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      Integrated Palliative Care for Nursing Home Residents: Exploring the Challenges in the Collaboration between Nursing Homes, Home Care and Hospitals

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          Abstract

          Introduction:

          Nursing home residents are a vulnerable and frail segment of the population, characterised by their complex and palliative care needs. To ensure an integrated approach to palliative care for this target group, working on a collaborative basis with multiple providers across organisational boundaries is necessary. Considering that coordinators of palliative networks support and coordinate collaboration, the research question is: ‘how do network coordinators perceive the process of collaboration between organisations in Flemish palliative networks?’

          Methods:

          A dual-phase sequential mixed-methods design was applied. First, the coordinators of each of the fifteen palliative networks in Flanders completed a survey in which they evaluated ten aspects of collaboration for two types of cooperation: between nursing homes and home care, and between nursing homes and hospitals. Next, the survey results thus obtained were discussed to improve understanding in a focus group composed of the above coordinators, and which was analysed on the basis of content analysis.

          Results:

          In both forms of cooperation, the ‘formalisation’ and ‘governance’ were the aspects that yielded the lowest mean scores. The coordinators in the focus group expressed a need for more formalised interaction among organisations with regard to palliative care, the establishment of formal channels of communication and the exchange of information, as well as the development of shared leadership.

          Conclusions:

          The perspectives of the coordinators on inter-organisational collaboration are a valuable starting point for interventions directed at the stronger integration of palliative care for residents of long term-care facilities.

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          Most cited references44

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          Modes of Network Governance: Structure, Management, and Effectiveness

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            A model and typology of collaboration between professionals in healthcare organizations

            Background The new forms of organization of healthcare services entail the development of new clinical practices that are grounded in collaboration. Despite recent advances in research on the subject of collaboration, there is still a need for a better understanding of collaborative processes and for conceptual tools to help healthcare professionals develop collaboration amongst themselves in complex systems. This study draws on D'Amour's structuration model of collaboration to analyze healthcare facilities offering perinatal services in four health regions in the province of Quebec. The objectives are to: 1) validate the indicators of the structuration model of collaboration; 2) evaluate interprofessional and interorganizational collaboration in four health regions; and 3) propose a typology of collaboration Methods A multiple-case research strategy was used. The cases were the healthcare facilities that offer perinatal services in four health regions in the province of Quebec (Canada). The data were collected through 33 semi-structured interviews with healthcare managers and professionals working in the four regions. Written material was also analyzed. The data were subjected to a "mixed" inductive-deductive analysis conducted in two main stages: an internal analysis of each case followed by a cross-sectional analysis of all the cases. Results The collaboration indicators were shown to be valid, although some changes were made to three of them. Analysis of the data showed great variation in the level of collaboration between the cases and on each dimension. The results suggest a three-level typology of collaboration based on the ten indicators: active collaboration, developing collaboration and potential collaboration. Conclusion The model and the typology make it possible to analyze collaboration and identify areas for improvement. Researchers can use the indicators to determine the intensity of collaboration and link it to clinical outcomes. Professionals and administrators can use the model to perform a diagnostic of collaboration and implement interventions to intensify it.
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              The determinants of successful collaboration: a review of theoretical and empirical studies.

              Successful collaboration in health care teams can be attributed to numerous elements, including processes at work in interpersonal relationships within the team (the interactional determinants), conditions within the organization (the organizational determinants), and the organization's environment (the systemic determinants). Through a review of the literature, this article presents a tabulated compilation of each of these determinant types as identified by empirical research and identifies the main characteristics of these determinants according to the conceptual work. We then present a "showcase" of recent Canadian policy initiatives--The Canadian Health Transition Fund (HTF)--to illustrate how the various categories of determinants can be mobilized. The literature review reveals that very little of the empirical work has dealt with determinants of interprofessional collaboration in health, particularly its organizational and systemic determinants. Furthermore, our overview of experience at the Canadian HTF suggests that a systemic approach should be adopted in evaluative research on the determinants of effective collaborative practice.
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                Author and article information

                Contributors
                Journal
                Int J Integr Care
                Int J Integr Care
                1568-4156
                International Journal of Integrated Care
                Ubiquity Press
                1568-4156
                03 April 2019
                Apr-Jun 2019
                : 19
                : 2
                : 3
                Affiliations
                [1 ]KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
                [2 ]KU Leuven – University of Leuven, Department of Clinical Psychology, Tiensestraat, Leuven, BE
                [3 ]End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, BE
                [4 ]Department of Internal Medicine, Ghent University, Ghent, BE
                Author notes
                Corresponding author: Sofie Hermans ( sofie.hermans@ 123456kuleuven.be )
                Author information
                http://orcid.org/0000-0002-9398-1092
                Article
                10.5334/ijic.4186
                6450250
                30971869
                45eccaed-f6ee-4e98-8561-5575e4a6a1bc
                Copyright: © 2019 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

                History
                : 31 May 2018
                : 12 March 2019
                Funding
                This study is part of the INTEGRATE project which is funded by the Flemish government agency for Innovation by Science and Technology (SBO-IWT nr 140009).
                Categories
                Integrated Care Case

                Health & Social care
                health service integration,integration,palliative care,networks,integrated healthcare systems

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