1. Is Knowledge ReallyIs Knowledge Really
Shared AcrossShared Across
Disciplines?Disciplines?
A qualitative study ofA qualitative study of
interdisciplinary team processinterdisciplinary team process
Elizabeth DurkinElizabeth Durkin
Amit NigamAmit Nigam
Northwestern UniversityNorthwestern University

2. Outline of PresentationOutline of Presentation
 Prior ResearchPrior Research
 Exploratory Research QuestionExploratory Research Question
 Research ApproachResearch Approach
 ResultsResults
 Discussion & ImplicationsDiscussion & Implications

3. Interdisciplinary TeamsInterdisciplinary Teams
DefinedDefined
 Members of various disciplines whoMembers of various disciplines who
share responsibility for coordinatingshare responsibility for coordinating
individualized patient care (Vinokur-individualized patient care (Vinokur-
Kaplan, 1995).Kaplan, 1995).
 Wide acceptance in the health andWide acceptance in the health and
human services (Crepeau, 1993;human services (Crepeau, 1993;
Schofield & Amodeo, 1999; Vinokur-Schofield & Amodeo, 1999; Vinokur-
Kaplan, 1995).Kaplan, 1995).

4. Interdisciplinary TeamInterdisciplinary Team
ProcessProcess
 Individuals shareIndividuals share unique knowledgeunique knowledge
from their respective disciplines tofrom their respective disciplines to
treat the “whole patient” (Vinokur-treat the “whole patient” (Vinokur-
Kaplan, 1995).Kaplan, 1995).
 Often a preferred mode of managingOften a preferred mode of managing
care for patients with complex orcare for patients with complex or
chronic needs.chronic needs.

5. Benefits ofBenefits of
Interdisciplinary TeamsInterdisciplinary Teams
 Benefits ascribed include:Benefits ascribed include:
– more rational care planningmore rational care planning
– increased patient access to careincreased patient access to care
– improvements in quality of careimprovements in quality of care
– reduction in fragmentation of servicereduction in fragmentation of service
delivery systemsdelivery systems
(Crepeau, 1993; D’Aunno, Alexander, &(Crepeau, 1993; D’Aunno, Alexander, &
Laughlin, 1996; Drake, et al., 1998;Laughlin, 1996; Drake, et al., 1998;
Schofield & Amodeo, 1999).Schofield & Amodeo, 1999).

6. Prior Research:Prior Research:
Interdisciplinary TeamsInterdisciplinary Teams
 Little empirical evidence demonstratingLittle empirical evidence demonstrating
efficacy (Schofield & Amodeo, 1999).efficacy (Schofield & Amodeo, 1999).
 Team is often treated as a “black box.”Team is often treated as a “black box.”
 Questions remain about whetherQuestions remain about whether
interdisciplinary health and human serviceinterdisciplinary health and human service
teams work and, if so, why they workteams work and, if so, why they work
(Alexander, Lichtenstein, Jinnett, &(Alexander, Lichtenstein, Jinnett, &
D’Aunno, 1996; Schofield & Amodeo, 1999)D’Aunno, 1996; Schofield & Amodeo, 1999)

7. Prior Research: TeamsPrior Research: Teams
and Groupsand Groups
 Groups are much more likely to discussGroups are much more likely to discuss
common information than uniquecommon information than unique
information (Stasser, Taylor, & Hanna,information (Stasser, Taylor, & Hanna,
1989)1989)
 Unique information is often discounted byUnique information is often discounted by
other members of the group.other members of the group.
 The presence of multiple disciplines aloneThe presence of multiple disciplines alone
does not ensure the contribution ofdoes not ensure the contribution of
disciplinary knowledge.disciplinary knowledge.

8. Exploratory ResearchExploratory Research
QuestionsQuestions
 Is knowledge from different disciplinesIs knowledge from different disciplines
shared within a single interdisciplinaryshared within a single interdisciplinary
human service team and, if so, how?human service team and, if so, how?
 What individual, group, andWhat individual, group, and
organizational level factors appear toorganizational level factors appear to
promote or impede the sharing ofpromote or impede the sharing of
unique knowledge?unique knowledge?

