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Background: Collaborative care is a philosophy that guides the work of interdisciplinary teams, patients, and their families internationally. Hospital organizations must create and cultivate environments to meet customer, health policy, and legislative mandates for improved collaborative care. This study aimed to inform and aid cultural change related to collaborative care relationships with the goal of improving the quality of care. Methods and Findings: A critical ethnography using mixed methodologies was conducted at a mid-sized non-acute hospital in Ontario, Canada. This article presents Phase 3 of a three-phase study that engaged senior leaders (SLs) in interviews about customer service and collaborative relationships. Phase 3 findings were triangulated with prior Phase 1 study results from healthcare providers (HCPs) and Phase 2 results from mid-level leaders (MLLs). The combined findings from all three phases formed a description of the organization's culture (self-awareness, congruency, and health), explicated five organizational tensions, and generated questions and innovative change ideas to advance growth toward a shared vision of "partners in care." Conclusions: A shared conceptual model of partners in care emerged from the shared conversations held in the research focus groups and interviews over the three phases in the study. Organizational questions, tensions, and possibilities were revealed to advance the culture of collaboration with patients, families, and staff. Innovations were identified and implemented to enhance collaborative practice. [ABSTRACT FROM AUTHOR]

Healthcare organizations are striving to meet legislated and public expectations to include patients as equal partners in their care, and research is needed to guide successful implementation and outcomes. The current research examined the meaning of customer service as related to the culture of care relationships within a Canadian hospital in southeastern Ontario. The goals were to better understand these expectations, develop shared meanings and influence cultural change from the perspective of the organization's employees about their interactions with patients, families and work colleagues, and to generate ideas and groundswell for change. An ethnographic approach within the critical research paradigm was used over the course of a three phase study, where direct care healthcare providers (Phase 1), mid-level leaders (Phase 2) and senior leaders (Phase 3) volunteered to explore their values, philosophies and suggestions for change in the organization's care relationships. This paper describes Phase 2 of the overall research project. A mixed methodology was used where mid-level leaders were individually surveyed and then participated in a focus group and/or interview to discuss these concepts. Mid-level leaders indicated that providing excellent customer service was important in their own work with many customers including staff, patients and their families, students, volunteers and outside agencies. They believed that this in turn led to improved partnerships for care, health service transitions and linkages, customer satisfaction and health outcomes. The majority stated that the organization's culture would support change related to customer service relationships and opportunities for this were explored. [ABSTRACT FROM AUTHOR]