THU0714-HPR Interprofessional collaboration in rheumatology rehabilitation – the clash between ideology and practice

Abstract

Background: Interdisciplinary collaboration in rheumatology rehabilitation is pivotal in order to meet the complex and multifaceted needs of the patients.1 However, in practice, an interprofessional approach is hard to achieve.2 Objectives: To explore how health professionals working with inpatient rehabilitation at a Danish hospital for rheumatic diseases, experience the interdisciplinary collaboration in practice compared to their ideals. Further, to explore what fosters or prevents interprofessional collaboration. Methods: In total six focus groups and two individual interviews were conducted with 32 health professionals (HPs) working with rehabilitation. The HPs included occupational therapists, physiotherapists, rheumatologists, nursing staff, a social worker and a dietician. The composition of the focus groups were monodisciplinary, except from one group where nurses and doctors from the outpatient unit were interviewed together. The individual interviews were conducted with a social worker and a dietician, as they were sole employers within these disciplines. The interviews were transcribed ad verbatim and a thematic condensation and indexing was used in the analysis of the data.3 Results: The analysis revealed a clash between ideals about interdisciplinary teamwork and the dominant monodisciplinary work practice. Physical, organisational and cultural factors were perceived as important barriers. Lack of common physical facilities hindered both informal and formal interdisciplinary cooperation. The organisational set up with only one interdisciplinary team meeting before the patients were admitted to hospital and with a lack of rheumatologists' involvement during admission did not support interdisciplinary teamwork. The existing monodisciplinary work culture acted as a barrier towards both formal and informal collaboration. All these factors led to a lack of knowledge about the contributions from other HPs. Common physical work and meeting facilities and informal networking fostered interprofessional collaboration. Conclusions: To support the development of interprofessional teamwork in rehabilitation practice, it is important to consider both common physical work facilities and to change the organisational and cultural factors acting as barriers towards collaboration. Further knowledge about the contributions from other HPs is a prerequisite to interprofessional collaboration.