자연주의적 탐구조사(Naturalistic Inquiry)

What makes organizations so similar? We contend that the engine of rationalization and bureaucratization has moved from the competitive marketplace to the state and the professions. Once a set of organizations emerges as a field, a paradox arises: rational actors make their organizations increasingly similar as they try to change them. We describe three isomorphic processes-coercive, mimetic, and normative—leading to this outcome. We then specify hypotheses about the impact of resource centralization and dependency, goal ambiguity and technical uncertainty, and professionalization and structuration on isomorphic change. Finally, we suggest implications for theories of organizations and social change.

The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields (Chinese Translation)

BACKGROUND: The delivery of effective, high-quality patient care is a complex activity. It demands health and social care professionals collaborate in an effective manner. Research continues to suggest that collaboration between these professionals can be problematic. Interprofessional education (IPE) offers a possible way to improve interprofessional collaboration and patient care. OBJECTIVES: To assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions; and to assess the effectiveness of IPE interventions compared to no education intervention.
SEARCH METHODS: For this update we searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 2006 to 2011. We also handsearched the Journal of Interprofessional Care (2006 to 2011), reference lists of all included studies, the proceedings of leading IPE conferences, and websites of IPE organisations. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client or healthcare process outcomes. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed the eligibility of potentially relevant studies. For included studies, at least two review authors extracted data and assessed study quality. A meta-analysis of study outcomes was not possible due to heterogeneity in study designs and outcome measures. Consequently, the results are presented in a narrative format. MAIN RESULTS: This update located nine new studies, which were added to the six studies from our last update in 2008. This review now includes 15 studies (eight RCTs, five CBA and two ITS studies). All of these studies measured the effectiveness of IPE interventions compared to no educational intervention. Seven studies indicated that IPE produced positive outcomes in the following areas: diabetes care, emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; collaborative team behaviour in operating rooms; management of care delivered in cases of domestic violence; and mental health practitioner competencies related to the delivery of patient care. In addition, four of the studies reported mixed outcomes (positive and neutral) and four studies reported that the IPE interventions had no impact on either professional practice or patient care. AUTHORS' CONCLUSIONS: This updated review reports on 15 studies that met the inclusion criteria (nine studies from this update and six studies from the 2008 update). Although these studies reported some positive outcomes, due to the small number of studies and the heterogeneity of interventions and outcome measures, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following three gaps will need to be filled: first, studies that assess the effectiveness of IPE interventions compared to separate, profession-specific interventions; second, RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes; third, cost-benefit analyses.

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Interprofessional education: effects on professional practice and healthcare outcomes (update)

Background and review context: Evidence to support the proposition that learning together will help practitioners and agencies work better together remains limited and thinly spread. This review id...

A best evidence systematic review of interprofessional education: BEME Guide no. 9

The main purpose of this paper is to draw attention to some facts and ideas that perhaps can help to identify problems or fields for development and research within the evaluation of training. Topics for group discussion are preceded by material on some basic concepts of evaluation and educational measurement. The ratio scale, the interval scale, the ordinal scale, and the nominal scale are given as examples of kinds of scales used in educational measurement; the problem of norms is discussed; potential purposes of evaluation or educational measurement are outlined; and some characteristics of a good measuring instrument are explained. The author also defends the inclusion of evaluation as an Integral part of a model for planning and carrying out educational programs. (BW) *********************************************************************** Documents acquired by ERIC include many informal unpublished * materials not available from other sources. ERIC makes every effort * * to obtain the best copy available. Nevertheless, items of marginal * * reproducibility are often encountered and this affects the quality * of the microfiche and hardcopy reproductions ERIC makes available * * via the ERIC Document Reproduction Service (EDRS). EDRS is not * responsible for the quality of the original document. Reproductions * * supplied by EDRS are the best that can be made from the original. *********************************************************************** U S DEPARTMENT OF HEALTH, EDUCATION &WELFARE NATIONAL INSTITUTE OF EDUCATION EVALUATION OF TRAINING

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Evaluation of Training.

