Figure 1
Programme development process.
Figure 2
Development of the draft programme.
Table 1
Characteristics of the participating interprofessional primary care team meetings.
| Team | Duration in minutes | Frequency of team meetings | Average number of participants | Disciplines |
|---|---|---|---|---|
| 1 | 90 | Once every two months | 7 | Family physician, practice nurse, physical therapist, occupational therapist, pharmacist |
| 2 | 60 | Once a month | 14 | Family physician, practice nurse, physical therapist, occupational therapist, psychotherapist, dietician, district nurse, psychologist, social worker, nurse |
| 3 | 60 | Once every six weeks | 8 | Family physician, practice nurse, physical therapist, occupational therapist, social worker, district nurse, neighbourhood care |
Table 2
Qualitative data collection.
| Team | Team observations (n = 12) | Individual interviews (n = 25) | Disciplines interviewed | Focus group meeting (n = 6) |
|---|---|---|---|---|
| 1 | Round 1 | N = 3 | Family physician, physical therapist, practice nurse | Practice nurse & physical therapist |
| Round 2 | N = 2 | Practice nurse, occupational therapist | ||
| Round 3 | N = 2 | Family physician, practice nurse | ||
| Round 4 | N = 3 | Practice nurse (× 2), family physician | ||
| 2 | Round 1 | N = 3 | Psychologist, practice nurse, family physician | Dietician & district nurse |
| Round 2 | N = 2 | Physical therapist, district nurse | ||
| Round 3 | N = 2 | Practice nurse, district nurse | ||
| Round 4 | N = 2 | Occupational therapist, district nurse | ||
| 3 | Round 1 | N = 2 | Social worker, physical therapist | Social worker & district nurse |
| Round 2 | N = 2 | Practice nurse, district nurse | ||
| Round 3 | N = 0 | No team member was available | ||
| Round 4 | N = 2 | Occupational therapist, district nurse |
Table 3
Components of the draft programme and suggested adjustments.
| Components of the draft programme | Description | Facilitators (+) and barriers (–) regarding the draft programme | Suggested adjustments |
|---|---|---|---|
| Team reflection framework | Periodic reflection offers teams the opportunity to share experiences and issues, and eventually improve functioning. The draft programme included the instruction to periodically reflect on team functioning during team meetings, based on the levels of communication as described within the TPCG model (content, procedures, interaction, personal, context). During reflection, the chairperson was supposed to ask stimulating questions, guide the evaluation and group analysis, to eventually draw conclusions and set learning objectives. | + Awareness of own performance + Active role of the chairperson + Secure group climate – Socially desirable answers – Little input – Superficial reactions | Form
|
Content
| |||
| Team instruction meeting | Kick-off meeting (1 hour) to inform and motivate all team members. | + Informative + All team members involved – Too much information in a short time – Time-consuming | Form
|
| Chairperson training | Training course focused on organizing and structuring IPT meetings, monitoring the patient perspective and *guiding the team through development* (including managing team dynamics and group processes). As part of the training course, the programme also included two peer feedback sessions to learn from and with each other. | + Structure + Focus on the patient + Attention to group processes and team dynamics + Time investment and workload + Cross-pollination: Learn from and about each other – Insufficiently context-specific – One session is insufficient – Lack of peer assessment in the workplace | Form
|
Content
| |||
| Format for getting to know each other | As a first step to improve team functioning, the draft programme offers a format that facilitates getting to know each other as a team. | + Positive team climate + Most of the team members know each other (by name, discipline) – Lack of knowledge of each other’s specialty and competences | Form
|
Content
| |||
| Format to discuss ground rules | A format with topics which can be used by the team to discuss and capture shared rules and agreements. | + Shared rules lead to greater clarity and uniformity + Useful for new team members + Efficiency + Increases mutual respect – Time-consuming – Some concepts are confusing – Conflicting views among team members – Too many rules – Some participants show little interest, fail to see the benefit | Form
|
Content
| |||
| Format to structure interprofessional team meetings | The interprofessional meeting structure provides a framework comprising a three-phase structure (preparation, meeting itself, follow-up) that can support teams in conducting efficient meetings. | + Clear and satisfactory meeting structure + Tight scheduling resulting in more efficiency and time being saved + Something to hold on to and structure the meeting – Risk of losing the strength of the old (less structured) approach | Content
|
| Overview of organizational roles (chairperson, secretary, introducer) | Overview of the tasks and responsibilities of four organizational roles that can be distinguished during IPT meetings. Roles include: chairperson, minutes secretary, presenter (of the patient’s case), and participant. | + Clear expectations + Division of workload + Creates a sense of fellowship + Interplay between chairperson and secretary + Chairperson acts as driving force and leader + Raising awareness of contributor’s role – Double role as chairperson and presenter – Lack of directive leadership – Not everyone is playing a role or contributes to the meeting – Presenters experience difficulties in presenting patient cases | Form
|
Content
| |||
| Form for preparing the meeting | A form which can be used to support discussing the patients. This form should be completed by the person presenting the case, and sent to the other team members prior to the meeting. The form includes the following components: name and discipline of the presenter, reason for presenting the patient case, description of the patient’s situation, stating the problem. The form also includes a description of the patient’s functioning and goals in a variety of domains related to patient’s health status (somatic and cognitive), activities and participation, environment (physical and social), the way the patient self manages and the resulting care agreements. | + Targeted preparation – Time consuming – Threshold to filling in for – Terminology – Unclear instructions – A lot of paperwork | Form
|
Content
| |||
| Six-step plan to discuss the patient in a patient-centred way | The plan contains six steps to discuss patient’s care plans in a patient-centred way. (1) Describing the patient’s situation, (2) goals and motivation, (3) analysis, (4) brainstorming on possible actions, (5) formulating concrete care agreements, (6) evaluation. | + Patient-centredness – Inclined to skip steps – Too detailed – Unaware of the steps | Form
|
Content
|
Figure 3
Framework to reflect on interprofessional team functioning.