04.01.01. Interprofessional collaboration
MRTs practice and actively engage in interprofessional collaboration within the healthcare setting to improve care delivery and patient outcomes
Importance of interprofessional collaboration
- While traditional team training programs focus on mutual support and backup behaviour, healthcare teams are unique in that not all team members are licensed or equipped to provide backup on tasks (e.g., differing scopes of practice, reliance upon a chain of command). For these reasons, collaborative team models are appropriate in these groups.1
- According to the World Health Organization (WHO), collaborative practice in healthcare occurs “when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings. It allows health workers to engage any individual whose skills can help achieve local health goals.”2
- Interprofessional collaboration (IPC) is the comprehensive process by which multiple professionals work together to deliver quality care,3,4 including MRTs.5–9
- Over the past decade, fostering IPC has become a global demand of policymakers, health organizations, and healthcare professions worldwide.2,4,7,10
- The responsibility of IPC is not solely with managers and policymakers because it requires the active participation of working professionals in the process.11
- This approach of engaging multiple health workers from different professional backgrounds working together with patients, families, and communities has been shown to provide a high quality of patient care.12
- Sufficient IPC may lead to better patient outcomes in terms of objective (e.g., reduced morbidity and mortality rates, length of stay, readmission, and improved communications) and/or subjective outcomes (e.g., patient ratings of satisfaction, willingness to recommend healthcare services to others, the perceived success of treatment).10,12–15
- Although positive results have been demonstrated, some research has indicated there is insufficient cumulative evidence to state which IPC intervention strategies positively impact the delivery of care to patients. Continued research regarding IPC intervention strategies is required.3
- MRTs benefit from IPC through7:
- enhancing patient-centred care,
- improving communication skills,
- supporting role clarity,
- improving team functioning, and
- decreasing conflict.
- In addition, research has shown that teamwork between healthcare professions may decrease workload,16 promote job satisfaction,17–19 and contribute to planning and decision-making in the field of human resources.17,20
Interprofessional collaboration in practice
- Healthcare practitioners and professions contribute differently to IPC. Moreover, differences exist between collaborative settings and healthcare subsectors.11
- Although evidence is limited, some research has shown three distinct ways in which practitioners contribute to ICP:
- by bridging professional, social, physical and task-related gaps;
- by negotiating overlaps in roles and tasks; and
- by creating spaces to be able to complete these tasks.
- Key elements that may contribute to fostering IPC in practice are:
- improving engagement with point of care clinicians,
- providing teams with authority to make process changes,
- incorporating capable improvement coaches within the team,
- incorporating a team leader with improvement expertise and organizational authority,
- creating capable administrative direction,
- employing supportive organizational leaders,
- conducting weekly progress reviews,
- receiving timely educational material, and
- using structured problem-solving methods.21
- The National Interprofessional Competency Framework for Canada, applicable from student to practitioner, presents six interconnecting interprofessional competency domains that are essential to demonstrate IPC.4,22
- Interprofessional Communication – learners/practitioners from different professions communicate with each other in a collaborative, responsive, and responsible manner.
- Patient/Client/Family/Community-Centred Care – learners/practitioners seek out, integrate, and value, as a partner, the input and the engagement of the patient/client/ family/community in designing and implementing care/services.
- Role Clarification – learners/practitioners understand their role and the roles of those in other professions and use this knowledge appropriately to establish and achieve patient/client/family and community goals.
- Team Functioning – learners/practitioners understand the principles of teamwork dynamics and group/team processes to enable effective interprofessional collaboration.
- Collaborative Leadership – learners/practitioners understand and can apply leadership principles that support a collaborative practice model.
- Interprofessional Conflict Resolution – learners/practitioners actively engage self and others, including the client/patient/family, in positively and constructively addressing disagreements as they arise.
