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      “You do need each member of the team to bring that next piece of the puzzle”: Allied health professionals’ experience of interprofessional complex care in hospital settings

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          Abstract

          This study explores the experiences of allied health professionals who work in interprofessional hospital complex care teams. The aim of the study was to identify factors influential to meaningful clinician experiences in these contexts. Increase in interprofessional complex care in hospital settings reflects rising population health complexity. Furthermore, growth in these models coincides with a heightened focus on health system efficiency due to rising healthcare costs, resource constraints, and health workforce shortfalls. Combined, these issues constitute a ‘wicked problem’. However, research exploring the experiences of clinicians working under these conditions is limited, exposing the knowledge gap of interest to this study. Using a qualitative approach, in-depth interviews were conducted with allied health professionals engaged in hospital-based interprofessional complex care, and their narratives were analysed according to the conceptual framework of complex adaptive phenomenology. The study identified four interconnected themes: workplace culture and leadership, interprofessional practice, healthcare ethics, and the ambiguity of complex care. Furthermore, the notion of ‘empowerment of self and others’ was a continuous thread throughout, which appeared essential to effective interprofessional practice. The study showed how the clinician experience provides a window to the functioning of a healthcare system and the bearing of experience on healthcare efficiency and sustainability. Recommendations include developing a more balanced approach to ‘efficiency’ in policy settings, implementing structured leadership development programs within the allied health workforce, empowering under-graduate practitioners through education to work effectively with uncertainty, and increasing research into the clinician experience of interdisciplinary complex care practice.

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          Most cited references117

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Implicit bias in healthcare professionals: a systematic review

            Background Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. Methods PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies. Results Forty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. Discussion The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Conclusions Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.
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              Organizing and the Process of Sensemaking

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Supervision
                Role: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS One
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 March 2025
                2025
                : 20
                : 3
                : e0317799
                Affiliations
                [1 ] Faculty of Education, Monash University, Clayton, Victoria, Australia
                [2 ] Alfred Health, Melbourne, Victoria, Australia
                [3 ] Australian College of Education, Melbourne, Victoria, Australia
                [4 ] Royal Society of Arts, London, United Kingdom,
                [5 ] Fronditha Aged Care, Mulgrave, Victoria, Australia,
                [6 ] To Be Loved Network, Kew East, Victoria, Australia,
                [7 ] Pacifica Congress, Unley, South Australia, Australia,
                [8 ] Safer Care Victoria, Melbourne, Victoria, Australia
                [9 ] Melbourne Health, Melbourne, Victoria, Australia
                [10 ] Monash University Clinical School, Melbourne, Victoria, Australia
                Murcia University, Spain, SPAIN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-6887-2708
                Article
                PONE-D-23-41562
                10.1371/journal.pone.0317799
                11908697
                40085526
                657006ee-8fd7-484e-a789-b2939b32caa6
                © 2025 Borghmans et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 December 2023
                : 4 January 2025
                Page count
                Figures: 2, Tables: 2, Pages: 27
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Allied Health Care Professionals
                Biology and Life Sciences
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                Decision Making
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                Custom metadata
                Data are available from the Institutional Data repository via the following link: https://doi.org/10.26180/24798981.v1

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