Primus inter pares. Fostering team leadership of general practitioners in the interprofessional care for frail elderly people
Primus inter pares. Onderzoek naar het leiderschap van de huisarts in interprofessionele zorg aan kwetsbare ouderen.
Ouderen blijven steeds langer thuis wonen. Hierdoor wordt de zorg voor zorgverleners in de eerstelijnszorg intensiever en complexer. Goede samenwerking tussen de verschillende professionals is daarbij noodzakelijk. Het teamwork vraagt om leiderschap vanuit een ‘transformationele benadering’: met aandacht voor motiveren, visie en teamcultuur. Deze rol wordt vaak toegewezen aan huisartsen.
Het doel van het onderzoek is om kennis op te doen over de invulling van deze leiderschapsrol door de huisarts. Door middel van actieonderzoek werken onderzoekers met zorgverleners, patiënten en experts aan effectieve strategieën, die direct toepasbaar zijn. We volgen 4 stappen:
- Inventariseren van de beschikbare kennis en de behoeften van huisartsen
- Selecteren van geschikte strategieën
- Toepassen van de strategieën en leren over bevorderende en belemmerende factoren
- Evalueren van de impact op de competenties van de huisarts, de samenwerking in het team en de kwaliteit van de geboden zorg.
Samenvatting van de aanvraag
PROBLEM STATEMENT GPs face an increasing number of elderly patients with complex care demands. Person centered, coherent care for this patient population requires interprofessional collaboration. Setting up and fostering interprofessional teamwork within a continuously changing practice requires a transformational approach to team leadership instead of a hierarchical approach. This leadership role in chronic care is often attributed to GPs. However, theoretical foundations and operationalisation of interprofessional team leadership into measurable behaviour are currently lacking. This study provides insight into what GPs need to fulfil a leadership role in interprofessional primary care teams, and is aimed to improve the person centeredness, structure and learning culture within the teams, and ultimately more coherent and person-centered care for the frail elderly patients. APPROACH In our participatory action research approach, researchers, professionals, patients and experts collaborate to develop high quality, practically applicable leadership strategies. Methods are selected that take the context variability of practice settings into account. We follow a spiralling, iterative approach, including four phases: I. Orientation on the topic, II. planning to initiate change; III. implementing the change and reflecting on the process; IV. Evaluation of impact. For each phase, we have formulated research questions. RESEARCH QUESTIONS Phase I (orientation) Study 1: What theories and strategies on GP team leadership are currently known among experts? An interview study. Study 2: How do GPs understand their interprofessional team leadership role and what needs for improvement do they see? A focus group study. Phase II (planning) Study 3: What strategies best fit GPs’ needs regarding effective, efficient and sustainable team leadership in frail elderly care? A World Café study approach. Phase III (implementation) Study 4: What are the barriers to and facilitators of implementing strategies to change GP team leadership? An iterative multiple case study. Phase IV (evaluation) Study 5: What is the impact of the implemented GPs’ leadership strategies on: a) The level of the GP: GPs’ leadership competences? b) The level of the interprofessional team: patient-centeredness of the team decisions, team structure and organisation, and learning culture? c) The level of the patient: quality of care in terms of coherence of care and person centeredness? Patient centeredness is the level of tailoring of the planned actions to the problems that are identified as most troubling by the individual patient. A mixed-methods before and after pilot impact study METHODS Phase I (Qualitative interview study and focus group study) starts with semi-structured interviews with 20 experts from different fields. The topic list is based on available systematic reviews on interprofessional team leadership. Furthermore, two focus groups with GPs and other health professionals will be held to get a deeper understanding of the perceived needs for improvement in GP team leadership. In phase II (World Café), a longlist of promising strategies to improve GPs’ interprofessional team leadership competences will be collected during a co-creative workshop with 20 participants: GPs and representatives of other primary care disciplines, experts, patients and researchers. The perceived needs for improvement from phase I serve as input. The multiple cases of phases III and IV are 6 interprofessional primary care teams. Baseline data will be gathered before the implementation of the GPs’ leadership strategies on the GP, team and patient levels. Then, the participating teams select strategies from the longlist of phase II that they expect to suit their context best. They will apply these strategies for 6 months. Thereafter, the GPs reflect on their experiences and needs in a focus group, based on individual 360 degrees feedback rounds. This process of applying the selected strategies, the feedback round and the focus group of GPs will be repeated in the next 6 months. The one-year follow-up data on the levels of the GPs, teams and patients will be collected according to the baseline measurement. RELEVANCE The outcomes of this study will provide a deeper understanding of interprofessional team leadership and its effectiveness in daily care practice. This is relevant since GPs play an important role in providing person centered and coherent care. The lessons learnt and the strategies to improve interprofessional team leadership will become available for research, practice and educational purposes.