- Elements of collaboration include respect, trust, shared decision making, and partnerships.2
- MRTs can increase their understanding of interprofessional collaboration by reviewing the National Interprofessional Competency Framework4 and strive for IPC.
Support for interprofessional education
- Interprofessional education (IPE) has been defined by WHO as when “two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes”.2
- Working professionals may be exposed to IPE through participating in IPE themselves, teaching IPE courses, and/or supporting students in IPE within clinical settings.
- IPE can occur at an individual-level or team-level intervention. However, IPE generally includes outcome goals of improvement at multiple levels, including individual (e.g., individual learning), the team (e.g., cohesion), and organizational levels (e.g., return on investment).23
- Extensive literature has shown that IPE promotes interdisciplinary collaboration and teamwork,3,24 reduces the barriers and preconceptions prevailing among various healthcare groups, promotes professional competencies, and increases professional pride.16,25–27
- A recent meta‐analysis has shown a persistently positive response to IPE by students in terms of their attitudes, perceptions, collaborative knowledge, and skills.28
- The effectiveness of IPE is perceived to have a greater impact when incorporated in workplace-based teaching and assessment pedagogies.25,29
- Formal opportunities exist for established professionals to participate in IPE.
- MRTs may find it useful to pursue such opportunities as part of their continuing professional development.
- Clinical leadership can play a pivotal role in connecting IPE to IPC within practice.25
References
- Hughes AM, Gregory ME, Joseph DL, et al. Saving lives: A meta-analysis of team training in healthcare. J Appl Psychol. 2016;101(9):1266-1304. doi:10.1037/apl0000120
- World Health Organization. Framework for action on interprofessional education and collaborative practice. World Health Organization; 2010:1-64. Accessed June 8, 2020. http://www.who.int/hrh/resources/framework_action/en/
- Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2017;(6). doi:10.1002/14651858.CD000072.pub3
- Canadian Interprofessional Health Collaborative. National interprofessional competency framework. Accessed June 25, 2020. https://drive.google.com/file/d/1kuNVQK5HpqHShJMItH0QpkJBybYYLtvR/view?usp=drive_open&usp=embed_facebook
- Lam J, Ng B, Shen S, Wong C. How is interprofessional collaboration applied by radiation therapists in the radiation therapy department in British Columbia? J Med Imaging Radiat Sci. 2015;46(3):S43-S51.e2. doi:10.1016/j.jmir.2015.04.016
- Busari JO, Moll FM, Duits AJ. Understanding the impact of interprofessional collaboration on the quality of care: A case report from a small-scale resource limited health care environment. J Multidiscip Healthc. 2017;10:227-234. doi:10.2147/JMDH.S140042
- Shah J, Harford JS, DuCharme PA, Pierce B, Alberico T, Steelman CB. Interprofessional collaboration in global health radiology. In: Mollura DJ, Culp MP, Lungren MP, eds. Radiology in global health: strategies, implementation, and applications. Springer International Publishing; 2019:113-126. doi:10.1007/978-3-319-98485-8_11
- Goh P, Prospero LD. The grey area: An exploration of the scope of practice for nurses and radiation therapists within the radiation oncology program focusing on interprofessional collaborative competencies of role clarity, communication, and team function. J Med Imaging Radiat Sci. 2017;48(1):11-15. doi:10.1016/j.jmir.2017.02.001
- Moore QT. Integrating interprofessional essentials into the imaging sciences. Radiol Technol. 2019;90(4):398-404.
