Factors Influencing Interprofessional Collaboration in General and During Multidisciplinary Team Meetings in Long-term Care and Geriatric Rehabilitation: a Qualitative Study

doi:10.21203/rs.3.rs-3340738/v1

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Research Article

Factors Influencing Interprofessional Collaboration in General and During Multidisciplinary Team Meetings in Long-term Care and Geriatric Rehabilitation: a Qualitative Study

https://doi.org/10.21203/rs.3.rs-3340738/v1

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Background

Interprofessional collaboration is essential to respond to the growing complexity of care and to maintain high-quality care in long-term care and geriatric rehabilitation. However, little is known regarding factors perceived by the actors involved as influencing interprofessional collaboration in long-term care and geriatric rehabilitation. We therefore examined the facilitators of and barriers to interprofessional collaboration in general and during multidisciplinary team meetings specifically as mentioned by the actors involved, as well as the differences between long-term care and geriatric rehabilitation. Also investigated was whether, and if so which patient outcome measures are used in multidisciplinary team meetings.

Methods

Qualitative study using thematic analysis. Ten focus groups and 18 semi-structured interviews were held with 14 patients, 13 informal caregivers, and 22 healthcare professionals in eight long-term care and geriatric rehabilitation facilities across the Netherlands.

Results

The perceived influencing factors can be classified into two general themes: 1) ‘Involvement of patient, informal caregiver, and healthcare professional’, categorised into: ‘participation of patients and informal caregivers’, ‘behaviour and attitude of team members’, ‘expectations of team members towards each other’, and ‘exchange of information, knowledge, and reciprocity in communication’; and 2) ‘Methodical approach to providing care for older people’, consisting of: ‘coordination of team procedures’, and ‘coordination of organisational procedures’. Also, one specific theme for multidisciplinary team meetings was identified: ‘Involvement of patient, informal caregiver, and healthcare professional in multidisciplinary team meeting, categorised into: ‘team procedures’, ‘working methodically’, and ‘participation in multidisciplinary team meetings. Standardised patient outcome measures were not often used in multidisciplinary team meetings.

Conclusion

People involved in long-term care and geriatric rehabilitation indicated that, apart from working methodically, being involved in care and multidisciplinary team meetings are essential factors influencing interprofessional collaboration. These factors must be taken into consideration to provide valuable, high-quality care to older people residing in long-term care and geriatric rehabilitation through interprofessional collaboration.

Trial registration

Not applicable

Interprofessional collaboration

long-term care

geriatric rehabilitation

multidisciplinary team meetings

facilitators

barriers

patient outcome measures

Long-term care (LTC) and geriatric rehabilitation (GR) have become increasingly complex in recent years due to more multimorbidity and complex geriatric syndromes.^{1, 2} Providing valuable, high-quality care for a growing population of older people requires multidisciplinary knowledge, treatment, and appropriate interprofessional collaboration (IPC).^{1, 3, 4} The World Health Organisation defines IPC as: multiple healthcare professionals from different professional backgrounds providing comprehensive services by working with patients, their families, carers, and communities to deliver the highest quality of care across settings.⁵

Recent studies show that factors influencing IPC can roughly be categorised as interdependent factors related to team performance, organisational conditions, and sharing information.^{4, 6} However, there are still many challenges to overcome to accomplish successful IPC with the involvement of all actors in LTC and GR. So far, only a few studies on IPC have been conducted in GR, and patients and informal caregivers are often not included. Besides, comparative research between LTC and GR is limited. Although both LTC and GR provide complex care for older people, delivered by healthcare professionals from various disciplines, little is known about differences in facilitators of and barriers to IPC between both settings.^{1, 2}

A better understanding of successful IPC requires knowledge of perceived and experienced influencing factors in general and during multidisciplinary team meetings (MDTMs); a MDTM is a formal meeting for the purpose of sharing information, discussing the health status of patients, and evaluating the care, using standardised patient outcome measures to improve communication.^7–10 Additionally, a MDTM provides an ideal opportunity for all actors involved to coordinate care. This improves the quality of care, but it also requires an understanding of each other’s expertise and IPC.^{4, 8} When MDTMs are well organised, they can enhance IPC.^11–14

The primary aim of this study is to examine which facilitators of and barriers to IPC are experienced by the actors involved in LTC and GR. Specifically, a distinction is made between facilitators of and barriers to IPC experienced in general as well as during MDTMs. Differences between LTC and GR are also investigated. A secondary aim is to explore if, and if so which patient outcome measures are used in MDTMs.

