The value of a quality improvement project in promoting interprofessional collaboration

The teamwork that is required for interprofessional collaboration in healthcare is not an inherent attribute of the current system, and must be fostered. Education, training, and role modelling are important enablers. From our experience we posit that participating in a quality improvement project can be also be an excellent vehicle to promote interprofessional collaboration.     

Sustaining interprofessional collaboration

There has been much written about new interprofessional collaborations, rather less about established or terminated collaborations. This paper briefly rehearses well known factors that encourage and discourage interprofessional collaboration, before considering factors that may help sustain collaborations or signal that termination of the collaboration is appropriate. The Clinical Skills Initiative at St Bartholomew's in London, UK is offered as a case study of a sustained interprofessional collaboration. It will be argued that a combination of continued need to collaborate and empowerment to do so, creates favourable conditions for sustained collaboration. The composition of the interprofessional team that comprises the collaboration is also seen as key.     

Interprofessional collaboration in palliative nursing: what is the patient-family role?

Interprofessional collaboration occurs when health professionals from different disciplines work together to identify needs, solve problems, make joint decisions on how best to proceed, and evaluate outcomes collectively. Interprofessional collaboration supports patient-centred care and takes place through teamwork. Team interactions, wider organizational issues, and environmental structures, such as safety, quality, efficiency and effectiveness issues influence this model of care. These broader contextual influences affect practice where there are tensions between the ideals of interprofessional collaboration and the realities of practice. This is evident when the patient and family position in interprofessional collaboration is considered. This article will discuss factors that affect interprofessional collaboration in relation to patients and families in palliative care. First, a definition of interprofessional collaboration is given, followed by an outline of the need for interprofessional collaboration. A brief discussion of key issues that influence collaboration follows, and a review of the implications for practice is presented.     

Examining the implementation of collaborative competencies in a critical care setting: Key challenges for enacting competency-based education

Interprofessional collaboration is recognised as an important factor in improving patient care in intensive care units (ICUs). Competency frameworks, and more specifically interprofessional competency frameworks, are a key strategy being used to support the development of attitudes, knowledge, skills, and behaviours needed for an interprofessional approach to care. However, evidence for the application of competencies is limited. This study aimed to extend our empirically based understanding of the significance of interprofessional competencies to actual clinical practice in an ICU. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers’ perspectives, behaviours, and interactions of interprofessional collaboration in a medical surgical ICU in a community teaching hospital in Canada. Approximately 160 hours of observations were undertaken and 24 semi-structured interviews with healthcare workers were conducted over a period of 6 months. Data were analysed using a directed content approach where two national competency frameworks were used to help generate an understanding of the practice of interprofessional collaboration. Healthcare professionals demonstrated numerous instances of interprofessional communication, role understandings, and teamwork in the ICU setting, which supported a number of key collaborative competencies. However, organisational factors such as pressures for discharge and patient flow, staffing, and lack of prioritisation for interprofessional learning undermined competencies designed to improve collaboration and teamwork. The findings demonstrate that interprofessional competencies can play an important role in promoting knowledge, attitudes, skills, and behaviours needed. However, competencies that promote interprofessional collaboration are dependent on a range of contextual factors that enable (or impede) individuals to actually enact these competencies.     

Interprofessional collaboration in the ICU: how to define?*

The intensive care unit (ICU) is a dynamic, complex and, at times, highly stressful work environment that involves ongoing exposure to the complexities of interprofessional team functioning. Failures of communication, considered examples of poor collaboration among health care professionals, are the leading cause of inadvertent harm across all health care settings. Evidence suggests effective interprofessional collaboration results in improved outcomes for critically ill patients. One recent study demonstrated a link between low standardized mortality ratios and self-identified levels of collaboration. The aim of this paper is to discuss determinants and complexities of interprofessional collaboration, the evidence supporting its impact on outcomes in the ICU, and interventions designed to foster better interprofessional team functioning. Elements of effective interprofessional collaboration include shared goals and partnerships including explicit, complementary and interdependent roles; mutual respect; and power sharing. In the ICU setting, teams continually alter due to large staff numbers, shift work and staff rotations through the institution. Therefore, the ideal 'unified' team working together to provide better care and improve patient outcomes may be difficult to sustain. Power sharing is one of the most complex aspects of interprofessional collaboration. Ownership of specialized knowledge, technical skills, clinical territory, or even the patient, may produce interprofessional conflict when ownership is not acknowledged. Collaboration by definition implies interdependency as opposed to autonomy. Yet, much nursing literature focuses on achievement of autonomy in clinical decision-making, cited to improve job satisfaction, retention and patient outcomes. Autonomy of health care professionals may be an inappropriate goal when striving to foster interprofessional collaboration. Tools such as checklists, guidelines and protocols are advocated, by some, as ways for nurses to gain influence and autonomy in clinical decision-making. Protocols to guide ICU practices such as sedation and weaning reduce the duration of mechanical ventilation in some studies, while others have failed to demonstrate this advantage. Existing organizational strategies that facilitate effective collaboration between health care professionals may contribute to this lack of effect.     

