Nobody is an island Embracing complex interactions in the context of
AbstractRationale, aims, and objectives Decision-making for patients with
comorbidity is neither an individual nor an only once matter, as it
takes place repeatedly within in a network of care providers. It is true
that in an acute phase specialists occupy a central and predominant
position, but later care providers increasingly rely on each other to
share the needs and concerns of their patients. The question this study
tries to answer is what fosters or hinders contact between healthcare
providers in the various phases of their patients' hospitalisation.
Method Practical experiences of caregivers from different disciplines
are examined using both narrative theories and aspects of complexity
thinking. The focus is on the factors that influence the manner in which
caregivers establish and develop their relationships. Results In the
curative phase, the primary physician communicates top-down decisions
and instructions to healthcare providers under his authority. The
involvement of a multiplicity of disciplines triggers an entanglement of
dichotomous voices. Eventually centralized coordination patterns give
way to a less dominant coordination. Conclusions Patients with
comorbidity require close cooperation between an increasing number of
healthcare providers. This cooperation can only be enhanced by
recognising the complex of relationships between these caregivers.
Research into these practices can benefit greatly by using methods,
which relate methods of complex and narrative-thinkers.