In this qualitative research, focus groups and semi-structured interviews were used to investigate the factors influencing IPC in general as well as during MDTMs as experienced by participants in LTC and GR.¹⁵ This approach was chosen to provide participants the opportunity to elaborate on their experiences. To reduce the possibility of hierarchical influences, separate focus groups were held for: 1) physicians and therapists; 2) nurses and healthcare aides; 3) managers; 4) patients, and 5) informal caregivers for LTC and GR.¹⁶ The Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ) was selected to report important aspects of the research team, methods, context, findings, analysis, and interpretations of the study.¹⁷ The Medical Research Ethics Committee Leiden Den Haag Delft (METC LDD) [N22.027] approved the study, as the research was not subject to the Medical Research Involving Human Subjects Act. Participants received a 20-Euro gift card for their participation. Data were collected between March and December 2022.

Setting

This study was performed at LTC and GR facilities in the Netherlands. Both LTC and GR are situated in nursing homes and provide care to older people with complex diseases and disabilities.^18–20 Patients residing in nursing homes are permanently or temporarily unable to live at home and receive 24/7 care. Patient care is provided by a multidisciplinary team consisting of elderly care physicians, psychologists, nurses, healthcare aides, speech therapists, occupational therapists, physiotherapists, spiritual counsellors, social workers, and activity supervisors. GR facilities specifically focus on frail elderly people who have complex multimorbidity and reduced learnability and trainability. However, these GR patients have a reasonable chance of returning to their home. A multidisciplinary team specialising in GR delivers treatment and care of a higher intensity than the treatment and care provided in LTC.²⁰ The length of stay in GR is up to six months, but mostly shorter, after which patients can again participate in society.

Participants

Purposive sampling was used to select participants relevant to the research question, for both the focus groups and the semi-structured interviews.¹⁵ Participants from LTC and GR facilities across the Netherlands were recruited. All participants had to work, reside, or have a relative residing in LTC or GR, and have sufficient knowledge of the Dutch language to participate in a focus group or interview. Additional inclusion criteria for healthcare workers were a minimum age of 18 and working in LTC or GR longer than three months. Informal caregivers had to be actively involved in their relative’s care. Participants received an information letter and informed consent form from the department manager of the facility where they resided or worked before enrolling. Once participants enrolled, they were provided with the definition of IPC by the World Health Organisation, and they received a short questionnaire to fill out their demographic characteristics online via Castor or on paper when there was no possibility to use an internet connection.

Data collection

Focus groups lasting 90 to 120 minutes were conducted with each of the five groups at one of the locations of the participating facilities. Each group consisted of at least four participants to enable discussion of the emerging issues. One researcher (AD) led the focus groups, assisted by a second researcher (HS or one of the three research interns with a background in medicine or psychology: TV, LS, or MD). Researchers used elicitation techniques to facilitate the group discussions and encourage participants to share their ideas.²¹ Four researchers (AD, TV, LS, and MD) conducted live or online interviews, depending on the participants' preferences. The interview topic guide is presented in Supplement 1.

Both the focus groups and semi-structured interviews were audio-recorded and transcribed verbatim. The participants did not receive a transcript or summary of the meeting as a member check.

Data analysis

After discussion in the research team, a sample size of at least 40 participants for ten focus groups (two focus groups per group) was agreed upon. This number will generate a general idea of the factors perceived by the actors involved as influencing IPC in LTC and GR combined.^{15, 22} Based on the focus groups, the researchers could determine questions to be asked during the additional semi-structured interviews for a more in-depth exploration and to ensure data saturation. The determined sample size for the additional interviews was 10-20.¹⁵ The inclusion of participants for interviews were completed when no new influencing factors of IPC emerged. Two researchers (AD, HS) used Braun and Clarke's six phases of thematic analysis to analyse the data and develop themes.^{23, 24} Data were coded by combining an inductive and deductive approach to thematic analysis.²⁴ The coding process was based on themes developed in previous research (i.e. team performance, organisational conditions, and information sharing).^{4, 15} Additional codes were added to the codebook based on inductive coding. Consensus meetings were held to ensure the quality of the data .¹⁵ Atlas.ti version 22 facilitated the ordering and structuring of the data.²⁵

A total of ten focus groups and eighteen semi-structured interviews were conducted in eight facilities providing LTC and GR, in which a total of 22 healthcare professionals, 10 managers, 14 patients, and 13 informal caregivers participated. The demographics of participants are shown in Table 1.

