“It’s Not Just About Getting Along”: Exploring Learning Through the Discourse and Practice of Interprofessional Collaboration (original) (raw)
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Interprofessional Perspectives on Teamwork in Health Care: A Case Study
The Milbank Memorial Fund Quarterly. Health and Society, 1983
team came to be viewed as an integral part of health care delivery and the sine qua non for getting tasks done. Yet much of the literature on teamwork has remained mainly prescriptive and has rarely been analytical. Anyone familiar with health care literature must largely assume that interprofessional teamwork is alive and doing well. The purpose of this study is to reexamine and challenge the literature's presentation of the " interdisciplinary team" concept. (For a typology of "team ," see Petrie 1976 and Schmitt 1981. In this study " inter professional" and " interdisciplinary" team are used interchangeably and refer to a phenomenon of practice that includes a physician and a nurse.) The study explores the assumption that a phenomenon of practice variously called an " interprofessional" or "interdisciplinary" team exists, and is an easily identifiable, well-defined, and bounded unit. What is known is that there exists a certain arrangement between health professionals who practice together. This paper proposes that there is a discrepancy between nursing's and medicine's views and expectations of " interdisciplinary team" and that this has important consequences for the viability of the interdisciplinary model of practice as it is portrayed in the literature. (For a historical review of the M ilb an k M em orial Fun d
Interprofessional Team Collaboration in Health Care
Introduction- Health care is a multifaceted activity which requires health care professionals to work together for the patient or service users in a collaborative way to deliver the desired outcome. Hospitals are complex organisations humming with activities of heterogeneous groups of people such as doctors, nurses, paramedical and administrative staff, all working with a common goal of providing health care to service users (Kaini 2005, p.1). Health care professionals work together in a collaborative manner in various forms. It involves complex interactions between two or more members of different professional disciplines (Reel and Hutchings, 2007, pp.137). In a basic form, health care professionals consult their patients or service users and, each other as required, about the services needed by their service users. In more complex form of care, health care professionals work more closely, identifying together with service users what care services are required, who provides them and what adjustments need to be made to the health care plan and management. WHO (2010) asserts that ‘it is no longer enough for health workers to be professional, in the current global climate, health workers also need to be interprofessional (WHO, 2010, pp.36).
What do doctors mean when they talk about teamwork? Possible implications for interprofessional care
Journal of Interprofessional Care, 2018
The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.
Learning in Critical Care a Focused Ethnography of Interprofessional Learning Culture
2019
Adult critical care is complex; therefore, the workforce develops specialist knowledge. Whilst interprofessional collaboration is concomitant with critical care, the ways different professions learn together are indistinct. This thesis explores the factors influencing interprofessional learning (IPL) culture in adult critical care, providing rich insight into staff perceptions and experiences of IPL, and investigates factors that promote or inhibit IPL in this acute care environment. IPL culture was explored using focused ethnography, adopting an interpretive epistemological position, with an ontological stance of social constructionism. Data collected over 12 months, in three adult critical care units in North East England, used partial participant observation and semi-structured interviews with critical care professions. Rich ethnographic data was thematically analysed. Findings showed that IPL occurred in all environments studied, but engagement with IPL differed across professions and potential IPL opportunities were missed. IPL culture was shaped by individuals, teams and organisations, and a changeable IPL climate existed which was affected by holistic influential factors. The environment was key to embedding IPL; in a space the visibility of professions promoted IPL more than their proximity, and each critical care department adapted spaces for IPL to occur. The IPL environment guide developed from the research findings indicates ways to enhance IPL. Whilst formal IPL opportunities were limited, professions perceived safe holistic patient centred care as a shared motivation to learn from others. Professions shared knowledge based upon their assumptions of peers' expertise, and IPL was enhanced when rationales underpinned instructions and when decision-making was interprofessional; the CAUSE decision-making model is a framework developed that incorporates rationales to promote IPL. Four stages of IPL were observed: preparing, enquiring, acting, and sharing, and IPL was enhanced when staff effectively collaborated, felt safe to ask questions, and when they humanised their professional role through humour and emotions as members of the community of critical care practice. With rich insight into the complexities of IPL in adult critical care, further work is needed to explore potential IPL improvements based upon the ethnographic findings in this thesis.
Junior doctors' experiences with interprofessional collaboration: Wandering the landscape
Medical Education, 2021
Context: The transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice that form the Landscape of Practice (LoP). This study aims to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice. Methods: In this multicentre qualitative study, 13 junior doctors individually drew two rich pictures of IPC experiences, one positive and one negative. A rich picture is a visual representation, a drawing of a particular situation intended to capture the complex and non-verbal elements of an experience. We used semi-structured interviews to deepen the understanding of junior doctors' depicted IPC experiences. We analysed both visual materials and interview transcripts iteratively, for which we adopted an inductive constructivist thematic analysis. Results: While transitioning into a doctor, junior doctors become foremost members of the physician CoP and shape their professional identity based on perceived values in their physician community. Interprofessional learning occurs implicitly, without input from the interprofessional team. As a result, junior doctors struggle to bridge the gap between themselves and the interprofessional team, preventing IPC learning from developing into an integrative process. This professional isolation leaves junior doctors wandering the landscape of practice without understanding roles, attitudes and expectations of others. Conclusions: Learning IPC needs to become a collective endeavour and an explicit learning goal, based on multisource feedback to take advantage of the expertise already present in the LoP. Furthermore, junior doctors need a safe environment to embrace and reflect on the emotions aroused by interprofessional interactions, under the guidance of experienced facilitators.
BMC Medical Education
Background Interprofessional collaborative practice (IPCP) offers great potential to improve healthcare. Increases in IPCP will require educating learners in authentic IPCP settings and will generate opportunities and challenges. Methods In January 2015, we implemented an IPCP model called Collaborative Care (CC) for hospitalized adult medical patients. We explored learner perspectives regarding their educational experiences. We deductively coded transcripts from semi-structured interviews with medical learners. Data related to educational experiences were thematically analyzed. Results Twenty-four of 28 (85.7%) medical learners rotating on CC from January to May 2015 completed interviews. Subsequent inductive analysis of these interviews identified four themes: Loss of Educational Opportunities during Rounds, Feelings of Uncertainty during New Situations, Strategies for Adaptation, and Improved Communication with Patients and the Team. Conclusions Increased implementation of IPCP w...