Structural conditions of interprofessional collaboration in neurological early rehabilitation wards: a qualitative study.

BACKGROUND: Early neurological and neurosurgical rehabilitation (ENR, phase B) forms the transition from acute treatment to further rehabilitation and requires close integration of acute medical and rehabilitative measures. Interprofessional collaboration (IPC) is a central component of rehabilitative care according to the ICF (International Classification of Functioning, Disability and Health) model. Previous research has focused on individual and team competencies to promote IPC. Recent studies suggest that IPC is also influenced by structural conditions. Against this background, the study examines which structural elements of ENR wards enable interprofessional work organisation. MATERIALS AND METHODS: The study employed a qualitative design, including group discussions with interprofessional teams across five neurological rehabilitation facilities with ENR wards in Germany. Using purposive sampling, 76 employees from six professional groups and three hierarchical levels participated in 15 interprofessional group discussions, which were transcribed verbatim. The evaluation was carried out as a qualitative structured content analysis with deductive and inductive categories according to Kuckartz and Rädiker based on Sackmann's cultural model. RESULTS: The results show three core structural dimensions that shaped interprofessional work organisation in ENR: (1) form of therapy planning, (2) staff allocation on the ward, and (3) information exchange. From these, three types of interprofessional work organisation (agile, adaptive, prospective) were reconstructed. Particularly beneficial for the care of ENR patients in phase B is decentralised therapy planning, adapted to clinical volatility, with fixed interprofessional ward teams, and daily structured handover meetings in addition to weekly team meetings. CONCLUSION: The findings suggest that ward organisation should be based on the severity of the patients' condition: the greater the clinical instability, the more flexible and closely knit the interprofessional work organisation should be.