Reports

The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members' various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient's problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.     

Interprofessional learning for pre-qualification health care students: an outcomes-based evaluation

Within health, it is widely acknowledged that a collaborative, team-oriented approach to care is required to ensure patient safety and quality of service delivery. A pre-qualification interprofessional learning experience should provide an ideal opportunity for students to gain the necessary knowledge, skills and attitudes to enable them to work as part of a patient-centred interprofessional team. In this article we report a multidimensional evaluation of a pre-qualification interprofessional learning (IPL) program. The program brings together senior year students from various health care professions on clinical placement in the same service area of a hospital to take part in shared, structured learning experiences centred on interprofessional teamwork. We used a combination of qualitative and quantitative methods to evaluate the IPL program. Results indicate that students' understanding of the roles of other team members was enhanced, and students and supervisors perceived the program to be of value for student learning. Measured changes in attitude were limited. Unexpected findings emerged in relation to role responsibilities within teams and attitudes towards doctors. We conclude that such programs have the potential to expand students' understanding of the contributions made by other professionals/colleagues to effective patient care, although challenges persist in overcoming pre-existing role stereotypes.     

Utilization of research methodology in designing and developing an interdisciplinary course in ethics

Within health, it is widely acknowledged that a collaborative, team-oriented approach to care is required to ensure patient safety and quality of service delivery. A pre-qualification interprofessional learning experience should provide an ideal opportunity for students to gain the necessary knowledge, skills and attitudes to enable them to work as part of a patient-centred interprofessional team. In this article we report a multidimensional evaluation of a pre-qualification interprofessional learning (IPL) program. The program brings together senior year students from various health care professions on clinical placement in the same service area of a hospital to take part in shared, structured learning experiences centred on interprofessional teamwork. We used a combination of qualitative and quantitative methods to evaluate the IPL program. Results indicate that students' understanding of the roles of other team members was enhanced, and students and supervisors perceived the program to be of value for student learning. Measured changes in attitude were limited. Unexpected findings emerged in relation to role responsibilities within teams and attitudes towards doctors. We conclude that such programs have the potential to expand students' understanding of the contributions made by other professionals/colleagues to effective patient care, although challenges persist in overcoming pre-existing role stereotypes.     

Professionals' perceptions of interprofessional working in community mental health teams

This paper seeks to establish whether the presence of core structures influences professionals' perceptions of interprofessional working within their teams by means of a cross-sectional questionnaire survey of all professionals working in integrated community mental health teams in an identified NHS Trust. The findings confirm that the interprofessional teams were integrated, but that the presence of meetings, Care Programme Approach policy or operational policy had little influence on perceptions of interprofessional working. Joint policies on documentation, risk and supervision were related to perceptions of interprofessional working. The majority of professionals were clear about their roles, but perceived that other members of the team did not recognise or understand these roles. Questions arise about how identified structures are operationalised in interprofessional teams. Practice areas may need to examine the effectiveness of the identified meetings and the involvement of the different professionals.     

Professionals' perceptions of interprofessional working in community mental health teams

This paper seeks to establish whether the presence of core structures influences professionals' perceptions of interprofessional working within their teams by means of a cross-sectional questionnaire survey of all professionals working in integrated community mental health teams in an identified NHS Trust. The findings confirm that the interprofessional teams were integrated, but that the presence of meetings, Care Programme Approach policy or operational policy had little influence on perceptions of interprofessional working. Joint policies on documentation, risk and supervision were related to perceptions of interprofessional working. The majority of professionals were clear about their roles, but perceived that other members of the team did not recognise or understand these roles. Questions arise about how identified structures are operationalised in interprofessional teams. Practice areas may need to examine the effectiveness of the identified meetings and the involvement of the different professionals.     

