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An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizat...
Context in source publication
Context 1
... MICM consists of three forms of health care: mobile hospital health care team, mobile home health care physician, and mobile hospital palliative team (Figure 1). 7 In the MICM, professionals from health care authorities work across borders to provide person-centered, coherent, coordinated, and costeffective health care with good quality provided by integrated teams. ...
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Objective
To examine available health engagement tools suitable to, or modifiable for, vulnerable pregnant populations.
Design
Systematic review.
Eligibility criteria
Original studies of tool development and validation related to health engagement, with abstract available in English, published between 2000 and 2022, sampling people receiving outp...
Citations
... 14 The purpose of this process is to provide coordinated and coherent, person-centered, team-based health care across organizational borders to support the most vulnerable patients who are at risk of inpatient care. [15][16] Municipal home health care will likely become increasingly complex as the transfer to local care continues, and it is likely that this situation will lead to challenges for health care providers. Although some studies have examined municipal health and social care from the perspectives of patients, relatives, and care professionals/providers, [15][16][17][18][19] the number of studies on home health care, which is becoming increasingly advanced, in the context of this transfer from the perspective of health care employees is limited. ...
... [15][16] Municipal home health care will likely become increasingly complex as the transfer to local care continues, and it is likely that this situation will lead to challenges for health care providers. Although some studies have examined municipal health and social care from the perspectives of patients, relatives, and care professionals/providers, [15][16][17][18][19] the number of studies on home health care, which is becoming increasingly advanced, in the context of this transfer from the perspective of health care employees is limited. ...
... It is well known that stress has negative impacts on interpersonal interactions, [28][29][30] and several studies have highlighted the importance of establishing interpersonal relationships when caring for severely ill persons in their homes. 15,[31][32] Rushing from one home to another while leaving no time for interaction with the persons living there affects the relationships between health care providers and their patients or the patients' relatives, 25 and it is important to recognize that these individuals may experience the home care personnel as unengaged or even believe that they themselves are the cause of the stressful situation. ...
Background
The process of transferring health care services from hospital care to municipal home health care is ongoing in Sweden, which contributes to an increasingly advanced health care in patients’ homes.
Methods
This study has a qualitative design. Data were collected in two rural municipalities in western Sweden during autumn 2020. Fourteen registered nurses and ten assistant nurses employed by the municipalities participated in focus group interviews, and three physicians in primary mobile health care employed by primary health care were individually interviewed via telephone. Reflexive thematic analysis was used to analyze data.
Results
The analyze resulted in two main themes. The first theme, Home—An arena in which one balances dual roles and respectfully negotiates the provision of care as a guest, was related to respect for the home and for those who live there. The second theme, Striving to fulfill expectations and requirements while simultaneously preserving professionalism, was related to profession and cooperation.
Conclusions
The result of this study shows that working in home health care requires negotiation to achieve an appropriate home- and work environment, and collaboration between health care providers to achieve good and safe patient care in the home.
... In the majority of the municipalities where the MICM has been implemented, all the patients are admitted into the care model when admitted to home health care, which is dictated by the agreement made by the health care authorities which created the MICM [59]. Previous studies have described the RN and MICM physician perspectives on the MICM [67,68], expressing the importance of building relationships between team members, as well as with the patient and next of kin. Furthermore, previous findings suggest that, although many patients and next of kin are pleased with the MICM, there are still obstacles. ...
... Providing health care in the home has previously been described by Swedish physicians as providing more information about the patient [67]. Receiving care within the home has been seen to have positive effects on sleep and physical activity [80], increasing patient participation, and facilitating a safe environment according to Swedish and an American study [68,80,81]. The positive effects could be related to how the participants experienced an easier daily life when receiving in-home health care, potentially reaching the goals of local health care [37] since the participants did not need to travel to receive at least part of their health care. ...
... The MICM attempted to diminish having several health care providers [57], something the patients still described having the need for after admittance. Cross-organizational collaborations have previously been described by RN and MICM physicians as negatively influencing the quality of care, where being part of the same organization was preferred [67,68]. Sweden is known for being a generous welfare state [28,30]. ...
Background
The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients’ and next of kin’s experiences of integrated care is however lacking, motivating exploration.
