An exploratory study of healthcare professionals’ perceptions of interprofessional communication and collaboration

Figures & data

Table 1. Themes, sub-themes, and illustrative data extracts.

Themes	Subthemes	Illustrative quotes
Structure of the medical round	Preparation	What I do find important, before the doctor and the nurse start their ward round, is that they prepare for it. This means they’ve carried out the necessary checks, and the nurses know what questions they want to ask. (Quality improvement officer D3:8)
	Timing of the medical round	I think you have to be prepared to shake off old habits. For example, we all talk about doing, say, ward rounds in the morning. We all have a fixed way of thinking. Why shouldn’t you do ward rounds in the afternoon? (Nurse D2:3)
	Communication tool	The patient does have a problem list, for which actions have been organized. And it’s important that these actions are followed up. Has any action been undertaken? Have the tests been done? Have the things been measured that should have been measured? (Physician D3:2)
Decision-making	Membership	I think it’s a very important opportunity for communication between the nurse and the doctor, where nurses explain their views about the patient, and where doctors explain how they are thinking and the direction in which they see the management of the patient going. (Nurse D1:5)
	Roles and responsibilities	I don’t totally agree with that, always discussing things with a nurse. Because that suggests that the junior doctor should make decisions in such a way that the nurse agrees. After all, the junior doctor makes a lot of decisions in which the nurse has no input. (Physician D3:4) But we don’t just make medical decisions during a ward round, so… I mean they [doctors] decide on management, and decisions are based on that. […] It seems to me that you discuss something together and of course as a nurse you can give advice, but it’s the doctor who makes the final decision. That seems perfectly clear to me. (Nurse D3:9)
	Knowledge and expertise	Yes, that should happen, and it saves a lot of time, because then decisions are made straight away. Doctors in training have to be able to think for themselves, that’s a must. But in reality the supervisor is immediately involved in everything, and helps out straight away in making decisions; so the nursing staff doesn’t have to wait an unnecessarily long time for an answer. (Physician D2:2) Yes, they’re not the ones leading the discussion [senior nurse]; the patient’s primary nurse does that. But they’re the ones who will report when things are going systematically wrong on the ward and who give feedback to the nurse. (Nurse D3:5)
	Care planning	Short-term care planning is focus for physician: A 24-h care plan is the maximum I think. (Physician D2:5) Long-term care planning is focus for nurses: I’d also like to see a care plan for the patient. This should include discharge and transfer of course, but maybe it should also include what the patient’s needs are if he’s transferred to a nursing home or to home care; what the patient is physically and mentally capable of, and draw up a care plan for that. (Nurse D2:5)
	Learning on the job	Well I think so; if I think of my own field, nursing, you have to make sure that after 4 years the nurses can do a ward round on their own. If you never let trainee nurses do the ward round and all of a sudden after qualifying they are expected to do it, then I wonder how capable they would be of doing it. (Nurse D1:4) So you must be given the opportunity—it sounds a bit strange when you’re talking about patient care—to make mistakes. Providing someone corrects you, these are the sorts of mistakes—faulty reasoning, faulty decision-making—that you learn the most from. So the more you think for junior doctors (I’m really against it), the greater the risk that they never become independent. (Physician D3:2)
Patients’ role	Participating in decision-making process	Active role of patients: I think […] that the patient has an important role to play in decision-making. You have to give the patient the opportunity to participate in what’s happening. (Nurse D1:6) Non-active role of patients: I think the patient should know what tests he’s going to have, but that’s completely different from getting them involved in decision-making. (Physician D2:5)
	Geographical movement across spaces	Two-stage spatial organisational structure of the medical round excluding patients: Patients should have a role. I think both, yes, maybe it’s rather specific, but on our ward we have a ‘sit-down’ pre-ward-round briefing at the computer, when we look at everything in the system. And then we go to the patients to tell them what we’ve discussed. Takes a bit more time perhaps, but it means you’ve got the complete picture. (Physician D1:3) One-stage spatial organisational structure of the medical round including patients: In an ideal situation you’d do the whole ward round by the bedside, because then you can check everything with the patient, and the patient knows straight away where he stands. And then you don’t just give the patient a summary of something, which means things get overlooked. (Quality improvement officer D1:1)