Dynamic role boundaries in intermediate care services.

Abstract

This paper examines the impact of intermediate care service delivery on the role boundaries of service providers. Two intermediate care teams were selected as case studies to explore the roles of workers in the context of an admission avoidance and assisted discharge service. Data were collected through semi-structured interviews with 26 intermediate care staff, including physiotherapists, occupational therapists, nurses, a social worker and support workers. The study found that therapists' roles were most closely aligned with each other, whilst nurses perceived their roles as being distinct from therapists, with a more medical emphasis. Therapists and nurses delegate a range of tasks to support workers, although the nature of task delegation differed across the two teams. A number of factors were associated with the role flexibility of staff including the setting, duration and nature of care, access to alternative care providers and the ability of staff to undertake joint visits. Contrary to previous research, the practitioners were not threatened by overlapping roles, and recognised that confidence in their own roles and an understanding of the roles of other workers was necessary to avoid feeling threatened. The study concludes that intermediate care can promote role overlap across a range of workers. Role overlap can enhance clinician confidence in their own area of expertise whilst optimising patient care. Role overlap has the potential to optimise limited staff resources in an interprofessional working environment. Interprofessional working can be enhanced in the workplace through joint visits and shared working practices.