Introduction
Integrated care is supported by teams with transparent communication processes, good strong leadership, and common goals to deliver person-centred care. Ward rounds are a setting where effective teamwork facilitates safe treatment planning and care delivery. The study aim is to explore characteristics of interdisciplinary teams that support person-centred care during ward rounds.

Methods
The study was conducted in a teaching hospital in metropolitan Sydney, Australia. A survey was administered to frontline clinicians working in two medical and two rehabilitation wards. Questions were developed from research literature and the industry experience of the study team. Multichoice and free text questions targeted enablers and challenges to effective teamwork, and exemplars of positive teamwork. Descriptive and thematic analyses were conducted.

Results
Seventy-seven clinicians participated (93% response rate - 34% from acute medical and 66% from rehabilitation specialties). Nursing represented 60% of participants, allied health clinicians 26%, and medical officers 14%. Findings across the two specialties were similar. Participants reported:

Enablers of teamwork
The three most commonly nominated enablers were: effective communication, a shared understanding of patient goals, and the clinical roles within the team. The greatest difference between the specialties was the use of a medically-led model: 40% of medical officers from rehabilitation nominated this as an enabler compared to none from acute medicine. No additional enablers were nominated by clinicians

Challenges to teamwork
The three most frequently nominated challenges were: ineffective interdisciplinary communication; individual personalities; lack of understanding about roles and responsibilities. Additional challenges were nominated in the free text section. These were grouped into three themes: time pressures, interdisciplinary team communication, and team morale. Second, disagreements in treatment planning. Third, a lack of leadership from senior team members.

Positive experiences of teamwork
There was consistency between clinicians’ experiences. Themes were: a specific plan that was communicated clearly; feeling valued; understanding interdisciplinary roles and expectations; a defined and effective leader; and patient-focused care.

Discussions
Team characteristics that support person-centred interdisciplinary ward rounds are common across all health disciplines. To ensure safe planning with patients during ward rounds, teams must first be able to work together to communicate effectively. Understanding one another’s roles and responsibilities ensures the right people at the right time are contributing and planning during rounds. Feeling valued empowers people to speak freely in a ward round, which facilitates patient safety.

Conclusions
Ward rounds require interdisciplinary teams to come together for the common goal of planning safe, quality care. Commonalities in enablers and challenges between intra- and interdisciplinary teams and specialties suggest teamwork characteristics are interchangeable across ward settings. Building resilient teams through shared values, leadership, respect, and confidence can support integrated person-centred care within the ward round environment.

Lessons learned
Commonalities in enablers and challenges between intra- and interdisciplinary teams and specialties suggest teamwork characteristics are interchangeable across ward settings.

Limitations
The study was at single site which is an exemplar of other acute care settings.

Suggestions for future research
Exploring the delivery of person-centred care during other processes such as education rounds would identify any commonalities.

INTRODUCTION: Building local relationships, trust and respect across the health and social sectors have been documented as integral for developing an integrated system of person-centred care. The 2017 Integrated Care Productivity Review by the Australian Productivity Commission reported that negative undercurrents affected relationships between disciplines and sectors¹. These were attributed to multiple factors and likely impede a multidisciplinary and collegiate approach to care as well as innovation. The implication noted here is that system reforms will not be enough for progressing Integrated Care and as presented elsewhere, relationships matter. ¹ ² ³ ⁴ ⁵⁶ ⁷

METHODS: To foster local relationships at the micro level, increase provider connectivity and service awareness, Integrated Care Communities of Practice (CoPs) have been developed in five local areas within south eastern Melbourne as part of the Victorian Integrated Care Model (VICM). The ultimate plan is that these facilitate collaboration.

The CoPs are unique in that they are multi‐discipline and multi-sector regular gatherings and have evolved to also offer providers a safe space to share experiences and knowledge in delivering local patient care, thereby promoting a collegiate environment.

The CoPs commenced in 2018 with 12 held in 2018-2019 and 18 CoPs planned for 2019-2020. Other CoP work includes the development of a toolkit which may assist with transferability into other regions.

RESULTS: To date there have been 10 CoPs with 545 attendees. In ongoing surveys 96% stated that they would attend future CoPs; 100% believe there are benefits in holding regular multidisciplinary and multiservice CoPs for their area and 93% have become aware of a service they were not aware of as a result of attending. Similarly 93% of attendees have met a provider or service they did not know previously while 100% would recommend the CoPs to colleagues. Other anecdotal outcomes have been reported.

DISCUSSION/CONCLUSION: Local frontline providers from all health and wellbeing sectors are attending CoPs in their own time and report that they will continue to attend future CoPs. Evaluation responses indicate a willingness to connect with other providers and familiarise themselves with services in their region. Once established, CoPs have the potential to be used as a ground up approach to facilitate improved collaborative person-centred care and provider confidence.

