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1.  Applying Organizational Science to Health Care: A Framework for Collaborative Practice 
Developing interprofessional education (IPE) curricula that improve collaborative practice across professions has proven challenging. A theoretical basis for understanding collaborative practice in health care settings is needed to guide the education and evaluation of health professions trainees and practitioners and support the team-based delivery of care. IPE should incorporate theory-driven, evidence-based methods and build competency toward effective collaboration.
In this article, the authors review several concepts from the organizational science literature and propose using these as a framework for understanding how health care teams function. Specifically, they outline the team process model of action and planning phases in collaborative work; discuss leadership and followership, including how locus (a leader’s integration into a team’s usual work) and formality (a leader’s responsibility conferred by the traditional hierarchy) affect team functions; and describe dynamic delegation, an approach to conceptualizing escalation and delegation within health care teams. For each concept, they identify competencies for knowledge, attitudes, and behaviors to aid in the development of innovative curricula to improve collaborative practice. They suggest that gaining an understanding of these principles will prepare health care trainees, whether team leaders or members, to analyze team performance, adapt behaviors that improve collaboration, and create team-based health care delivery processes that lead to improved clinical outcomes.
doi:10.1097/ACM.0b013e31829523d1
PMCID: PMC3695060  PMID: 23702530
2.  From parallel practice to integrative health care: a conceptual framework 
Background
"Integrative health care" has become a common term to describe teams of health care providers working together to provide patient care. However this term has not been well-defined and likely means many different things to different people. The purpose of this paper is to develop a conceptual framework for describing, comparing and evaluating different forms of team-oriented health care practices that have evolved in Western health care systems.
Discussion
Seven different models of team-oriented health care practice are illustrated in this paper: parallel, consultative, collaborative, coordinated, multidisciplinary, interdisciplinary and integrative. Each of these models occupies a position along the proposed continuum from the non-integrative to fully integrative approach they take to patient care. The framework is developed around four key components of integrative health care practice: philosophy/values; structure, process and outcomes.
Summary
This framework can be used by patients and health care practitioners to determine what styles of practice meet their needs and by policy makers, healthcare managers and researchers to document the evolution of team practices over time. This framework may also facilitate exploration of the relationship between different practice models and health outcomes.
doi:10.1186/1472-6963-4-15
PMCID: PMC459233  PMID: 15230977
3.  Organizational Determinants of Interprofessional Collaboration in Integrative Health Care: Systematic Review of Qualitative Studies 
PLoS ONE  2012;7(11):e50022.
Context
Inteprofessional collaboration (IPC) between biomedically trained doctors (BMD) and traditional, complementary and alternative medicine practitioners (TCAMP) is an essential element in the development of successful integrative healthcare (IHC) services. This systematic review aims to identify organizational strategies that would facilitate this process.
Methods
We searched 4 international databases for qualitative studies on the theme of BMD-TCAMP IPC, supplemented with a purposive search of 31 health services and TCAM journals. Methodological quality of included studies was assessed using published checklist. Results of each included study were synthesized using a framework approach, with reference to the Structuration Model of Collaboration.
Findings
Thirty-seven studies of acceptable quality were included. The main driver for developing integrative healthcare was the demand for holistic care from patients. Integration can best be led by those trained in both paradigms. Bridge-building activities, positive promotion of partnership and co-location of practices are also beneficial for creating bonding between team members. In order to empower the participation of TCAMP, the perceived power differentials need to be reduced. Also, resources should be committed to supporting team building, collaborative initiatives and greater patient access. Leadership and funding from central authorities are needed to promote the use of condition-specific referral protocols and shared electronic health records. More mature IHC programs usually formalize their evaluation process around outcomes that are recognized both by BMD and TCAMP.
