Printer Friendly

Inter professional Competency Framework for Health Service Managers in Oman: An e-Delphi Study.

The World Health Organization (WHO) provides a framework for inter professional collaboration in education and practice as a means of strengthening the capabilities of healthcare professions in addressing the multifaceted global health workforce crisis. (1) One strategic action is through inter professional education (IPE), which can enhance collaboration, collegiality, and teamwork. IPE introduces students from two or more professions to learn about, from, and with each other to be fully immersed in collaboration and improve health outcomes. (1) Furthermore, students are prepared for a collaborative, practice-ready workforce to emulsify the skills of their members, share case management, and provide better health services to patients and the community. (1) Hence, IPE is an educational strategy and activity to enhance attitudes, knowledge, skills, and behaviors of the students to develop collaborative practice. (2)

Several frameworks and models have been developed to build a sound basis for the health profession education. For instance, in the USA, a public-private partnership was formed to develop the National Center for Inter professional Practice and Education. This partnership supports the national leadership, scholarship, evidence, and coordination. It also contributed to the advancement of IPE and practice. (3) The academic service partnership (ASP) between the Academic Health Center at the University of Minnesota, and the Office of Health Information Technology at the Minnesota Department of Health, initiated team based health care grounded in care coordination, patient engagement, and the utilization of health information technology (IT). (4) In the UK, the inception of the Center for the Advancement of Inter professional Education (CAIPE) in 1987, aimed to promote health and well being, and improve the health and social care of the public by advancing IPE. (5) The Japan Association for Inter professional Education initiated a three-year, government-funded project to formulate its inter professional competency framework with various professional organizations in healthcare and social sciences. (6) Qatar initiated the IPE-based model using the College of Pharmacy proposed by the University of British Columbia. The initiative was run for 14 programs, at four healthcare institutions, including Qatar University, We ill Cornell Medical College in Qatar, the University of Calgary in Qatar, and the College of North Atlantic in Qatar. (7) The results of this initiative provided better understanding, planning, facilitation, and integration of IPE towards competency development within the practice and education. (7) The evidence from different countries revealed that IPE is a strategic preparation to provide optimal patient care, engaged clinicians, and collaborative inter professional practice. (8-10) The integration of IPE in higher education institutions before graduation supports learning assimilation. (11,12)

In Oman, the education of health professionals appeared to be at an early stage of development and was described as discipline-specific, and thus offered little opportunity for learning inter professional skills. (11) In recent years, health professions such as nursing, medicine, and other allied health professions are working in a uni-professional paradigm. In the meantime, there is a paucity of evidence about ASPs to support health professions and prepare future graduates as managers. (4,13) ASPs can bridge the gap between theory and practice, strengthen team cohesion, nurture collegiality, and prevent hierarchical professionalization and compartmentalization of each discipline. The healthcare system in Oman is looking forward to improving its quality of care as a collaborative practice.

There are other issues that Oman is currently facing. The Ministry of Health (MoH) surmised that there is a radical demographic and epidemiologic transition, aging, and a predominance of non-communicable diseases and injuries, as well as other concerns related to political, economic, social, technological, environmental, and legal aspects. (14) Thus, the MoH's Health Vision 2050 was developed to serve as a schematic blueprint, which focuses on the critical role of education in developing effective and efficient human resources for health. (14,15) This roadmap also hopes to empower the academic and service industries in preparing future leaders and managers in meeting the increasing demands of its growing population.

Many countries have already witnessed IPE as an enabling factor in achieving both short- and long-term goals, and how a collaborative practice sustains quality care. (1,5,6,9,11,16,17) The MoH aims to develop a responsive workforce as the demands for globalization become palpable. Hence, there is an urgent call to develop fit-for-purpose competencies for health service managers who will stand at the forefront. The development of inter professional competencies for health service managers will be a direct basis towards an active inter professional learning and inter professional working environment. Oman needs succinct IPE preparation and inter professional collaborative practice to achieve safe, efficient, effective, patient-centered, and equitable quality health outcomes and to sustain the human resources for health in the coming years. Lastly, the Health Vision 2050 can be realized through such concerted efforts to prepare future health service managers vis-a-vis curricular reforms, educative-innovative mechanisms, abrogated academic-service silos, and adaptive mindsets for better graduate outcomes. (14)


This study utilized a multiple methods research design comprising of qualitative content analysis and a three-round e-Delphi technique. (18) The use of qualitative content analysis guided the researchers to understand the multifaceted dimensions of participants' views through systematic coding and categorizing emerging statements. (19) The e-Delphi study design was used to obtain expert panel opinions to facilitate the development of inter professional competencies for health service managers. This technique utilized a series of sequential rounds that sought to gain a reliable consensus from a group of experts. (20-27) Despite the integration of many strategies, the format always followed a series of rounds of data collection and analysis. An e-Delphi technique is an environmentally friendly approach to research that leads to rapid feedback and responses from an expert panel. (26) Donohoe et al, (27) surmised that using e-Delphi, participants could have access to the virtual laboratory or online platform that saves time, effort, and cost.