Table 1

Demographics of participants from long-term care and geriatric rehabilitation involved in the study per group and per setting
		Healthcare professionals				Patients	Informal caregivers
		Physicians and therapists	Nurses and healthcare aides		Managers
Focus groups	LTC	3	6		4	4	6
	GR	3	2		3	5	5
Interviews	LTC	5	1		2	4	1
	GR	1	1		1	1	1
Mean age in years (SD)	LTC	35.3 (6.8)	51.3 (12.8)		50.8 (8.7)	80.5 (10.2)	72.7 (9.8)
	GR	31.5 (7.9)	46.3 (10.1)		53.3 (12.9)	75.3 (7.2)	55.5 (13.8)
Gender (n male /female)	LTC	0 / 8	0 / 7		0 / 6	2 / 6	4 / 3
	GR	0 / 4	2 / 1		2 / 2	2 / 4	4 / 2
Mean years working in care team (SD)	LTC	4.8 (6.8)	3.9 (1.9)		7.7 (6.9)
	GR	4.8 (2.9)	7.0 (5.6)		2.7 (1.5)
Mean hours working per week (SD)	LTC	22.0 (7.1)	29.7 (6.0)		33.7 (7.8)
	GR	34.0 (2.3)	29.3 (8.3)		30.0 (12.0)
Mean length of stay in months (SD)	LTC					18.1 (4.3)
	GR					1.3 (0.6)
Mean hours actively involved in patient care per week (SD)	LTC						20.1 (17.1)
	GR						20.2 (19.7)
Mean years actively involved in patient care (SD)	LTC						18.5 (16.5)
	GR						3.6 (4.5)
Relationship to the patient	Partner			LTC			3
				GR			2
	Son/daughter			LTC			2
				GR			2
	Brother/sister			LTC			1
				GR			1
	Son-/daughter-in-law			LTC			1
				GR			0
	Neighbour			LTC			0
				GR			1
LTC, Long-Term Care; GR, Geriatric Rehabilitation

Factors influencing IPC

Healthcare professionals, patients, and informal caregivers reported numerous factors influencing IPC in LTC and GR, which were grouped into two general themes and one specific theme regarding MDTMs.

The first theme related to general IPC was ‘Involvement of the patient, informal caregiver, and healthcare professionals', consisting of the categories: a) participation of patients and informal caregivers; b) behaviour and attitude of team members, c) expectations of team members towards each other, d) the exchange of information, knowledge, and reciprocity in communication. The second theme was ‘A methodical approach to providing care for older people’, composed of the categories: a) coordinating team procedures, and b) coordinating organisational procedures.

The theme specific for facilitators of and barriers to IPC during MDTMs was ‘Involvement of patient, informal caregiver, and healthcare professionals in MDTMs’ and was composed of the categories a) team procedures of MDTMs, b) working methodically in MDTMs, and c) participants of MDTMs. An overview of all themes, categories, and codes is presented in Table 2.

