The disconnect between what evidence-based research indicates is best care for the seriously ill patient and what is delivered is significant. Local communities are charged with addressing the impact of this breakdown in care for their residents. In a system initially designed to cure, medical care is focused now on slowing the progression of complex, chronic illnesses in an aging population. The opportunities for a breakdown in care are significant. This participant action research study explored factors contributing to the breakdown of care for the seriously ill in an isolated, medically under-served County in Northwestern U.S. The combined action research and appreciative inquiry approach in this study focused on what were the actionable interventions community stakeholders considered taking in supporting improvement in the care of the County’s population. Purposeful sampling of community providers identified 14 physicians, registered nurses and clinical social workers, who participated in semi-structured interviews. Data was analyzed through the theoretical lenses of general systems, complexity, and working whole systems theories. Issues related to trust, turf, and respect emerged as stakeholders minimized the role and effectiveness of others, and overemphasized both the capacity and burden of their agency or profession’s ability and responsibility to address the problem. Professional training and position in the medical hierarchy were linked to the perceptions of stakeholders across all work settings and need to be acknowledged in future collaborations across disciplines. County specific recommendations are included along with recommendations for additional research.
|Commitee:||Delong Hamilton, Tobi, Hackstaff, Lynn|
|Department:||Public Service Leadership|
|School Location:||United States -- Minnesota|
|Source:||DAI-A 79/01(E), Dissertation Abstracts International|
|Subjects:||Social work, Public health, Health care management|
|Keywords:||Action research, Palliative care, Serious illness, Social work|
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