The Institutional Review Board reviewed the proposal, and the study was approved by the MoH independent ethics committee. Following approval, a consultative meeting was initiated to identify the selected panel of experts from different healthcare institutions. Twenty experts were nominated based on their position, educational requirement, and work experience. Experts had to be knowledgeable, with at least five years experience in administration, leadership, and management to participate in the study. There were three rounds and a web-based designed survey used for data collection. Ten experts who met the inclusion criteria were included in a pilot study and underwent three rounds and a similar platform to determine the usability and clarity of the questions and instructions included.

In round one, the eligible experts were provided with a one-day seminar workshop to provide a background of the research study, its purpose, objectives, outcomes, expectations, and process. Each participant was given a study kit manual and the dates of the next round. The Survey Monkey[R]

URL website and password were included. Informed consent was obtained; confidentiality and anonymity were given emphasis. Two weeks were given as a waiting period for an expert to respond and they were reminded every week via email. In round two, a blind email was sent to the experts with the identified competencies generated from round one. The researchers analyzed the results and the extracted responses were combined to those with similar context to formulate specific themes using NVivo[R] (QSR International Pty Ltd. Version 11.4.0). Experts were contacted for clarity and refinement of ambiguous terminologies. The completed responses based on the constructed themes were sent via email for further suggestions and recommendations. In round three, experts were contacted by email with the final list of the competencies to evaluate the level of importance of each identified domain and indicator.

In round one, an open-ended question was introduced to the experts. The question for round one was: "What are the required inter professional competencies for health service managers in Oman?" Members of the panel were asked to list down all the required inter professional competencies for health service managers. The researchers met for several weeks for coding, categorizing, and thematization until the statements were saturated. (18,19) The themes and statements were sent to the experts for their review and clarification. In round two, the completed responses based on the constructed themes were sent via email for further suggestions and recommendations. In round three, experts were instructed to rate the level of importance using a 5-point Likert Scale from very unimportant (1) to very important (5). Responses were analyzed using SPSS Statistics (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.) to determine the mean values, interquartile range (IQR), and frequency. The accepted competencies were established with means [greater than or equal to] 4.4, an interquartile distribution (IQD) [less than or equal to] 1.25, and when the consensus reached 80.0%.


Table 1 presents the profile characteristics of the participants. Based on the findings, 20 experts were informed and consented to participate in the study from various health professions including nursing (n = 6, 30.0%), medicine (n = 3, 15.0%), laboratory science (n = 3, 15.0%), pharmacy (n = 4, 20.0%), medical imaging science (n = 2, 10.0%), and physiotherapy (n = 2, 10.0%). Sixty-five percent (n = 13) of participants were from clinical practice, and the majority had 5-14 years experience (n = 16, 80.0%). The majority of participants were 30-39 years old (n = 16, 80.0%) and female (n = 14, 70.0%). Seventy-five percent of the participants had a master's degree (n = 15), 10.0% had a doctorate (n = 2), and 15.0% were medical doctors (n = 3).

Twenty experts were informed, consented, and validated the final lists of the competencies. From the lists, nine domains and 41 emerging statements reached the consensus of agreement among the experts' criteria. The statements with means (M) [greater than or equal to] 4.4 and IQD [less than or equal to] 1.25 and where the consensus reached 80.0% were considered to have a higher level of importance. Table 2 presents the overall themes based on qualitative content analysis. There was 90.0% to 95.0% level of agreement among the experts on the nine inter professional competency domains, which included: resilience (M = 4.7, IQD = 0.40), research leverage (M = 4.7, IQD = 0.60), inter professional ethics (M = 4.7, IQD = 0.80), quality improvement (M = 4.7, IQD = 0.80), IT (M = 4.6, IQD = 0.80), leadership (M = 4.5, IQD = 1.00), management skills (M = 4.5, IQD = 0.80); communication (M = 4.5, IQD = 1.00), and team dynamics (M = 4.5, IQD = 1.00).

Table 3 represents the inter professional competencies along with the indicators and level of importance as evaluated by the panel of experts. Each domain comprised of three to five indicators.

Figure 1 presents the IPE competency domains for health service managers in Oman. This framework is comprised of nine domains including resilience, research leverage, inter professional ethics, quality improvement, IT, leadership and management skills, effective communication, and teamwork. The integration of these domains will serve as the basis for academic and service organizations to further enhance the level of competencies among the graduates as future practitioners. Grounded and supported by the Health Vision 2050 and WHO Framework for Action on Health System, (1,14,15) the inter professional competency domains aim to bridge the gap between theory and practice as IPE becomes an inherent strategy. Thus, this builds the ASP to integrate both inter professional and service learning, where students and practitioners are engendered with strategic visions to enhance and promote the health of Omani society, disease prevention strategies, patient centered approaches to care, equity, transparency, and collaboration, among others. According to the MoH, as the country progresses, future health service managers will need to immerse themselves in the understanding of the six building blocks of the health system in Oman, (i.e., governance, finance, health services, human resources for health, medical equipment and products, and IT) that are aligned with the proposed inter professional competency. (14)


