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Table 4 Themes and subthemes

From: Competencies to promote collaboration between primary and secondary care doctors: an integrative review

Theme

Subthemes (associated knowledge, skills and attitudes)

Patient-centred care: a common concern

Being able to work together with the same patient-centred goals

Work from a common patient centred framework

Respect and understand the patients’ view

Know the background of the patient

Set shared goals

Shared care thinking

Collaborative attitude and respect

Being able and willing to work together with respect for partners in collaboration

Respect each other

Respect each other’s roles, expertise and task distribution. Do not re-refer, do not retain

Respect each other’s values related to the patients’ outcome

Be willing to cooperate, be open-minded

Look beyond one’s own position and task

Accept limitations to autonomy

Roles and responsibilities

Being able to know, make arrangements about, work in and follow up on a clear division of tasks, roles and responsibilities

Understand, make arrangements about and cooperate in a clear division of tasks, roles and responsibilities

Share responsibility for (continuing) care

Give and receive feedback and address conflicts

Be (directly) accessible and available

Use consultation as an educational opportunity

 ° Recognise moment, learning needs and sufficiency moment

 ° Use and provide appropriate means

 ° Deliver valuable information in a tactful way

Specific responsibilities for PCD

 ° Provide appropriate, timely referral

 ° Follow up advice

 ° Prepare the patients for the hospital visit

Specific responsibilities SCD

 ° Have clear referral requirements

 ° Provide consultation

 ° Include the PCD in important decision-making in the hospital

 ° Guarantee that appropriate follow up is arranged

 ° Confirm appropriate treatment plan, matched to the patient

 ° Display interest in the patient and look for additional pertinent information

 ° Take into account the referrer’s characteristics

 ° Invite requesters for informal consultation

Mutual knowledge and understanding

Being able to identify, know about and understand partners in collaboration

Know your own limitations

Know each other, doctors, personally

Know the training, workplace and resources of the other

Know the referral and communication system

Understand the profession and perspective of the other and be able to match expectations

Understand team dynamics and power relations

Communication

Being able to communicate well in the right way on the right moment

What should be communicated

 ° Physical symptoms and medication: new, dose, duration, changes

 ° Communicate only appropriate and essential information

 ° Communicate the ending of consultation

 ° Good request: states the urgency, a clear question and includes all the necessary information, including psychological information when relevant

 ° Good reply: addresses the question asked, is prompt, adequate, detailed, shows understanding of the patient, includes prognosis, a treatment plan, future steps and follow up

When should communication take place

 ° Timely: sometimes this means quick, other times this means knowing when to communicate based on the medical situation

 ° Immediate and direct in emergency situations

 ° At admission, at major decision-making points and at discharge

How should communication take place

 ° Way of communication depends on urgency request

 ° Communicate concise

 ° Communicate without condescension

Good oral communication

 ° Communicate friendly, clearly (tone, pace, accent) and listen open and active

 ° Ensure that it’s heard and understood

 ° Communicate diplomatic with patients about colleagues

Good written communication

 ° Well-structured written communication by PCD: Provide referral reason and clinical information in the referral letter

 ° Well-structured written communication by SCD: Summarise findings, assessment and management plan in a comprehensive non-discourteous letter, with bulleted recommendations at the bottom of response

Leadership

Being able to show leadership to facilitate collaboration

Manage persons (mediate, motivate, influence, build teams and relationships)

Manage processes to facilitate collaboration (coordinate, organise well-functioning systems for collaboration, plan collaboration processes)

Show leadership on organisational level and beyond to support collaborative practice