Table 2a

Overview of the themes, categories, and codes of facilitators of and barriers to interprofessional collaboration in general
Potential Themes	Categories	Codes
Potential Themes	Categories	Facilitators	Barriers
Involvement of patient, informal caregiver, and healthcare professional	Informing each other	• Clear information exchange between healthcare professionals	• Healthcare professionals do not know who is informal caregiver
		• Balance between sharing information in writing and through conversation	• Informal caregiver is not informed, or not in a timely manner, or is informed retrospectively
		• Up-to-date handover information	• People involved are not or insufficiently informed about the care process
		• Informing family caregivers about policy decisions	• Family caregivers are not or insufficiently informed about the roles of healthcare professionals
		• Clarity about care process among all persons involved (patient, family caregiver and healthcare professional)	• Ignoring family caregiver contribution
	Mutual communication	• Mutual communication among stakeholders	• No or limited communication between persons involved
		• Short lines of communication between professionals in nursing home and hospital care	• No or limited contact between family caregiver and healthcare professional
		• Uniform use of language	• Limited communication between healthcare professionals
		• Listening to each other
	Participation of all persons involved	• Engaging with each other	• Unclear attitude towards each other
		• Willingness of patient, family caregiver and health care professional to help	• Family caregiver not or not actively involved
		• Open attitude	• Not knowing each other
		• Interest in each other
		• Positive team atmosphere
		• Equality of permanent and temporary team members
	Behaviour and attitude of team members towards each other	• Low-threshold accessibility of healthcare professionals	• Showing no interest in each other•
		• Calling each other to account/giving feedback	• Little or no empathy
		• Showing empathy
		• Social activities with team to get to know each other
		• Self-reflection
	Team members' expectations towards each other	• Agreement on goals	• Failure to honour agreements
	Team members' expectations towards each other	• Mutually attuned expectations	• No or limited attuning
Methodical approach to providing care for older people	Coordinating team procedures	• Clear procedures	• No clear procedures
		• Joint coordination regarding treatment plan	• No or limited coordination between care professionals about their contribution
		• Working in complementary manner to each other
		• Systematically planned evaluation moments with persons involved
	Coordinating organisational procedures	• Availability of multidisciplinary health professionals for treatment	• Healthcare professionals having no or limited control regarding treatment process
	Coordinating organisational procedures	• Policy support for collaboration between care professionals	• Unclear policy on procedures

Table 2b

Overview of the themes, categories, and codes of facilitators of and barriers to interprofessional collaboration specific for multidisciplinary team meetings.
Potential Themes MDTM	Categories MDTM	Codes MDTM
		Facilitators	Barriers
Involvement of patient, informal caregiver, and healthcare professional in MDTMs	Participants in the MDTM	• Patient and/or family caregiver attending the MDTM	• Patient and family caregiver not involved in MDTM
		• Multidisciplinary healthcare professionals attending the MDTM
		• Decisive MDTM chairperson
		• Patient-tailored presence of disciplines at MSTM
	MDTM - Team procedures	• Patient and family caregiver influence on content of MDTM	• Ignoring team agreements regarding MDMT
		• Clarity about MDTM process	• No clear vision about conducting the MDMT
		• Clarity about goal of MDTM
		• Clarity about chairmanship of MDTM
	Methodical approach to MDTM	• Planned actions during MDTM
		• Organized consultation structure for providing feedback from MDTM to patient and family caregiver

1) Involvement of the patient, informal caregiver, and healthcare professional

Participants emphasised that the involvement of all actors, including patients and informal caregivers, is essential for IPC. More specifically, they indicated that the participation, behaviour, and attitude of people in LTC and GR were important influencing factors. Emerging facilitating factors of IPC, such as engaging with each other, having an open attitude towards others, and giving feedback to each other, are discussed by all actors.

"We have no problem saying things to each other, for example a psychologist who thinks I should approach a patient in a different manner. He will come to me directly: 'please say it in more in a positive way instead of giving commands'. And that often helps". Healthcare professional (therapist) - GR in interview 26701

According to the participants, engaging with each other also creates a sense of responsibility and responsiveness towards each other. They underlined that connecting with each other enables communication between them.

"We intentionally pay attention to each other and our cooperation is improving more and more, so we are increasingly open towards each other. It becomes easier to bring up and discuss collaboration problems ". Healthcare professional (Manager) - GR in focus group 16701

However, participants stated they experienced that not being involved, for instance, not being informed about potential changes in the care, or not having clarity about the involvement of others, can be a barrier to IPC.

Knowing the expectations of team members was also mentioned by participants as an influencing factor. Involvement can be enhanced by factors such as mutual coordination with regard to expectations and having shared goals.

"The power of taking care of people and doing that together, especially to empower the client. Being in charge in life, looking for goals that are important to that particular person, because I can think up all kinds of stuff, but it has to benefit the person in question". Healthcare professional (therapist) - LTC in interview 25702

Nevertheless, aligning expectations can be challenging. Examples mentioned were when people do not keeping agreements or when different healthcare professionals have different expectations of the goals of a patient.

