20.500.12556/ReVIS-14319 Klinična pot pacienta po možganski kapi – analiza dejavnikov vpliva na sodelovanje v multidisciplinarnem timu Clinical pathway of the stroke patient: an analysis of factors influencing collaboration within the multidisciplinary team Teoretična izhodišča: Sodelovanje posameznika v multidisciplinarnem timu je pomemben, a empirično premalo raziskan dejavnik kakovosti zdravstvene obravnave. Kljub obsežni literaturi o pomenu medpoklicnega sodelovanja v zdravstvu celovitega empiričnega razumevanja dejavnikov, ki sodelovanje posameznika v timu dejansko oblikujejo, v literaturi primanjkuje, zlasti v specifičnem kontekstu klinične poti za možgansko kap. Disertacija temelji na integraciji treh komplementarnih teoretičnih okvirov: teorije načrtovanega vedenja, ki pojasnjuje individualno raven sodelovalnega vedenja; teorije relacijske koordinacije, ki sodelovanje razume kot rezultat kakovostnih odnosov in komunikacije ter modela medpoklicnega sodelovanja, ki poudarja pomen organizacijskih struktur, formalizacije procesov in podpore vodstva kot strukturnih pogojev za učinkovito timsko sodelovanje. Klinična pot pacienta po možganski kapi je bila izbrana kot raziskovalni kontekst zaradi strukturiranosti in nujnosti usklajenega delovanja večjega števila strokovnih profilov. Namen disertacije je bil empirično preveriti, kateri dejavniki statistično značilno vplivajo na sodelovanje posameznika v multidisciplinarnem timu in oceniti njihovo relativno moč. Metode: Uporabljen je bil kvantitativni in kvalitativni raziskovalni pristop. V kvantitativnem delu je bila izvedena anketna raziskava med zdravstvenimi delavci v sedmih slovenskih bolnišnicah (N = 219). Za analizo podatkov sta bili uporabljeni Spearmanova korelacija in hierarhična multipla linearna regresijska analiza, s katero je bilo preverjenih sedem sklopov dejavnikov timskega sodelovanja. V kvalitativnem delu je bila izvedena tematska analiza 31 intervjujev z zdravstvenimi delavci različnih poklicnih profilov iz istih bolnišnic, z namenom poglobljene razlage kvantitativnih ugotovitev. Rezultati: Hierarhični regresijski model je pojasnil 62,0 % variance timskega sodelovanja, kar kaže na visoko pojasnjevalno moč modela. Statistično najpomembnejši neodvisni napovedniki timskega sodelovanja v končnem modelu so dokumentiranje zdravstvene obravnave (ß = 0,396; p < 0,001), posameznikovo komuniciranje (ß = 0,215; p = 0,001) in usmerjenost na pacienta (ß = 0,158; p = 0,014). Poklic (ß = 0,156; p = 0,022) in vloga v timu (ß = 0,192; p = 0,006) sta statistično značilna napovednika na individualni ravni, medtem ko delovna doba, družbena odgovornost, način komuniciranja v timu, komuniciranje z vodstvom in odpor do novosti v končnem modelu niso dosegli statističnih značilnosti. Koordinacija je statistično značilno povezana s sodelovanjem posamično (ß = 0,611; p < 0,001), v končnem modelu pa izgubi vpliv. Kvalitativna analiza je identificirala hierarhijo in psihološko varnost kot prikrita sistemska dejavnika, ki v kvantitativnem modelu nista neposredno merjena, a dosledno pojasnjujeta, zakaj statistično značilni dejavniki delujejo različno intenzivno med poklicnimi skupinami. Razprava: Rezultati potrjujejo, da je sodelovanje posameznika v multidisciplinarnem timu večnivojski pojav, ki ga oblikujejo individualni, interakcijski in organizacijski dejavniki. Dokumentiranje zdravstvene obravnave se je izkazalo kot eden najpomembnejših dejavnikov sodelovanja, pri čemer zmanjšanje vpliva koordinacije po vključitvi dokumentiranja v regresijski model nakazuje njuno tesno povezanost. Ker mediacijska analiza ni bila izvedena, teh povezav ni mogoče interpretirati kot dokaz posrednega učinka, predstavljajo pa pomembno izhodišče za nadaljnje raziskovanje. Statistično neznačilni rezultati pri družbeni odgovornosti in komuniciranju z vodstvom ne pomenijo njune nepomembnosti, temveč kažejo na njuno kontekstualno pogojenost. Kvalitativni del raziskave je dodatno osvetlil pomen hierarhičnih razmerij in psihološke varnosti, ki vplivata na pripravljenost posameznikov za aktivno sodelovanje v timu. Rezultati podpirajo večnivojski konceptualni model sodelovanja posameznika v multidisciplinarnem timu ter odpirajo nova raziskovalna vprašanja o razmerju med dokumentiranjem, koordinacijo in timskim sodelovanjem. Na aplikativni ravni ugotovitve kažejo, da ima izboljšanje kakovosti dokumentiranja pomemben potencial za krepitev timskega sodelovanja v zdravstvenih organizacijah. Theoretical background: An individual's collaboration within a multidisciplinary team is an important but empirically underexplored factor in healthcare quality. Although there is extensive literature on the importance of interprofessional collaboration in healthcare, a comprehensive empirical understanding of the factors that shape an individual's collaboration within a team is