Initial programme theory developing for interprofessional case discussions (InCaD) in acute hospital care: a realist...

Area of Science:

• Healthcare Management
• Health Services Research
• Realist Evaluation

Background:

• Interprofessional case discussions (InCaD) are crucial for complex patient care in hospitals.
• Lack of theoretical frameworks impedes consistent InCaD implementation and evaluation.
• This study develops an initial programme theory for InCaD using realist methodology.

Purpose of the Study:

• To identify Context-Mechanism-Outcome (CMO) configurations for InCaD.
• To establish a theory-driven framework for InCaD implementation and evaluation.
• To improve patient care and staff well-being through structured InCaD.

Main Methods:

• Employed a multi-method realist evaluation approach.
• Included systematic review (42 studies) and stakeholder focus groups (17 participants).
• Synthesized data to generate CMO configurations through thematic coding and iterative discussions.

Main Results:

• Identified direct mechanisms (e.g., interprofessional reflection) and indirect mechanisms (e.g., team trust).
• Patient outcomes included improved care quality, satisfaction, and continuity.
• Staff outcomes included enhanced job satisfaction, team cohesion, and efficiency; nurse leadership was a key driver.

Conclusions:

• Provides a theory-driven framework for implementing and evaluating InCaD.
• Understanding CMO interactions enhances patient safety, care quality, and staff well-being.
• Recommends validation in diverse settings for broader application.