"Should someone undergoing rehabilitation be able to make their own bed, or does care staff do it for them?" Patient - GR in interview 26801

Within the theme of the involvement of patient, informal caregiver, and healthcare professionals, factors related to ‘the exchange of information, knowledge, and reciprocity in communication’ were also regarded as important for IPC. Participants noted that factors such as sufficient and efficient communication with each other about the care process and listening to each other were enabling factors that can result in a sense of well-being.

"No matter how busy they are, they take the time to listen to you, I think that's very important and that feels good." Patient - LTC in interview 25810

However, when the communication between people involved in LTC and GR is insufficient, it will create discontent among those involved in the care and may restrict IPC.

"This morning my father was informed in like five seconds, your wife is going to move. I think, as her daughter I would like to be there. Why am I not told beforehand?" Informal caregiver - GR in focus group 16901

2) A methodical approach to providing care for older people

Participants noticed the coordination of team procedures as an important influencing factor in IPC. They stated, for instance, that when a patient is overtaxed, the care for this patient requires adequate coordination between all parties involved. With this, they can align their involvement with the patient's needs. They also noticed that IPC is enhanced when team members work in ways that complement each other and use comprehensible methods.

"I am currently facilitating team collaboration. I don't do that myself, others do this together and I am the one who makes sure that everyone actually can and will do it. So I walk the wards, am visible, approachable, and I solve things that are mine to solve. But others solve things where they need to". Healthcare professional (manager) - GR in interview 26702

Participants furthermore emphasised that coordination of organisational procedures is an important overall category within the theme of methodical approach. They frequently mentioned an influencing factor: the availability of supportive organisational policies for IPC. They also indicated the importance of multidisciplinary healthcare professionals having the opportunity to work together in providing the care for older people in LTC and GR. However, participants also noted the possibility of diverse interpretations in the work process as a potential pitfall. For anyone involved in care, non-explicit working processes and unclear policies regarding working methods are reported to hinder collaboration and reaching joint objectives.

"And those rules, because the more rules there are, the more leeway you have to bypass them. You need a shared a vision rather than a whole bunch of separate rules." Patient - GR in interview 26801

3) The involvement of patient, informal caregiver, and healthcare professionals in MDTMs

Participants specifically emphasised factors influencing IPC during MDTMs. They stated that working with team procedures and using a methodical approach in MDTMs are important influencing factors. They noticed that a clear process and well-defined goals of MDTMs facilitated IPC during these meetings. The participants also revealed that the reason why a variety of people are coming together to clarify goals in MDTMs must be clear. However, they also reported that an unclear vision of team functioning in MDTMs generates uncertainty regarding the involvement of the participants in MDTMs, which in turn influences IPC.

"And also a difference in vision. Whether you see the MDTM as no more than chatting for an hour, or that it is where actions and evaluations are agreed upon. That really is a huge difference." Healthcare professional (healthcare aide) - LTC in focus group 15702

In general, there are similarities in many of the factors reported to influence IPC in LTC and GR. However, with regard to MDTMs, differences are reported for organisational procedures, such as a higher frequency of MDTMs in GR (once a week) than in LTC (once every six months).

Patient outcome measures

Standardised patient outcome measures were not often used in MDTMs, according to the participants. Measures mentioned by participants related to the status of physical and psychological functioning and patient safety. An overview of the mentioned patient outcome measures is shown in Table 3.

Table 3

*Overview of the mentioned patient outcome measures used in Multidisciplinary Team Meetings in Long-Term Care and Geriatric Rehabilitation*
Patient outcome measures
Activities of Daily Living
Assessment of Motor and Process Skills
Medication management
Barthel Index
Blood pressure
Blood test (blood sampling)
Body Mass Index
Canadian Occupational Performance Measure
Day curves
Decubitus risk score/ Time model
Delirium observational screening
Fall risk
Fluid (intake/output) list
Geriatric Depression Scale
Glucose measurement
Hand squeeze test
Heart rate
Incident report Client
Incident report Staff
Mini-Mental State Examination
Montreal Cognitive Assessment
Neuropsychiatric Inventory
Neuropsychological examination
Pain score
Risk inventories
Short Nutritional Assessment Questionnaire
Temperature
Utrecht scale for the evaluation of clinical rehabilitation
Weight, Bioelectrical Impedance Analysis
6-minute walking test

This study examined perceived facilitators of and barriers to IPC in general and also in MDTMs by the actors in LTC and GR. Facilitators of and barriers to IPC in general were classified into two general themes: 1) ‘Involvement of patient, informal caregiver, and healthcare professional’, 2) ‘Methodical approach to providing care for older people’. One specific theme was identified for IPC in MDTMs: ‘Involvement of patient, informal caregiver, and healthcare professional in MDTMs’. The use of standardised patient outcome measures during MDTMs was explored; it was shown they were not often used in MDTMs.

