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Collaboration in Health and Social Care: Service User Participation and Teamwork in Interprofessional Clinical Microsystems
Jönköping University, School of Health Science, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis addresses the relationship between citizens and the welfare state with a focus on the collaboration between service users and professionals in Swedish health and social care services. The overall aim of the thesis was to explore how professionals and service users experience collaboration in health and social care.

Descriptive and interpretative study designs were employed in the four studies that comprise this thesis. A total of 87 persons participated in the four studies, including 22 service users and 65 front-line professionals. The research methods included focused group interviews, individual interviews and interactive participant reflection dialogues.

The first study describes the discursive patterns in the front-line professionals’ constructions of ‘we the team’ which positions the service user as both a member and a non-member of the interprofessional team. The second study surfaces the difficulties of interprofessional teamwork as perceived by professionals. The third and the fourth studies explore how service users and professionals construct and perceive the concept of service user participation. The findings show that collaboration in terms of service user participation cannot only be understood as contract relationships between consumers and service providers. Service users and professionals perceive that there are several other ways to act as a citizen and for people to exercise human agency in relation to the welfare state. This thesis shows that the various conceptions of service user participation in interprofessional practice encompass dimensions that include themes of togetherness, understanding and interaction within the clinical microsystem.

The findings of the four studies are discussed and used to create models that aim to conceptualise collaboration. These models can contribute to learning and improvement processes which facilitate the development of innovative service user-centered clinical microsystems in health and social care.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2011. , 143 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 15
Keyword [en]
consumer participation, collaboration, empowerment, microsystem, interprofessional, teamwork, service user participation, social citizenship.
National Category
Social Work
Identifiers
URN: urn:nbn:se:hj:diva-15022ISBN: 978-91-85835-14-0OAI: oai:DiVA.org:hj-15022DiVA: diva2:417626
Public defence
2011-05-25, Forum Humanum, Hälsohögskolan i Jönköping, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2011-05-17 Created: 2011-05-17 Last updated: 2011-05-17Bibliographically approved
List of papers
1. Difficulties in collaboration: A critical incident study of interprofessional healthcare teamwork
Open this publication in new window or tab >>Difficulties in collaboration: A critical incident study of interprofessional healthcare teamwork
2008 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 22, no 2, 191-203 p.Article in journal (Refereed) Published
Abstract [en]

The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members’ various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient’s problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.

Keyword
interprofessional relations, sociology of professions
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-6913 (URN)10.1080/13561820701760600 (DOI)
Available from: 2008-12-09 Created: 2008-12-09 Last updated: 2012-02-07Bibliographically approved
2. Discursive Patterns in multiprofessional healthcare teams
Open this publication in new window or tab >>Discursive Patterns in multiprofessional healthcare teams
2006 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 53, no 2, 244-252 p.Article in journal (Refereed) Published
Abstract [en]

Background. In recent decades there has been an increasing demand in Western countries to change care organisations and to coordinate resources and professional competencies to better meet the needs of the patient/service user. Since society promotes this kind of work, it may be valuable to explore the self-presentations of a multi-professional health care team.

Aim. The aim of this paper is to report a study conducted to explore how members of multi-professional health care teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions.

Methods. A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 health care professionals in six authentic multi-professional teams in south-east Sweden. The analysis focused on the participants’ discursive constructions of multi-professional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I.

Findings. The constructions of we by multi-professional health care teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus.

Conclusions. The mentioned discursive patterns provide powerful rhetorical resources for the team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (“the others”) by linking to a societal discourse that promotes collaboration.

Keyword
discourse analysis, interprofessional practice, teamwork, membership, self-presentations.
Identifiers
urn:nbn:se:hj:diva-6908 (URN)
Available from: 2009-01-08 Created: 2008-12-09 Last updated: 2011-05-17Bibliographically approved

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