Conclusions
The major themes emerging from our review suggest that successful collaborative relationships between BMD and TCAMP are similar to those between other health professionals, and interventions which improve the effectiveness of joint working in other healthcare teams with may well be transferable to promote better partnership between the paradigms. However, striking a balance between the different practices and preserving the epistemological stance of TCAM will remain the greatest challenge in successful integration.
doi:10.1371/journal.pone.0050022
PMCID: PMC3510174  PMID: 23209634
4.  Complementary practitioners as part of the primary health care team: evaluation of one model. 
BACKGROUND. A four-partner, non-fundholding, urban practice with 6000 patients has since September 1991 worked closely with nine complementary practitioners working part time on a private, fee-paying basis. AIM. This study set out to describe and evaluate a model of integrating complementary practitioners into the primary health care team. METHOD. A description of the model operating in the practice was compiled. Qualitative analysis was carried out of semistructured interviews with all members of the primary health care team using the method of a cooperative enquiry. Retrospective quantitative data on patients attending complementary practitioners were also examined. RESULTS. The model allowed patients to refer themselves or be referred by a team member, encouraged communication between team members, and did not require any specific funding. After two years the model had been largely successful in preventing conflict over power, control and decision making; had maintained commitment to the idea of integrating complementary and allopathic medicine; and was self-funding. However, despite varied mechanisms set up to share knowledge and ideology, the rate of change in this area was slower than expected and referral rates were varied. The dilemma of charging patients for complementary medicine in an environment where health care is free emerged as a major concern among the doctors and practice staff. CONCLUSION. The method of cooperative inquiry allowed the whole team to gain an understanding of other viewpoints and to use the research to tackle the problems raised. This model could be adopted and used by any enthusiastic general practice.
PMCID: PMC1239231  PMID: 7619572
5.  Beyond the limitations of best practices: How logic analysis helped reinterpret dual diagnosis guidelines 
Evaluation and program planning  2006;30(1):94-104.
The co-occurrence of mental health and substance use disorders is becoming increasingly recognized as a single problem, and professionals recognize that both should be addressed at the same time. Medical best practices recommend integrated treatment. However, criticisms have arisen, particularly concerning the difficulty of implementing integrated teams in specific health-care contexts and the appropriateness of the proposed model for certain populations. Using logic analysis, we identify the key clinical and organizational factors that contribute to successful implementation. Building on both the professional and organizational literatures on integrated services, we propose a conceptual model that makes it possible to analyze integration processes and places integrated treatment within an interpretative framework. Using this model, it becomes possible to identify key factors necessary to support service integration, and suggest new models of practice adapted to particular contexts.
doi:10.1016/j.evalprogplan.2006.10.005
PMCID: PMC3547976  PMID: 17689316 CAMSID: cams2582
Dual disorders; Mental health; Substance abuse; Integration; Program theory; Logic analysis; Evaluation
6.  Analysis and development of multiprofessional teams in medical rehabilitation 
Team analysis and team development are important instruments of organizational development and quality management. They contribute to team optimization in medical rehabilitation. Team analysis allows assessment of strengths and weaknesses of teams, resulting in possible recommendations for team development. So far there are only a few empirical studies and little practical experience analyzing multiprofessional teams in the health care field and inpatient medical rehabilitation in particular. This article presents team analyses performed on twelve multiprofessional medical rehabilitation teams in Germany and corresponding recommendations for team development.
A heuristic model of team analysis and team development was designed for this purpose. The model comprises the following parameters: input (team structure), process (teamwork) and output (team success). Variables to measure these parameters were derived from team performance models and known weaknesses of teams in medical care. Team analyses were conducted by administering a semi-standardized interview form and a short questionnaire to the head physicians of participating clinics while a survey was administered to all members of the rehabilitation team.
The results of the team analyses suggested the use of team development measures on each team. The teams were classified into three categories by their need for team development (low, medium and high). Furthermore five modules of team development could be generated from the results of the team analyses: (1) executive coaching, (2) communication training, (3) changing attitude towards teamwork, (4) task-oriented team development, and (5) training on socio-integrative aspects of teamwork. Some of these modules are important constituents of quality management programs. Team development can facilitate quality management programs, particularly with regard to process and output relating to leadership and staff. The study shows, that there is a basic, yet variable need of team analysis and team development in the medical rehabilitation facilities.