Sustainable interprofessional teamwork needs a team-friendly healthcare system: Experiences from a collaborative Dutch programme

ABSTRACT

The significance of effective interprofessional teamwork to improve the quality of care has been widely recognised. Effective interprofessional teamwork calls on good collaboration between professionals and patients, coordination between professionals, and the development of teamwork over time. Effective development of teams also requires support from the wider organisational context. In a Dutch village, healthcare professionals work closely together, and mutual consultations as well as interprofessional meetings take place on a regular basis. The network was created as a precondition for sustainable interprofessional teamwork in elderly care. However, several external barriers were experienced regarding the supportive structure and cooperative attitude of the healthcare insurer and municipality. The aim of the article is to examine these experience-based issues regarding internal organisation, perspective, and definition of effective teamwork. Complicating factors refer to finding the right key figures, and the different perspectives on team development and team effectiveness. Our conclusion is that the organisation of healthcare insurance companies needs to implement fundamental changes to facilitate an interprofessional care approach. Furthermore, municipalities should work on their vision of the needs and benefits of a fruitful collaboration with interprofessional healthcare teams. The challenge for healthcare teams is to learn to speak the language of external partners. To support the development of interprofessional teams, external parties need to recognise and trust in a shared aim to provide quality of care in an efficient and effective way.     

Family physicians’ perspectives on interprofessional teamwork: Findings from a qualitative study

The aim of this study was to describe family physicians’ perspectives of their role in the primary care team and factors that facilitate and hinder teamwork. A qualitative study was conducted employing individual interviews with 19 academic/community-based family physicians who were part of interprofessional primary care teams in Edmonton, Alberta, Canada. Professional responsibilities and roles of physicians within the team and the facilitators and barriers to teamwork were investigated. Interviews were audiotaped, transcribed and analysed for emerging themes. The study findings revealed that family physicians consistently perceived themselves as having the leadership role on in the primary care team. Facilitators of teamwork included: communication; trust and respect; defined roles/responsibilities of team members; co-location; task shifting to other health professionals; and appropriate payment mechanisms. Barriers to teamwork included: undefined roles/responsibilities; lack of space; frequent staff turnover; network boundaries; and a culture of power and control. The findings suggest that moving family physicians toward more integrative and interdependent functioning within the primary care team will require overcoming the culture of traditional professional roles, addressing facilitators and barriers to teamwork, and providing training in teamwork.     

Team effectiveness in academic primary health care teams

Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.     

Changing student attitudes through interaction: Findings from an interprofessional workshop

Healthcare professionals are increasingly expected to work in interprofessional teams. Students therefore need opportunities to learn and practise skills that will allow them to be effective team members when they enter the workforce. This article summarises an interprofessional learning experience for 289 undergraduate and graduate students representing 13 programmes in a College of Health Professions (CHP) at a US public university. The half-day workshop provided an opportunity for participants with no prior interprofessional education to collaborate in a problem-solving case study and to inform students of other professions about their professions. Faculty members from all CHP programmes collaborated in writing the case study and facilitating student discussions during the event. Attitudes related to interprofessional collaboration and professional roles were assessed prior to and after workshop participation. A paired t test showed a statistically significant difference in four attitude questions. Participants reported a significant increase in understanding the roles of other professionals in healthcare and community situations. They also reported an increased understanding of the benefits and challenges of working in interprofessional teams. This event successfully introduced participants to interprofessional collaboration and provided them the opportunity to share their professional expertise and understand the expertise of others.     

Teaching interprofessional teamwork skills to health professional students: A scoping review

An expanding body of literature is examining interprofessional teamwork and its effect in healthcare. To produce capable healthcare professionals prepared to participate in interprofessional roles, teamwork training must begin early in health professional students’ training. The focus of this scoping review was to explore interprofessional education (IPE) studies designed to teach and/or assess interprofessional teamwork skills to students from two or more different health professions, to find and describe effective pedagogy and assessment strategies. Using a scoping review methodology, 1,106 abstracts were reviewed by three teams of investigators. Eligibility criteria were inclusion of students in interprofessional teams, an intervention to improve interprofessional teamwork skills and assessment of outcomes related to teamwork. Thirty-three studies met the criteria for inclusion. The literature was varied in terms of study design, teaching methods and assessment measures for interprofessional teamwork. The lack of rigorous, comparable studies in this area makes recommending one teaching method or assessment measure over another difficult. Regardless of teaching method, it appears that most learning activities where interprofessional teams interact result in positive changes in student perceptions and attitudes towards IPE and practice. As health education programs seek to incorporate more interprofessional activities into their respective programs, it is important to review methods and measures that would best fit their individual program. This review highlights the importance of standardising the reporting of methods and outcomes for those who wish to incorporate the studied methods into their curricula.     

