A collaborative inquiry to explore a multidisciplinary approach to developing practice in hip fracture care.

BackgroundHip fracture is a common, serious and well-defined injury which requires early surgical fixation, medical care and rehabilitation. Standards for its prevention and management are clearly defined in national clinical guidelines and standards (SIGN, 2002, NHS QIS, 2004). Despite this, local reports indicate that the experience for older people and their families following hip fracture care was poor. The complex journey following hip fracture care crosses traditional service delivery boundaries, creating challenges for the coordination and integration of health and social care for the older people with this injury.Overall aimThe aim of this study was to explore a multidisciplinary collaborative approach to developing practice in hip fracture care.Design and methodA collaborative inquiry design was used. A purposive sample of sixteen clinical leaders from different disciplines working with older people with hip fracture met for eight two-hourly action meetings. Included in these meetings were identifying the strengths and limitations of the present hip fracture service, values clarification, creating a shared vision, sharing clinical stories and reviewing a set of case records. To support the process three patients and two carers were interviewed to provide evidence of their experience of care. A reflective journal was kept throughout the study.FindingsFacilitation strategies complemented the traditional top-down directive leadership style normally experienced by those involved. This collaborative approach enabled the team to collect and reflect on evidence from different sources helping them learn that psychosocial factors were immensely important in recovery. These included providing continuity of care; giving information and checking understanding; asking if help was needed; ensuring that there was support in place once the older person was home; and being realistic about the time it took to recover following this injury. A key outcome was the team’s recognition of the need for integrated working and unified case records