PMCID: PMC2736513  PMID: 19742278
team analysis; team development; medical rehabilitation
7.  A framework and a measurement instrument for sustainability of work practices in long-term care 
Background
In health care, many organizations are working on quality improvement and/or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization.
Methods
The exploratory methodological design consisted of three phases: a) framework development; b) instrument development; and c) field testing in former improvement teams in a quality improvement program for health care (N teams = 63, N individual = 112). Data were collected not until at least one year had passed after implementation.
Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach's alpha coefficient. A long and a short version of the instrument are proposed.
Results
The χ2- difference test of the -2 Log Likelihood estimates demonstrated that the hierarchical two factor model with routinization and institutionalization as separate constructs showed a better fit than the one factor model (p < .01). Secondly, construct validity of the instrument was strong as indicated by the high factor loadings of the items. Finally, the internal consistency of the subscales was good.
Conclusions
The theoretical framework offers a valuable starting point for the analysis of sustainability on the level of actual changed work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the subscales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects.
doi:10.1186/1472-6963-11-314
PMCID: PMC3234291  PMID: 22087884
8.  Evolution of the integrative health care literature in the CAM field—a bibliometric analysis 
Background
Integrative health care (IHC) has become a popular term used in practice and research to define the blending of complementary and alternative medicine (CAM) and conventional care as an innovative approach to health care delivery.
Purpose and objectives
To conduct a bibliometric analysis to develop a better understanding of the evolution of the concept of IHC in the CAM field.
Methods
All articles on IHC published between 1915 and 2008 indexed in the ISI web of knowledge database were retrieved. Title and abstract review were conducted to determine eligibility. Inclusion criteria included a research report and integration of CAM and conventional therapies. A second review of the full papers will be conducted to determine the final article sample, which will be analyzed using a rigorous bibliometric analysis approach.
Results
Three thousand and five articles were retrieved and 35% met the inclusion criteria in the first screening round. Descriptive and relational bibliometric indicators will be presented, including the volume of research by year, keywords used, impact of the publication and collaboration amongst researchers.
Discussion and conclusion
Application of a bibliometric analysis allows for a broad and focused overview of the IHC literature within its historical and cultural context, and evaluation of the research output and its impact.
PMCID: PMC2807054
bibliometrics; complementary and alternative medicine (CAM)
9.  Organizational culture, team climate and diabetes care in small office-based practices 
Background
Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices.
Methods
We conducted cross-sectional analyses of data from 83 health care professionals involved in diabetes care from 30 primary care practices in the Netherlands, with a total of 752 diabetes mellitus type II patients participating in an improvement study. We used self-reported measures of team climate (Team Climate Inventory) and organizational culture (Competing Values Framework), and measures of quality of diabetes care and clinical patient characteristics from medical records and self-report. We conducted multivariate analyses of the relationship between culture, climate and HbA1c, total cholesterol, systolic blood pressure and a sum score on process indicators for the quality of diabetes care, adjusting for potential patient- and practice level confounders and practice-level clustering.
Results
A strong group culture was negatively associated to the quality of diabetes care provided to patients (β = -0.04; p = 0.04), whereas a more 'balanced culture' was positively associated to diabetes care quality (β = 5.97; p = 0.03). No associations were found between organizational culture, team climate and clinical patient outcomes.
Conclusion
Although some significant associations were found between high quality diabetes care in general practice and different organizational cultures, relations were rather marginal. Variation in clinical patient outcomes could not be attributed to organizational culture or teamwork. This study therefore contributes to the discussion about the legitimacy of the widespread idea that aspects of redesigning care such as teamwork and culture can contribute to higher quality of care. Future research should preferably combine quantitative and qualitative methods, focus on possible mediating or moderating factors and explore the use of instruments more sensitive to measure such complex constructs in small office-based practices.
doi:10.1186/1472-6963-8-180
PMCID: PMC2529292  PMID: 18717999
10.  Persistence of unsafe practice in everyday work: an exploration of organizational and psychological factors constraining safety in the operating room 
Quality & Safety in Health Care  2006;15(3):165-170.