In 2008, Oman was ranked 84th out of 184 countries in the Human Development Index, an increase from previous years. The country is considered as showing high human development by the United Nations Development Program. (14) The MoH has been an instrument in the development of a sustainable workforce and needs to continue strengthening the resources for human health. Oman needs a workforce recognized as stewards and key players in policy analysis and development, strategic planning, standard setting and regulation, organization of service provision, ensuring intersectoral coordination, and the monitoring and evaluation of health plans implementation. (14) Hence, this study was conducted as a moral commitment and social responsibility of the researchers to be part of leveraging the required competencies for future health service managers. The Inter professional Competency Framework hopes to motivate and empower current and future leaders to advance practice, inform policy, and transform the health system. The proposed framework is grounded on the MoH's Health Vision 2050 and the WHO Framework for Action on Health System to ensure a strategic alignment based on country-specific needs (1,14) and fit-for-purpose competencies, which will be required in the coming years.

Furthermore, based on expert opinions, resilience was ranked the number one quality that embodies adaptability to the changes, challenges, and any other forms of stressful situation inherent within and outside the organization. With the advent of technology, the demands are also increasing, including changes in patient demographics, as patients are becoming more informed and are no longer passive recipients but collaborators in their care. (14) Developing one's resilience means developing one's tenacity, patience, resourcefulness, optimism, and persistence. Resilience is a prelude to critical thinking and shared decision-making concerning the organization, patients, families, communities, and profession. Resilience is the ability to perform well, adapt to changing circumstances, and maintain a sense of professional and personal fulfillment. (28) Optimism was identified as a critical attribute of resilience along with flexibility, adaptability, ability to bounce back against adversity, tolerance, excellent organizational skills, communication, and teamwork. (29) The future of a sustainable workforce relies on the managers' responsiveness to the emerging changes and trends in the health system in the country and international communities. (14)

The service delivery, to a large extent, requires evidence-based approaches in planning, directing, controlling, and organizing. Research leverage widens the opportunities to utilize the dynamic processes and approaches for strategic actions, project initiatives, or quality improvement. The health system requires shared decision-making and problem-solving skills that are not based on trial and error, subjectivity, biases, or antiquated practices. Having a sound background in research, managers will be able to integrate facts to inform the health profession and practice. Managers who exemplify research competence can motivate teams to develop service initiatives or improvements for the organization and the country at large. Those initiatives can further meet the demands, expectations, and needs of patients, families, and communities. Managers need to be encouraged to be increasingly committed to translating scientific outputs relevant to patient care, patient service initiatives, resources cost-efficiency, and overall organizational success. With this, the organization leverages its competitive advantage through evidence-based management to sustain quality care and effective outcomes. (30-32) The MoH also envisions to "develop mechanisms to measure peoples' needs, satisfaction and utilization of health services and ensure that the health system is responsive to these needs," (14) which can be achieved through health system research. The Research Council has been established to develop a National Research Strategy as an instrument to ingrain research backgrounds among future health service managers and is not only intended for academicians or clinicians. (33) Managers can strengthen their organizations "building a research environment and research capacities to achieve scientific excellence and through assisting research dissemination and utilization". (14)

Inter professional ethics is also an enabling competency for health service managers. This domain codifies the foundation toward work values, value integration, and value-based management. Inter professional ethics will guide the implementation of effective management processes. Engel and Prentice (34) mentioned that collaboration is a relational process that operates within a framework of moral action and moral integrity. Healthcare organization is a diverse system and is exposed to many sentinel events that may affect operation, interaction with others, and even the organization's overall performance. Thus, inter professional ethics can alleviate the conundrum of conflicts, fragmented health care, and compartmentalization of various health professions because the collaborative practice needed focuses on patient-centricity and a humanistic component of care segregating the health profession differences. Further, through embodied inter professional ethics, the code of professionalism and code of conduct can be developed to guide practice, which is grounded in mutual understanding and respect while in a diverse and inclusive environment. (35) Managers need to integrate quality practice to improve the organization, patient services, and inter professional work environment through quality improvement initiatives. Managers should engage in continuous professional and inter professional development to enhance team performance and efficient uses of resources (both internal and external). (17,36) Quality improvement is the consolidated effort of the service providers, patients, and their families, payers, policymakers, educators, and stakeholders. In an era of healthcare driven by biological and technical advances, sustained quality improvement and quality service produce better patient outcomes, better system performance, and better professional development. (37-39) Quality improvement purports that at all levels of the organization, each member needs to be empowered to deliver individualized, holistic, and patient-centered care.