1) Involvement of patient, informal caregiver, and healthcare professional

The involvement of all actors is important for effective IPC. Involvement means being associated with others and addressing the participation needs of actors involved in care.^26–28 Besides involvement, attitude and behaviour – for instance, having an open attitude towards others - were also regarded as essential factors influencing IPC. This is in line with the theme ‘Team performance’ identified in our systematic review in LTC and GR.⁴ Being involved and having an open attitude create the opportunity to align expectations, which is in line with findings in other studies.^29–31 Knowing each other’s expectations enables substantial reciprocity in communication. It encourages the exchange of information and knowledge, which is related to a sense of well-being, and thus facilitates IPC.^{30, 32} However, inadequate communication between team members or, for example, people not honouring agreements, as mentioned by participants, may lead to misaligned expectations, which is confirmed in the literature.³⁰ This may impede involvement and thus hinder IPC. Besides, we also must consider that being involved with each other can take place at different levels, concern different circumstances and may change over time, as shown by Lakin (2022).²⁷ So, for continuous and adequate IPC, mutual involvement is a factor that warrants continuous attention and regular evaluation by the team. These findings have implications for future research to examine how to apply these facilitating factors for IPC to all actors involved in LTC and GR.

2) Methodical approach to providing care for older people

A methodical approach (or lack thereof) to providing care also impacts IPC. In line with other studies, working with a methodical approach fits the identified theme ‘organisational conditions’ of our systematic review, which can be beneficial to IPC.⁴ In this context important factors influencing IPC are working with team procedures, such as team coordination, and organisational procedures, such as policies regarding working methods. Effective coordination, for instance, and anticipating and adjusting communication when circumstances change, will enable teams to better adapt to various and often changing situations in the complex care of older people and foster their collaboration, which is in line with findings in other studies.³³ This will be supported by having organisational policies about working methods and explicit work processes, as stated in earlier research.³⁴ So, working methodically should be carefully considered by organisations and teams working in complex care. It enables teams to anticipate frequently changing situations and anticipatory behaviour benefits group coordination and collaboration.³³ However, more research is needed to examine the role of anticipatory behaviour in LTC and GR with regard to enhancing IPC.

3) Involvement of patient, informal caregiver, and healthcare professional in MDTMs

Previous research has shown that a methodical approach to MDTMs stimulates clear team procedures and comprehensible goals.^35–37 Transparency and a methodical approach are beneficial for managing MDTMs, supporting the appropriate match between all actors involved in meeting the patient's needs, as indicated in other studies.^{2, 29, 36, 38} A methodical approach can be beneficial, especially in GR because of the noticeably shorter admission time. The pace of the care process in GR makes involving patients and informal caregivers challenging. It requires coordinated communication between all actors involved and management of expectations in a relatively short period of time. To be able to swiftly respond to changing circumstances in the care calls for anticipatory behaviour.³³ However, as a result of an unclear vision of team functioning in MDTMs and, for instance, patients and informal caregivers not being involved, as shown in our study, collaboration within a group can easily deteriorate.^35–37 Working methodically, including working with participants who fit patients' needs and anticipatory behaviour can help MDTM teams improve IPC. So, to enhance IPC in general, facilities for LTC and GR can benefit from a well-defined context of MDTMs.

The use of patient outcome measures during MDTMs

Although in our study not many healthcare professionals, patients, and informal caregivers in LTC and GR indicated standardised patient outcome measures were used in MDTMs, the literature shows it has various benefits. Using patient outcome measures supports a comparable view of patients’ functional status.³⁹ In addition, it ensures uniformity in language, which also was indicated to be a facilitator to IPC ⁴ These factors can be supportive and align mutual expectations of patients, informal caregivers, and healthcare professionals. In this way LTC and GR can benefit from using patient outcome measures to facilitate IPC in MDTMs and in general. Future studies should examine perceived barriers to using patient outcome measures in MDTMs.