Hierarchies in interprofessional training

ABSTRACT

Adverse patient outcomes are often the result of conflict or poor communication among healthcare professionals. Use of interprofessional care teams can improve healthcare and delivery of services. Healthcare systems have been historically hierarchical in nature with physicians regularly taking a leadership position. The presence of hierarchy can be a source of conflict in interprofessional healthcare teams. This article analyzes qualitative data from a four-day interprofessional training for family medicine residents, pharmacy students, nurse practitioner students, and counseling psychology students. Data was collected through journals, participant observation, and focus groups. Findings from this study demonstrate three key themes related to hierarchy: (1) tension regarding the idea that the physician is the team leader or “quarterback,” (2) experiences of marginalization by team members while working in interprofessional teams, and (3) the tendency for issues regarding hierarchy to go unresolved. Additionally, authors briefly address structures within healthcare that contribute to hierarchy as well as a discussion of alternative models of teamwork and healthcare delivery.     

Reply to Manthorpe & Iliffe

Effective interprofessional collaboration is considered essential for optimum healthcare delivery. Studies have investigated interprofessional education (IPE) as a means for improving collaborative practice, and evidence suggests that the clinical setting offers opportunities for interprofessional learning (IPL). Little is known, however, about the aspects of clinical practice that students perceive as meaningful to their IPL. This study explores physiotherapy students' experiences of collaborative working, and identifies their perceptions of the skills used and factors affecting interprofessional interactions in the clinical setting. Twenty second-year physiotherapy students studying in London provided written critical incident reports describing good and poor interprofessional collaborative encounters in the clinical setting. The data were subjected to thematic content analysis. Students identified communication and interprofessional relationships as the main factors affecting collaboration and perceived teamwork in formal contexts (e.g., team meetings) as generally effective with positive outcomes for professionals and patients. Informal collaboration was perceived to be poor and attributed primarily to insufficient direct contact and communication. The wide range of described experiences and learning outcomes indicate that clinical placements provide potentially valuable IPL opportunities. Facilitating the development of informal (ad hoc) collaborative teamwork skills is proposed as an important consideration when planning and implementing IPE in this setting.     

Does time matter? Exploring the relationship between interdependent teamwork and time allocation in Swedish interprofessional teams

This paper explores the relationship between time allocation on formal and informal forms of contact within interprofessional teams and an interdependent collaboration. Data were collected by a questionnaire including items on work organization, team climate and time allocation that was responded to by 226 professionals from 44 interprofessional teams. An additional sample of 139 professionals from 18 teams responded to the same questionnaire except for the item on time allocation. The teams worked within occupational health care, psychiatry, rehabilitation and school health care. On average, team members spent about 22% of their available work time on internal meetings/consultations and they perceived their collaboration as fairly interdependent. No correlation was found between, on the one hand, time invested in meetings and informal consultations within the team and, on the other hand, degree of team interdependence. Instead, interdependence was predicted by team climate, followed by manager coordination and self-regulation. However, there may be a lower limit: all 44 teams allocated at least about 10% of their work time to internal meetings and consultations. The results suggest three ways to strengthen interprofessional team collaboration – development of team climate and communication and more opportunity for both manager coordination and self-regulation.     

Does time matter? Exploring the relationship between interdependent teamwork and time allocation in Swedish interprofessional teams

This paper explores the relationship between time allocation on formal and informal forms of contact within interprofessional teams and an interdependent collaboration. Data were collected by a questionnaire including items on work organization, team climate and time allocation that was responded to by 226 professionals from 44 interprofessional teams. An additional sample of 139 professionals from 18 teams responded to the same questionnaire except for the item on time allocation. The teams worked within occupational health care, psychiatry, rehabilitation and school health care. On average, team members spent about 22% of their available work time on internal meetings/consultations and they perceived their collaboration as fairly interdependent. No correlation was found between, on the one hand, time invested in meetings and informal consultations within the team and, on the other hand, degree of team interdependence. Instead, interdependence was predicted by team climate, followed by manager coordination and self-regulation. However, there may be a lower limit: all 44 teams allocated at least about 10% of their work time to internal meetings and consultations. The results suggest three ways to strengthen interprofessional team collaboration - development of team climate and communication and more opportunity for both manager coordination and self-regulation.     