9. Research SiteResearch Site
 Interdisciplinary social services teamInterdisciplinary social services team
focused on coordinating resources forfocused on coordinating resources for
homeless people with substancehomeless people with substance
abuse and mental health issues.abuse and mental health issues.
 Team designed to draw people withTeam designed to draw people with
background in 3 human service fieldsbackground in 3 human service fields
– Eight team members from seven differentEight team members from seven different
“home” agencies“home” agencies
– Racial, ethnic and gender diversityRacial, ethnic and gender diversity

10. Research ApproachResearch Approach
 Qualitative StudyQualitative Study
– Team-member interviews 2 months after projectTeam-member interviews 2 months after project
launchlaunch
– Field Observation for 7 month periodField Observation for 7 month period
 Team trainings (n=5)Team trainings (n=5)
 Team meetings involving discussion and coordinationTeam meetings involving discussion and coordination
of care for clients (n=7)of care for clients (n=7)
 Study in exploratory/ theory developmentStudy in exploratory/ theory development
stagestage
– Modified Grounded Theory approachModified Grounded Theory approach

11. Results: Team Member RoleResults: Team Member Role
Team members identified themselvesTeam members identified themselves
as occupying a shared role and not aas occupying a shared role and not a
unique one.unique one.
 Blue: “No, no. I think we all think ofBlue: “No, no. I think we all think of
ourselves as able to provide all services,ourselves as able to provide all services,
and so we're not turning to … we might turnand so we're not turning to … we might turn
to each other if there's an agency-specificto each other if there's an agency-specific
question, you know … but in terms ofquestion, you know … but in terms of
handling a client, I would … I feel competenthandling a client, I would … I feel competent
to do everything, and I think the rest of theto do everything, and I think the rest of the
team, give or take, feels the same way.”team, give or take, feels the same way.”

12. Results: Team Member RoleResults: Team Member Role
 Yellow: “… [This team] is different because allYellow: “… [This team] is different because all
of us are basically … case managers. And onof us are basically … case managers. And on
the other team that I was on, we had a doctor,the other team that I was on, we had a doctor,
we had a [child welfare] worker … you know.we had a [child welfare] worker … you know.
So it was a little different, our goals wereSo it was a little different, our goals were
different coming in the door. The [childdifferent coming in the door. The [child
welfare] person was focused in on the well-welfare] person was focused in on the well-
being of the child in the household, and I wasbeing of the child in the household, and I was
focused in on the mother's substance abuse,focused in on the mother's substance abuse,
and the doctor was focused in on the mother'sand the doctor was focused in on the mother's
maternal health. [This team], we all basicallymaternal health. [This team], we all basically
are… coming from a case managementare… coming from a case management
perspective…”perspective…”

13. Results: Member BackgroundResults: Member Background
Team members had similar workTeam members had similar work
backgrounds.backgrounds.
 Yellow: And then, again, we work fromYellow: And then, again, we work from
different agencies, even though basically alldifferent agencies, even though basically all
of us have … basically done the same thing.of us have … basically done the same thing.
I think two may do a little more with theI think two may do a little more with the
mentally ill, and then, me, more withmentally ill, and then, me, more with
substance abuse. And I think all of us havesubstance abuse. And I think all of us have
basic case management.basic case management.

14. Results: Shared CaseloadResults: Shared Caseload
Team members all shared the sameTeam members all shared the same
caseload.caseload.
 ““Purple: My other teams were working withPurple: My other teams were working with
specific cases, so there wasn't as muchspecific cases, so there wasn't as much
willingness or ownership to the process ofwillingness or ownership to the process of
the team or the goals of the team. Thisthe team or the goals of the team. This
team – everybody's working on all cases…team – everybody's working on all cases…
so there's more ownership in this team, andso there's more ownership in this team, and
willingness to share the load. And part ofwillingness to share the load. And part of
that [shared caseload] is also to createthat [shared caseload] is also to create
ownership to the goal of the team, or whatownership to the goal of the team, or what
our project's mission is.”our project's mission is.”

