# Initial programme theory developing for interprofessional case discussions (InCaD) in acute hospital care: a realist approach

## TL;DR

This study creates a framework for interprofessional case discussions in hospitals using a realist approach to improve patient care and staff outcomes.

## Contribution

The paper introduces an initial programme theory for InCaD using realist methodology to explain how and why it works in acute hospital care.

## Key findings

- Key mechanisms include interprofessional reflection, structured protocols, and shared decision-making.
- Contextual factors like leadership support and nurse leadership are crucial for successful InCaD implementation.
- Outcomes include improved patient care quality and staff job satisfaction.

## Abstract

Interprofessional case discussions (InCaD) are vital for managing complex patient care in acute hospital settings. Despite their widespread use, the absence of theoretical frameworks hinders consistent implementation and evaluation. This study aims to develop an initial programme theory for InCaD using a realist methodology to identify Context-Mechanism-Outcome (CMO) configurations.

This study employed a multi-method approach grounded in the realist methodology following a prospective approach of the RAMESES II reporting standards for realist evaluations. Data were collected from three sources: internal programme documents, a systematic review (N = 42), and stakeholder focus group interviews (N = 17) involving nurses, physicians, managers and therapists. Internal programme documents provided an understanding of theoretical foundations and informed the review and interview design. The systematic review followed PRISMA 2020 guidelines and included studies on multiprofessional case discussions in inpatient settings. Focus group interviews were conducted with hospital stakeholders to explore practical insights into the implementation and impact of InCaD. Data synthesis involved generating CMO-configurations through thematic coding and iterative team discussions.

The analysis identified direct mechanisms, such as interprofessional reflection, structured protocols, and shared decision-making, and indirect mechanisms, such as fostering team trust and a culture of learning. Key outcomes for patients included improved care quality, satisfaction, and continuity, while staff outcomes encompassed enhanced job satisfaction, team cohesion, and workflow efficiency. Contextual factors, including leadership support and tailored adaptations, were crucial for successful implementation. Nurse leadership emerged as a significant driver of InCaD’s effectiveness.

This study provides a theory-driven framework for systematically implementing and evaluating InCaD in clinical practice. By understanding the interactions of context, mechanisms, and outcomes, healthcare organizations can enhance patient safety, care quality, and staff well-being. Future research should validate and refine these findings in diverse healthcare settings to inform broader applications.

The online version contains supplementary material available at 10.1186/s12913-025-13865-5.