- Kaiser L, Bartz S, Neugebauer EAM, Pietsch B, Pieper D. Interprofessional collaboration and patient-reported outcomes in inpatient care: Protocol for a systematic review. Syst Rev. 2018;7(1):126. doi:10.1186/s13643-018-0797-3
- Schot E, Tummers L, Noordegraaf M. Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. J Interprof Care. 2020;34(3):332-342. doi:10.1080/13561820.2019.1636007
- Zanotti R, Sartor G, Canova C. Effectiveness of interprofessional education by on-field training for medical students, with a pre-post design. BMC Med Educ. 2015;15(1):121. doi:10.1186/s12909-015-0409-z
- Tremblay D, Roberge D, Touati N, Maunsell E, Berbiche D. Effects of interdisciplinary teamwork on patient-reported experience of cancer care. BMC Health Serv Res. 2017;17(1):218. doi:10.1186/s12913-017-2166-7
- Will KK, Johnson ML, Lamb G. Team-based care and patient satisfaction in the hospital setting: A systematic review. J Patient-Centered Res Rev. 2019;6(2):158-171. doi:10.17294/2330-0698.1695
- Fewster-Thuente L, Velsor-Friedrich B. Interdisciplinary collaboration for healthcare professionals. Nurs Adm Q. 2008;32(1):40-48. doi:10.1097/01.NAQ.0000305946.31193.61
- Harnett N, Bak K, Lockhart E, et al. The clinical specialist radiation therapist (CSRT): A case study exploring the effectiveness of a new advanced practice role in Canada. J Med Radiat Sci. 2018;65(2):86-96. doi:10.1002/jmrs.281
- Espinoza P, Peduzzi M, Agreli HF, Sutherland MA. Interprofessional team member’s satisfaction: A mixed methods study of a Chilean hospital. Hum Resour Health. 2018;16. doi:10.1186/s12960-018-0290-z
- Chang W-Y, Ma J-C, Chiu H-T, Lin K-C, Lee P-H. Job satisfaction and perceptions of quality of patient care, collaboration and teamwork in acute care hospitals. J Adv Nurs. 2009;65(9):1946-1955. doi:10.1111/j.1365-2648.2009.05085.x
- Mathieu J, Maynard MT, Rapp T, Gilson L. Team effectiveness 1997-2007: A review of recent advancements and a glimpse into the future. J Manag. 2008;34(3):410-476. doi:10.1177/0149206308316061
- Suter E, Deutschlander S, Mickelson G, et al. Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis. J Interprof Care. 2012;26(4):261-268. doi:10.3109/13561820.2012.663014
- Larson DB, Mickelsen LJ, Garcia K. Realizing improvement through team empowerment (RITE): A team-based, project-based multidisciplinary improvement program. RadioGraphics. 2016;36(7):2170-2183. doi:10.1148/rg.2016160136
- Canadian Interprofessional Health Collaborative. A national interprofessional competency framework.; 2010:1-32. Accessed June 25, 2020. https://drive.google.com/file/d/1Des_mznc7Rr8stsEhHxl8XMjgiYWzRIn/view?usp=sharing&usp=embed_facebook
- Saving lives: A meta-analysis of team training in healthcare. Accessed June 25, 2020. https://psycnet.apa.org/fulltext/2016-29687-001.html
- Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: Effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2013;2013(3). doi:10.1002/14651858.CD002213.pub3
- Guraya SY, Barr H. The effectiveness of interprofessional education in healthcare: A systematic review and meta-analysis. Kaohsiung J Med Sci. 2018;34(3):160-165. doi:10.1016/j.kjms.2017.12.009
- Zwarenstein M, Bryant W. Interventions to promote collaboration between nurses and doctors. Cochrane Database Syst Rev. 2000;(2). doi:10.1002/14651858.CD000072
- Wang Z, Feng F, Gao S, Yang J. A systematic meta-analysis of the effect of interprofessional education on health professions students’ attitudes. J Dent Educ. 2019;83(12):1361-1369. doi:10.21815/JDE.019.147
- Reeves S, Fletcher S, Barr H, et al. A BEME systematic review of the effects of interprofessional education: BEME guide no. 39. Med Teach. 2016;38(7):656-668. doi:10.3109/0142159X.2016.1173663
- Yousuf Guraya S. Workplace-based assessment; applications and educational impact. Malays J Med Sci MJMS. 2015;22(6):5-10.