15. Results: Unique KnowledgeResults: Unique Knowledge
Unique knowledge that was shared involvedUnique knowledge that was shared involved
concrete information about community resources.concrete information about community resources.
 Purple asks Grey about [Agency A’s] policy on coming back.Purple asks Grey about [Agency A’s] policy on coming back.
 Grey: Sometimes they don’t mind … if people come back ifGrey: Sometimes they don’t mind … if people come back if
there is a bed available.there is a bed available.
 Purple: an HIV bed. Are there HIV beds available?Purple: an HIV bed. Are there HIV beds available?
 Grey: There’s a directory of HIV transitional services…Grey: There’s a directory of HIV transitional services…
 Blue: What about [Agency B]?Blue: What about [Agency B]?
 Purple: Oh, Maria: Talk to her. I had thought about gettingPurple: Oh, Maria: Talk to her. I had thought about getting
her involved…her involved…
 Purple: [to Green] What about your friend at [Agency C].Purple: [to Green] What about your friend at [Agency C].
What is her name? …What is her name? …
 Green: WandaGreen: Wanda
 Purple: [to Green] I feel like we are coming at you with a lotPurple: [to Green] I feel like we are coming at you with a lot
of things at once, but this is a high priority client.of things at once, but this is a high priority client.

16. Results: Unique KnowledgeResults: Unique Knowledge
 Orange and Blue get into a conversation about aOrange and Blue get into a conversation about a
client who was undocumented and is shifting overclient who was undocumented and is shifting over
to [a Latino agency]… from [Blue’s agency]… Blueto [a Latino agency]… from [Blue’s agency]… Blue
describes him and asks about the residentialdescribes him and asks about the residential
program at [Orange’s agency]. Orange asks howprogram at [Orange’s agency]. Orange asks how
functional he is, saying it could be a problem if hefunctional he is, saying it could be a problem if he
was not functional [and] mentions anotherwas not functional [and] mentions another
residential program. Blue describes hisresidential program. Blue describes his
functionality. [Based on Blue’s description], Orangefunctionality. [Based on Blue’s description], Orange
clarifies that… it should be possible so long as heclarifies that… it should be possible so long as he
[really meets functional requirements].[really meets functional requirements].

17. Results: Value of UniqueResults: Value of Unique
KnowledgeKnowledge
Team members highly valued uniqueTeam members highly valued unique
knowledge regarding services because ofknowledge regarding services because of
its contribution to the team goal (linkingits contribution to the team goal (linking
clients to services).clients to services).
 Orange: “[F]or example, I am very comfortable withOrange: “[F]or example, I am very comfortable with
[assessment] in substance abuse and in mental[assessment] in substance abuse and in mental
illness, but I think I need more, and I can get thatillness, but I think I need more, and I can get that
from my co-workers, regarding referrals. Casefrom my co-workers, regarding referrals. Case
management: referrals, places, contacts.”management: referrals, places, contacts.”

18. Results: Value of UniqueResults: Value of Unique
KnowledgeKnowledge
 Purple: “Yellow brings … works withPurple: “Yellow brings … works with
[Agency E] and she …has also been in the[Agency E] and she …has also been in the
field for a lot of years, working with addictedfield for a lot of years, working with addicted
women, also … has a lot of knowledgewomen, also … has a lot of knowledge
about resources with [Agency E] so that'sabout resources with [Agency E] so that's
been invaluable, because she totally linksbeen invaluable, because she totally links
us to a lot of services in that area.”us to a lot of services in that area.”

19. LimitationsLimitations
 Only studied one team.Only studied one team.
 Team not interdisciplinary in traditionalTeam not interdisciplinary in traditional
sense.sense.
 Data collection took place during earlyData collection took place during early
phase of team implementation.phase of team implementation.

20. DiscussionDiscussion
 Role uniformity encourages knowledgeRole uniformity encourages knowledge
sharingsharing
– Factors contributing to development of a shared roleFactors contributing to development of a shared role
 Similar backgrounds (albeit in different fields)Similar backgrounds (albeit in different fields)
 Shared vs. individual caseloadsShared vs. individual caseloads
 Nature of the knowledge mattersNature of the knowledge matters
– Team members tended to share unique knowledge that:Team members tended to share unique knowledge that:
 Could be understood and readily used by other teamCould be understood and readily used by other team
members.members.
 Related to accomplishing team goal (linking clients toRelated to accomplishing team goal (linking clients to
services)services)

21. ImplicationsImplications
 Information sharing can and doesInformation sharing can and does
occur in health & human serviceoccur in health & human service
teams.teams.
 Organizations can create conditions inOrganizations can create conditions in
which information can be shared.which information can be shared.
– Team compositionTeam composition
– Work processesWork processes