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A J curve of interprofessional change: co-locating non-health partners in an oncology unit

13 February 2020
15 min read
Volume 29 · Issue 3

Abstract

Background:

Internationally, clinicians face increased demand, pressure on resources and unmet patient needs. A community social support service was co-located within cancer clinics in Glasgow, Scotland to help address some of these needs.

Aim:

To analyse the impact of the service on clinical staff and to propose an explanatory theory of change.

Method:

Qualitative exploratory design, using thematic analysis of semistructured interviews with 8 nurse specialists and 2 medical oncologists from lung, breast, head and neck, and gastrointestinal oncology teams in Glasgow in 2018–2019.

Findings:

Four themes captured this process: ‘The conversation’, ‘A better experience’, ‘Freedom to focus’ and ‘Working hand in hand’.

Conclusion:

Together, these four themes explained the process of effective interprofessional working. This process would have been predicted by the J-curve literature on diffusion of innovations. Linking J-curve theory to this successful process provides new understanding that could prove essential for clinical teams who are implementing change within their practice.

This article examines how clinicians working in outpatient cancer care adapted to the co-location of a novel community support service, Improving the Cancer Journey (ICJ), which is designed to meet the holistic concerns of every cancer patient in Glasgow (Box 1). Since its inception in 2014, ICJ has supported more than 4000 people, especially those most in need due to social deprivation (Snowden et al, 2018). ICJ is offered to all people newly diagnosed with cancer via letter, but it is also available to people with existing cancers at any stage of their illness or recovery. To widen access, in 2016 ICJ was situated within outpatient services in local hospitals in Glasgow. The positive impact ICJ has had on patients has been documented (Young and Snowden, 2019). This article focuses on understanding how being newly co-located with ICJ affected the way clinicians worked. This is important to understand because it is a working example of integrating health and social care, a long-standing aim worldwide that has proved historically difficult (Heenan and Birrell, 2006).

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