Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team
Authors: Stacie A Salsbury, Robert D Vining, Donna Gosselin, Christine M Goertz
Journal: Chiropr Man Therap (2018)
Keywords: chiropractic, interprofessional relations, musculoskeletal pain, patient-centered care, professional competence, rehabilitation
MeSH terms: Brain Injuries / rehabilitation, Manipulation, Chiropractic / psychology, Nervous System Diseases / rehabilitation, Physicians / psychology, Spinal Cord Injuries / rehabilitation, Stroke / therapy, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Adult, Brain Injuries / psychology, Chiropractic, Delivery of Health Care, Integrated, Evaluation Studies as Topic, Family / psychology, Female, Humans, Interdisciplinary Communication, Interdisciplinary Placement, Interviews as Topic, Male, Middle Aged, Nervous System Diseases / psychology, Patient Care Team, Patients / psychology, Spinal Cord Injuries / psychology, Stakeholder Participation, Stroke / psychology, Young Adult

Background:
While chiropractors are integrating into multidisciplinary settings with increasing frequency, the perceptions of medical providers and patients toward adding chiropractors to existing healthcare teams is not well-understood. This study explored the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting.
Methods:
This qualitative analysis was part of a multi-phase, organizational case study designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team. The setting was a 62-bed rehabilitation specialty hospital located in the northeastern United States. Participants included patients, families, community members, and professional staff of the administrative, medical, nursing, and therapy departments. Data collection consisted of audiotaped, individual interviews and profession-specific focus groups guided by a semi-structured interview schedule. Transcripts were imported into a qualitative data analysis program for data analysis. An iterative coding process using thematic content analysis categorized key themes and domains.
Results:
Sixty participants were interviewed in June 2015, including 48 staff members, 6 patients, 4 family members, and 2 community members. Our analysis generated a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings composed of 5 domains and 13 themes. The central domain, Patient-Centeredness, or the provision of healthcare that is respectful, responsive, and inclusive of the patient's values, preferences, and needs, was mentioned in all interviews and linked to all other themes. The Professional Qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence. Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor's ability to work within an interdisciplinary setting. Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.
Conclusions:
Our findings provide an expanded view of the qualities that chiropractors might bring to multidisciplinary healthcare settings. Rather than labeling stakeholder perceptions as good, bad or indifferent as in previous studies, these results highlight specific attributes chiropractors might cultivate to enhance the patient outcomes and the experience of healthcare, influence clinical decision-making and interprofessional teamwork, and impact healthcare organizations.