This paper explores the factors that influence the persistence of unsafe practice in an interprofessional team setting in health care, towards the development of a descriptive theoretical model for analyzing problematic practice routines. Using data collected during a mixed method interview study of 28 members of an operating room team, participants' approaches to unsafe practice were analyzed using the following three theoretical models from organizational and cognitive psychology: Reason's theory of “vulnerable system syndrome”, Tucker and Edmondson's concept of first and second order problem solving, and Amalberti's model of practice migration. These three theoretical approaches provide a critical insight into key trends in the interview data, including team members' definition of error as the breaching of standards of practice, nurses' sense of scope of practice as a constraint on their reporting behaviours, and participants' reports of the forces influencing tacit agreements to work around safety regulations. However, the relational factors underlying unsafe practice routines are poorly accounted for in these theoretical approaches. Incorporating an additional theoretical construct such as “relational coordination” to account for the emotional human features of team practice would provide a more comprehensive theoretical approach for use in exploring unsafe practice routines and the forces that sustain them in healthcare team settings.
doi:10.1136/qshc.2005.017475
PMCID: PMC2464856  PMID: 16751464
patient safety; organisational factors; teamwork
11.  A Model for Implementing Integrative Practice in Health Care Agencies 
Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM) in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a) professional and research development, b) health human resource planning, c) regulation and legislation and d) practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals.
PMCID: PMC3046020  PMID: 21614155
integrative care; integrative practice model; complementary/alternative medicine; inter-paradigm teams
12.  Research of organization of integrated primary care: a conceptual model 
Introduction
Primary health care in The Netherlands evolves from small general practices to multidisciplinary teams. Research on the effects on outcomes of organization of primary care is hardly available.
Aims
Develop a conceptual model to be able to systematically arrange empirical evidence on the effects of different types of organizations of integrated (primary) care.
Methods
During an expert meeting of directors of health centres we identified essential elements which they consider important for integrated primary care. Based on the outcomes of the meeting we designed a first draft of the conceptual model and completed it, based on literature.
Results and Conclusion
Based on an inventory and analysis of different definitions of primary care and integrated care, we formulated a definition of integrated primary care: ‘The smooth process of assistance and care provided by multiple disciplines within Primary Care, experienced by citizens’. The developed conceptual model contains elements to enable the delivery of integrated primary care (such as culture, professional competences, relationships and network system) and factors that affect the fluent process (such as subsequent financing, organization, ICT, legislation and regulations).
Discussion
Debate the model with participants of the conference to determine whether the model will be sufficient.
PMCID: PMC3184793
integrated primary care; inter disciplinary collaboration; conceptual model; health systems development
13.  Factors predicting team climate, and its relationship with quality of care in general practice 
Background
Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relationship between team climate and quality of care.
Methods
Cross sectional survey of a convenience sample of 14 general practices and their staff in South Tyneside in the northeast of England. Team climate was measured using the short version of Team Climate Inventory (TCI) questionnaire. Practice characteristics were collected during a structured interview with practice managers. Quality was measured using the practice Quality and Outcome Framework (QOF) scores.
Results
General Practitioners (GP) had a higher team climate scores compared to other professionals. Individual's gender and tenure, and number of GPs in the practice were significantly predictors of a higher team climate. There was no significant correlation between mean practice team climate scores (or subscales) with QOF scores.
Conclusion
The absence of a relationship between a measure of team climate and quality of care in this exploratory study may be due to a number of methodological problems. Further research is required to explore how to best measure team functioning and its relationship with quality of care.
doi:10.1186/1472-6963-9-138
PMCID: PMC3224748  PMID: 19653911
14.  Complementary and Alternative Medicine Use as Health Self-Management: Rural Older Adults With Diabetes 
Objectives
This study describes complementary and alternative medicine (CAM) use among rural older adults with diabetes, delineates the relationship of health self-management predictors to CAM therapy use, and furthers conceptual development of CAM use within a health self-management framework.
Methods
Survey interview data were collected from a random sample of 701 community dwelling African American, Native American, and White elders residing in two rural North Carolina counties. We summarize CAM use for general use and for diabetes care and use multiple logistic modeling to estimate the effects of health self-management predictors on use of CAM therapies.
