title: Improving the experience of hip fracture care: A multidisciplinary collaborative approach to implementing evidence-based, person-centred practice.
abstract: BACKGROUND
  Hip fracture care is well supported by national guidelines and audit that provide evidence of safe interventions and an improved process. In the drive for organisational efficiency, complications have been reduced and length of stay shortened. Prioritising targets and performance alone can lead to poor multidisciplinary communication that potentially omits the psychosocial needs of older people recovering from hip fracture.
  
  
  OBJECTIVE
  To explore a multidisciplinary collaborative approach to implementing evidence-based, person-centred hip fracture care.
  
  
  METHODS
  Collaborative inquiry.
  
  
  METHODS
  Sixteen clinical leaders (n = 16) from different disciplines, working with older people with hip fracture at different stages of the care pathway participated in eight two-hourly facilitated action meetings. Data collection included strengths and limitations of the present service, values clarification, clinical stories, review of case records and reflections on the stories of three older people and two carers.
  
  
  RESULTS
  Hip fracture care was driven by service pressures, guidelines and audits. The care journey was divided into service delivery units. Professional groups worked independently resulting in poor communication. Time away from practice enabled collaboration and the sharing of different perspectives.
  
  
  CONCLUSIONS
  Working together improved communication and enhanced understanding of the whole care experience.
  
  
  CONCLUSIONS
  Enabling teams to find evidence of safe, effective person-centred cultures requires facilitated time for reflective practice.
authors: NHS Lothian, Community Health, East Lothian, UK. Electronic address: christiejane1@aol.com.
authors: Jane
authors: J
authors: Christie
authors: School of Nursing, Midwifery and Social Care, Edinburgh Napier University, UK. Electronic address: m.macmillan@napier.ac.uk.
authors: Maureen
authors: M
authors: Macmillan
authors: Formerly Geriatric Medicine, University of Edinburgh, UK; Formerly Ortho-Geriatric Medicine, NHS Lothian, UK. Electronic address: drcolintcurrie@hotmail.com.
authors: Colin
authors: C
authors: Currie
authors: School of Nursing, Midwifery and Social Care, Edinburgh Napier University, UK. Electronic address: g.matthews-smith@napier.ac.uk.
authors: Gerri
authors: G
authors: Matthews-Smith
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology; D003299:Cooperative Behavior; D055317:Evidence-Based Practice / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D033183:Interdisciplinary Communication; D008137:Longitudinal Studies; D018802:Patient-Centered Care / Q000379:methods
keywords: Communication; Culture; Evidence-based practice; Geriatric Medicine; Orthopaedics