This paper proposes a new concept and a frame of reference that should permit the development of a better understanding of a phenomenon that is the development of a cohesive and integrated health care practice among professionals in response to clients' needs. The concept is named "interprofessionality" and aims to draw a clear distinction with another concept, that of interdisciplinarity. The utilization of the concept of interdisciplinarity, which originally concerns the development of integrated knowledge in response to fragmented disciplinary knowledge, has caused some confusion. We need a concept that will specifically concern the development of a cohesive practice among different professionals from the same organization or from different organizations and the factors influencing it. There is no concept that focuses clearly on this field. Interprofessionality concerns the processes and determinants that influence interprofessional education initiatives as well as determinants and processes inherent to interprofessional collaboration. Interprofessionality also involves analysis of the linkages between these two spheres of activity. An attempt to bridge the gap between interprofessional education and interprofessional practice is long overdue; the two fields of inquiry need a common basis for analysis. To this end, we propose a frame of reference, an interprofessional education for collaborative patient-centred practice framework. The framework establishes linkages between the determinants and processes of collaboration at several levels, including links among learners, teachers and professionals (micro level), links at the organizational level between teaching and health organizations (meso level) and links among systems such as political, socio-economic and cultural systems (macro level). Research must play a key role in the development of interprofessionality in order to document these linkages and the results of initiatives as they are proposed and implemented. We also believe that interprofessionality will not be pursued without the requisite political will.

Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept

This paper is the first of two that highlights key elements needed for consideration in the planning and implementation of interprofessional educational (IPE) interventions at both the pre and postlicensure qualification education levels. There is still much to be learned about the pedagogical constructs related to IPE. Part 1 of this series discusses the learning context for IPE and considers questions related to the ‘‘who, what, where, when and how’’ related to IPE. Through a systematic literature review that was conducted for Health Canada in its move to advance Interprofessional Education for Patient Centred Practice (IECPCP), this paper provides background information that can be helpful for those involved in an interprofessional initiative. A historical review of IPE sets the international context for this area and reflects the work that has been done and is currently being initiated and implemented to advance IPE for health professional students. Much can be learned from the literature related to the pedagogical approaches that have been tried and the issues that need to be addressed related to the learner, the educator and the learning context which this paper examines.

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Key elements for interprofessional education. Part 1: The learner, the educator and the learning context

In the second paper of this two part series on Key Elements of Interprofessional Education (IPE), we highlight factors for success in IPE based on a systematic literature review conducted for Healt...

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Key elements of interprofessional education. Part 2: Factors, processes and outcomes

Health Canada (the federal government department in Canada responsible for health issues) commissioned a research team to conduct an environmental scan and research report in order to understand interprofessional education and collaborative patient-centred practice (IECPCP). This paper presents the findings from semi-structured telephone interviews with key informants conducted as part of the environmental scan. Grounded theory analysis was employed in order to identify factors associated with interprofessional education and collaborative practice initiatives. These factors were grouped according the following themes: lack of consensus regarding terminology; the need for both champions and external support; sensitization to the effects of professional culture, and logistics of implementation. Findings are discussed related to the literature and to the other papers included in this supplement to the Journal of Interprofessional Care.

Factors in implementing interprofessional education and collaborative practice initiatives: findings from key informant interviews.

Interprofessional education (IPE) is regarded by many health care practitioners (i.e., nurses, occupational therapists, physicians), educators, and policy makers as an important activity to enhance the quality of teamwork and patient care. While the focus on developing an evidence basis for IPE has demonstrated the potential value of IPE for improving collaboration and patient outcomes, exploration of key concepts that underpin IPE has been overlooked. In this commentary, we aim to begin addressing this oversight by identifying and discussing key conceptual factors that are critical for the planning and implementation of IPE. We draw upon our prior IPE curricula development and research experiences, as well as the published literature, to argue that seven interconnecting learner-focused, faculty-focused, and organization-focused factors are key to the successful planning and implementation of IPE. We also argue that IPE planners need to be cognizant of all seven factors and how they interact with one another to help ensure they maximize success in their work.

Ivy Oandasan

Papers

Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept

Key elements for interprofessional education. Part 1: The learner, the educator and the learning context

Key elements of interprofessional education. Part 2: Factors, processes and outcomes

Factors in implementing interprofessional education and collaborative practice initiatives: findings from key informant interviews.

Key factors in planning and implementing interprofessional education in health care settings.