¹Productivity Commission 2017, Integrated Care, Shifting the Dial: 5 year Productivity Review, Supporting Paper No. 5, Canberra.

²Buckingham H and Curry N (2018) "Working across boundaries: realising the vision of integrated care", Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/working-across-boundaries-realising-the-vision-of-integrated-care

³ Curry, N and Ham, C. (2010) Clinical and service integration The route to improved outcomes. The King’s Fund
https://www.kingsfund.org.uk/sites/default/files/Clinical-and-service-integration-Natasha-Curry-Chris-Ham-22-November-2010.pdf

⁴ Ham, C. (2018) A progress report on integrated care systems. The King’s Fund comment. https://www.kingsfund.org.uk/blog/2018/03/progress-report-integrated-care-systems

⁵ Integrated care models: an overview. 2016 Health Services Delivery Programme Division of Health Systems and Public Health WHO Europe
www.euro.who.int/__data/assets/pdf_file/.../Integrated-care-models-overview.pdf

⁶ Middleton L, Rea H, Pledger M, Cumming J. A realist evaluation of local networks designed to achieve more integrated care. Int J Integrated Care 2019; 19(2):4, DOI: http://doi.org/10.5334/ijic.4183

⁷Trust Matters for Integrated Care. Abstract, 2013 Kings Fund
https://www.kingsfund.org.uk/sites/default/files/Paper5_Trust_matters_for_integrated_careSept13.pdf

Introduction: Clinical genomics, reading a person’s entire genetic material for healthcare benefit, is a complex transformative approach to patient care offering the potential for diagnosis and changes in treatment plans for patient groups who have few conventional diagnostic and treatment options available. However, the promise of this new technology can only be delivered with the close interaction of a range of scientists and healthcare practitioners. This cross-discipline collegial expectation is challenged by the speed at which the field of genomics is evolving, with new discoveries and technological advances unbalancing the delicately emerging status quo.

To identify the challenges and benefits of team working for clinical genomics, we drew on three qualitative datasets to investigate how these professional groups manage the necessity of integrated working to maximise clinical outcomes.

Theory/method: Interviews examining the determinants of implementation and improvement of clinical genomics were undertaken in 2018/19 with laboratory scientists, genetic and other medical specialists’ (n=56). Group 1 interviews provided in depth findings of the experience from identifying patients for whom this test is appropriate to communicating results back to patients; Group 2 interviews explored the relationship between the laboratory and the genetic clinician; Group 3 interviews focused on perceptions from one clinical area (acutely unwell children). Interviews were audio recorded with participants’ permission, fully transcribed and managed in NVivo 12. We used the Framework approach (Ritchie & Lewis, 2003) to analyse all three datasets to identify themes of integrated teamworking in an evolving sociotechnical healthcare context.

Results:Three themes were identified; i) Knowledge: e.g. the capacity to cope with the speed of evolving knowledge and the importance of external links for knowledge development, ii) Professional Identity: e.g. the ability to recognise and value the skills of others and ‘stepping up’ as needed, and finally iii) Team Dynamics: e.g. the importance of external representation and managing the ‘emotional load’.

Discussion: For integrated teams in a new disruptive healthcare discipline, Knowledge, Professional Identity and Team Dynamics all play a vital role in establishing, maintaining and progressing the functioning of the team. Inter-theme contribution occurs to promote teamworking that serves to improve patient care.

Conclusion: As scientific technology progresses, and plays an increasing role in healthcare, it is essential we understand how teams straddling the scientist/clinical divide negotiate the interaction of Knowledge, Professional Identity and Team Dynamics. Learnings from the experience in clinical genomics can be used in other emerging technologies to maximise the experience for team members and clinical benefit for patients.

Lessons:Understanding how the themes of Knowledge, Professional Identity and Team Dynamics interact is essential to facilitate teamworking in novel sociotechnical healthcare fields. Using evidence-based approaches to promote theme-related concepts may act to support the functioning of teams.

Lmitations: These data were gathered from three different datasets focused on implementation/improvement.

Further study is required in this field to explore how the three key themes interact longitudinally as knowledge progresses. Future research also needs to focus on how more recently emerging professions (such as bioinformaticians and genetic counsellors) establish their role in these dynamic teams.

1. An introduction
Australia has a high performing health system. However, care delivery is fragmented and challenging for patients to navigate. In 2016, a Bilateral Agreement on coordinated care was established between the Commonwealth of Australia and New South Wales (NSW) to improve the delivery of care for patients and reduce avoidable demand for health services.
The priority area, Multidisciplinary Team Care in the Community aims to build the capability of healthcare professionals to work together and deliver comprehensive patient-centred care.