Results
The majority of respondents used some form of CAM for general purpose, whereas far fewer used CAM for diabetes care. The most widely used CAM categories were food home remedies, other home remedies, and vitamins. The following health self-management predictors were related to the use of different categories of CAM therapies: personal characteristics (ethnicity), health status (number of health conditions), personal resources (education), and financial resources (economic status).
Discussion
CAM is a widely used component of health self-management among rural among older adults with diabetes. Research on CAM use will benefit from theory that considers the specific behavior and cognitive characteristics of CAM therapies.
PMCID: PMC1622916  PMID: 16497962
15.  Collaborative agency to support integrated care for children, young people and families: an action research study 
Abstract
Introduction
Collaboration was legislated in the delivery of integrated care in the early 2000s in the UK. This research explored how the reality of practice met the rhetoric of collaboration.
Theory
The paper is situated against a theoretical framework of structure, agency, identity and empowerment. Collectively and contextually these concepts inform the proposed model of ‘collaborative agency’ to sustain integrated care. The paper brings sociological theory on structure and agency to the dilemma of collaboration.
Methods
Participative action research was carried out in collaborative teams that aspired to achieve integrated care for children, young people and families between 2009 and 2013. It was a part time, PhD study in collaborative practice.
Results
The research established that people needed to be able to be jointly aware of their context, to make joint decisions, and jointly act in order to deliver integrated services, and proposes a model of collaborative agency derived from practitioner’s experiences and integrated action research and literature on agency. The model reflects the effects of a range of structures in shaping professional identity, empowerment, and agency in a dynamic. The author proposes that the collaborative agency model will support integrated care, although this is, as yet, an untested hypothesis.
PMCID: PMC4027932  PMID: 24868192
integrated; collaborative; agency
16.  Potentials and barriers in cooperation between conventional and complementary practitioners at a Danish Multiple Sclerosis Hospital 
Introduction
More than 50% of the People with Multiple Sclerosis (PwMS) in Denmark have used complementary and alternative medicine (CAM). The majority of these combine CAM and conventional treatment, and from 2004 to 2010 the Danish Multiple Sclerosis Society conducted a research project with the purpose of investigating and testing models for cooperation between conventional and complementary practitioners.
Theory
Five health care providers and five CAM practitioners were set up to work together from 2004 to 2010 in developing and offering integrated treatment to 200 PwMS at a Danish MS Hospital. The investigation of the collaborative process between practitioners has been based on theories of epistemic cultures as well as learning theories, focusing on interdisciplinary development.
Methods
Empirical material consists of individual interviews with practitioners, a group interview with practitioners, a group interview with professional staff at the Danish MS Hospital, interviews with patients as well as written responses from the practitioners.
Results and conclusions
The six-year cooperation among the practitioners documented mutual inspiration and learning within the team, as well as numerous basic challenges involved in developing interdisciplinary treatment for PwMS. Cooperation between researchers and the treatment team resulted in the development of four interdisciplinary models, which describe the potentials and barriers in relation to various types of collaboration.
Discussions
In many cases, integrating CAM and conventional treatment providers is seen as an ideal. This paper points out the importance of not overlooking the opportunities, values and the potential inherent in a pluralistic ideal in terms of the patients’ own active efforts and the dynamism that can arise when the patient becomes a co-informant, co-coordinator and/or co-integrator.
PMCID: PMC3225281
multiple sclerosis; integrative treatment; integrative care; teambased treatment; complementary medicine; CAM
17.  Advancing Integration Through Evidence Informed Practice: Northwestern Health Sciences University’s Integrated Educational Model 
Explore (New York, N.Y.)  2011;7(6):396-400.
