Interprofessional Team

Collaboration (IPTC) in Hospitals

Bachchu Kailash Kaini

PhD Student (Part Time)

Business School

University of Greenwich

Context

• Health care is multifaceted and complex activity

• Changes in demographic structure and disease pattern

• Increased cost of care

• Concept of specialties and sub-specialties emerging

• Expansion of roles of health care professionals (HCPs)

• Well informed patients and more choices

• Changing health care environment requires new ways of working & collaborative practice

Hospital Environment

Medical Nursing

AHPs

Organisational Policies

Organisational Structures

Resources Available

Boards & Functional

Teams

Voluntary Sectors

Professional Groups

Legislations Community

Government

Regulatory Bodies

Other Service Providers

Commissioners

Service Users

Admin & Mgmt

• Occupation refers to someone’s job

• Occupation can become profession when:

– It gains full status and identity

– It goes through various stages of training, education

and qualifications

– It is recognition by a regulatory body or authority

– It gains high degree of autonomy

• Profession is special type of occupation

Occupation and Profession

• A group of people who have undertaken a given

programme of education and/or training, and as

a result of this are permitted to become part of

much larger and somewhat exclusive group (Hammick et al, 2009).

• Characteristics of profession

– Intellectual activities

– Based on science and learning

– Used for practical purposes

– Can be taught

– Organised internally

– Altruistic (Flexer, 1915; quoted in Ducanis and Golin, 1979)

Profession

• IPC is a collaborative working (Leathard, 2003;

HFO, 2007; Hawley, 2007) in which HCPs share

common purpose of developing mutually

negotiated goals (Payne, 2000; Pietroni, 1992)

which are achieved through agreeing a care

plan, the management of it and procedures

(Colyer, 2012).

• IPC to happen in practice, HCPs:

– Pool their skill, knowledge and expertise

– Shared professional view points

– Make joint decision

– Learn from each other

Interprofessional Care

IPC, Teamwork and Collaboration

Collaboration

Teamwork

Differing forms of interprofessional work (Reeves et al, 2010; p.44)

Different but Shared Approaches

Medical

AHPs Nursing

Knowledge

Professional Contribution

Skills

Expertise

Personal Attributes

Care Philosophies

Problem-solving Styles

Professional Culture

Interprofessional Team Collaboration

IP Team Formation •Team composition •Hierarchies •Roles and responsibilities •Protocols and strategies •Resources

IP Team Development •Leadership •Support for team •Training & development •Regular review •Reward

IPTC •Collaboration •Co-ordination •Co-operation •Commitment •Communication •Cohesion •Openness & trust

Desired Outcome of IPTC

For Service Users Satisfied Service Users

Healthy Life Improved Health Status

For HCPs Satisfied Workforce Professional Growth Employee Retention

Shared Goal of Interprofessional Team Collaboration (IPTC) (Effective Delivery of Health Care)

Impact of IPTC

Team Performance Wider range of expertise & shared decision making

Burden and challenges shared Tasks divided between members

Greater efficiency in the use of resources

Staff Satisfaction

Satisfied work force Professional growth Employee retention

Support and motivation from each other

Quality of Care

Consistent and continuity of care Timely and appropriate referral Reduced harms and incidents Reduced ambiguous message

Satisfied service users

Better Interaction, Communication and Co-operation

Communicate closely and clearly Honest and open interaction

Authenticity of communication Procedural documents

Delivery of Health Care Holistic approach

Improve standards of service delivery

Impact of IPTC

Team Performance Wider range of expertise & shared decision making

Burden and challenges shared Tasks divided between members

Greater efficiency in the use of resources

Staff Satisfaction

Satisfied work force Professional growth Employee retention

Quality of Care

Consistent and continuity of care Timely and appropriate referral Reduced harms and incidents Reduced ambiguous message

Satisfied service users

Better Interaction, Communication and Co-operation

Communicate closely and clearly Honest and open interaction

Authenticity of communication Procedural documents

Delivery of Health Care Holistic approach

Improve standards of service delivery

Theoretical Constructs of IPTC

Division of Labour

(Specialisation and Increased Productivity,

Social & Technical Div. of Labour)

Role Theory

(Roles & Responsibilities,

Leadership, Decision Making,

Training & Education)

Human Factors

(Communication, Interaction, Professional

culture, Ethics, Personality)

Theory of Profession

(Professional Power, Identity,

Autonomy, Boundaries etc.)