Interprofessional empathy: A four-stage model for a new understanding of teamwork

ABSTRACT

Collaboration in healthcare implies that health providers share responsibility and partner with each other in order to provide comprehensive patient care. A review of the empirical literature on teamwork in healthcare settings suggests that the relationships between service providers remain conflictual and variable in commitment to interprofessional collaboration. Recently, social psychologists have given considerable attention to the possibility that empathy could be used to improve intergroup attitudes and relations. Although empathy may be referred to as a means to humanize healthcare practices, few published studies from the healthcare literature focus on the nature of interprofessional empathy. Understanding frameworks different from your own and empathizing with other members of the team is fundamental to collaborative practice. The aim of this study was to understand the nature of empathy among members of interprofessional teams within a hospital environment. This study followed the lived experience of 24 health professionals with their perspective of empathy on interprofessional teams. A two-step procedure was used consisting of semi-structured interviews and depth interviews. Phenomenological data analysis was used to identify common themes and meanings across interviews. From the findings, a four-stage developmental model of interprofessional empathy emerged: Stage 1 is engaging in conscious interactions; Stage 2 requires using dialogical communication; Stage 3 is obtained when healthcare professionals consolidate understanding through negotiating differences between each other; and Stage 4 shows mastery of nurturing the collective spirit. Knowledge of this stage model will provide clinicians with the information necessary to develop awareness of how day-to-day activities within their interprofessional teams influence the development of interprofessional empathy.     

A patient-centred team-coaching concept for medical rehabilitation

Team coaching enhances teamwork and subsequently improves patient-centredness in medical rehabilitation clinics. Even though interprofessional teamwork is regarded as a crucial factor in medical rehabilitation, to date no evaluated team-coaching approaches are available for improving interprofessional teamwork in medical rehabilitation in Germany. Based on a systematic literature search and interviews with staff, managers, and patients of rehabilitation clinics, we developed a team-coaching approach that is standardized in its process but based on the individual needs and requests of each clinic. It takes a systemic perspective and is goal-oriented and solution-focused. The approach mainly serves to provide impulses to make use of resources within the team and to support a self-directed organisational learning process. It is manualized and can, therefore, be used by professionals aiming to improve interprofessional teamwork in their clinic. A multi-centre, cluster-randomized controlled study that was conducted to evaluate the team-coaching approach showed positive results. Team organization, knowledge integration, and responsibility can be improved, and, therefore, the implementation of the patient-centred team-coaching approach in interprofessional rehabilitation teams can be recommended.     

Modelling the effect of perceived interdependence among mental healthcare professionals on their work role performance

The purpose of mental healthcare system reform was to enhance service efficiency by strengthening primary mental healthcare and increasing service integration in communities. Reinforcing interprofessional teamwork also intended to address the extensive and multidimensional needs of patients with mental disorders by bringing together a broader array of expertise. In this context, mental healthcare professionals (MHCPs) from various health and social care professions are more interdependent in many aspects of their work (tasks, resources, and goals). We wanted to examine the effect of perceived interdependence among MHCPs on their work role performance in the context of mental healthcare. For this purpose, we developed and tested a model coherent with the Input-Mediator-Outcome-Input (IMOI) framework of team effectiveness. Data from questionnaires administered to 315 MHCPs from four local health service networks in Quebec, Canada were analysed through structural equation modelling and mediation analysis. The structural equation model provided a good fit for the data and explained 51% of the variance of work role performance. Perceived collaboration, confidence in the advantages of interprofessional collaboration, involvement in the decision process, knowledge sharing, and satisfaction with the nature of the work partially mediated the effect of perceived interdependence among team members on work role performance. Therefore, perceived interdependence among team members had a positive impact on the work role performance of MHCPs mostly through its effect on favourable team functioning features. This implies, in practice, that increased interdependence of MHCPs would be more likely to truly enhance work role performance if team-based interventions to promote collaborative work and interprofessional teaching and training programs to support work within interprofessional teams were jointly implemented. Participation in the decision process and knowledge sharing should also be fostered, for instance, by adopting knowledge management best practices.     