Physicians’ attitudes about interprofessional treatment of chronic pain: family physicians are considered the most important collaborators

Scand J Caring Sci; 2013; 27; 303–310 Physicians’ attitudes about interprofessional treatment of chronic pain: family physicians are considered the most important collaborators Aims and objectives: Interprofessional collaboration is the process in which different professional groups work together to positively impact health care. We aimed to explore physicians’ attitudes toward interprofessional collaboration in the context of chronic pain management with the implication that if attitudes are not positive, appropriate interventions could be developed. Design: A quantitative attitudes study. Ethical issues: The ethical committee approved the study. Methods: A web‐based survey about interprofessional treatment of chronic pain was administered to physicians. Outcome measures were as follows: physicians’ demographic and workplace information, previous experience of working within an interprofessional team, and attitudes towards interprofessional collaboration in chronic pain management. Results: There were 90 physicians who responded to the survey. Physicians had positive attitudes towards team work in the context of chronic pain, but they were undecided about sharing their role within an interprofessional team. The family physician was singled out as the most important as well as the most common collaborator in chronic pain treatment. Interprofessional educational seminars and workshops were suggested as methods for improving interprofessional collaboration. Conclusions: Interprofessional collaboration may be enhanced with continuing medical education that will bring together different healthcare professionals, enable them to exchange experiences and learn about their potential roles within a team.     

Promotion of role clarification in the Health Care Team Challenge

Interprofessional collaboration has consistently been associated with positive client-care outcomes. Role clarification is one facet of interprofessional collaboration that is thought to be crucial for effective interprofessional team functioning. Given the positive outcomes associated with interprofessional collaboration, educators have begun to integrate formal interprofessional education events into healthcare curricula. The Health Care Team Challenge (HCTC) is a collaborative competition designed to promote interprofessional competencies among students in healthcare fields. The current study empirically investigated whether this event promoted role clarification among participants. Sixteen participants in five healthcare professions (occupational therapy, physiotherapy, clinical psychology, nursing, and medicine) completed two questionnaires to assess role clarification before and after participating in this event. Results indicate that participants’ understanding of their own and other professions’ roles improved after participating in this team activity. These results suggest that the HCTC is effective in promoting role clarification and collaboration among healthcare students.     

The global emergence of IPE and collaborative care

Abstract

As the United States faces an impending shortage in the primary care workforce, interprofessional teamwork training to improve clinic efficiency and health outcomes is becoming increasingly important. Currently there is limited integration of interprofessional training in educational models for health professionals. The implementation of Patient Aligned Care Teams at the Department of Veterans Affairs (VA) has provided an opportunity for interprofessional collaboration among trainee and faculty providers within the VA system. However, integration of interprofessional education is also necessary to train future providers in order to provide effective team-based care. We describe a transportable educational model for health professional collaboration from our experience as a VA Center of Excellence in Primary Care Education, including a complementary novel one-year post-Master’s adult nurse practitioner interprofessional clinical fellowship. With growing recognition that interprofessional care can improve efficiency and outcomes, there is an increasing need for programs that train future providers in collaboration and team-based care.     

The untapped potential of behaviour analysis and interprofessional care

ABSTRACT

Interprofessional collaboration has become a sought-after component of quality mental health care. Higher education institutions and mental health organizations seek to equip clinicians with the ability to provide cohesive clinical services while working collaboratively with a diverse group of professionals. Although research suggests that there may be benefits of interprofessional collaboration in mental health settings, collaborative practice initiatives have struggled with conceptual and methodological limitations. A behaviour analytic contribution to interprofessional care provides a philosophical position with an analytical goal distinguished by the prediction and influence of events, theoretical clarity, and methodological rigour that are needed within interprofessional research and practice. At the philosophical level, the extension of functional contextualism to interprofessional care research may provide a framework to achieve the valued ends of improving interprofessional collaboration and ultimately improving health-related outcomes for service users. Interprofessional collaboration can be conceptualized as metacontingency, a behaviour analytic concept that allows for a group level analysis of contributing social components. This paper uses the example of mental health care to guide a conceptual analysis of the potential application of behaviour analytic methodology within interprofessional practice, research, and education.     

