title: The significance of professional roles in collaboration on patients' transitions from hospital to home via an intermediate unit.
abstract: The increasing complexity of the healthcare system and of patients' conditions, as well as resource limitations, calls for collaboration between professionals and institutions. The objective of this study was to explore the significance of professional roles in collaboration on patients' transitions from hospital to home via an intermediate care unit. We studied collaboration in the intermediate unit and between healthcare providers in the unit, a hospital and four municipalities in the hospital catchment area. Data were drawn from interviews with thirty-eight healthcare providers within specialist and primary health care and from observations in six multidisciplinary meetings, six report meetings and four discharge meetings in the unit. Transcripts of interviews and observations were analysed using a method of systematic text condensation. The results show that collaboration inside the intermediate unit and between the healthcare institutions was primarily 'a nursing matter'. Collaboration among the nurses was generally good. Except for the physician, all the healthcare providers experienced the collaboration in the unit as unidisciplinary rather than interprofessional. Although they wanted to collaborate interprofessionally, they were unable to do so in practice. The unit's physiotherapists and occupational therapists found themselves to be excluded from the nurses' community of practice, while the physician experienced the collaboration as excellent. The findings indicate that healthcare providers have different understandings of interprofessional collaboration and that in certain situations, they consider interprofessional collaboration to be an inappropriate working method. Interprofessional collaboration can promote a learning environment among healthcare providers. To achieve better interprofessional collaboration, it is probably necessary to create mutual understandings of interprofessionality and to reach an agreement on the situations in which it is an appropriate way to work.
authors.affiliation: Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Anne-Kari
authors.initials: AK
authors.lastname: Johannessen
authors.forename: Sissel
authors.initials: S
authors.lastname: Steihaug
mesh_terms: D003299:Cooperative Behavior; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D010360:Patient Transfer; D024382:Professional Role
keywords: intermediate unit; interprofessional collaboration; older patients; professional identity; qualitative research