Scottish healthcare student's perceptions of an interprofessional ward simulation: An exploratory,descriptive study

The most memorable learning occurs during placement. Simulated interprofessional learning is a logical learning opportunity to help healthcare professionals work beyond their professional silos. In this qualitative study, we investigated the perceived learning of students from six health professions (adult nursing, diagnostic radiography, occupational therapy, physiotherapy, dietetics, and pharmacy) from their participation in a 45 min interprofessional ward simulation. Semistructured focus groups were undertaken, and data were analyzed using framework analysis. Two overarching themes were evident, each of which had subthemes: (i) the ward simulation as an interprofessional education opportunity (subthemes: reality of situations and interactions); and (ii) the perceived learning achieved (subthemes: professional roles, priorities, respect, communication, teamwork, and quality of care). The results indicated that a short interprofessional ward simulation, unsupported by additional learning opportunities or directed study, is a useful and engaging interprofessional learning opportunity. Students appear to have learnt important key messages central to the interprofessional education curricula to help develop practitioners who can effectively work together as an interprofessional team, and that this learning is partly due to simulation allowing things to go wrong.     

Interprofessional health care teams: attitudes and environmental factors associated with participation by community pharmacists

The purpose of this study was to determine whether community pharmacists are prepared to assume a more active role as members of the primary health care team. A secondary objective was to develop multi-items scales for future studies involving pharmacists, as well as other health professions. This paper reports on rates of participation by community pharmacists as members of interprofessional health care teams, the extent to which this participation was related to pharmacists' attitudes about their preparedness for this role, their relationship with physicians, and their assessment of potential barriers to interprofessional teamwork within their practice setting. A mail questionnaire was sent to community pharmacists across Canada between February and April, 2004. The overall response rate was 35.2% (470/1337) with the highest response rate in the Prairie Provinces (40.6%) and the lowest in Quebec (24.4%). Pharmacists on teams were more likely to agree their training and skills were sufficient to participate, and to report good relations with physicians. Pharmacists on teams were more likely to agree there was more opportunity to meet and get to know other health disciplines, and to see teamwork as part of their role. They were also more likely to agree physicians wanted their input, and less likely to see other disciplines as being too protective of their professional "turf". Pharmacists on teams did not differ from those not on teams in rating lack of time, bad past experiences with teamwork, financial reimbursement or proximity to other health care workers as barriers to being a member of a community-based primary care team.     

Exploring physiotherapy students' experiences of interprofessional collaboration in the clinical setting: a critical incident study

Effective interprofessional collaboration is considered essential for optimum healthcare delivery. Studies have investigated interprofessional education (IPE) as a means for improving collaborative practice, and evidence suggests that the clinical setting offers opportunities for interprofessional learning (IPL). Little is known, however, about the aspects of clinical practice that students perceive as meaningful to their IPL. This study explores physiotherapy students' experiences of collaborative working, and identifies their perceptions of the skills used and factors affecting interprofessional interactions in the clinical setting. Twenty second-year physiotherapy students studying in London provided written critical incident reports describing good and poor interprofessional collaborative encounters in the clinical setting. The data were subjected to thematic content analysis. Students identified communication and interprofessional relationships as the main factors affecting collaboration and perceived teamwork in formal contexts (e.g., team meetings) as generally effective with positive outcomes for professionals and patients. Informal collaboration was perceived to be poor and attributed primarily to insufficient direct contact and communication. The wide range of described experiences and learning outcomes indicate that clinical placements provide potentially valuable IPL opportunities. Facilitating the development of informal (ad hoc) collaborative teamwork skills is proposed as an important consideration when planning and implementing IPE in this setting.