PDF(Pubmed)
Abstract：
BACKGROUND: The need for interprofessional collaboration has been emphasized by health organizations. This study was part of a mixed-methods evaluation of interprofessional teamwork modules implementation in an emergency department (ED), where a major intervention was didactic training of team roles and behaviours in combination with practice scenarios. The aim of the study was to evaluate the implementation of interprofessional teamwork modules from a staff perspective and focus on how implementation fidelity may be sustained.
METHODS: In this mixed-methods case study we triangulated staff data from structured observations, semi-structured interviews, and a questionnaire repeated at intervals over 5 years. A protocol of key team behaviours was used for the observations conducted in June 2016 and June 2018, 1½ and 3½ years after the initial implementation. A purposeful sample of central informants, including nursing and medical professionals and section managers, was interviewed from May to June 2018. The interview guide consisted of open-ended questions about the experiences of interprofessional teamwork modules and the implementation process. The questionnaire consisted of five statements about the perceived workload, interprofessional collaboration and patient satisfaction, where each was rated on a Likert scale.
RESULTS: Good fidelity to four out of five key team behaviours was observed during the first year. However, fidelity was sustained only for one key team behaviour after 3 years. We conducted a qualitative content analysis of 18 individual interviews. The theme Enjoying working together, but feeling less efficient emerged of the interprofessional teamwork modules, despite shorter ED stays for the patients. Negative experiences of the staff included passive team leaders and slow care teams. The theme Stimulating to create, but challenging to sustain emerged of the implementation process, where barriers were not adressed and implementation fidelity not sustained. The staff questionnaire showed that the perceived work conditions was improved in periods of high fidelity, but deteriorated to pre-implementation levels as fidelity to the key team behaviours decayed in 2018.
CONCLUSIONS: Extensive planning and successful initial implementation were not enough to sustain the key behaviour changes in the study. The use of implementation frameworks can be helpful in future projects.
METHODS: In this mixed-methods case study we triangulated staff data from structured observations, semi-structured interviews, and a questionnaire repeated at intervals over 5 years. A protocol of key team behaviours was used for the observations conducted in June 2016 and June 2018, 1½ and 3½ years after the initial implementation. A purposeful sample of central informants, including nursing and medical professionals and section managers, was interviewed from May to June 2018. The interview guide consisted of open-ended questions about the experiences of interprofessional teamwork modules and the implementation process. The questionnaire consisted of five statements about the perceived workload, interprofessional collaboration and patient satisfaction, where each was rated on a Likert scale.
RESULTS: Good fidelity to four out of five key team behaviours was observed during the first year. However, fidelity was sustained only for one key team behaviour after 3 years. We conducted a qualitative content analysis of 18 individual interviews. The theme Enjoying working together, but feeling less efficient emerged of the interprofessional teamwork modules, despite shorter ED stays for the patients. Negative experiences of the staff included passive team leaders and slow care teams. The theme Stimulating to create, but challenging to sustain emerged of the implementation process, where barriers were not adressed and implementation fidelity not sustained. The staff questionnaire showed that the perceived work conditions was improved in periods of high fidelity, but deteriorated to pre-implementation levels as fidelity to the key team behaviours decayed in 2018.
CONCLUSIONS: Extensive planning and successful initial implementation were not enough to sustain the key behaviour changes in the study. The use of implementation frameworks can be helpful in future projects.
摘要：
背景：卫生机构强调了跨专业合作的必要性。这项研究是对急诊科（ED）跨专业团队合作模块实施的混合方法评估的一部分，其中主要的干预措施是结合实践场景对团队角色和行为进行教学培训。该研究的目的是从工作人员的角度评估跨专业团队合作模块的实施，并着重于如何维持实施保真度。
方法：在这个混合方法案例研究中，我们从结构化观察中三角化员工数据，半结构化面试,并每隔5年重复一次问卷。在2016年6月和2018年6月，在最初实施后的1½和3½年进行的观察中使用了关键团队行为的协议。有目的的中央线人样本，包括护理和医疗专业人员和科室经理，于2018年5月至6月接受采访。面试指南包括有关跨专业团队合作模块的经验和实施过程的开放式问题。问卷包括五个关于感知工作量的陈述，跨专业合作和患者满意度，每个都在李克特量表上进行了评级。
结果：在第一年观察到5个关键团队行为中有4个表现良好。然而,3年后，忠诚只持续了一个关键的团队行为。我们对18次个人访谈进行了定性内容分析。主题是一起享受工作，但是感觉跨专业团队合作模块效率降低了，尽管患者的ED停留时间较短。员工的负面经历包括被动的团队领导和缓慢的护理团队。主题激励创造，但是实施过程的持续挑战出现了，在没有克服障碍和无法维持实施忠诚的地方。员工问卷显示，在高保真度时期，感知的工作条件得到了改善，但由于2018年对关键团队行为的忠诚度下降，因此恶化到实施前的水平。
结论：广泛的计划和成功的初步实施不足以维持研究中的关键行为变化。实施框架的使用对未来的项目很有帮助。
方法：在这个混合方法案例研究中，我们从结构化观察中三角化员工数据，半结构化面试,并每隔5年重复一次问卷。在2016年6月和2018年6月，在最初实施后的1½和3½年进行的观察中使用了关键团队行为的协议。有目的的中央线人样本，包括护理和医疗专业人员和科室经理，于2018年5月至6月接受采访。面试指南包括有关跨专业团队合作模块的经验和实施过程的开放式问题。问卷包括五个关于感知工作量的陈述，跨专业合作和患者满意度，每个都在李克特量表上进行了评级。
结果：在第一年观察到5个关键团队行为中有4个表现良好。然而,3年后，忠诚只持续了一个关键的团队行为。我们对18次个人访谈进行了定性内容分析。主题是一起享受工作，但是感觉跨专业团队合作模块效率降低了，尽管患者的ED停留时间较短。员工的负面经历包括被动的团队领导和缓慢的护理团队。主题激励创造，但是实施过程的持续挑战出现了，在没有克服障碍和无法维持实施忠诚的地方。员工问卷显示，在高保真度时期，感知的工作条件得到了改善，但由于2018年对关键团队行为的忠诚度下降，因此恶化到实施前的水平。
结论：广泛的计划和成功的初步实施不足以维持研究中的关键行为变化。实施框架的使用对未来的项目很有帮助。