Method
A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later.
Results
The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making.
Conclusion
Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.
... Existing evidence indicates that teams with higher levels of intrateam trust and trust in their leader perform more effectively [31]. Additionally, previous research provides evidence that mutual trust is positively associated with provider and patient satisfaction [32,33]. When members of the team feel valued and acknowledged for their work, mutual trust within the team can form [23]. ...
Interprofessional healthcare team function is critical to the effective delivery of patient care. Team members must possess teamwork competencies, as team function impacts patient, staff, team, and healthcare organizational outcomes. There is evidence that team training is beneficial; however, consensus on the optimal training content, methods, and evaluation is lacking. This manuscript will focus on training content. Team science and training research indicates that an effective team training program must be founded upon teamwork competencies. The Team FIRST framework asserts there are 10 teamwork competencies essential for healthcare providers: recognizing criticality of teamwork, creating a psychologically safe environment, structured communication, closed-loop communication, asking clarifying questions, sharing unique information, optimizing team mental models, mutual trust, mutual performance monitoring, and reflection/debriefing. The Team FIRST framework was conceptualized to instill these evidence-based teamwork competencies in healthcare professionals to improve interprofessional collaboration. This framework is founded in validated team science research and serves future efforts to develop and pilot educational strategies that educate healthcare workers on these competencies.
... The main focus of the interviews was not COVID-19 but was part of a larger study on health care professionals experiences of working in an MICM [47,48]. The participants were informed prior to the study that questions about COVID-19 would be included. ...
Background
Since COVID-19 emerged, over 514 million COVID-19 cases and 6 million COVID-19-related deaths have been reported worldwide. Older persons receiving home health care often have co-morbidities that require advanced medical care, and are at risk of becoming severely ill or dying from COVID-19. In Sweden, over 10,000 COVID-19-related deaths have been reported among persons receiving municipal home health and social care. Home health care professionals have been working with the patients most at risk if infected. Most research has focused on the experiences of professionals in hospitals and assistant nurses in a home care setting. It is therefore valuable to study the experiences of the registered nurses and physicians working in home health care during the COVID-19 pandemic to learn lessons to inform future work.
Method
A thematic qualitative study design using a semi-structured interview guide.
Results
The health care professionals experienced being forced into changed ways of working, which disrupted building and maintaining relationships with other health care professionals, and interrupted home health care. The health care professionals described being forced into digital and phone communication instead of in-person meetings, which negatively influenced the quality of care. The COVID-19 pandemic brought worry about illness for the health care professionals, including worrying about infecting patients, co-workers, and themselves, as well as worry about upholding the provision of health care because of increasing sick leave. The health care professionals felt powerless in the face of their patients’ declining health. They also faced worry and guilt from the patients’ next of kin.
Conclusion
Home health care professionals have faced the COVID-19 pandemic while working across organizational borders, caring for older patients who have been isolated during the pandemic and trying to prevent declining health and feelings of isolation. Due to the forced use of digital and phone communication instead of in-person visits, the home health care professionals experienced a reduction in the patients’ quality of care and difficulty maintaining good communication between the professions.
... A comparatively new integrated care model, the MICM consists of three forms of health care: the mobile hospital health care team, mobile home health care physician, and mobile hospital palliative team ( Fig. 1) [22] working in collaboration with municipal health and social care [21]. ...
... • The integrated team is also to co-create a medical health care plan (MHCP) with the patient and their next of kin at least once a year. • Beyond the included core elements within the integrated care model, the MICM has been implemented in varying ways in different municipalities [22]. Before the implementation of the MICM: ...
... The MICM is based on collaboration between different professions, creating an integrated team where the physician mainly collaborates with the RN [33]. In a previous study, the nurses working in MICM described how collaboration was organized between them and that the physician was essential in how the quality of care was perceived, the nurses' sense of work satisfaction as well as the sense of security of the nurses, patients, and next of kin [22]. To further describe other professions' perceptions with the MICM will allow for a wider view of the model, where the physician has a major role. ...
Background
An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.
Methods
A phenomenographic qualitative study design, with semi-structured interviews using an interview guide.
Results
Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians’ role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients’ homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making.
Conclusions
The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other’s medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model.