A consistent theme running through the healthcare debate is the need for new care models that include collaborative, team-based care. There is also growing recognition that interprofessional education is critical to achieving collaborative, patient-centered care. Not unlike conventional, biomedical professions, CAM (complementary and alternative medicine) professions have also educated students in silos with little interaction between various disciplines. Northwestern Health Sciences University, under their NIH NCCAM-funded R-25 grant, is breaking new ground in requiring that their students in chiropractic, massage, and OAM complete a common course in evidence informed practice. A previous Explore column described the core competencies that the students are required to achieve. This column focuses on the practicalities and challenges of offering a course to students enrolled in three different degree programs. Perhaps it will stimulate readers to consider how we might achieve interprofessional education that brings together all health professional students, biomedical and CAM.
doi:10.1016/j.explore.2011.08.010
PMCID: PMC3408026  PMID: 22051565
18.  Developing Measures of Educational Change for Academic Health Care Teams Implementing the Chronic Care Model in Teaching Practices 
Journal of General Internal Medicine  2010;25(Suppl 4):586-592.
BACKGROUND
The Chronic Care Model (CCM) is a multidimensional framework designed to improve care for patients with chronic health conditions. The model strives for productive interactions between informed, activated patients and proactive practice teams, resulting in better clinical outcomes and greater satisfaction. While measures for improving care may be clear, measures of residents’ competency to provide chronic care do not exist. This report describes the process used to develop educational measures and results from CCM settings that used them to monitor curricular innovations.
SUBJECTS
Twenty-six academic health care teams participating in the national and California Academic Chronic Care Collaboratives.
METHOD
Using successive discussion groups and surveys, participants engaged in an iterative process to identify desirable and feasible educational measures for curricula that addressed educational objectives linked to the CCM. The measures were designed to facilitate residency programs’ abilities to address new accreditation requirements and tested with teams actively engaged in redesigning educational programs.
ANALYSIS
Field notes from each discussion and lists from work groups were synthesized using the CCM framework. Descriptive statistics were used to report survey results and measurement performance.
RESULTS
Work groups generated educational objectives and 17 associated measurements. Seventeen (65%) teams provided feasibility and desirability ratings for the 17 measures. Two process measures were selected for use by all teams. Teams reported variable success using the measures. Several teams reported use of additional measures, suggesting more extensive curricular change.
CONCLUSION
Using an iterative process in collaboration with program participants, we successfully defined a set of feasible and desirable education measures for academic health care teams using the CCM. These were used variably to measure the results of curricular changes, while simultaneously addressing requirements for residency accreditation.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-010-1358-1) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-010-1358-1
PMCID: PMC2940445  PMID: 20737234
Chronic Care Model; quality improvement; graduate medical education; ambulatory care; practice-based learning and improvement; systems-based practice
19.  Framework for primary care organizations: the importance of a structural domain 
Purpose
Conceptual frameworks for primary care have evolved over the last 40 years, yet little attention has been paid to the environmental, structural and organizational factors that facilitate or moderate service delivery. Since primary care is now of more interest to policy makers, it is important that they have a comprehensive and balanced conceptual framework to facilitate their understanding and appreciation. We present a conceptual framework for primary care originally developed to guide the measurement of the performance of primary care organizations within the context of a large mixed-method evaluation of four types of models of primary care in Ontario, Canada.
Methods
The framework was developed following an iterative process that combined expert consultation and group meetings with a narrative review of existing frameworks, as well as trends in health management and organizational theory.
Results
Our conceptual framework for primary care has two domains: structural and performance. The structural domain describes the health care system, practice context and organization of the practice in which any primary care organization operates. The performance domain includes features of health care service delivery and technical quality of clinical care.
Conclusion
As primary care evolves through demonstration projects and reformed delivery models, it is important to evaluate its structural and organizational features as these are likely to have a significant impact on performance.
doi:10.1093/intqhc/mzm054
PMCID: PMC2533520  PMID: 18055502
conceptual framework; organizational theory; performance measurement; primary care; quality of health care
20.  Measuring organizational readiness for knowledge translation in chronic care 
Background
Knowledge translation (KT) is an imperative in order to implement research-based and contextualized practices that can answer the numerous challenges of complex health problems. The Chronic Care Model (CCM) provides a conceptual framework to guide the implementation process in chronic care. Yet, organizations aiming to improve chronic care require an adequate level of organizational readiness (OR) for KT. Available instruments on organizational readiness for change (ORC) have shown limited validity, and are not tailored or adapted to specific phases of the knowledge-to-action (KTA) process. We aim to develop an evidence-based, comprehensive, and valid instrument to measure OR for KT in healthcare. The OR for KT instrument will be based on core concepts retrieved from existing literature and validated by a Delphi study. We will specifically test the instrument in chronic care that is of an increasing importance for the health system.
