Interprofessional Collaboration:
The Case of Integrative Health Care Teams

    Beverly Wellman and Merrijoy Kelner

     ...
Intellectual Context
 Sociologists have concentrated on the
characteristics needed to become professional
     Friedson 1...
Interpersonal Collaboration
 Interprofessional collaboration challenges the expectations
 embedded in being a professiona...
Need for Interprofessional Communication
Focus of Research
 To examine and describe the nature and extent
 of interprofessional collaboration
 in two different in...
Methods – Communication
Social Network Questions related to
  communication patterns among practitioners:
 What formal me...
Methods – Collaboration
 In-depth Open-ended Questions related to
 their hopes and aspirations working in
 collaborative ...
Methods – Observation
 Staff Meetings and Waiting Room Observations
 related to the nature and extent of collaboration:
 ...
Comparing Two Centres
 Population - Total sample of practitioners

    Centre A – 2 physicians, 1 psychiatrist,
    2 ps...
Centre A Characteristics
 9 women and 3 men
 Average age = 40 (youngest is 23; oldest is 67)
 Years in practice - less ...
Communication Patterns
 Almost all the practitioners reported that they mainly speak
  with the administrative staff and ...
Motivations for Practicing
 When asked what made them decide to practice at Centre A,
  their answers revolved around 3 m...
Centre B
We’re just beginning

 The interviews with all the practitioners are
 taking place this week

 We have attende...
Other Canadian Studies
Gaboury et al., Hollenberg, and Soklaridis all found
 that interprofessional collaboration was lim...
Implications for Networked Teams
 If interprofessional collaborative teamwork is to flourish, it requires:
   Dedicated ...
Towards Integrative
Health Care Networks
Acknowledgements
 We thank:
 The Lotte & John Hecht Memorial Foundation
    for supporting this research
 The heads of ...
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Interprofessional Collaboration:The Case of Integrative Health Care Teams (by Beverly Wellman and Merrijoy Kelner)

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Information & Social Networks Symposium 2010
Dalhouise University
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Interprofessional Collaboration:The Case of Integrative Health Care Teams (by Beverly Wellman and Merrijoy Kelner)

  1. 1. Interprofessional Collaboration: The Case of Integrative Health Care Teams Beverly Wellman and Merrijoy Kelner Institute for Life Course and Aging University of Toronto bevwell@chass.utoronto.ca http://www.utoronto.ca/CAMlab Information and Social Networks Symposium, Dalhousie University Halifax, October 4th, 2010
  2. 2. Intellectual Context  Sociologists have concentrated on the characteristics needed to become professional Friedson 1986, Abbott 1988  The shared set of characteristics attributed to professions include:  autonomy from oversight  clear boundaries around knowledge claims independence of practice Gieryn 1983, Collins 1990
  3. 3. Interpersonal Collaboration  Interprofessional collaboration challenges the expectations embedded in being a professional Engel & Gursky 2003,Hudson 2002  Working in collaborative teams conveys the idea of sharing  Requires collective action oriented toward a common goal D’Amour et al. 2005  Integrative health care is a Canadian instance of interprofessional collaboration  A combination of biomedical care & complementary and alternative medicine (CAM) Gaboury et al 2009, Bourgeault & Mulvale 2006
  4. 4. Need for Interprofessional Communication
  5. 5. Focus of Research  To examine and describe the nature and extent of interprofessional collaboration in two different integrative health care settings  To both observe and ask the practitioners how they relate to each other and share patient information under one physical and organizational roof
  6. 6. Methods – Communication Social Network Questions related to communication patterns among practitioners:  What formal mechanisms are in place to enhance collaboration? i.e., scheduled meetings, case conferences  How would you describe your everyday interactions with the other practitioners? For example, who do you mostly talk to? What about? How often? Where?
  7. 7. Methods – Collaboration  In-depth Open-ended Questions related to their hopes and aspirations working in collaborative interprofessional teams:  What made you decide to practice at this health care centre?  Do you feel as if you operate as part of a team or pretty much on your own?
  8. 8. Methods – Observation  Staff Meetings and Waiting Room Observations related to the nature and extent of collaboration:  Who attends staff meetings  Atmosphere  Patterns of communication  Conflict and mechanisms for resolving it  Waiting/reception area  Practitioner-practitioner interactions
  9. 9. Comparing Two Centres  Population - Total sample of practitioners  Centre A – 2 physicians, 1 psychiatrist, 2 psychologists, 1 registered massage therapist, 2 naturopaths, 3 TCM practitioners (one is the head of the centre), 1 chiropractor  Centre B – 2 physicians (one is the head of the centre), 1 RMT/Reiki/Cold Laser Therapist, 1 TCM, 1 energy healer, 1 naturopath, 1 nutritionist & Orthomolecular Practitioner Lifestyle Counsellor, 1 integrative medicine consultant  Analysis – 3 project members are independently coding the interviews  The transcribed interviews will be entered into NVivo8 for qualitative analysis
  10. 10. Centre A Characteristics  9 women and 3 men  Average age = 40 (youngest is 23; oldest is 67)  Years in practice - less than 1 year to 25 years  Practicing @ the centre- 3 months to 4 years Mechanisms in place to enhance collaboration  All the practitioners reported that there were no formal mechanisms  No common area for practitioners to congregate
  11. 11. Communication Patterns  Almost all the practitioners reported that they mainly speak with the administrative staff and the head of the centre  The TCM doctors reported speaking mainly with each other and the head of the centre  The medical doctors and psychologists reported speaking mainly with the naturopaths as well as the administrative staff and the head of the centre The naturopaths spoke to the medical doctors and the psychologist (as patients)  Most communication is hallway chatter  A couple of practitioners mentioned being patients of other practitioners giving them an opportunity for communication
  12. 12. Motivations for Practicing  When asked what made them decide to practice at Centre A, their answers revolved around 3 main ideas:  They liked the concept of collaborative care  They were connected to the head of the centre either as former patients or friends  They admired the head of the centre and the environment she has created  Almost all reported that they worked independently but say they want to work as a team  TCM practitioners report working as a team with each other
  13. 13. Centre B We’re just beginning  The interviews with all the practitioners are taking place this week  We have attended one staff meeting where we observed a considerable degree of trust, openness and interest in each other’s professional work
  14. 14. Other Canadian Studies Gaboury et al., Hollenberg, and Soklaridis all found that interprofessional collaboration was limited at integrative health centres (free standing and hospitals):  The dominance of biomedicne over other kinds of care  They also found different philosophies of care and using different terminology hampered communication
  15. 15. Implications for Networked Teams  If interprofessional collaborative teamwork is to flourish, it requires:  Dedicated times  Opportunities for the sharing of knowledge & patient information  Building trust and respect as well as ways to manage conflict  Sharing patient charts  Collaboration is limited by rules of confidentiality between biomedical and CAM practitioners.  A more inclusive education in medical schools  Exposure to the strengths and weaknesses of a variety of modalities  Exposure to the terminology of other kinds of care Co-location ≠ Collaboration ≠ Integration
  16. 16. Towards Integrative Health Care Networks
  17. 17. Acknowledgements  We thank:  The Lotte & John Hecht Memorial Foundation for supporting this research  The heads of the 2 integrative centres for welcoming us  The practitioners for their cooperation  Alexander Rodney for her research assistance

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