Loes Meijer

How professionals learn while collaborating

Samenvatting

The central aim of this thesis was to understand, from a variety of perspectives, the process of collaboration of healthcare professionals from different organizations (primary and secondary care) in arranging for jointly coordinated patient care. Patients receiving care from both the primary care and secondary care settings need health care providers who collaborate and coordinate their shared care. General practitioners and medical specialists deliver their shared care across the boundaries of their work settings and organizations, while they are mainly trained within their own setting, and have little insight into each other’s competences and capabilities. The increasing involvement of other professionals, such as nurses, physician assistants, nurse practitioners, with new responsibilities especially for patients with chronic diseases and multimorbidity, also increases the complexity of collaborating in shared patient care. From different perspectives, with various methods (questionnaire, interviews, single case study) and theoretical backgrounds, we examine how healthcare providers arrange, shape and change their collaborative patient care across organizational boundaries and learn during these processes. With the four dimensional model of d’Amour and the Cultural Historical Activity Theory of Engeström (Engeström & Pyörälä, 2021; Kerosuo & Engeström, 2003) we analyzed this complexity of collaboration of regionally involved healthcare providers, while arranging collaborative patient care trajectories and creating Collaborative Patient Care Agreements (CPCAs).