Interprofessional working is recognized as valuable in Nepalese hospitals but faces barriers. A study of 38 healthcare professionals from 3 hospitals found that while collaboration is understood, medical professionals dominate due to differences in roles, status, and education. Barriers to interprofessional working include a lack of training and protocols, professional silos, and poor communication. Improving interprofessional collaboration in Nepal requires strategies like additional education, supportive policies, strong clinical leadership, and fostering respect between professions.

1. Interprofessional Working in
Hospitals: The Case of Nepal
Dr Bachchu Kailash Kaini
(PhD, MBA, PGDHM, BL, BEd, BCom, Certificate in Clinical Audit in Health & Social Care)

2. Context
• Changes in demographic structure and
disease pattern
• Increased cost of care
• Concept of specialties and sub-specialties
emerging
• Well informed patients and more choices
• Expansion of roles of health care
professionals (HCPs)
• Changing health care environment
requires new ways of working &
collaborative practice

3. • IPC is a collaborative working in which HCPs
share common purpose of developing mutually
negotiated goals which are achieved through
agreeing a care plan, the management of it and
procedures (HFO, 2007; Hawley, 2007; Leathard, 2003; Payne, 2000; Pietroni, 1992; Colyer, 2012).
• Interprofessional working (IPW) to happen in
practice, HCPs:
– Pool their skill, knowledge and expertise
– Shared professional view points
– Make joint decision
– Learn from each other
Interprofessional Care (IPC)

4. • Collaboration, IPW and effective communication:
reduces the clinical incidence, misunderstanding
and errors, and enables HCPs be more readily
aligned to the departmental and organisational
vision (Verhorsek et al, 2010;. Mills et al, 2008; CHSRF, 2006; Joint Commission, 2005)
• More positive health care outcomes are
achieved by collaborating effectively between
HCPs(Byrnes et al, 2009; CHSRF, 2006; Nolte, 2005; EICP, 2005; Holland et al, 2005;
Pollard, 2005; Dow and Evans, 2005; McAlister et al, 2004; Leathard, 2003; Miller et al, 2001;
Biggs, 1997; Ritter, 1983)
• Other aspects of IPW researched and assessed
in the past
Literature Review

5. Power Perspectives of Theory of Professions
• Theory of Professions: division of labour
based on skills, knowledge and expertise
• Knowledge is a source of power and it has
great influence in determining professional
behaviour and dominance
• Medical dominance exists in health care
and professional dominance of medical
professionals comes from autonomy
(Freidson, 1970a; 1970b)

6. • To identify and analyse various factors that
support and hinder IPW in Nepalese hospitals
• To examine understanding and perceptions of
IPW among HCPs
• To assess perceptions of IPW on health care
delivery in Nepal
• To examine professional power perspectives of
theory of professions in relation to IPW
• To make recommendations for improving
interprofessional collaborative practices
Research Objectives

7. Research Methodology
• Qualitative research method, case study
• Purposive sampling
• Three hospitals in Kathmandu, 38 HCPs (40%
nursing, 34% Medical and 26% AHPs)
• Use of semi structured interview schedule &
analysis of documentary evidence
• Qualitative content analysis
• Interpretive thematic approach
• Open coding, categorisation, theme generation,
establish relationships, interpretation &
conclusion

8. Demographics
34%
37%
29%
Participants by Hospital Types
Public
Private
Voluntary
34%
40%
26%
Participants by Professional Groups
Medical
Nursing
AHPs
56%
44%
Participants by Gender
Male
Female

9. Main Findings
• IPW is widely understood, recognised
and valued by HCPs
• HCPs carry out different roles, values,
status and responsibilities
• Verbal means of communication is
used most of the time. Other common
forms: medical notes, team meetings
• Service users involvement in IPC is
valued

10. Main Findings
• Power differences in medical, nursing and
AHPs
• Dominance of medical professionals exists in
Nepalese hospitals
• Medical professionals lead IPC team
• HCPs perceived different levels of autonomy
• Boundaries between HCPs changing
• Cultural and gender differences in medical,
nursing and AHPs

11. Main Findings
• HCPs do not have significant contact with one
another during their formal or university
education
• HCPs learn IPC skills at work and they felt
competent
• IPW is not sufficiently motivated amongst
HCPs and adequate appreciation is lacking
• Concept of IPW and power perspectives of
theory of professions are equally applicable in
Nepalese context

12. Perceived Barriers to IPW
• Organisational: Lack of training and
education, no protocol for IPW, high
workload & no support from
management
• Professional: Professional dominance
and isolation, hierarchy & no
understanding of other professions
• Personal: Poor communication, ego,
negative attitude & no mutual respect

13. Recommendations for Improving IPW
• Training and education
• Policies and guidance
• Clinical leadership
• Organisational structures and
support
• Appropriate communication