Barriers in the implementation of interprofessional continuing education programs – a qualitative study from Germany

BMC Medical Education

Stephanie Stock¹  Marcus Redaelli²  Sibylle Kautz-Freimuth¹  Ralf Tebest¹  Sibel V Altin¹ 

[1] Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleuelerstr. 176-178, 50935 Cologne, Germany;Institute of General Practice, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany

关键词: Health policy implications;    Needs assessment;    Interprofessional continuing education;    Medical education;   

Others  :  1090403
DOI  :  10.1186/1472-6920-14-227

 received in 2014-06-17, accepted in 2014-10-13,  发布年份 2014

【 摘 要 】

Background

Insufficient communication and coordination is one of the most problematic issues in German health care delivery leading to detrimental effects on health care outcomes. As a consequence interprofessional continuing education (CIPE) is gathering momentum in German health policy and health care practice aiming to enhance service quality and patient safety. Nevertheless, there is limited evidence on the course of implementation and the perceived effectiveness/acceptance of CIPE in German health care. This paper describes the objectives and formal characteristics of CIPE trainings and maps important determinants influencing the success of CIPE implementation from the perspective of providers offering CIPE trainings for German health care professionals.

Methods

Forty-nine training institutions offering CIPE for health care professionals were identified by a structured web search including the websites of German medical education associations and public/private training institutions. Directors and managers of the identified institutions were invited to participate in a semi-structured interview. The interview guideline was developed using the SPSS method by Helferich and colleges. Interviews were analyzed using the summarizing content analysis developed by Mayring resulting in a paradigm that contextualizes hindering factors regarding the implementation of CIPE in the German health care system.

Results

Overall, 19 of the identified institutions agreed to participate with one director/manager per institution resulting in a response rate of almost 38.8%. The included institutions offer n = 85 CIPE trainings for health care professionals. Trainings offered mainly address the enhancement of domain, social and personal competencies of the participating health care professionals and follow three main objectives comprising better care of severely ill patients, improvement of patient safety by sustained risk management as well as a more patient centered care. Implementation of CIPE in Germany is influenced by various hindering factors mostly coming from systemic (missing incentives), behavioral (hierarchy problems) and methodological (limited quality assurance) factors.

Conclusion

CIPE is an evolving concept in the German health care system. There are various difficulties that impede a successful implementation of CIPE and might be mitigated by specific health policy interventions such as mandatory CIPE participation of health care professionals and comprehensive pre-license interprofessional education.

