Hur teamarbete kan förbättras vid patientförflyttningar utifrån ett kvalitetsutvecklingsperspektiv

Avhandlingen ger en djupare förståelse för hur teamarbete upplevs och kan förbättras i patientförflyttningsprocessen från en intensivvårdsavdelning och till en vårdavdelning. Det utvecklade mätverktyget gör det också möjligt att mäta upplevt teamarbete i den aktuella processen, vilket kan utgöra en grund för förbättringar.

Runt 30 personer medverkade vid licentiatseminariet som hölls i Zoom. 

Huvudhandledare: Docent Pernilla Ingelsson

Biträdande handledare: Docent Marie Häggström

Opponent: Adjungerad professor, Bonnie Poksinska, Linköpings universitet, Institutionen för ekonomisk och industriell utveckling (IEI)

Sammanfattning

Teamarbete är en grundläggande del inom Quality Management (QM), och att arbeta tillsammans på ett framgångsrikt sätt är också en viktig del när det gäller att förbättra det en organisation gör. Teamarbete är även en grund för att uppnå hög vårdkvalitet, patientsäkerhet och vårdkontinuitet inom hälso- och sjukvården. Att samverka i team över avdelningsgränser för att skapa hög vårdkvalitet blir särskilt viktigt när det handlar om att flytta kritiskt sjuka patienter.

I denna licentiatavhandling beskrivs hur ett mätinstrument har utvecklats för att mäta teamarbete vid patientförflyttningar från en intensivvårdsavdelning och till en vårdavdelning, samt även resultat från genomförda fokusgruppsdiskussioner med medarbetare i vårdteam vid två sjukhus.

Studierna visade att teamarbetet har en viktig roll när det gäller att skapa förutsättningar för helhetssyn i processen. Medarbetarna uttryckte bland annat ett behov av en ökad och tydligare samverkan mellan team över avdelningsgränser, men också en önskan om en ökad involvering av patienter och närstående när det gäller förbättringar av teamarbetet. Tydliga roller, ansvar och struktur i team samt formaliserade processer för kommunikation, kompetensutbyte och beslutsfattande var andra förslag som lyftes av medarbetarna för hur teamarbetet skulle kunna förbättras i processen.

Abstract

Team collaboration is a fundamental part of Quality Management (QM), and working together successfully is an important part of improving an organization. Team collaboration is also essential for achieving quality of care, patient safety and care continuity, especially when handling critically ill patients. Transferring a patient from an intensive care unit (ICU) to a general ward demands planning, communication, competence, a system view, and a quality culture. This patient transfer process, called ICU transitional care, extends across hospital boundaries, which have different organizational cultures, technologies, and knowledge. It is a challenge to manage these differences in order for team collaboration to meet the needs of patients, relatives and co-workers. To achieve this, further research is required to understand how care teams, both within hospital units and between organizational boundaries, can collaborate more successfully and efficiently to achieve quality of care in the ICU transitional care process.

The overall purpose of this thesis is to contribute to a deeper understanding of how to improve team collaboration within ICU transitional care aiming to increase quality of care. To achieve this, four research questions were formulated and three case studies conducted. In the first case, a systematic literature review was performed to explore the extent to which Quality Management and Nursing Science can offer complementary perspectives to provide better quality of care by looking at Quality Management core concepts and tools. Findings from this study revealed, among other things, a need for further research on team collaboration in ICU transitional care. The purpose of the second study was to develop and test a questionnaire aiming to measure the perception of team collaboration in the patient transfer process from the ICU to the general ward. This study also aimed to analyze the results to see how the questionnaire could help improve team collaboration within ICU transitional care. Empirical data were collected from two ICUs at two hospitals. Participants at the ICUs answered the developed questionnaire, and the results showed that it could be used for measuring perceived team collaboration in this patient transfer process. The results from the questionnaire also gave insights that might be useful for improving team collaboration in this ICU transitional care process. The purposes of the third study were, first, to describe how co-workers’, within a team, perceived team collaboration in patient transfers from ICU to general wards and, second, to describe co-workers’ suggestions for an improved future state of team collaboration. Focus group discussions (FGDs) were conducted at two hospitals to answer the two questions. There were several findings from the study, and the results indicated that team collaboration has an important role when creating prerequisites for a holistic view of the process, and that there was a perceived need among the co-workers to improve team collaboration over organizational boundaries. Co-workers also expressed a need for more involving patients and relatives when improving team collaboration.

Four overarching conclusions can be drawn from this research. Firstly, Quality Management is used in ICU transitional care to improve the quality of care. Secondly, multi-professional team collaboration is perceived to be easier and better developed within hospital units than between them. Collaborating in teams between hospital units is challenging for several reasons. Some reasons are unclarity in routines for communication and decision-making, for example who decides what.  A third conclusion is the importance of how teams and team collaboration are defined and structured in ICU transitional care. This involves roles and responsibilities of teams. Teams have specific characteristics that are important for their performance. A fourth conclusion is an expressed need to involve patients and relatives more when it comes to improve team collaboration in ICU transitional care. The main findings from the three studies presented in this thesis have given insight and deeper understanding of how co-workers perceive team collaboration within ICU transitional care at two hospitals located in Sweden, and co-workers’ suggestions for how team collaboration can be improved aiming to increase quality of care.

Stort grattis till Lilly-Mari och all lycka till i det fortsatta arbetet!

Hela avhandlingen finns att ladda ner från DIVA.