Transcending boundaries for collaborative patient care

Abstract

Dutch general practitioners (GPs) and medical specialists (MSs) create collaborative patient care agreements (CPCAs) to improve intraprofessional collaboration. We set out to identify contradictions between the activity systems of primary and secondary care that could result in expansive learning and new ways of working collaboratively. We analysed nineteen semi-structured interviews using activity theory (AT) as a theoretical framework and using these two activity systems as the units of analysis. There were contradictions within and between the activity systems related, for example, to different understandings of ‘care’ in generalist and specialist settings. GPs and MSs were able to identify contradictions and learn expansively when they iteratively co-created CPCAs in groups. They found it much harder to tackle contradictions, however, when they disseminated these tools within their respective professional communities, leaving unresolved contradictions and missed opportunities for collaboration. This research shows the educational benefits of taking collective responsibility for improving collaborative patient care.

Keywords:

• Patient management; continuing education
• change (or change management)
• work-based learning

Acknowledgements

The authors would like to thank the participating GPs, MSs and management. The authors would also like to express their appreciation for the inspiring teamwork with the guest editors for this issue and also during the AMEE conference 2019. Hein Hogerzeil stichting did not have an influence on the design of this study nor on the results presented.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Collaborative Patient Care Agreement (CPCA): Co-created agreement between healthcare professionals (Medical Specialist as well as General Practitioners as others), working in different organisations envisioning ways of patientcare across boundaries.

Collaborative Patient Care Agreement-group (CPCA-group): Group who co-creates the CPCA.

Clinician Teacher: Is used to indicate that the teacher is also an active practitioner.

Additional information

Funding

The present study was financially supported by the Hein Hogerzeil Stichting.

Notes on contributors

Loes J. Meijer

Loes J. Meijer, MD, is General Practitioner in Amersfoort. She is also a Clinician Teacher and PhD student at Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.

Esther de Groot

Esther de Groot, is Assistant Professor, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.

Gerdine Honing-de Lange

Gerdine Honing-de Lange, was, at the time of data collection, a sixth-year medical student at the University Medical Center, Utrecht, the Netherlands.

Grainne Kearney

Grainne Kearney, PhD MRCGP, is a General Practitioner and Clinical Lecturer in the Centre for Medical Education, Queen’s University Belfast, Northern Ireland.

François G. Schellevis

François G. Schellevis, MD, is Emeritus Professor of the Dept. General Practice, Amsterdam Public Health Research Institute Amsterdam University Medical Centers, Location VUmc, the Netherlands and Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.

Roger A. M. J. Damoiseaux

Roger A. M. J. Damoiseaux, Professor, MD, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht, 3584 CX, Netherlands.