【 授权许可】

   
2014 Altin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Advisory Council on the Assessment of Developments in the Health Care System: Kooperation und Verantwortung - Voraussetzungen einer zielorientierten Gesundheitsversorgung. [Cooperation and Responsibility- Prerequisites for Target-Oriented Health Care]. Bonn: Nomos; 2007. Ref Type: Report
• [2]Nolte E, Knai C, Hofmarcher M, Conklin A, Erler A, Elissen A, Flamm M, Fullerton B, Sonnichsen A, Vrijhoef HJ: Overcoming fragmentation in health care: chronic care in Austria, Germany and The Netherlands. Health Econ Policy Law 2012, 7:125-146.
• [3]Regulating quality and safety of health and social care. - International experiences http://www.rand.org/content/dam/rand/pubs/research_reports/RR500/RR561/RAND_RR561.pdf webcite
• [4]Antoni C: [Interprofessional teamwork in healthcare.] Interprofessionelle Teamarbeit im Gesundheitsbereich. Z EvidFortbildQualGesundhwesen 2010, 104:18-24.
• [5]Attributes of a Health Literate Organization [http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdf webcite]
• [6]Barr H, Koppel I, Reeves S, Hammick M, RFreeth D: Effective Interprofessional Education: Argument, Assumption and Evidence. London, UK: Blackwell; 2005.
• [7]Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M: Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013, 3:CD002213.
• [8]Le Deist FD, Winterton J: What is competence? Hum Resour Dev Int 2005, 8:27-46.
• [9]Dahlgaard K: [Improving team-based collaboration between doctors and nurses-New opportunities through process optimization and extended tasks for nurses.] Verbesserung der teamorientierten Zusammenarbeit zwischen Ärzten und Pflegenden–Neue Chancen durch Prozessorientierung und erweiterte Aufgaben für Pflegende. Z EvidFortbildQualGesundhwesen 2010, 104:32-38.
• [10]Hahn EG: [Cooperation of health professionals: the role of education and training.] Kooperation der Gesundheitsberufe: die Rolle von Aus- und Weiterbildung. GMS Z Med Ausbild 2007, 24:Doc153.
• [11]Helferich C: [The Quality of Qualitative Data: Manual for Conducting Qualitative Interviews] Die Qualität qualitativer Daten: Manual für die Durchführung qualitativer Interviews. Wiesbaden: VS Verlag für Sozialwissenschaften; 2005.
• [12]Blanck B: [Dealing with diversity and alternatives as a challenge for research, teaching and practice] Umgang mit Vielfalt und Alternativen als Herausforderung für Forschung, Lehre und Praxis. Erwägen-Wissen-Ethik 2005, 16:537-551.
• [13]Mayring P: [Qualitative Content Analysis. Basics and Technics.] Qualitative Inhaltsanalyse. Grundlagen und Techniken. Basel: Beltz UTB; 2003.
• [14]Mathison S: Why triangulate? Educ Res 1988, 17:13-17.
• [15]Mahler C, Karstens S, Roos M, Szecsenyi J: [Interprofessional education for patient-centred practice: development of outcome-focused competencies for a Bachelor Programme Interprofessional Health Care]. Z Evid Fortbild Qual Gesundhwes 2012, 106:523-532.
• [16]Schildmann J, Härlein J, Burchardi N, Schlögl M, Vollmann J: Breaking bad news. - An interprofessional course for medical and nursing students. GMS Z Med Ausbild 2006, 23:Doc67.
• [17]Davidson M, Smith RA, Dodd KJ, Smith JS, O’Loughlan MJ: Interprofessional pre-qualification clinical education: a systematic review. Aust Health Rev 2008, 32:111-120.
• [18]Owen JA, Schmitt MH: Integrating interprofessional education into continuing education: a planning process for continuing interprofessional education programs. J Contin Educ Health Prof 2013, 33:109-117.
• [19]Trojan L, Suter E, Arthur N, Taylor E: Evaluation framework for a multi-site practice-based interprofessional education intervention. J Interprof Care 2009, 23:380-389.
• [20]Kreindler SA, Dowd DA, Dana Star N, Gottschalk T: Silos and social identity: the social identity approach as a framework for understanding and overcoming divisions in health care. Milbank Q 2012, 90:347-374.
• [21]Khalili H, Orchard C, Laschinger HK, Farah R: An interprofessional socialization framework for developing an interprofessional identity among health professions students. J Interprof Care 2013, 27:448-453.
• [22]Hall P: Interprofessional teamwork: professional cultures as barriers. J Interprof Care 2005, 19(Suppl 1):188-196.
• [23]Schulz-Nieswandt F: [Is medical culture changing? Anthropology and depth psychology of integrated healthcare as an organizational development] Wandel der Medizinkultur? Anthropologie und Tiefenpsychologie der Integrationsversorgung als Organisationsentwicklung. Berlin: Duncker & Humbold; 2010.
• [24]Knoll M, Lendner I: [Nurses’ perspective on interprofessional communication on an intensive care unit]. Pflege 2008, 21:339-351.
• [25]Rosenstein AH: Original research: nurse-physician relationships: impact on nurse satisfaction and retention. Am J Nurs 2002, 102:26-34.
• [26]Silver IL, Leslie K: Faculty development for continuing interprofessional education and collaborative practice. J Contin Educ Health Prof 2009, 29:172-177.
• [27]Atwal A, Caldwell K: Do all health and social care professionals interact equally: a study of interactions in multidisciplinary teams in the United Kingdom. Scand J Caring Sci 2005, 19:268-273.