Table 3.
Barriers influencing the implementation of CIPE in German health care
| Category | Definition | Subcategory | Selection of illustrations |
|---|---|---|---|
| Sytemic barriers | Hindering factors coming from insufficient CIPE delivery structures and missing incentives to participate | Variation in CIPE demand due to missing physician related incentives to participate and sufficient nurse-related incentives | “Most physicians in the hospital context need very specific educational courses most educational sites cannot provide”. (IN7) |
| Insufficient utilization of public relation measures to familiarize new target groups (professions) with CIPE | “Physicians mainly participate in CIPE trainings when they can receive CME credits”. (IN2) | ||
| “What we often hear is, “Oh, you also have a program for us?” That’s irritating because we offer our CIPE program for years now and we tried to find adequate multiplicators to distribute the information to physicians”. (IN6) | |||
| Behavioral barriers | Hindering factors coming from differing professional socialization processes | Hyrarchie problems between professions participating in CIPE | “Well, especially physicians tend to behave very bored when visiting CIPE trainings. Often they react harsh saying that this is a waste of time”. (IN10) |
| Misleading communication patterns and structures due to hierarchical structures in health care organizations | “What our lecturers experience very often is that physicians admit that they often rely on nurses when it comes to communication with patients. I think that this might be one reason why they do not feel responsible for these things”. (IN17) | ||
| Differing attitudes in regard to the relevance of CIPE between health care professions | |||
| Methodological barriers | Hindering factors coming from an insufficient utilization of quality assurance measures among CIPE providers | Insufficient utilization of curricula and standardized evaluation procedures | “There is much flexibility in the design of continuing medical education leading to structural and quality assurance problems”. (IN19) |
| Qualification gap among CIPE lecturers | “By now, we do not use specific requirements when it comes to recruit lecturers for our CIPE offers. We are more than satisfied if we receive applications of lecturers who worked with various professional groups”. (IN15) | ||
| Attitudinal barriers | Hindering factors associated with general attitudes regarding the role, relevance and effectiveness of CIPE in medical education | Perception of CIPE as no “one size fits all” strategy for the realization of interprofessional health care delivery | “What we are doing is very important and we experience that it helps a lot to find solutions to problems in health care delivery. But on the other hand what we do is a drop in the bucket. CIPE is one link in the chain. It requires more efforts in the education of health professions”. (IN12) |
| CIPE as one measure amongst many |