2. Description of policy context and objective
Service provision is split between the Commonwealth and state governments. Coordinating care is challenged when services operate in isolation.
The system fails to effectively meet the needs of people who are vulnerable or have chronic or complex health and social care needs. Service access and care pathways are complicated and disjointed. At a system level, there is variation in care and outcomes with poor coordination between providers.
Integrating health services locally, delivers targeted and coordinated care for vulnerable people and improves patient experiences and outcomes.
3. Targeted population
People in the community with chronic or complex health and social needs or deemed at risk of rehospitalisation.
4. Highlights
NSW Health leads a state-wide Multidisciplinary Team Care Working Group. Membership includes representation from Primary Health Networks, Local Health Districts, Ministry of Health and clinicians.
A purpose designed survey to identify existing high-quality models of multidisciplinary team care was developed and distributed broadly across the system. Questions were multiple-choice and free text. Survey topics included: identification of service exemplars; description of models; identification of team members; and challenges, barriers and enablers for high quality coordinated care. A total of 255 responses were received, which identified 1525 examples of multidisciplinary team care. Out of the identified models, 456 will be analysed further.
5. Comments on transferability
This work builds on learnings from the NSW Integrated Care Strategy and the Commonwealths Health Care Homes program which both support person centred care, collaboration and partnerships.
We aim to develop guidance for multidisciplinary team care in the community that centres on the patient, and engages partners based on the patients clinical need.
6. Conclusions
Preliminary analysis of the data demonstrates patients are not often included in the multidisciplinary team. General Practitioners, who are usually the first point of contact for patients, are often excluded from many multidisciplinary teams
This could suggest that person-centred care is not truly being delivered across the healthcare system or a lack of awareness of the importance of the role of the patient within the multidisciplinary team or a broader systems issue.
Additional General Practitioner interviews and observational visits at exemplar sites will enhance the survey data and provide more information about models of multidisciplinary team care in the community in NSW.
The learning identified will be written up into system guidance and we will work with the system to implement the key elements and contribute to long term health reforms in Australia.

Introduction: Fibromyalgia (FM) is a complex chronic disease characterized by widespread pain, non-restorative sleep, mood and cognitive impairment and often accompanied by inflammatory arthritis or other co-morbidities. This condition affects approximately 3-6% of the world’s population; increasing with age and more often affects women. Diagnosis and long-term management of patients with FM poses a challenge to primary care providers and specialists. Too often, initial diagnosis is delayed, care is fragmented, and health service utilization remains high. There is currently no gold-standard treatment for FM and many patients live with chronically uncontrolled symptoms and functional disability. Consensus across national FM guidelines include a multimodal approach with emphasis on non-pharmacological therapies and self-management strategies. Yet, many patients do not have access to this type of integrated care. The objective of the study was to test the implementation of a community-based interprofessional team-based FM program to equip patients with sustainable long-term and effective disease self-management.

Methods: A pilot randomized controlled trial was conducted using mixed methods with a 10-week intervention offered to FM patients in a small urban setting. The intervention included an interprofessional team offering personalized exercise and supportive education with a focus on self-management in small groups. Participants completed questionnaires at baseline, post- and 3-months post-intervention. Assessment tools included standardized measures of participants’ perceptions of quality of care, FM impact on daily functioning, and mental health. Frequency and purpose of emergency department visits was assessed. Patient focus groups and provider interviews were completed following the intervention to gather perspectives on the care model and patient impact.

Results: Significant improvements from start to end of the intervention were shown in the primary outcome of patient-perceived quality of care, and also in secondary outcomes of impact of FM on daily functioning; and attitudes towards pain. Emergency department visits displayed a decreased trend in frequency of visits during, and over 3 months following, the intervention.

Discussions: Improved attitudes to pain combined with enhanced daily function have the potential for lasting benefits to the personal and economic costs of FM. Implementation of this group intervention has the potential to offer a sustainable strategy to provide integrated FM care in small urban settings.

Conclusions & Lessons Learned: Patient-perceived quality of care is paramount to chronic disease management. This innovative integrated care model for FM patients has the potential to make significant differences for patients and providers with existing resources and sustainable capacity for generalization to other communities and chronic diseases.

Limitations: Based on the local demographics, our patient population is largely Caucasian, female, and primarily older. Significant loss-to-follow-up was noted at 3 months post-intervention.

Suggestions for Future Research: Future studies with larger sample sizes will be required to replicate results and to identify factors that might impact effectiveness of the integrated care model (e.g., disease severity, gender, attendance). Research is also needed to study factors impacting sustained improvements and whether a similar model is beneficial for people with other chronic conditions.