Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Lloy, Wylie

Abstract

Interprofessional collaboration (IPC) is a care model in which different healthcare providers work together to achieve optimum patient outcomes. Ineffective IPC may lead to up to 70% of adverse events in obstetric care. In Rwanda, the need to reinforce effective IPC to improve maternal and neonatal outcomes was revealed following a maternal death audit conducted between 2009 and 2013. Also, in 2017, it was reported that 84% of maternal deaths were due to preventable causes, and 36% were due to delays within health facilities.

To improve maternal and newborn care quality in Rwanda, the ‘Training Support Access Model for Maternal Newborn and Child Health’ (TSAM-MNCH) project initiated mentorship programs in 2017. The purpose of this study was to explore IPC experiences among obstetric and neonatal care team members who participated in mentorship to explore the barriers and benefits in implementing IPC.

A qualitative descriptive case study design underpinned by a constructivism paradigm was used, semi-structured interviews were conducted with twenty-five healthcare provider mentees and five director generals of the five hospitals where mentorship was implemented.

The findings suggest that in general participants were not satisfied with the current IPC practice, they mentioned several challenges dominated by power relation issues affecting communication. Another challenge was a stressful work environment characterized by insufficient staff, lack of necessary equipment, and lack of motivation. Participants suggested training on IPC and the availability of protocols and guidelines to guide the clinical practice. The participant reported benefits of the TSAM mentorship program, included an increase in self-confidence and awareness of their own responsibilities, which also contributed to an improved working relationship.

The results from this study contribute to evidence for improvement in IPC practice. There is a need for policymakers, hospital managers, researchers, and health professional educators to create more systematic ways to improve IPC, including training on IPC and ensuring IPC remains on the health priority agenda. Future studies should identify the number of maternal and neonatal deaths caused by a failure in effective collaboration and strategies to sustain the improvements in practice as a result of mentorship programs.

Summary for Lay Audience

It is widely known that effective collaboration between healthcare teams contribute to better patient outcome, whereas ineffective IPC may lead to poor health outcomes. Research has demonstrated that ineffective collaboration among healthcare professionals may contribute to up to 70% of adverse medical events. Within the context of Rwanda, the maternal death audit conducted from 2009 to 2013 highlighted the need to improve interprofessional collaboration to reduce the maternal and neonatal mortality rates.

In 2017, it was also reported that 84% of maternal deaths were due to preventable causes, and 36% were due to delays within health facilities. This research study intended to examine the experiences of healthcare professionals working in maternity services to explore the challenges and benefits of applying interprofessional collaboration for the management of obstetric and neonatal emergencies. The study also aimed at understanding the experiences with the TSAM mentorship program and IPC practice.

A qualitative descriptive case study design was used. The study recruited twenty-five healthcare professionals who participated in the mentorship program by the TSAM project in Rwanda, and five director generals of the five hospitals where mentorship was implemented, to elicit their perspectives on how to sustain IPC practice.

The findings indicated several barriers to effective IPC, including issues of power relations affecting communication, stressful work environments characterized by insufficient staff, lack of necessary equipment, and lack of motivation. Participants suggested training on IPC and the availability of protocols and guidelines to guide the clinical practice. Participants appreciated the benefits of the TSAM mentorship in improving IPC practice. This study contributes to evidence for improvement in IPC to contribute to the reduction in maternal and neonatal mortality rates in Rwanda

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