Methods
Phase one: We will conduct a systematic review of the theories and instruments assessing ORC in healthcare. The retained theoretical information will be synthesized in a conceptual map. A bibliography and database of ORC instruments will be prepared after appraisal of their psychometric properties according to the standards for educational and psychological testing. An online Delphi study will be carried out among decision makers and knowledge users across Canada to assess the importance of these concepts and measures at different steps in the KTA process in chronic care.
Phase two: A final OR for KT instrument will be developed and validated both in French and in English and tested in chronic disease management to measure OR for KT regarding the adoption of comprehensive, patient-centered, and system-based CCMs.
Discussion
This study provides a comprehensive synthesis of current knowledge on explanatory models and instruments assessing OR for KT. Moreover, this project aims to create more consensus on the theoretical underpinnings and the instrumentation of OR for KT in chronic care. The final product--a comprehensive and valid OR for KT instrument--will provide the chronic care settings with an instrument to assess their readiness to implement evidence-based chronic care.
doi:10.1186/1748-5908-6-72
PMCID: PMC3158542  PMID: 21752264
21.  General practitioners in partnership with management: an organisational model for debate. 
BMJ : British Medical Journal  1993;306(6873):308-310.
The role of general practitioners is changing and expanding. Doctors have more control over the treatment received by their patients but remain largely unaccountable to the public and management. This article proposes an organisational model for integrating primary and secondary care which retains the advantages of fund-holding while giving management control over overall strategy. It proposes that general practitioners control funds for all primary and secondary care. Secondary care will be contracted through a joint team of managers and an elected general practice executive committee. A new health care purchasing authority will contract for primary services with individual practices or primary care provider units. General practitioners will have local contracts reflecting their desire to provide an expanded range of services and the needs of the community.
PMCID: PMC1676864  PMID: 8461651
22.  A primary health care team manifesto. Adelaide Medical Centre Primary Health Care Team. 
Over a two year period an inner city primary health care team constructed a manifesto which defined the common aims and objectives of the team. The statement was not comprehensive, but it served a variety of purposes. Audit was made explicit and a framework was provided for the team's annual report. The manifesto has proved useful for trainees and other new members of staff. It has given the team a sense of direction, and it is hoped that it will foster teamwork through team members feeling that they have 'ownership' of the plan. The manifesto was conceived in advance of the government's white paper and new contract for general practitioners. It addresses the perceived health needs of the practice population in a practical way. Other primary health care teams may wish to adapt or use the framework of the manifesto to produce their own version.
PMCID: PMC1371482  PMID: 2003955
23.  Improving public health through student-led interprofessional extracurricular education and collaboration: a conceptual framework 
In the US, health care professionals are trained predominantly in uniprofessional settings independent of interprofessional education and collaboration. Yet, these professionals are tasked to work collaboratively as part of an interprofessional team in the practice environment to provide comprehensive care to complex patient populations. Although many advantages of interprofessional education have been cited in the literature, interprofessional education and collaboration present unique barriers that have challenged educators and practitioners for years. In spite of these impediments, one student-led organization has successfully implemented interprofessional education and cross-disciplinary collaboration. The purpose of this paper is to provide a conceptual framework for successful implementation of interprofessional education and collaboration for other student organizations, as well as for faculty and administrators. Each member of the interprofessional team brings discipline-specific expertise, allowing for a diverse team to attend to the multidimensional health needs of individual patients. The interprofessional team must organize around a common goal and work collaboratively to optimize patient outcomes. Successful interdisciplinary endeavors must address issues related to role clarity and skills regarding teamwork, communication, and conflict resolution. This conceptual framework can serve as a guide for student and health care organizations, in addition to academic institutions to produce health care professionals equipped with interdisciplinary teamwork skills to meet the changing health care demands of the 21st century.