This study was performed at facilities for LTC and GR in the Netherlands. Although we believe that our results are valid for Dutch interprofessional collaboration in LTC and GR, in other countries or cultures other themes may come up in these settings. So, a challenging task for further research is the specification of themes in IPC outside the Netherlands and comparing the emerging themes.

Strength and Limitations

The strengths of this qualitative research include working with a clear definition of IPC, the active involvement of all actors from both LTC and GR, and the use of separate focus groups to provide an opportunity for the various actors to elaborate on their experiences and avoid hierarchical influences. Although conducting homogeneous focus groups may have led to missing discussions with mixed participants groups, the additional semi-structured interviews allowed for an in-depth examination to cover all important topics regarding IPC. It should be noted that this study focused primarily on facilitators of and barriers to IPC. Patient outcome measures to enhance IPC and differences between LTC and GR were discussed less extensively.

Interprofessional collaboration is necessary for the provision of valuable, high-quality care in LTC and GR. The complexity of caring for older people residing in these facilities requires coordinated multidisciplinary knowledge, care, and treatment, which in turn necessitates the collaboration between healthcare professionals, patients, and informal caregivers. The involvement of all actors requires a well-balanced process, both in general and in MDTMs. Enhancing such a process involves a methodical approach with clear policies regarding working methods and effective coordination. Acknowledging the often changing circumstances in the care of older people also means acknowledging that effective coordination is essential. It supports regulating the involvement of all actors needed to meet patients' needs. Also essential to enable responding to the often changing circumstances is anticipatory behaviour from all actors and regular evaluations of their involvement, which will enhance IPC.^{28–30, 38} Interprofessional collaboration in general as well as in MDTMs benefits from using patient outcome measures in MDTMs to enhance common language, sharing information and with this communication. Using them can support communication between all actors about the functional status of a patient. Clear communication helps to manage expectations between patients, informal caregivers, and healthcare professionals, which in turn facilitates IPC.³⁹ Thus, interprofessional collaboration in complex care in LTC and GR requires a well-coordinated team consisting of actors involved in meeting patient needs. They have to be aware of the often changing circumstances in care. They must anticipate these changes by regularly evaluating their involvement and managing expectations in formal multidisciplinary team meetings.

Abbreviation	Meaning
LTC	Long-Term Care
GR	Geriatric Rehabilitation
IPC	Interprofessional Collaboration
MDTM	Multidisciplinary team meeting
METC LDD	Medical Research Ethics Committee Leiden Den Haag Delft

Ethics approval and consent to participate

The Medical Research Ethics Committee Leiden Den Haag Delft (METC LDD) [N22.027] reviewed the study protocol and judged exempt from the Medical Research Involving Human Subjects Act. For all participants, informed consent was obtained to participate in the study.

Consent for publication

Not applicable

Availability of data and materials

The dataset is available from the corresponding author upon reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding sources

This work was supported by the University Network for the Care Sector South Holland.

Authors’ contributions

All authors, AD, WA, and HS, fulfil the criteria for authorship and have read and approved the manuscript.

Acknowledgements:

We thank Tim van de Velde (TV), Lars Stoffer (LS), and Merlijn van Dirven (MD), for helping with the data collection.

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No competing interests reported.

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You are reading this latest preprint version

Factors Influencing Interprofessional Collaboration in General and During Multidisciplinary Team Meetings in Long-term Care and Geriatric Rehabilitation: a Qualitative Study

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Version 1

Abstract

Background

Methods

Setting

Participants

Data collection

Data analysis

Results

Factors influencing IPC

1) Involvement of the patient, informal caregiver, and healthcare professional

2) A methodical approach to providing care for older people

3) The involvement of patient, informal caregiver, and healthcare professionals in MDTMs

Patient outcome measures

Discussion

1) Involvement of patient, informal caregiver, and healthcare professional

2) Methodical approach to providing care for older people

3) Involvement of patient, informal caregiver, and healthcare professional in MDTMs

The use of patient outcome measures during MDTMs

Strength and Limitations

Conclusions

List of abbreviations

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1