The need for organizational development in pain clinics: a case study.

Abstract

This study describes the practical implementation of an interdisciplinary rehabilitation model for patients with long-term, non-malignant pain. The main purpose was to explore the organizational prerequisites for interdisciplinary function. The pragmatic aim was to extend our understanding of the management of these patients. The subjects (n =24) were seven insurance representatives, four work leaders, seven nurses, three doctors, one psychologist and two physiotherapists. Data sources included focus group interviews, participant observation (field notes) and a review of written documents. The constant comparative method for grounded theory was used to analyse the data. The data showed that the rehabilitation of chronic pain patients should be organized as an "integrated wholeness", requiring an "agile organization" to promote solutions tailored to suit the needs of each patient. Moreover, a "common core knowledge" of chronic pain and "mission clarity" are important as guidance for the interdisciplinary practical rehabilitation work. This kind of interdisciplinarity requires "interdisciplinary roles" and "integrational leadership"'. The practical implication of this was the development of communication structures, internally as well as externally, promoting collaboration and integration. Approval at organizational level is necessary to transform the ideas of interdisciplinarity to reality and create integrated cooperation between professionals. A lack of attention to this question may account for repeated failures in terms of health care service integration and positive rehabilitation outcomes among the patients concerned.