doi:10.2147/JMDH.S52019
PMCID: PMC3926462  PMID: 24550677
interprofessional education; conceptual framework; student organization; health care teams
24.  A survey of Canadian regulated complementary and alternative medicine schools about research, evidence-based health care and interprofessional training, as well as continuing education 
Background
While some effort has been made to integrate complementary and alternative medicine (CAM) information in conventional biomedical training, it is unclear whether regulated Canadian CAM schools’ students are exposed to research activities and continuing education, or whether topics such as evidence-based health care and interprofessional collaboration (IPC) are covered during their training. Since these areas are valued by the biomedical training field, this may help to bridge the attitudinal and communication gaps between these different practices. The aim of this study was to describe the training offered in these areas and gather the perceptions of curriculum/program directors in regulated Canadian CAM schools.
Methods
A two-phase study consisting of an electronic survey and subsequent semi-structured telephone interviews was conducted with curriculum/program (C/P) directors in regulated Canadian CAM schools. Questions assessed the extent of the research, evidence-based health care, IPC training and continuing education, as well as the C/P directors’ perceptions about the training. Descriptive statistics were used to describe the schools’, curriculum’s and the C/P directors’ characteristics. Content analysis was conducted on the interview material.
Results
Twenty-eight C/P directors replied to the electronic survey and 11 participated in the interviews, representing chiropractic, naturopathy, acupuncture and massage therapy schools. Canadian regulated CAM schools offered research and evidence-based health care training as well as opportunities for collaboration with biomedical peers and continuing education to a various extent (58% to 91%). Although directors were generally satisfied with the training offered at their school, they expressed a desire for improvements. They felt future CAM providers should understand research findings and be able to rely on high quality research and to communicate with conventional care providers as well as to engage in continuing education. Limited length of the curriculum was one of the barriers to such improvements.
Conclusions
These findings seem to reinforce the directors’ interest and the importance of integrating these topics in order to ensure best CAM practices and improve communication between CAM and conventional providers.
doi:10.1186/1472-6882-13-374
PMCID: PMC3877872  PMID: 24373181
Complementary and alternative medicine; Continuing education; Curriculum development; Evidence-based health care training; Interprofessional training; Research training
25.  Practice assistants in primary care in Germany – associations with organizational attributes on job satisfaction 
BMC Family Practice  2013;14:110.
Background
Job satisfaction and organizational attributes in primary care teams are important issues as they affect clinical outcomes and the quality of health care provided. As practice assistants are an integral part of these teams it is important to gain insight into their views on job satisfaction and organizational attributes. The aim of this study was to evaluate the job satisfaction of practice assistants and the organizational attributes within their general practices in Germany and to explore the existence of possible associations.
Methods
This observational study was based on a job satisfaction survey and measurement of organizational attributes in general practices in the German federal state of Baden-Wuerttemberg. Job satisfaction was measured with the 10-item ‘Warr-Cook-Wall job satisfaction scale’. Organizational attributes were evaluated with the 21-items ‘survey of organizational attributes for primary care’ (SOAPC). Linear regression analyses were performed in which each of SOAPC scales and the overall score of SOAPC was treated as outcome variables.
Results
586 practice assistants out of 794 respondents (73.8%) from 234 general practices completed the questionnaire. Practice assistants were mostly satisfied with their colleagues and least of all satisfied with their income and recognition for their work. The regression analysis showed that ‘freedom of working method’ and ‘recognition of work’, the employment status of practice assistants and the mode of practice were almost always significantly associated with each subscale and overall score of SOAPC.
Conclusions
Job satisfaction is highly associated with different aspects of organizational attributes for primary care (‘communication’, ‘decision-making’ and ‘stress’). Consequently, improved job satisfaction could lead to a better-organized primary care team. This implication should be investigated directly in further intervention studies with a special focus on improving the recognition for work and income.
doi:10.1186/1471-2296-14-110
PMCID: PMC3750430  PMID: 23915225
General practice; Practice assistant; Organizational attributes; Job satisfaction; Primary health care

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