Interprofessional student meetings in municipal health service - Mutual learning towards a Community of Practice in patient care

Mutual engagement is fundamental in interprofessional collaboration. This paper investigated how mutual engagement evolves in interprofessional student meetings when medical, nursing, occupational therapy and physiotherapy students shape their own collaboration and learning in patient care. We conducted a qualitative study with an ethnographic design. The data material consists of 200 hours of observations across nine student groups and two informal conversations with each student group during a two-week clinical placement in the period of 2014–2015. The interprofessional student meetings and the informal conversations were audio recorded, and field notes were prepared from our observations of the student activities. In the data analysis, we relied on an interpretative thematic analysis and used the sociocultural theory of learning as an interpretative framework. The analysis showed that mutuality evolved through three types of mutual engagement: facilitating interactions, actual interactions and clarifying further interactions. In conclusion, complex mutual engagement in patient care evolved and was maintained in interprofessional student meetings when the students had an explicit opportunity to shape their own interprofessional collaboration and learning. The students’ opportunity to shape the interprofessional collaborative practice in patient care themselves appeared to be a criterion for success.     

Can one eat collaboration? Menus as metaphors of interprofessional collaboration

The turn of the century has seen a sudden upsurge in publications and initiatives around the development of interprofessional collaboration in Japan. In Japanese, the term 'team-treatment' is generally used to mean interprofessional collaboration, but hitherto there have been no generally accepted definitions and conceptualizations of the term, nor are there guidelines as to how it may be implemented in practice. In order to facilitate understanding of the different modes of interprofessional collaboration and issues in practice, we introduced the use of menus as metaphors for interprofessional collaboration in a class of first year students of nursing. There were two 90-minute classes available for exploring this topic. Through the use of a metaphor the students demonstrated they were able to conceptualize interprofessional collaboration, identify the value of nurses working together with other professionals and issues involved in making team-treatment work. The purpose of this paper is to share the experience of using metaphors as a teaching/learning strategy, including reflection on the successes and some limitations of what, for us, was an interesting educational innovation.     

A conceptual model for interprofessional education: the international classification of functioning, disability and health (ICF)

A shared language and conceptual framework is essential to successful interprofessional collaboration. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a shared language and conceptual framework that transcends traditional disciplinary boundaries. This paper will familiarize readers with the ICF and describe the biopsychosocial perspective that is adopted in its conceptual framework and language. The presentation of a case study will illustrate how the ICF can enhance interprofessional learning by promoting a multidimensional perspective of an individual's health concerns. The case study will also highlight the value of the shared language and conceptual framework of the ICF for interprofessional collaboration. It is argued that a strong foundation in the principles exemplified by the ICF may serve to enhance interprofessional communication, and in so doing, encourage involvement in interprofessional collaboration and healthcare.     

Leadership characteristics for interprofessional collaboration in China

AimTo explore the perceptions of health professionals and educators regarding the characteristics of leadership that they believed were required for successful interprofessional education and interprofessional collaboration initiatives in China.BackgroundLeadership is a key competency in the successful implementation of any collaborative initiative in healthcare. However, there are few studies about leadership characteristics how these facilitate interprofessional collaboration in health care, especially in China.MethodsData for this secondary analysis came from a qualitative study of Interprofessional Team Development in China. Grounded theory methods were used to analyze fifteen semi-structured interviews from the original study.FindingsThe three leadership characteristics extracted that facilitated interprofessional collaboration were: 1) serving as a role model of Junzi (according to Confucianism the idea person); 2) initiating and maintaining collaboration; and 3) showing benevolence to all team members during interprofessional collaboration. One overarching category that surfaced throughout the interviews was that leaders who behaved in ways congruent with typical Chinese cultural expectations for leadership would be most effective.ConclusionThis study describes the characteristics of leadership for interprofessional collaboration, providing directions for training and cultivation of healthcare professionals and workers so that they are better prepared for and work more effectively in interprofessional collaborative practice.     

How the past influences interprofessional collaboration between obstetricians and midwives in the Netherlands: Findings from a secondary analysis

Collaborations between groups of professionals often have a long history, which can still influence contemporary practice. If problems in the collaboration occur, the search for effective interventions for these problems may be informed by analysing current practice as well as the historical development of the collaboration. The study focused on the collaboration between obstetricians and midwives in the Netherlands. We performed a secondary analysis of questionnaire data focusing on midwives evaluating the collaborative performance of obstetricians in the Netherlands. Template analysis was used to analyse the questionnaires. The initial template was based on a model for interprofessional collaboration. As a final step, we reflected on the results in light of the historical development of the collaboration. The midwives experienced a power imbalance and a lack of trust and mutual acquaintanceship in their collaboration with obstetricians. They also reported a need for interprofessional governance and formalization. Most of these reported problems in the collaboration have their origin in the historical development of both professions and in the development of the collaboration between both professional groups. Combining an exploration of contemporary interprofessional practice with a historical perspective on interprofessional collaboration is fruitful for understanding problems in collaboration between professional groups, and provides guidance for improving collaboration.     