The MoH described Oman as being in the transitional stage of development between efficiency-driven and innovation-driven economy. (14) The use of IT can provide a more critical understanding of big data and data science, their effective utilization, and the positive impact on the overall performance of the organization. Hence, managers need to understand the principles upon which the organization and professional health information system used by service providers and patients are based. It has been posited that informatics in healthcare could provide effective and efficient utilization of services in the organization. (3) For instance, the American Medical Informatics Association biomedical informatics leads to more scientific and practical use of data, information, and knowledge for scientific inquiry, problem-solving, and decision-making to improve human health. (3) In the modern age, IT is not only utilized for clinical services or patient care management, but also for human resources management (HRM). Efficient and effective HRM contributes to the success of any national healthcare system. (4) 0 The integration of IT within the context of health services organizations yields accurate statistical data and information on the healthcare workforce. Human resource executives from 92 private hospitals identified critical factors in the adoption of the information systems, which need to be addressed. These key factors include IT infrastructure, top management support, IT capabilities of staff, perceived cost, competitive pressure, perceived compatibility, centralization, perceived complexity, formalization, innovativeness of senior executives, technology vendor support, relative advantage, and government regulations and supports. (40)

The MoH mentioned that "an effective health system requires increasing numbers of other human resources in categories such as health economists, clinical statisticians, health planners, and health system researchers". (14) In a similar vein, the MoH needs an initial boost to increase numbers of human resources to face shortages. These human resources for health, which are needed and required, should understand and cultivate leadership best practices to achieve the organization's vision and mission aligned with the Health Vision 2050. According to Kim et al, (41) a hospital requires effective leadership to influence others in providing safe, effective, efficient, equitable, patient-centered, and quality health services. The inter professional leadership along with the teamwork, coordination, communication, and collaboration can further improve patient-centered and family-centered practices. However, territorial behavior has been observed among professional groups and agencies, which was considered a deterrent to inter professional collaboration. (42) Managers who have the mindset to defend their territories in a bureaucratic organization may result in these behaviors. Thus, to alleviate these barriers, altruistic leadership has been found to be substantially grounded in concern for others, the organization, and society.

Managers need to integrate practical management skills and the core principles of management processes. (1) The comprehensive approach to leading and managing the workforce relies on the capability of the managers to enhance other employees, utilize their utmost capacity, level of productivity, and quality outcomes. Managers should sustain a culture of excellence where human behaviors and human relations are embedded. (38) With this, managers need to develop capabilities to revitalize the health system during turbulent times and become more sensitive to the needs of both organizations and stakeholders. (43) Managers are expected to address challenges such as patients' needs and demands, an adequate workforce, accessibility to quality care, health equality, medical costs, and the adoption of technology, among other issues. (43) Thus, through effective management processes, the managers can further introduce service co-production and value co-creation to heighten organizational capabilities. (44,45) On the other hand, management processes also require "reliable, relevant, up-to-date and timely health and health-related information" for sound health policy formulation, and for the development of health plans and strategies. (14)

Inter professional communication reflects the ability to communicate respectfully and responsively with others including patients, families, communities, and colleagues in a diverse working environment, regardless of race, religion, place of origin, language, socioeconomic status, and background. Communication, though a fundamental component of active management, is highly integral to the strengthening teamwork and collaboration. Matziou et al, (46) mentioned that through open communication, there would be mutual understanding and collaborative relationships. Despite physicians and nurses varying in views about their practice, open communication will strengthen their relations because there is trust, respect, and shared accountability. (38) Undeniably, the health system is in rapid transformation, and managers need to continue as both beacon and steward to build a collaborative practice and milieu that will require understanding how teams work together. (47,48) The inter professional teamwork should be efficient, open, and equitable tactical, with shared responsibility and influence. (49) Shoham et al, (47) recommended evaluating the communication process regarding types, quality, and dynamic nature of inter professional interaction so that managers can determine the areas for improvement.

Within inter professional team dynamics, managers develop a holistic team for safe, effective defect-free care. (50) Team dynamics enhance inter professional relationships and yield high quality, comprehensive, coordinated care, and affect providers' outcomes. (48,51,52) However, inter professional teams need a manager who acts as the mediator and facilitates the interaction. (53) According to Mitchell et al, (54) more than 70% of medical errors are attributable to dysfunctional team dynamics, and through inter professional teams these errors can be prevented. To develop inter professional teams, it requires transformational leadership, shared values, and shared group identity. (54) The MoH heightens the intersectoral partnership and collaboration in

Oman as joint actions among the health sector and one or more other sectors to improve health. (14) In this regard, health service managers of the future need to understand that true collaboration among sectors is expected to be effective if it takes place at more than one level (i.e, national, governmental, and community), especially if the activities are integrated through policy or legislation. (14)

This study offers a novel contribution to the emerging era of Internet research. We used a multi method approach using qualitative content analysis and e-Delphi technique to ensure the accuracy of the findings where country-specific expert opinions were illuminated. The use of e-Delphi is cost-effective and provides access to an expert opinion without geographical limitations or the time restrictions placed on face-to-face data collection, (22) and the anonymity prevents undue influence and other expert dominance. Further, the use of a web-based design survey (i.e., SurveyMonkey[R]) provides a virtual platform without geographical limitations, minimizes the issues in handwriting, and eases the data entry. Owing to the limitation of this study, although 20 experts were consulted, the response rate yielded more than 80.0%.


