Coordination and Leadership in Palliative Care Teams in Switzerland
E. Reeves1, B. Liebig1, R. Schweighoffer1 (1Department of Applied Psychology, FHNW)
Poor coordination in health care teams quite often is associated with poor inter-professional collaboration and leadership, this is true also for palliative care. Despite considerable research in the area of inter-professional collaboration, little is known about the barriers and facilitators to coordination and leadership of palliative care teams as smallest units of palliative care networks (Eychmüller 2015).
This contribution aims to identify some of the barriers and facilitators to coordination and leadership that are specific to palliative care in Switzerland.
 We thank the Swiss National Science foundation for the financial support of this study as part of NRP 74 ‘Smarter Health Care’
The analysis starts from Bainbridge's et al. (2010) conceptual framework of health service evaluation. The investigation of barriers and facilitators of leadership is carried out via qualitative analysis of problem-centered interviews with 40 health care professionals in primary and specialized palliative care, as well as providers of support services in four Swiss cantons, namely; Ticino, Luzern, Basel-City and Vaud. The sample included 24 interviews with General Practitioners (GP’s) and (Spitex-) nurses in primary palliative care, 16 interviews with specialist in hospitals, hospices, mobile palliative care and private practice. Interviews were analyzed and interpreted using qualitative content-analysis.
The analysis identifies several barriers to coordination and leadership in palliative care teams, including, first of all, the informal character of team relations and team composition, and (still) a lack of defined coordination and leadership roles, which only sometimes overlap. Further, frequent changes in care teams, ambiguous professional roles related to different care settings, inconsistent attitudes towards leadership and poor communication in between and within primary and specialized care teams. On the other hand, trust in professional competencies, communication, a vision of ‘team-work’, as well as shared values regarding leadership, can facilitate coordination and leadership in palliative care.
Our findings suggest that clearly defined coordination and leadership roles, which correspond to the requirements of different care settings, help to improve collaboration between care providers and the quality of care. More general, the idea of ‘team-work’ has to be strengthened between care providers in the outpatient area as well as between institutional actors of primary and specialized care. Differentiated approaches of coordination and leadership, as well as team development for palliative care providers in and across in- and outpatient care seem essential to support networking in the field.