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.     

Views from the field: Medical student experiences and perceptions of interprofessional learning and collaboration in rural settings

Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning and collaboration, (c) experiencing the importance of social connections to interprofessional collaboration and learning, and (d) realisations that interprofessional collaboration is a means of overcoming barriers in rural areas. We discuss our findings using the socio-material perspective of complexity theory. These findings may be used to inform undergraduate programs in re-defining, re-creating, developing, and fostering interprofessional learning opportunities for medical students in rural communities as well as to support clinical faculty through ongoing professional development.     

Do multidisciplinary integrated care pathways improve interprofessional collaboration?

This paper reports on the evaluation stage of an action research project on interprofessional collaboration in discharge planning. Findings from interviews with health care professionals working in the acute sector had revealed concerns about discharge planning and multidisciplinary teamwork. In the United Kingdom the National Health Service (NHS) Plan has reinforced the need for an integrated approach to health care. Effective health care integration requires effective communication, teamwork and the commitment to deliver integrated care. Integrated documentation is a key strategy for enhancing interprofessional collaboration and reducing the isolation of professionals, and has been successfully implemented in a range of health care settings. Presented with the concerns about the collaborative process in discharge planning, an action research strategy was chosen to bring about change in an orthopaedic ward in one London teaching hospital. This paper will evaluate the implementation of an integrated care pathway with fractured neck of femurs in one London teaching hospital. Care pathways facilitate the management of defined patient groups using interdisciplinary plans of care. The emphasis will be on understanding whether integrated care pathways enhance and develop interprofessional collaboration and enable effective information access and flow across the professions and the organization. The criteria for evaluation, forming the hypotheses of the study, were that interprofessional nonverbal and verbal communication would be enhanced and that interprofesisonal collaboration would increase. Methods of evaluation used were: (i) stakeholder interviews, (ii) interprofessional audit and (iii) analysis of the variances from the integrated care pathway. The evaluation revealed that although integrated care pathways led to improved outcomes for the health care trust there was little evidence to suggest that interprofessional relationships and communication were enhanced. Furthermore, key factors in discharge delays appeared to be organizational rather than professional.     

The “elephant in the room”: using emotion management to uncover hidden discourses in interprofessional collaboration and teamwork

Abstract

Shared decision-making and interprofessional collaboration are important approaches to achieving consumer-centered care. The concept of shared decision-making has been expanded recently to include the interprofessional healthcare team. This study explored healthcare providers’ perceptions of barriers and facilitators to both shared decision-making and interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers, including medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Healthcare providers identified several factors as barriers to, and facilitators of shared decision-making that could be categorized into three major themes: factors associated with mental health consumers, factors associated with healthcare providers and factors associated with healthcare service delivery. Consumers’ lack of competence to participate was frequently perceived by mental health specialty providers to be a primary barrier to shared decision-making, while information provision on illness and treatment to consumers was cited by healthcare providers from all professions to be an important facilitator of shared decision-making. Whilst healthcare providers perceived interprofessional collaboration to be influenced by healthcare provider, environmental and systemic factors, emphasis of the factors differed among healthcare providers. To facilitate interprofessional collaboration, mental health specialty providers emphasized the importance of improving mental health expertise among general practitioners and community pharmacists, whereas general health providers were of the opinion that information sharing between providers and healthcare settings was the key. The findings of this study suggest that changes may be necessary at several levels (i.e. consumer, provider and environment) to implement effective shared decision-making and interprofessional collaboration in mental healthcare.     

Perceptions of interprofessional collaboration within child mental health care in Norway

The present study investigates professionals' perceptions of interprofessional collaboration (IPC) in the field of mental health care for children and adolescents. In this study, a 48-item questionnaire was developed to measure perceptions of interprofessional collaboration. A theoretical model (PINCOM) is presented and suggests that interprofessional collaboration is perceived at the individual-, group- and organizational level. The questionnaire was distributed to a sample consisting of 157 professionals in Western Norway. The results of this exploratory study show that the most prominent constructs of collaboration perceived by the professionals were: motivation, group leadership, social support and organizational culture. Furthermore, results indicate that women are more oriented than men toward IPC aspects of communication, coping and organizational domain. It is suggested that the questionnaire may be used to help improve interprofessional collaboration in clinical practice by indicating new ways to enhance dialogue between professionals and to investigate changes in perception of interprofessional collaboration over time. Limitations of the present study were identified and suggestions for future studies within the field are provided.