• Realising the value of IPTC

• Interprofessional education & training

• Different professional cultures

• Professional identity, power and structures

• Roles and responsibilities

• Human factors

Issues and Challenges

Focus of the Study

Medical

Nursing AHPs Collaboration

Teamwork

Interprofessional Care

HCPs Satisfied Workforce Professional Growth Employee Retention

Impact to HCPs Interprofessional Team

Collaboration Input for Health Care

Research Questions

• How do various health care professionals

interact and collaborate in hospitals?

• What is the impact of IPTC on HCPs’ job

satisfaction, employee retention and

professional growth?

• To identify and analyse various factors that

support and hinder IPTC

• To examine the understanding of and

perceptions of IPTC among health care

professionals

• To examine the impact of IPTC on job

satisfaction, employee retention and

professional growth

• To make recommendations for improving

interprofessional team collaborative practices

Research Objectives

First Exploration – Pilot Study

• Team of HCPs – medical, nursing and AHPs

• Qualitative and quantitative study, semi-structure interview schedule & questionnaire used

• Observation of the clinical practice

• Findings of the pilot study – IPTC is part of their professional life

– Roles and responsibilities of HCP well defined

– Variety of personal and interprofessional skills and competencies are required to deliver effective interprofessional care

– Professional autonomy is accepted and respected

– IPTC is desirable as it brings many benefits to service users and HC professionals

– IPTC boost employee morale and increase job satisfaction

– Few opportunities for interprofessional learning and training are available at the organisational level

Research Methodology

• Mixed methods - qualitative and quantitative methods

• Purposive sampling

• Three hospitals in Nepal – public, private and voluntary hospitals

• Different teams with a different composition and types of professionals

• Survey - questionnaire

• Interviews with HCPs - semi structured schedule

• Documents and secondary data analysis

• Cross tabulation, frequency, descriptive analysis and correlation

• Phenomenological approach

References

• Bope, E.T., & Jost, T.S. (1994). Interprofessional collaboration: factors that affect form, function and structure, in R. Michael Casto and Maria C. Julia, Interprofessional care and collaborative practice. California: Brooks/Cole Publishing. pp 61 – 69.

• Canadian Health Services Research Foundation (2006). Teamwork in Health Care: Promoting effective teamwork in health care in Canada. CHSRF. http://www.chsrf.ca/Migrated/PDF/ResearchReports/CommissionedResearch/teamwork-synthesis-report_e.pdf. Accessed on 4 September 2012.

• Colyer, H. (2012). Responsibilities and accountabilities in interprofessional working. In G. Koubel and H. Bungay (eds.), Rights, risks and responsibilities: Interprofessional working in health and social care. Basingstoke: Palgrave Macmillan.

• Duncanis, A.J. and Golin, A.K. (1979). The Interdisciplinary Health Care Team: A Handbook. Maryland: Aspen Systems Corporation.

• Hammick, M., Freeth D., Copperman, J and Goodsman. D. (2009). Being Interprofessional. Cambridge: Polity.

• Hawley, G. (ed.) (2007). Ethics in clinical practices: an interprofessional approach. Essex: Pearson Education.

• Health Force Ontario (HFO), (2007). Interprofessional Care: A Blueprint for Action in Ontario, Interprofessional Care Project. Ontario: Health Force Ontario.

• Leathard, A. (2003). Interprofessional Collaboration: From Policy to Practice in Health and Social Care. East Sussex: Routledge.

• Payne, M. (2000). Teamwork in Multiprofessional Care. New York: Palgrave.

• Pietroni, P. (1992). ‘Towards reflective practice – the language of health and social care’, Journal of Interprofessional Care. 1: 7 – 16.

• Reves, S., Lewin, S., Espin, S. and Zwarenstein, M. (2010). Interprofessional teamwork for health and social care. West Sussex: Wiley-Blackwell.