lacking, particularly in the specific context of the clinical pathway for stroke. This dissertation is based on the integration of three complementary theoretical frameworks: the theory of planned behaviour, which explains collaborative behaviour at the individual level; the theory of relational coordination, which views collaboration as the result of high-quality relationships and communication; and the model of interprofessional collaboration, which highlights the importance of organisational structures, formalised processes, and management support as structural conditions for effective teamwork. The clinical pathway of the post-stroke patient was chosen as the research context because of its structured nature and the need for coordinated action among a large number of professional profiles. The aim of the dissertation was to empirically test which factors have a statistically significant effect on an individual's collaboration within a multidisciplinary team and to assess their relative strength. Methods: A quantitative and qualitative research approach was used. In the quantitative part, a survey was conducted among healthcare workers in seven Slovenian hospitals (N = 219). Spearman's correlation and hierarchical multiple linear regression analysis were used to analyse the data, testing seven sets of teamwork factors. In the qualitative part, a thematic analysis of 31 interviews with healthcare workers from various professional profiles in the same hospitals was conducted to provide an in-depth explanation of the quantitative findings. Results: The hierarchical regression model explained 62.0% of the variance in teamwork, indicating high explanatory power. The most important independent predictors of teamwork in the final model are healthcare documentation (β = 0.396; p < 0.001), individual communication (β = 0.215; p = 0.001), and patient-centredness (β = 0.158; p = 0.014). Profession (β = 0.156; p = 0.022) and role within the team (β = 0.192; p = 0.006) are also statistically significant predictors at the individual level, whereas length of service, social responsibility, manner of communication within the team, communication with management, and resistance to innovation did not reach statistical significance in the final model. Coordination is significantly associated with collaboration when considered alone (β = 0.611; p < 0.001), but loses its effect in the final model. The qualitative analysis identified hierarchy and psychological safety as latent systemic factors not directly measured in the quantitative model, but which consistently explain why the statistically significant factors operate with differing intensity across professional groups. Discussion: The results confirm that an individual's collaboration within a multidisciplinary team is a multilevel phenomenon shaped by individual, interactional, and organisational factors. Healthcare documentation emerged as one of the most important factors in collaboration, with the reduction in the effect of coordination after including documentation in the regression model suggesting a close interrelationship. As mediation analysis was not performed, these associations cannot be interpreted as evidence of an indirect effect, but they represent an important starting point for further research. The statistically non-significant results for social responsibility and communication with management do not imply that these are unimportant, but rather indicate their contextual dependence. The qualitative part of the study further highlighted the importance of hierarchical relationships and psychological safety, which influence individuals' willingness to actively collaborate within the team. The results support a multilevel conceptual model of individual collaboration within a multidisciplinary team and raise new research questions about the relationship between documentation, coordination, and teamwork. At the applied level, the findings indicate that improving the quality of documentation has significant potential to strengthen teamwork in healthcare organisations. multidisciplinarni tim sodelovanje v timu klinična pot možganska kap dokumentiranje zdravstvene obravnave komunikacija koordinacija obravnave multidisciplinary team team collaboration clinical pathway stroke healthcare documentation communication care coordination true false false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2026-07-18 18:14:53 2026-07-18 18:14:53 2026-07-19 03:11:11 0000-00-00 00:00:00 2026 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 25250 4464$$Simec_Mateja_DD.pdf 4464$$Simec_Mateja_DD.pdf 1 E1BD432BBFBA534A2F5CEB71C82FEA49 d2c5a41e2c0e3906aabb815c5bd21c38a2d17b38d5dd85197296a3b9038419b1 cfde2755-82c3-11f1-a19f-001a4af901a5 https://revis.openscience.si/Dokument.php?lang=slv&id=17361 Univerza v Novem mestu - Fakulteta za zdravstvene vede 0 0 0