The development of inter professional competency domains for managers in various healthcare organizations is imperative. The academic and service industries have the responsibility to prevent compartmentalization of the health professions through the integration of IPE where the collaborative practice is envisioned. The growing demand for inter professional managers who have the resilience, research background, ethics, quality improvement, IT, leadership and management, communication, and team dynamics are needed. Those managers who have the fit-for-purpose competencies can further address the challenges faced. Thus, the MoH needs to empower both academic and service industries to develop graduates into holistic leaders and managers through IPE integration to fully become an instrument in the realization of the Health Vision 2050. The inter professional competency domains will also prepare future health service managers to become more adaptive, responsive, with the integral component of progressive reforms toward safe, quality, and sustained health outcomes at the macro-level grounded in collaboration, collegiality, and mutual trust between the academic and service sectors.


Article history:

Received: 15 May 2018

Accepted: 26 June 2018


DOI 10.5001/omj.2018.90


The authors declared no conflicts of interest. No funding was received for this study.


(1.) Framework for action on inter-professional education and collaborative practice. World Health Organization. Health workforce 2010 [cited 2018 May]. Available from: http://

(2.) Barr H, Koppel I, Hamminck M, Freeth D. Effective Inter professional Education: Assumption, Argument and Evidence. London: Blackwell; 2005.

(3.) Brandt BF, Cerra FB, Delaney CW. The United States National Center for Inter-professional Practice and Education: Integrating an informatics approach to inter-professional work. J Interprof Care 2015; 29(6):592-595.

(4.) Rajamani S, Westra BL, Monsen KA, LaVenture M, Gatewood LC. Partnership to promote inter-professional education and practice for population and public health informatics: A case study. J Interprof Care 2015; 29(6):555-561.

(5.) Centre for the Advancement of Inter-professional Education. What is CAIPE? 2018 [cited 2018 May]. Available from:

(6.) Haruta J, Sakai I, Otsuka M, Yoshimoto H, Yoshida K, Go to M, et al. Development of an inter-professional competency framework in Japan. J Interprof Care 2016 Sep; 30(5):675-677.

(7.) El-Awaisi A, Wilby KJ, Wilbur K, El Hajj MS, Awaisu A, Paravattil B. A Middle Eastern journey of integrating Inter-professional Education into the healthcare curriculum: a SWOC analysis. BMC Med Educ 2017 Jan; 17(1):15.

(8.) Brazeau GA. Inter-professional education: more is needed. Am J Pharm Educ 2013 Nov; 77(9):184.

(9.) McNeal GJ. Inter-professional education: an IOM imperative. ABNF J 2013; 24(3):69-70.

(10.) Nandan M, Scott PA. Inter-professional practice and education: holistic approaches to complex health care challenges. J Allied Health 2014 Aug; 43(3):150-156.

(11.) Inuwa IM. Inter-professional Education (IPE) activity amongst health sciences students at sultan qaboos university. Sultan Qaboos Univ Med J 2012 Nov; 12(4):435-441.

(12.) Al Harthy SN, Al Subhi N, Tuppal C, Renosa MD. A systematic review of the selected evidence on the effectiveness of inter-professional education (IPE) in developing interprofessional learning environment. Nurse Media Journal of Nursing 2016; 5(2):76-87.

(13.) Tuppal C, Renosa M, Al Harthy S. Extent of collaboration in Building academic-service partnerships in nursing. Nurse Media Journal of Nursing. 2016; 6(2):47-58.

(14.) Ministry of Health. Health Vision 2050. In: Under-secretariat for Planning Affairs. 1st ed. Sultanate of Oman: Ministry of Health; 2014.

(15.) Al-Riyami A. Health vision 2050: A committed step towards reforms. Oman Med J 2012 May; 27(3):190-191.

(16.) American Inter-professional Health Collaborative. What is AIHC? 2018 [cited 2018 May]. Available from: https://

(17.) Dobson RT, Stevenson K, Busch A, Scott DJ, Henry C, Wall PA. A quality improvement activity to promote inter professional collaboration among health professions students. Am J Pharm Educ 2009 Jul; 73(4):64.

(18.) Wallace SJ, Worrall L, Rose T, Le Dorze G. Core outcomes in aphasia treatment research: An e-delphi consensus study of international aphasia researchers. Am J Speech Lang Pathol 2016 Dec; 25(4S):S729-S742.

(19.) Dinner S. Content analysis in for educational science research: Meta-analysis, meta-synthesis, and descriptive content analysis. Bartin University Journal of Faculty of Education 2018; 7(1):176-190.

