Interprofessional collaboration in Austrian primary care: an analysis of requirements and challenges

Abstract Background Primary health care (PHC) is built on interprofessional collaboration (IPC) between health and social professions. According to international frameworks, interprofessional communication, client-centred care, collaborative leadership, role clarification, team functioning and interprofessional conflict resolution are essential for IPC. As of April 2022, 36 PHC units were registered in Austria. This study aims to explore the perspectives of health care professionals on IPC in PHC in Austria. Methods Between October 2021 and March 2022, 15 guided group interviews were conducted with a total of 57 representatives of the professional groups biomedical analytics, dietetics, medical training therapy, medicine, midwifery, nursing, occupational therapy, office assistance, orthoptics, pharmacy, physiotherapy, psychotherapy, radiology technology, social work and speech therapy. The data was analysed using qualitative content analysis according to Mayring. Results Interdisciplinary counselling and prevention services, monitoring, acute interventions and treatment of chronic diseases are seen as fields of action for increased IPC in PHC. Interprofessional relationships are established during joint home visits and weekly multiprofessional meetings, when communication is collegial. Challenges mentioned for the IPC in PHC were i.e. role ambiguity, lack of time for networking or unclear legal regulations. Taking over responsibility as well as the ability to delegate and to deal with conflict, a sense of justice and willingness to accept criticism are core competences required for IPC in PHC. Conclusions The interviewees aim to get more involved in PHC, but not all feel optimally prepared for the necessary collaboration in this setting. In their view, specific training content, focusing on the unique structure of PHC, the roles of all the involved professional groups and conflict management, is necessary to successfully shape IPC in the interest of the clients. Key messages Austrian health care professionals desire specific training content for interprofessional collaboration in primary health care. Austrian health care professionals see opportunities but also challenges for their professional group in primary health care.


Objectives:
Healthcare systems and healthcare workers have been under considerable strain during the COVID-19 pandemic in many countries. Our study aimed to assess the mental well-being of Finnish healthcare workers from two hospital districts with differing COVID-19 incidence rates (HUS, Hospital district of Helsinki and Uusimaa/Helsinki University Hospital; and Kymsote, Social and Health services in Kymenlaakso region) during the first wave of the COVID-19 pandemic in spring 2020.

Material and methods:
The data of this prospective survey study was collected during summer 2020, and a total of 996 healthcare workers (HUS N = 862, Kymsote N = 134) participated. Mental health symptoms were self-reported, and symptom criteria followed ICD-10 classification, excluding duration criteria. We divided participants into symptom categories ''often/sometimes'' (those who met the diagnostic criteria), and ''rarely/never'' (those not meeting the diagnostic criteria), and compared these groups to sociodemographic factors and factors related to work, workload, and well-being.

Results:
Despite differences in COVID-19 incidence, the degree of mental health symptoms did not differ between HUS and Kymsote districts (p = 1). A significant relationship was found between self-reported diagnostic mental health symptoms and experiences of insufficient instructions for protection against COVID-19 (in HUS cohort, p < 0.001), insufficient recovery from work (p < 0.001), and subjective increased workload (p < 0.001).

Conclusions:
These findings show the importance of sufficient, welldesigned instructions for protection from SARS-CoV-2 for healthcare workers, indicating their need to feel safe and protected at work. The workload of healthcare workers should be carefully monitored to keep it moderate and ensure their adequate recovery from work. Sufficient control of the epidemic to keep the burden of the healthcare system as low as possible is essential for healthcare workers' well-being.

Key messages:
Workload of healthcare workers should be carefully monitored during a pandemic to keep it moderate and ensure adequate recovery in all regions, regardless of the local disease burden. The importance of sufficient, well-designed instructions for healthcare workers and their need to feel safe and protected at work.

Background:
Germany is increasingly recruiting foreign healthcare staff due to the shortage of skilled workers. This diversity of professional and cultural backgrounds poses a challenge to everyday life in inpatient care. Previous studies have focused on the renegotiation of professional identities and competencies in nursing or medicine. In contrast, this study sheds light on group-specific mechanisms through a comparative analysis: How do doctors and nurses deal with diversity in the workplace? Where do profession-specific differences emerge and what does this mean for future interventions?

Methods:
Eight group discussions (June 2019 to October 2020) were conducted with groups of doctors and nurses with and without a migration background in four hospitals in two federal states in Germany; including 22 nurses and 10 doctors (n = 32). The data were analysed using the documentary method to examine professional meaning-making processes. The results were validated intersubjectively.

Results:
The respective handling of diversity in the workplace is influenced by different professional group identities. The situation is precarious for nurses with a migration background -especially for those with an academic degree, as nursing is still an apprenticeship profession in Germany. In the medical profession, on the other hand, diversity does not lead to significant controversies, even if cultural differences are discussed.

Conclusions:
Dealing with diversity is negotiated within professional groups. As nursing or medical 'communities of practice' (E. Wenger), these have a mediating role through which they can mitigate institutional and individual barriers to the integration of migrants in the workplace.

Background:
Health professionals face a variety of professional challenges in today's plural societies. Sciences propose a specific skill set can help to meet those challenges. Various terms and sometimes extensive concepts are provided for diversity competence. The related learning processes are time-consuming and demanding to implement in hectic clinical realities, so that a basic, easy to deplore training package of essential skills would be desirable in order to enable health professionals to take equally good care of all patients including migrants and minorities.

Methods:
A two-round Delphi study was conducted to prioritise teaching objectives; 31 clinical and academic migrant health experts from 13 European countries participated. A round of open questions was followed by a standardised rating round of 65 items. Data was descriptively analysed (m, M, SD) and consensus defined as 80% of experts assigning high importance to a competence.

Results:
The process identified essential competences as well as high priority cognitive, affective and pragmatic competences, leading to a minimal definition of diversity competence for health professionals which includes respectfulness, empathy, diversity awareness and reflection, knowledge on social determinants as well as ethics and human rights; Further skills are: being able to listen, observe and communicate understandably, including professional usage of interpreters, shared decision-making and individual, need-based care.

Conclusions:
The panel reached consensus on many of the competences. In general, attitudes and practical skills were considered essential. Basic trainings that meet the needs of professionals and help them cope with everyday challenges can be designed on the grounds of these findings. We provide a working definition of 'diversity competence of health professionals' for scientific exchange and investigation and propose the conscious use of a 'diversity' instead of 'intercultural'' terminology.

Key messages:
In the light of various diversity and cultural competence definitions, we need to specify essential competences for health workers to meet the needs of diverse patient populations. Experts' prioritisations of key diversity competences can be used to prioritise teaching objectives to train health professionals to take equally good care of all patients.