Health care today is characterized by an increasing number of patients with comorbidities for whom interphysician collaboration seems very important. We reviewed the literature to understand what factors affect interphysician collaboration, determine how interphysician collaboration is measured, and determine its effects. We systematically searched six major databases. Based on 63 articles, we identified five categories that influence interphysician collaboration: personal factors, professional factors, preconditions and tools, organizational elements, and contextual characteristics. We identified a diverse set of mostly unvalidated tools for measuring interphysician collaboration that focus on information being transferred and understood, frequency of interaction and tone of the relationship, and value judgements about quality or satisfaction. We found that interphysician collaboration increased clinical outcomes as well as patient and staff satisfaction, while error rates and length of stay were reduced. The results should, however, be interpreted with caution, as most of the studies provide a low level of evidence.

Background. Being a nurse or physician in todays complex healthcare practice involves more than just responsibility for one aspect of care during one episode in a patients care trajectory. Both professionals are expected to take on a clinical leadership role and contribute positively to the reduction of care fragmentation and help in spanning professional boundaries. Although nurses may be well placed to identify the needs for integration, they may lack the position and status (compared to physicians) to address those needs as leaders. The aim of this study is to analyse similarities and differences between nurses and physicians in clinical leadership roles within a hospital context and explore how this relates to their interdisciplinary collaborative behaviours and perception on their job. Method. A cross-sectional survey among physicians and nurses was conducted to measure clinical leadership, job satisfaction, workload, and interdisciplinary collaborative behaviours. Results. Our results suggest that nurses (n=329) and physicians (n=100) show similar clinical leadership behaviours, based on equivalent scores on the clinical leadership scale. However, physicians score higher on the global leadership scale indicating they are more likely to perceive themselves as leaders than nurses. As clinical leaders, both nurses and physicians are more likely to express interdisciplinary collaborative behaviours. Furthermore, physicians who scored higher on the clinical leadership scale reported higher satisfaction with their job, whereas, for nurses, their score on the clinical leadership scale did not relate to their job satisfaction. Conclusion. As nurses in hospitals have the most frequent and direct involvement with patients, it seems inevitable for them to act as clinical leaders to promote patient-centred care. However, nurses less often perceived themselves as clinical leaders while showing suitable behaviours. Future studies should focus on the strategies nurses use to exert their clinical leadership, and for example, if nurses require the use of more dominant strategies to effect change.

Hospitals have been encouraged to develop more process-oriented designs, structured around patient needs, to better deal with patients suffering from multi-morbidity. However, most hospitals still have traditional designs built around medical specialties. We aimed to understand how hospital designs are currently developing and what the important drivers are. We built a typology to categorize all Dutch general hospitals (61), and we interviewed hospital managers and staff. The inventory showed three types of hospital building blocks: units built around specific medical specialties, clusters housing different medical specialty units, and centers; multi-specialty entities provide the most suitable structure for a process-oriented approach. Only some Dutch hospitals (5) are mainly designed around centers. However, most hospitals are slowly developing towards hybrid designs. Competitive drivers are not important for stimulating these redesigns. Institutional pressures from within the health care sector and institutional ‘mimicking’ are the main drivers, but the specific path they take is dependent on their ‘heritage’. We found that hospital structures are more the result of incremental, path-dependent choices than ‘grand-designs’. Although the majority of the Dutch general hospitals still have a general design built around medical specialties, most hospitals are moving towards a more process-oriented design.

Introduction: The complexity of healthcare is increasing, mainly due to the prevalence of multimorbidity in an ageing population. Complex care for patients with multimorbidity requires a multidisciplinary approach. Traditional physician-centered hospital structures do not facilitate the necessary multidisciplinary collaboration. European hospitals are implementing process-based hospital designs with patient- and process-oriented units to stimulate multidisciplinary collaboration. Patient-oriented units are formed based on shared patient groups and focus on care trajectories, while process-oriented units are formed based on having similar processes and focus on efficiency. Purpose: This study has two aims. First, to study the effect of introduction of these units on multidisciplinary collaboration and perceived impact (efficiency, innovation, and effectiveness). Second, to study whether there are differences between patient- and process-oriented units. Methods: A survey-based longitudinal evaluation study was conducted in 2020 and 2022 among physicians in a Dutch hospital to measure multidisciplinary collaboration (relational coordination) and perceived impact (efficiency, innovation, and effectiveness). In addition, open questions were used to enrich the data. Results: Quantitative and qualitative data together suggest that physicians in patient-oriented units notice benefits from the redesign to multidisciplinary units, they perceive higher impact over time. Physicians in process-oriented units achieve a better relationship with the physicians in their unit over time, but they do not perceive impact as high as physicians in patient-oriented units. Conclusion: A process-based design with patient- and process-oriented units is supportive of multidisciplinary collaboration and perceived impact, especially for physicians in patient-oriented units. Physicians in patient-oriented units are positive about the introduction of these units as they feel it contributes to better multidisciplinary patient care. As the results for physicians in process-oriented units may be less directly visible in terms of quality of care, they are less likely to see positive effects, even though their relationships are improving.

Due to the growing number of complex (multimorbid) patients, integrating and coordinating care across medical specialties around patient needs is an urgent theme in current health care. Clinical leadership plays an important role in stimulating coordination both within and between specialty groups, which results in better outcomes in terms of job satisfaction and quality of care. In this light, this study aims to understand the relation between physicians’ clinical leadership and outcomes, focusing on the sequential mediation of relationships and coordination with physicians within their own medical specialty group and from other specialties. A cross-sectional self-administered survey among physicians in a Dutch hospital (n = 107) was conducted to measure clinical leadership, relational coordination at two levels (medical specialty group and between different specialties), quality of care, and job satisfaction. Clinical leadership was related to better quality of care through more relational coordination within the medical specialty group. Clinical leadership was related to more job satisfaction through more relational coordination within the medical specialty group, through more relational coordination between specialties, and sequentially through both kinds of relational coordination. Physicians who act as clinical leaders are important for crossing specialist boundaries and increasing care outcomes. To improve multidisciplinary collaboration, managers should encourage clinical leadership and pay attention to the strong relationships between physicians from the same specialty.

Introduction: The number of requests for medical assistance in dying (MAID) based on psychological suffering has significantly increased in recent years. People that request MAID based on psychological suffering often have a long-term history within mental health care that has not (yet) led to recovery. The risk of death by suicide in this group is high. Relatively little is known about people who request MAID based on psychological suffering and their death wish. The lack of knowledge results in a lack of targeted counseling options and suicide prevention for people who request MAID based on psychological suffering. The current study therefore focuses on the characteristics, psychological processes and support needs of people who request MAID based on psychological suffering, and how death wishes and suicidality develop during and after a MAID request. The aim of this research is to contribute to better care and support for this vulnerable group. Methods: To answer the questions above we conduct a prospective longitudinal observational study. Participants twice complete a digital questionnaire: one shortly after registering with Expertisecentrum Euthanasie (EE) for their MAID request and one six months after completing the first questionnaire. Participants are 16 years or older and have requested MAID at EE based on psychological suffering. Ethics and dissemination: The study was approved as a study subject to the Medical Research Involving Human Subject Act (WMO) by the METC of Amsterdam UMC. Risks of participating in the study are low and explicit attention is paid to participant safety. The study results will be disseminated through scientific publication, conferences, and a webinar for mental health professionals. Based on participants support needs, a plan will be developed for support services to prevent suicide by people who requested MAID based on psychological suffering. Thus, the study will contribute to better counseling and suicide prevention for this vulnerable group.