Barriers to collaboration
Many challenges in promoting collaboration among healthcare professionals have been identified. There are systemic determinants which can determine whether and to what degree collaborative practice is possible. These include compensation schemes, professional practice regulation, institutional policies, and the physical environment. These factors may be beyond the control of the team.
There are also factors within the team, and therefore in control of the team. These include members having different interests, goals, expectations, styles, and experiences which can complicate communication and generate conflict.
Inter-professional teams may also include members with varying levels of authority, prestige, salary, and other factors that add a further challenge of managing and negotiating power arrangements.
Other barriers identified by Daniel and Rosenstein (2008) and Hamid (2014) include:
* Personality differences
* Hierarchy
* Disruptive behaviour
* Culture and ethnicity
* Generational differences
Gender
* Historical inter-professional and intra-professional rivalries
* Differences in language and jargon
* Differences in schedules and professional routines
* Varying levels of preparation, qualifications, and status
* Differences in requirements, regulations, and norms of professional education
* Fears of diluted professional identity
* Differences in accountability, payment, and rewards
* Concerns regarding clinical responsibility
* Complexity of care
* Emphasis on rapid decision making
* Differences in history and cultural context
* Historical inter professional and intra professional rivalries
* Differences in language and jargon
* Differences in professional routines
* Varying levels of preparation, qualifications and status
* Fears of diluted professional identity
It is therefore expedient for team leaders to manage these diverse interests and capitalise on the strengths of the team composition. A team leader may be able to facilitate the negotiation of authority and responsibility which are issues rooted in the complex interactions of the team.
Nurturing collaboration in healthcare
nurturing collaborative practice among healthcare professionals involves identifying and maximising the key determinants of collaboration. These include:
Structural determinants: The physical and organisational environment in which an interdisciplinary team operates can impact the degree and nature of collaborative interactions. Environment can be taken to include physical spaces, temporal arrangements, schedules, processes, organised activities, and communication tools that may either encourage or discourage effective team collaboration. Organisational structure can include the architectural considerations (physical structure, functionality, and aesthetics) and management considerations (defined relationships between team members and between teams) and has both formal and informal parts.
Psychological Determinants: Human interactions are a key component of collaboration. The determinants of collaboration include a host of psychological factors. The term ‘‘psychological environment’’ is used to include culture in a broad sense (attitudes and behaviours) and at all levels (organisational, professional, team, and individual). These ‘‘interactional determinants’’ include team members’
Willingness to collaborate.
Mutual trust and respect.
Communication.
More on psychology
Two principal issues are involved in the psychology of healthcare teams. First, professional groups have educational determinants. These encompass distinct cultures because of specialised training, professional identity, as well as positions and roles within the healthcare system, thus inter professional role boundaries, power differences, and conflicts between the priorities of professional and team membership can result.
Secondly, the potential for lack of respect, trust, and poor communication in which conflict and psychological safety may play a role.
Collaborative practice may also be promoted through education and skills training. There is the need for understanding of role boundaries and expectations within the team and learning how to balance the needs of professional identity and team identity. An approach that de-emphasises individual professional needs and roles in favour of team goals and collaboration will promote a more patient-centred model of care.
There is need to develop the ability to engage in effective formal and informal communication, including negotiation and conflict resolution skills; ability to use a language of respect and dignity, and knowing what terminology and communication approaches to use with different professions and different individuals.
Effective use of language plays an important role in collaborative communication. Use of inclusive language may reflect underlying notions of connectedness with the team. Knowledge and use of appropriate technical terminology may also be important for clear communication and for generating mutual respect and confidence, particularly in highly technical and specialised environments.
Inter Professional Education (IPE): This is the education of professionals from multiple disciplines, together with a goal of improving their ability to work with one another collaboratively. IPE is very crucial in nurturing healthcare teams that will work collaboratively. Collaborative practice is both encouraged and enabled through education and communication-related skill training. Inter Professional Education imparts both collaborative skills and a sense of collective responsibility among the professions involved. There is the need to revisit the “Ife philosophy of medical education”.
Conclusion
A collaborative, inter-professional team brings about lots of benefits and supports high quality and safe care, reduction in costs, patient and staff satisfaction and engagement, as well as organisational efficiency and innovation. It puts the patient at the centre of the healthcare team’s focus and allows all health professionals, with the patient, to collaboratively provide input, be part of the decision making, and improve outcomes.
Provision of physical and structural opportunities, a psychologically supportive environment, and appropriate education and training are all important to promoting collaborative practice.
There is a need to focus on addressing inequalities and asymmetries in power and influence between the patient and the healthcare provider and among different providers for them to contribute towards the design of a better framework for communication and collaboration between the different actors. Organisational structures in the health system need to be redesigned so as to better nurture collaborative relationships which support integrated working and decision-making between providers, healthcare professionals and patients.
A patient-centred and team-focused, inter professional collaborative practice represents a new playing field for today’s healthcare plans and hospitals. Leadership is integral to creating a motivated team. The ultimate goal is still the highest pursuit of the healthcare mission and the workforce must be equipped with tools and resources to handle the challenges of the healthcare environment.
Permit me to end with the story behind the “Ubuntu” philosophy in southern Africa. An anthropologist proposed a game to a group of African tribal children. He placed a basket of sweets near a tree and made the children stand 100 metres away. He then announced that whoever reaches the tree and the basket first would get all the sweets in the basket. When he said “ready steady go”, the children all held each other’s hands, ran together towards the tree, divided the sweets equally among themselves and enjoyed it.
When the anthropologist asked them why they did so, they answered “Ubuntu” which means “how can one be happy when the others are sad?” “Ubuntu” in South African language means “I am because we are”. This is a strong message for all generations and healthcare professionals. There is need to develop the Ubuntu attitude.
By Comrade Abdrafiu Adeniji, National President, NANNM