(20.) Holloway K. Doing the e-Delphi: Using online survey tools. CIN: Computers, Informatics. Nursing. 2012; 30(7):347-350.

(21.) Cole ZD, Donohoe HM, Stellefson ML. Internet-based Delphi research: case based discussion. Environ Manage 2013 Mar; 51(3):511-523.

(22.) Murphy K, Walker K, Duff J, Williams R. The collaborative development of a pre-operative checklist: An e-Delphi study. Journal of Peri-operative Nursing in Australia. 2016; 29(1):36-43.

(23.) Taylor RM, Feltbower RG, Aslam N, Raine R, Whelan JS, Gibson F. Modified international e-Delphi survey to define healthcare professional competencies for working with teenagers and young adults with cancer. BMJ Open 2016 May; 6(5):e011361.

(24.) Toronto CE. Health literacy competencies for registered nurses: An e-Delphi Study. J Contin Educ Nurs 2016 Dec; 47(12):558-565.

(25.) Vaughan-Graham J, Cott C. Defining a Bobath clinical framework-A modified e-Delphi study. Physiother Theory Pract 2016 Nov; 32(8):612-627.

(26.) Keeney S, McKenna H, Hasson F. The Delphi technique in nursing and health research. John Wiley & Sons; 2011. p. 1-17.

(27.) Donohoe H, Stellefson M, Tennant B. Advantages and limitations of the e-Delphi technique: Implications for health education researchers. Am J Health Educ 2012; 43(1):38-46.

(28.) Robertson HD, Elliott AM, Burton C, Iversen L, Murchie P, Porteous T, Matheson C. Resilience of primary healthcare professionals: A systematic review. The British Journal of General Practice. J R Coll Gen Pract 2016; 66(647):e423-e433.

(29.) Matheson C, Robertson HD, Elliott AM, Iversen L, Murchie P. Resilience of primary healthcare professionals working in challenging environments: a focus group study. Br J Gen Pract 2016 Jul; 66(648):e507-e515.

(30.) Banaszak-Holl JP, Zheng KP, Griffith JR. Critical next steps in developing evidence-based management of health care organizations. Health Care Management Review July/ September. 2009; 34(3):219-221.

(31.) Arndt M, Bigelow B. Evidence-based management in health care organizations: A cautionary note. Health Care Management Review 2009; 34(3):206-213.

(32.) Arndt M, Bigelow B. Response to the commentaries: evidence-based management in health care organizations: A cautionary note. Health Care Management Review 2009; 34(3):222-223.

(33.) Al Mawali AH, Al Qasmi AM, Al Sabahi SM, Idikula J, Elaty MA, Morsi M, et al. Oman vision 2050 for health research: A strategic plan for the future based on the past and present experience. Oman Med J 2017 Mar; 32(2):8696.

(34.) Engel J, Prentice D. The ethics of inter-professional collaboration. Nurs Ethics 2013 Jun; 20(4):426-435.

(35.) Hewison A, Sim J. Managing inter-professional working: using codes of ethics as a foundation. J Interprof Care 1998; 12(3):309-321.

(36.) Thompson SA, Tilden VP. Embracing quality and safety education for the 21st century: building inter-professional education. J Nurs Educ 2009 Dec; 48(12):698-701.

(37.) Batalden PB, Davidoff F. What is "quality improvement" and how can it transform healthcare? Qual Saf Health Care 2007 Feb; 16(1):2-3.

(38.) Alrashdi I, Al Qasmi A. Staff perception of relative importance of quality dimensions for patients at tertiary public services in Oman. Oman Med J 2012 Sep; 27(5):396401.

(39.) Al-Abri R, Al-Balushi A. Patient satisfaction survey as a tool towards quality improvement. Oman Med J 2014 Jan; 29(1):3-7.

(40.) Alam MG, Masum AK, Beh L-S, Hong CS. Critical factors influencing decision to adopt human resource information system (HRIS) in hospitals. PLoS One 2016 Aug; 11(8):e0160366.

(41.) Kim CS, King E, Stein J, Robinson E, Salameh M, O'Leary KJ. Unit-based inter-professional leadership models in six US hospitals. J Hosp Med 2014 Aug; 9(8):545-550.

(42.) Axelsson SB, Axelsson R. From territoriality to altruism in inter-professional collaboration and leadership. J Interprof Care 2009 Jul; 23(4):320-330.

(43.) Rabbani F, Hashmani FN, Mukhi AA, Gul X, Pradhan N, Hatcher P, et al. Hospital management training for the Eastern Mediterranean Region: time for a change? J Health Organ Manag 2015; 29(7):965-972.

(44.) Palumbo R. Cont-extualizing co-production of health care: a systematic literature review. Int J Public Sector Management 2016; 29(1):72-90.

(45.) Ranjan KR, Read S. Value co-creation: Concept and measurement. Academy of Marketing Science Journal 2016; 44(3):290-315.

