Barriers to Inter-Organisational Collaboration in the Preoperative Management of Patients with Osteoarthritis of the Hip or Knee

Mohsen Hussein; Nevenka Kregar Velikonja; Karmen Erjavec

doi:10.5334/ijic.6995

Figures & Tables

Table 1

Qualitative data collection characteristics (N = 53).

LEVEL OF HEALTHCARE SYSTEM	PARTICIPANTS
Micro	16 patients
	10 physicians-specialists (6 orthopaedists, 2 anaesthetists and 2 physiatrists)
	5 general practitioners
	4 nurses
	4 physiotherapists
	3 other health professionals (dietician, occupational therapist and psychologist)
Meso	6 managers of health organisations
Macro	5 stakeholders from regulatory, financial, professional and scientific sectors

Table 2

Characteristics of participants (N = 94).

CHARACTERISTICS	N	%
Gender
Male	25	26.6
Female	69	73.4
Level of education
Secondary school	17	18.1
Bachelor’s degree	37	39.4
Specialisation and master’s degree	29	30.9
Doctorate	11	11.7
Professional groups
Nurses	47	50.0
Physicians	30	31.9
Other healthcare professionals	11	11.7
Others	6	6.4
Institution of employment
Community health centre	10	10.6
Public general hospitals	70	74.5
Public orthopaedic or rehabilitation centre	5	5.3
Private orthopaedic centre	9	9.6

Table 3

Assessment of the frequency of collaboration with other professions in the preoperative management of a patient with hip or knee osteoarthritis. (1 ‘never’, 2 ‘rarely’-in less than 20% of patients’, 3 ‘occasionally’- in 20% to 50% of patients, 4 ‘often’- in 50% to 80% of patients, 5 ‘very often’ – in more than 80% of patients).

STATEMENT	PROFESSION	N	MEAN	SD	ANOVA (P)
To monitor the patient’s medical condition, I rely on the received documentation (on the authenticity of the documentation as a basis for clinical treatment).	MD	30	3.27	1.82	0.002**
	nurse ↑	47	4.21	1.28
	other HP	11	3.55	2.50
	other employees ↓	6	1.67	1.63
	all respondents	94	3.67	1.77
When making decisions, I ask for an opinion another competent person.	MD	30	2.60	1.73	<0.001**
	nurse ↑	47	4.06	1.23
	other HP	11	2.36	2.11
	other employees ↓	6	2.33	2.06
	all respondents	94	3.29	1.70
All those involved in the medical treatment of an individual patient (including professionals from other organisations) are treated as team members.	MD	30	2.20	1.64	0.031**
	nurse ↑	47	2.64	1.53
	other HP	11	1.36	1.80
	other employees ↓	6	1.17	0.41
	all respondents	94	2.26	1.61

[i] Legend: ** Differences among groups significant at the 0.01 level; ↓ – lowest mean score; ↑ – highest mean score; MD – physicians; HP – health professionals.

Table 4

Respondents’ opinions about the performance of collaboration between their organisation and other healthcare providers in treatment of patients with hip or knee osteoarthritis (from 1 ‘I absolutely don’t agree’ to 5 ‘I absolutely agree’).

STATEMENTS	PROFESSION	N	MEAN	SD	ANOVA (P)
We are sufficiently informed about the competencies of other healthcare organisations and support activities according to the needs of the patients we treat.	MD ↑	30	3.60	0.77	0.001**
	nurse	47	2.43	1.31
	other HP	11	2.18	2.35
	other employees ↓	6	1.50	1.22
	all respondents	94	2.71	1.46
We provide continuous patient care in collaboration with external healthcare providers.	MD	30	2.33	1.12	0.009**
	Nurse ↑	47	2.74	1.56
	other HP ↓	11	1.27	1.48
	other employees	6	1.50	1.22
	all respondents	94	2.36	1.48
External healthcare providers are responsive in engaging in patient care.	MD	30	2.23	1.10	0.009**
	Nurse ↑	47	2.72	1.44
	other HP ↓	11	1.27	1.48
	other employees	6	1.67	1.63
	all respondents	94	2.33	1.42
Depending on the patient’s needs, we exchange information with external providers for more comprehensive, safe, and quality treatment.	MD	30	2.23	1.13	0.053
	Nurse ↑	47	2.60	1.52
	other HP ↓	11	1.45	1.63
	other employees	6	1.50	1.22
	all respondents	94	2.28	1.03
We are more cost-effective through targeted collaboration with external healthcare providers.	MD	30	2.03	1.44	0.016*
	Nurse ↑	47	2.60	1.51
	other HP ↓	11	1.18	1.66
	other employees	6	1.67	1.63
	all respondents	94	2.19	1.46
We have appropriate legal bases for collaboration with external healthcare providers.	MD	30	1.97	0.99	0.013*
	nurse ↑	47	2.43	1.52
	other HP↓	11	1.00	1.41
	other employees	6	1.50	1.22
	all respondents	94	2.05	1.41
We have secured funding for collaboration with external healthcare providers.	MD ↑	30	1.77	0.85	0.259
	nurse	47	1.64	2.07
	other HP↓	11	1.00	1.41
	other employees	6	1.67	1.63
	all respondents	94	1.61	1.10

[i] Legend: * Differences among groups significant at the 0.05 level; ** differences among groups significant at the 0.01 level; ↓ lowest mean score; ↑ highest mean score; MD – physicians; HP – health professionals.

Table 5

Barriers of inter-organisational collaboration in treating a patient with hip or knee osteoarthritis.

BARRIERS – THEMES	PATIENTS	HEALTH PROFESSIONALS	OTHER STAKEHOLDERS
Macro level
Individuality culture and level of developed System	Personal responsibility for/engagement in obtaining health treatment; Distrust in system	Poorly functioning health system with exceptional individuals	Low personal responsibility for introduction of key changes
Administrative/Regulative	Too much administration	Too much administration; Complicated and time-consuming implementation of regulations	Weak work organisation in health settings
Funding	Lack of resources	Lack of resources; unpaid inter-organisational collaboration	Lack of resources
Power imbalance and conflicts	–	Overpowering financier	–
Meso level: (inter-)organisational level
Lack of leadership and coordination	–	Weak organisation; Inter-organisation collaboration on personal level	Organisational managers protect their territory/rights
Lack of staff	Shortage of GPs	Shortage of nurses and GPs	Shortage of nurses and GPs
Micro level (service delivery)
Different professionalisation	–	Interdisciplinary rivalry	–
Lack of technological standards	–	Incompatible IT infrastructure	Incompatible IT infrastructure
Lack of trust	Lack of trust	Lack of trust	Lack of trust
Lack to communication	Lack of time for communication	Lack of time for communication	Lack of willingness to communication
Resistance to change	Fear of losing one’s rights	Fear of additional workload	Fear of losing status quo
Clinical practices
Lack of information exchange	–	Lack of information exchange between GPs and specialists	–
Pressure	Demands on special health treatment	Pressure from patients	Application of pressure in general