Integrated models of care in Canadian hospitals: Findings from a multi-methods study

Background: Canada historic approach to care delivery has led to a significant overburdening of the Canadian health workforce. As a result, the country is now facing significant HHR challenges. Federal and non-federal initiatives over the past 3 years have placed unanimous emphasis on implementing team-based models of care across all healthcare settings. Interprofessional team-based models of care (henceforth, MoC) are one potential approach to alleviating HHR burden. As hospitals make up one of the foci of HHR challenges, better understanding the state of interprofessional team-based models of care within hospital settings may improve the ability to make effective policy recommendations for healthcare quality improvement and system change. Approach: This exploratory project aimed to identify innovative MoC in pan-Canadian hospital settings while understanding how these models can support Canada HHR challenges and develop implementation considerations for scalability. An emergent design methodology was used to conduct 2 phases of data collection: ) a literature search to synthesize existing knowledge on characteristics of successful MoC and an environmental scan to identify exemplar cases of MoC across Canadian hospitals; and 2) subsequent qualitative semi-structured interviews with participants representing these case examples. Qualitative content analysis was used to synthesize all data into key themes and recommendations for practice. Results: Our search found 52 peer-reviewed articles; we interviewed participants from 2 case examples. There was no consistent definition or framework of teams/teamwork, success, or interprofessional MoC in the literature findings nor our interview findings. Despite this, common themes emerged across both literature and interview findings. These themes were synthesized into the following: Interprofessionally-oriented leadership, clear roles and expectations, teamwork, collaboration, trust integrity and transparency, valuing diverse perspectives, growth mindset, and the criticality of context. Drawing on the thematic synthesis of our findings, we developed 4 core recommendations: (). Design teams with a few core or anchor roles and multiple floating or flexible roles (2) Implement routine team processes (e.g huddles)or a similar space and channel for open communication, (3) re-envision and Repurpose staff to combat resource scarcity, (4) Recognize that addressing HHR gaps or barriers requires tailored and targeted interventions.Implications: This project yielded three broad opportunities for provincial and territorial consideration to enable the implementation of innovative and impactful models of care in hospitals: bolstering education and training, enhancing information and evaluation sharing, and breaking down barriers while building up incentives. Our data made it evident that there is no single model of care suited for implementation on a pan-Canadian scale. However, tailored interventions leveraging the existing needs, resources, and contexts of different hospital settings can be effective in improving team cohesion, staff retention, and patient and provider experience of care.

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