(46.) Matziou V, Vlahioti E, Perdikaris P, Matziou T, Megapanou E, Petsios K. Physician and nursing perceptions concerning inter-professional communication and collaboration. J Interprof Care 2014 Nov; 28(6):526-533.

(47.) Shoham DA, Harris JK, Mundt M, McGaghie W. A network model of communication in an inter-professional team of healthcare professionals: A cross-sectional study of a burn unit. J Interprof Care 2016 Sep; 30(5):661-667.

(48.) Molyneux J. Interprofessional teamworking: what makes teams work well? J Interprof Care 2001 Feb; 15(1):29-35.

(49.) Hewitt G, Sims S, Harris R. Evidence of communication, influence and behavioural norms in inter-professional teams: a realist synthesis. J Interprof Care 2015 Mar; 29(2):100105.

(50.) Winter-bottom F, Seoane L. Crossing the quality chasm: it takes a team to build the bridge. Ochsner J 2012; 12(4):389393.

(51.) Song H, Ryan M, Tendulkar S, Fisher J, Martin J, Peters AS, et al. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study. Health Care Manage Rev 2017 Jan/Mar; 42(1):28-41.

(52.) Wilbur K, Hasnani-Samnani Z, Kelly I. Inter-professional education activity among undergraduate nursing and pharmacy students in the middle east. Nurse Educ 2015 Jul-Aug; 40(4):163-164.

(53.) Kapral O. Healthcare managers on inter-professional teams. J Interprof Care 2011 Jan; 25(1):77-78.

(54.) Mitchell R, Parker V Giles M, Boyle B, Boyle B. The ABC of health care team dynamics: understanding complex affective, behavioral, and cognitive dynamics in inter-professional teams. Health Care Manage Rev 2014 Jan-Mar; 39(1):1-9.

Said Nasser Al Harthy [1], Cyruz P. Tuppal [1] *, Ana E. Sta Ana [1], Jenny Reynecke [1], Imad Al Husami [1] and Abdallah Al Rubaiey [2]

[1] Health Service Management Program, Higher Institute for Health Specialties, Ministry of Health, Muscat, Oman

[2] Health Specialty Education, Office of the Undersecretary of Planning Affairs, Ministry of Health, Muscat, Oman

Caption: Figure 1: Inter professional education competency domains for health service managers in Oman. (1,14)
Table 1: Profile characteristics of the experts
(n = 20).

Characteristics               n (%)

Health professions
  Nursing                   6 (30.0)
  Medicine                  3 (15.0)
  Laboratory science        3 (15.0)
  Pharmacy                  4 (20.0)
  Medical imaging science   2 (10.0)
  Physiotherapy             2 (10.0)

  Education                 7 (35.0)
  Practice                  13 (65.0)

Management experience
  5-14                      16 (80.0)
  15-20 +                   4 (20.0)

  < 30-39                   16 (80.0)
  40-60 +                   4 (20.0)

  Male                      6 (30.0)
  Female                    14 (70.0)

Education level
  Masters                   15 (75.0)
  Doctorate                 2 (10.0)
  Medical doctor            3 (15.0)

Table 2: Overall interprofessional competency
domains based on the level of importance (n = 20).

Interprofessional          Level of importance

competency          Mean   IQD    Consensus   Pass
Resilience          4.7    0.40     95.0      Yes
Research leverage   4.7    0.60     94.8      Yes
Interprofessional   4.7    0.80     94.0      Yes
Quality             4.7    0.80     94.0      Yes
Information         4.6    0.80     93.2      Yes
Leadership          4.5    1.00     91.6      Yes
Management skills   4.5    0.80     91.0      Yes
Communication       4.5    1.00     90.8      Yes
Team dynamics       4.5    1.00     90.0      Yes

IQD: interquartile distribution.
Statements with a mean > 4.4 andIQD < 1.25 and where consensus
reached 80.0% were considered to have a higher level of importance.

Table 3: Interprofessional competency indicators and level
of importance (n = 20).

Competency domain                           Level of importance

                                       Mean  IQD   Consensus  Pass

  Is patient, tenacious, and           4.9   0.00    99.0     Yes
  resourceful when seeking
  information to satisfy a request
  or complete a project.

  Deals effectively with pressure and  4.8   0.00    97.0     Yes
  remain optimistic and persistent,
  even under adversity.

  Adapts to stressful situations.      4.8   0.00    96.0     Yes

  Maintains progress when handling     4.7   1.00    94.0     Yes
  multiple tasks and projects, even
  under stressful situations or when
  faced with competing deadlines.

  Utilizes critical thinking in        4.4   1.00    89.0     Yes
  decision making concerning the
  organization, patients, families,
  communities, and own profession.

Research leverage

  Has a sound background in research   4.9   0.00    99.0     Yes
  process (e.g., conceptualization,
  planning, empirical, analysis,
  dissemination, and translation).

