“It is no longer enough for health workers to be professional. In the current global climate, health workers also need to be inter-professional” (WHO, 2010).
Modern organisations are often complex entities in which cross-disciplinary teams are increasingly called upon to innovate, implement change, and improve work quality and efficiency. Contemporary healthcare system delivery processes involve numerous interactions among multiple healthcare practitioners with varying levels of educational and occupational training. Thus, collaboration within a team of multi-disciplinary health professionals is vital to provision of qualitative, comprehensive and patient-centered care.
Collaboration is the cornerstone of success in any healthcare system. Effective collaboration among healthcare professionals improves patient outcomes, quality and safety of patient care, as a result of the coordination and communication among the professionals.
Collaboration among healthcare professionals allows for the individual and collective skills and experience of team members to function together more effectively and deliver higher level of services than each would working alone.
This concept of collaboration is buttressed by the maxim, “the whole is greater than the sum of its parts”. Lack of collaboration within the healthcare system often results in medical errors and thus constitutes a risk for consumers of healthcare services.
Various definitions of collaboration have been proffered by different individuals and organisations. The World Health Organisation (WHO) defines collaborative practice as when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers and communities to deliver the highest quality of care across settings.
A collaborative healthcare team can also be defined as a group of health practitioners from different professions who share patients and patient-care goals and have the responsibilities for complementary tasks on an ongoing basis.
Others have defined collaboration as:
A process by which different healthcare professionals work together, negotiate agreements and manage conflicts, with all valuing and understanding one another.
A dynamic, transforming process of creating a power-sharing partnership for purposeful attention to needs and problems (practice) to achieve successful outcomes.
An efficient, effective, and satisfying way to offer healthcare services through a process by which interdependent professionals structure a collective action toward patient’s care needs.
The above definitions and others reveal that collaboration is an integration of activities and knowledge that requires a partnership of shared authority and responsibility. Sullivan (1998) describes four critical elements which characterise collaborative practice in healthcare as follows:
Coordination (working to achieve shared goals).
Cooperation (contributing to the team, understanding and valuing the contributions of other team members).
Shared decision-making (relying on negotiation, communication, openness, trust, and a respectful power balance).
Partnerships (open, respectful relationships cultivated over time in which all members work equitably together).
Dynamics of collaboration in healthcare
Taken together collaboration among healthcare providers implies that providers from different specialties, disciplines or sectors work together. This includes a wide spectrum of activities, from simple, electronically-conveyed messages or face-to-face encounters to comprehensive inter-professional, perhaps integrated, work. Integration implies a certain degree of collaboration among the parties who work together.
On a practical level, it must be said that it requires an effort to integrate and translate themes and schemes shared by different professional groups. So also it is for shared ownership of common goals, decision-making processes, and the integration of specialised professional knowledge and expertise.
Members of a collaborative healthcare team bring to the team the specialised knowledge, skills, methods and attitudes of their disciplines. Members then integrate their observations, bodies of expertise and spheres of decision-making to coordinate, collaborate, and communicate to optimise client care.
Requirements for successful teamwork
Clear and known roles and tasks for team members
Shared responsibility for team success
Appropriate balance of member participation for the task at hand
Acknowledgment and processing of conflict
Clear specifications regarding authority and accountability
Clear and known decision making procedures
Regular and routine communication and information sharing
Enabling environment, including access to needed resources
Mechanism to evaluate outcomes and adjust accordingly
Benefits of collaboration in healthcare
Quality of care: Collaboration among healthcare professionals leads to improved health outcomes. It improves quality of care, through factors such as transfer of knowledge, sharing of information, and enhanced decision-making. Collaborative teams demonstrate improved sharing of evidence-based practices between professions, improved decision-making, and increased innovation. Synergy in a healthcare team also leads to reduced length of hospital stay, improved compliance with standards of drug prescription, improved quality audit results, and improved symptom and psychosocial management. A collaboratively practicing workforce will be more responsive, efficient, and considerate of patient, family, and community roles, as well as providing improved care.
Patient engagement: Collaboration among healthcare teams can improve patient education and patient engagement in their care. These include behavioural changes such as information seeking and effective delivery of information, patient involvement in decision-making and patient participation in self-care. When communicating information to patients, collaborative care ensures that approaches are consistent, responsive and foster understanding, thus enabling patients to participate in care decisions. Clients are supposed to be the primary actors in medical decision making, and health professionals should adopt a supportive role. Also, because learning needs, desires, capacity, and style can vary greatly among patients, it becomes necessary for the healthcare team to coordinate among the members methods for educating and instructing patients in appropriate and consistent ways. A collaborative patient-clinician interaction generates trust and rapport, which in turn leads to greater levels of openness, negotiation, successful adherence to medical care strategies, and reduced anxiety.
Patient safety: The impact of collaboration on patient safety cannot be overemphasised. Several studies have identified reductions in rates of medical error when interprofessional collaboration is strong and teams are trained to work safely, cooperatively, and in a coordinated way to avoid gaps in quality assurance measures.
Patient safety and quality of care are considered to be highly dependent on work environment factors such as teamwork culture. This is the responsibility of all levels of health organisations.
Staff and organisation benefits: Organisations and their staff also benefit from synergistic and collaborative work environment as staff satisfaction and retention is higher in healthcare organisations where staff members engage in a collaborative culture of quality and safety. Other benefits to staff include greater perceptions of empowerment and recognition. This may be because collaborative teams generally have a more horizontal rather than hierarchical power structures. They also have more open and inclusive communication and greater levels of role understanding, respect, and appreciation among members. Highly collaborative, high-performance teams may also drive value and process improvement, innovation, initiative, and performance, increase employee work engagement, and reduce staff absenteeism. All these effects result in a more competitive and efficient organisation.
In addition, the following opportunities afforded by collaborative practice have been identified by Hamid (2014):
It empowers team members
It closes communication gaps
It enables comprehensive patient care
It minimises readmission rates
It promotes team mentality/morale
It promotes patient-centered care
By Comrade Abdrafiu Adeniji, National President, NANNM