RESUMEN
Team coaching enhances teamwork and subsequently improves patient-centredness in medical rehabilitation clinics. Even though interprofessional teamwork is regarded as a crucial factor in medical rehabilitation, to date no evaluated team-coaching approaches are available for improving interprofessional teamwork in medical rehabilitation in Germany. Based on a systematic literature search and interviews with staff, managers, and patients of rehabilitation clinics, we developed a team-coaching approach that is standardized in its process but based on the individual needs and requests of each clinic. It takes a systemic perspective and is goal-oriented and solution-focused. The approach mainly serves to provide impulses to make use of resources within the team and to support a self-directed organisational learning process. It is manualized and can, therefore, be used by professionals aiming to improve interprofessional teamwork in their clinic. A multi-centre, cluster-randomized controlled study that was conducted to evaluate the team-coaching approach showed positive results. Team organization, knowledge integration, and responsibility can be improved, and, therefore, the implementation of the patient-centred team-coaching approach in interprofessional rehabilitation teams can be recommended.
Asunto(s)
Relaciones Interprofesionales , Mentores , Grupo de Atención al Paciente/organización & administración , Atención Dirigida al Paciente/organización & administración , Centros de Rehabilitación/organización & administración , Actitud del Personal de Salud , Conducta Cooperativa , Alemania , Objetivos , Procesos de Grupo , HumanosRESUMEN
AIM OF THE STUDY: Interprofessional collaboration is a main precondition of successful treatment in rehabilitation. In order to improve interprofessional collaboration, a clinic-specific, goal- and solution-oriented and systemic team development approach was designed. The aim of the study is the evaluation of this approach. METHODS: A multi-centre cluster-randomized controlled study with staff questionnaires. RESULTS: The team development could be implemented successfully in 4 of 5 clinics and led to significant improvements in team organisation, willingness to accept responsibility and knowledge integration. The effects are small and are caused by the opposed development of intervention and control group. CONCLUSIONS: The team development approach can be recommended for rehabilitation practice. A train-the-trainer approach will be developed and further studies are planned in order to disseminate the approach and to investigate the conditions of implementation.
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Actitud del Personal de Salud , Relaciones Interprofesionales , Modelos Organizacionales , Grupo de Atención al Paciente/organización & administración , Rehabilitación/organización & administración , Formación del Profesorado/organización & administración , Alemania , Cultura OrganizacionalRESUMEN
BACKGROUND: Interdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation. METHODS: Considering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis. RESULTS: The exploration of team members' and clinical managers' descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient treatments, clarity with regard to roles and responsibilities of team members, and mutual esteem and appreciation between different professions). CONCLUSIONS: The synthesis underscores that there is meaningful heterogeneity in team training needs; training interventions should be locally adapted for each clinic in terms of training content and training strategies. Tailored team interventions are important for rehabilitation clinics. Future work should evaluate employed team training concepts over time as well as training contents, implementation strategies, and learning outcomes. This includes using robust study designs and evaluating team-training effects.
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Actitud del Personal de Salud , Comunicación Interdisciplinaria , Grupo de Atención al Paciente/organización & administración , Medicina Física y Rehabilitación/educación , Adulto , Conducta Cooperativa , Femenino , Grupos Focales , Alemania , Humanos , Capacitación en Servicio/métodos , Capacitación en Servicio/organización & administración , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/normas , Medicina Física y Rehabilitación/organización & administración , Investigación Cualitativa , Recursos Humanos , Adulto JovenRESUMEN
The detection of patients with comorbid mental disorders is of high clinical importance in cardiac and orthopaedic rehabilitation. To simplify detection of cases, screening instruments are recommended. This study investigated the discriminant validity of the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS-D) to identify patients with comorbid mental disorders and specifically affective or anxiety disorders. 213 patients with cardiovascular diseases and 206 patients with musculoskeletal diseases participated in a two-stage survey. Patients were assessed with the GHQ-12 and the HADS-D; and they were examined for DSM-IV mental disorders by clinical standardized interview (CIDI). Validity of the two screenings regarding the detection of mental disorders was compared using ROC-analysis. In both patient groups the HADS-D performed better in nearly all analyses compared to the GHQ-12, especially in the detection of affective disorders (AUC in cardiac patients 0.78, in orthopaedic patients 0.79). Both screening instruments can be used for the detection of comorbid affective and anxiety disorders in patients with cardiovascular and musculoskeletal diseases. Limitations in performance of screening instruments are due to the different methodological approaches of tests as well as to difficulties in diagnosing mental disorders in patients with physical illness.