out unnecessary visits or postpones ones where test results were not available. These actions took about three working hours but they reduced clinical list size by 40 per cent (from an average 33 to 19 attendees). Surprisingly, however, even though more new patients were seen waiting lists were not significantly reduced because new patients got more attention. The authors became conscious that these efficiencies could reduce patient satisfaction and junior doctor education and training, which they avoided.

Keith Hurst