https://orcid.org/0000-0002-1968-9202
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ABSTRACT
Interprofessional collaboration (IPC) is key to ensuring safe quality care for patients. However, IPC intervention outcomes are variable, leading to calls for systems theories to understand complex interactions in healthcare. Using networked ecological systems theory (NEST), we aimed to uncover facilitators and barriers impacting the interactions between nurses and physicians in a specialty healthcare center. A qualitative study involving 55 non-participant observations and 17 individual semi-structured interviews was conducted at the National Neuroscience Institute of Singapore from April 2019 to March 2021. Template analysis was used to analyze the data. The most important IPC facilitators were exosystemic institutional support and physicians’ willingness to engage in IPC in the microsystems that together enabled the establishment of disease-based outpatient programs fostering patient-centered interactions among different healthcare professionals (HCP). We also found that patient-, disease-, and systems-related knowledge played an important role in facilitating IPC. Macrosystemic entrenchments such as intraprofessional composition of ward rounds emerged as a significant barrier. However, microsystemic efforts such as chat groups connecting all HCP involved in the care of the patients in the wards have fostered IPC. Although still preliminary, these findings suggest NEST can be useful to inform systematic interventions to improve IPC.
Acknowledgments
We would like to thank Dr Tina Martimianakis (University of Toronto and The Wilson Centre) for her valuable comments on our draft; Ms Shihui Tang, the Research Assistant; and Ms Jeannie Lum, and Amy Cheng for their administrative support.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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Notes on contributors
Yang Yann Foo
Yang Yann Foo is an Assistant Professor with the Duke-NUS Medical School.
Kevin Tan
Kevin Tan is a Senior Consultant Neurologist with the National Neuroscience Institute.
Jai Rao
Jai Rao is a Senior Consultant Neurosurgeon with the National Neuroscience Institute.
Wee Shiong Lim
Wee Shiong Lim is Senior Consultant Geriatrician with Tan Tock Seng Hospital.
Xiaohui Xin
Xiaohui Xin is a Senior Research Manager with the Singapore General Hospital.
Qianhui Cheng
Qianhui Cheng is a Senior Executive with the National Neuroscience Institute.
Elaine Lum
Elaine Lum is an Assistant Professor with the Duke-NUS Medical School.
Nigel CK Tan
Kevin Tan is a Senior Consultant Neurologist with the National Neuroscience Institute.
Nigel CK Tan is a Senior Consultant Neurologist with the National Neuroscience Institute.