  Continues to integrate evidence to   4.9   0.00    98.0     Yes
  inform the health professions on
  effective service improvement

  Advocates research as a tool         4.6   1.00    93.0     Yes
  towards knowledge management and
  restructuring of the organization
  whenever necessary.

  Able to translate the available      4.6   1.00    92.0     Yes
  findings from scholarly works to
  support organizational performance.

  Commits oneself in producing         4.6   1.00    92.0     Yes
  scientific outputs relevant to
  patient care, customer service
  initiatives, and overall
  organizational success.

Interprofessional ethics

  Builds consensus based on the        4.8   0.00    96.0     Yes
  ethical principles regarding
  planning, directing, organizing,
  and controlling.

  Cultivates mutual respect and        4.8   0.00    96.0     Yes
  shared values for the health
  profession and practice.

  Promotes a productive culture by     4.7   0.75    95.0     Yes
  valuing individuals and their

  Acts with honesty and integrity in   4.7   0.75    94.0     Yes
  relationships with patients,
  families, and other team members.

  Appreciates cultural diversity and   4.4   1.00    89.0     Yes
  inclusion of each health

Quality improvement

  Engages in continuous professional   4.7   0.75    95.0     Yes
  and interprofessional development
  to enhance team performance.

  Uses both internal and external      4.7   0.75    95.0     Yes

  sources of feedback for insight and
  engagement in self-regulation and

  Initiates quality improvement        4.7   1.00    94.0     Yes

  Uses quality improvement             4.6   1.00    93.0     Yes
  approaches and
  strategies to heighten
  interprofessional collaboration
  and teamwork.

  Measures competencies of             4.6   1.00    93.0     Yes
  each unit where collaboration
  is in effect.

Information technology

  Understands the principles upon      4.7   0.75    95.0     Yes
  which organizational and
  professional health information
  system used by healthcare
  professionals and patients are

  Evaluates information and its        4.7   0.00    94.0     Yes
  sources critically and incorporates
  selected information into his or
  her knowledge and value system.

  Assures confidentiality of           4.7   1.00    94.0     Yes
  protected patient health
  information when using health
  information systems under his or
  her control.

  Understands and uses the Internet    4.6   1.00    92.0     Yes
  and the World Wide Web.

  Knows various types of health        4.5   1.00    91.0     Yes
  information systems, their
  clinical, and administrative uses.


  Establishes goals, deliverables,     4.8   0.00    97.0     Yes
  timelines, and budgets.

  Develops future leaders by being     4.8   0.00    96.0     Yes
  involved in the organization-wide
  mentoring program.

  Leads process improvement programs   4.4   1.00    89.0     Yes
  in all major systems falling under
  the area of control.

  Holds responsible for providing      4.4   1.00    89.0     Yes
  measurable, timely, cost-effective,
  and high-quality results.

Management skills

  Formulates objectives and            4.8   0.00    97.0     Yes
  priorities and implements plans
  consistent with the long-term
  interests of the organization.

  Designs approaches and procedures    4.7   0.75    95.0     Yes
  to develop a strategic plan.

  Acknowledges organizational          4.4   1.00    89.0     Yes

  strengths and develops a plan to
  address areas needing improvement.

  Develops innovative customer         4.4   1.00    88.0     Yes
  service initiative which
  significantly improves quality and
  enhances customer satisfaction.


  Able to integrate the                4.6   1.00    92.0     Yes
  organization's vision despite
  professional differences.

  Communicates plans and activities    4.6   1.00    92.0     Yes
  in a manner that supports the
  entire organization.

  Expresses oneself effectively both   4.5   1.00    91.0     Yes
  orally and in written form.

  Values the diversity of the           4.5   1.00    90.0     Yes
  organization to develop trusting
  and professional working
  relationships with the patients,
  families, communities, and

  Skillfully settles differences by    4.4   1.00    89.0     Yes
  using a win-win approach to
  maintain trusting working

  professional relationships.

Team dynamics

  Collaborates with other              4.7   0.75    94.0     Yes
  professionals in an interactive
  open communication and
  interpersonal skills.

  Shares responsibility and            4.5   0.75    91.0     Yes
  accountability with other
  professions toward patient's and
  organization's outcomes.

  Appreciates the process of teamwork  4.5   1.00    91.0     Yes
  and team development.

IQD: interquartile distribution.

Statements with a mean [greater than or equal to] 4.4 and IQD [less
than or equal to] 1.25 and where consensus reached 80.0% were
considered to have a higher level of importance.
COPYRIGHT 2018 SyndiGate Media Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2018 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Harthy, Said Nasser Al; Tuppal, Cyruz P.; Reynecke, Ana E. Sta Ana Jenny; Husami, Imad Al; Rubaiey,
Publication:Oman Medical Journal
Article Type:Report
Geographic Code:7OMAN
Date:Nov 1, 2018
Previous Article:Patent Contralateral Processus Vaginalis in Infants and Children: Is Herniotomy Justified.
Next Article:Childbirth Fear and Associated Factors in a Sample of Pregnant Iranian Women.

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters