Foundations of Interprofessional Practice

Introduction

Healthcare always has and will always be a team effort. The fact that healthcare is and will always be a team effort has led to the cultivation of interprofessional education. Bridges et al. (2016) note that interprofessional education is a concerted method to develop healthcare students and transform them into future interprofessional team members. There are very many complex medical issues that will be faced in the context of healthcare, and they will need to be addressed by interprofessional teams. As such, it is important to train future healthcare professionals to work in such teams rather than simply focusing on their given discipline. Voqt and Voqt (2017) note that interprofessional teams are very important since they lead to the improvement of healthcare delivery, healthcare quality, as well as an improvement in the safety of patients. Due to such a requirement, there is a need for core principles for team-based care to be noted and then taught to various individuals of different disciplines so that they can learn to work together.

teams to be successful, it must begin as early as possible. Voqt and Voqt (2017) note that for such teams to be formed and for them to be successful it must begin at the student level, and that mandate will fall upon academic institutions as well as various professional organizations that will prepare students for interprofessional collaboration when they are in the field. There are various models of successful collaborative practices which are expected to continue to evolve as an interprofessional practice becomes inextricably interwoven in every healthcare service. The purpose of this paper is to explore the foundations of interprofessional practice. It shall be divided into two sections. The First Section will be written in the 3rd person, and it will be about an experience that I have had as a student on placement. The incident will be linked to issues of collaborative practice and will relate to various elements that have been taught in the module. Additionally, underlying issues that can have a positive or a negative impact on ensuring that the service user remains central is all these proceedings will also be explored. The purpose of the first portion will not be to apportion blame but to explore and understand how one can be part of an effective team and the various factors that may encourage or sabotage the interprofessional collaboration. The second section of the paper will be written in 1st person, and it will be a reflective piece guided by the Atkins and Murphy reflective model. The focus of the reflective piece will be to identify my various strengths and competencies and the areas which I have to develop as a future professional in collaborative practice. There shall be references to the group activities in which I was involved, and how that has increased my understanding of collaboration.

Over the years, it has been widely acknowledged within health care circles that there is a great need for interprofessional collaboration between individuals from various disciplines which has led to the birth of Interprofessional Education (IPE). Carpenter and Dickinson (2016) note that there is a key assumption in relation to interprofessional education and that is the fact that if various professionals are brought together from various fields and they have the opportunity to learn from each other and in so doing dissipate the various stereotypes that have a negative impact on interprofessional practice. One theory that is usually used as a basis for IPE is the contact hypothesis. The contact hypothesis maintains that the best way to reduce friction between the two groups and encourage more collaboration between the two groups is to bring the two groups together (Thistlethwaite 2012). However, some such as Allport (1954) have argued that simply putting groups of people in the same place is not enough to reduce the friction that may exist between them. The researcher argued that for contact theory to apply, then there must be equal status within the group, the group must be working towards common goals, they must have unequivocal support from individuals in authority, and finally, they must be willing to cooperate with each other (Allport, 1954). Those conditions have been referred to as the contact variables, and it has been argued that they must all, or at least the majority of them must be present for interprofessional collaboration to occur.

A key limitation of the contact theory is that it does not state how the change will occur, but it does maintain that will occur as long as people are in contact with each other. Hewstone and Brown (1986) state that there should be additional contact variables for the increased probability that the interprofessional collaboration will be successful. The variables are, there should be positive expectations; the work which has mandated the need for interprofessional collaboration must be successful; there should be a focus on both the similarities and the differences of the different members within the group; finally, in the inevitable instance where conflict arises, the group members must simply view it as part of the group dynamic rather than attributing it to stereotypical values of the other members.

In relation to the experience encountered during placement, there were various experiences that required interprofessional collaboration. The experience shall be used to explain various theoretical perspectives; shall explore how various issues arise in the context on interprofessional collaboration; shall examine how even in the midst of negative issues in interprofessional collaboration, it is important to focus on the service user, and how experience led to a greater overall understanding of how an effective team should operate as well as the role that individuals play so as to ensure the greater success of the team. The placement revolved around a community with low incomes, family issues, gender related issues, poor housing, and instances of drug abuse. My role was to assist Client to get her housing sorted and communicate with student finance on her behalf to get their disability allowance and maintenance grant sorted. To advocate on behalf of the client when contacting or talking to other housing organizations. Students on placement were encouraged to focus on openness when listening to patient’s expressing their needs as well as during every moment of contact. The interdisciplinary approach revolved around helping individuals in the physiotherapy department, referring individuals with psychological issues or those experiencing psychological distress to the psychology department, and also the inclusion of home services in relation to the care provided.

The experience was relatively novel since every individual in the various departments was simultaneously viewed to be a practitioner, an educator, and a learner. It was an interesting experience since it helped each different professional to learn different things in relation to the various core competencies that individuals from other professions have and the various roles that they contribute to the overall healthcare process in relation to that specific healthcare facility. The professionals located in the facility include but are not limited to nurses, physicians, social workers, physical therapists, pharmacists, administrators, occupational therapists, and educators. In the midst of that placement, it seemed that the key role of simultaneously viewing the various profession as practitioners, educators, and learners was to help in overcoming stereotypes. Baker et al. (2011) note that a key barrier to interprofessional education and collaborative practice is professional cultures and stereotypes. Hewstone and Brown (1986) note that stereotyping usually occur when individuals are categorized based on observable characteristics such as race, gender, or professional uniform. Parillo (2013) also notes that “a stereotype is an oversimplified generalization by which we attribute certain traits or characteristics to an entire group without regard to individual differences.” Stereotypes abound within healthcare professional circles, and they are a key barrier to collaborative practice. Baker (2011) observe that the stereotyping tends to arise when healthcare professionals believe that a certain body of healthcare knowledge is only for them and not for other healthcare individuals. In response to such a view, they are less inclined to collaborate with other professionals since they do not consider them privy to the “professional secrets” of their healthcare profession. Additionally, professional culture is also a key barrier to collaborative practice. Baker (2011) interviewed around 132 healthcare professionals, and they noted that the socialization process has an influence on professional culture and the way through which various healthcare professionals view themselves. For example, physicians tend to view themselves as the leaders of the team while nurses, therapists, social workers, and various other healthcare professionals, tend to simply view themselves as team players (Baker et al. 2011). In such a scenario, a collaborative practice since it divests more power to a given profession at the expense of other professions.

In the placement, it was noticed that a bit of stereotyping as informed by professional culture and the socialization process did exist. Physicians tended to be at the top of the healthcare chain, which means that they had relatively more power than all other individuals in the teams. As such, there was always a tone of finality in the manner through which they shared their information, and one could see that there was a bit of friction with the other healthcare professionals. Another barrier that was noted relates to accreditation. That means that many healthcare professionals were very discipline-specific in their knowledge, which is not an issue given the fact that a healthcare professional must be competent in their knowledge as it pertains to their discipline. However, that does present a challenge to interprofessional practice. Bennet et al. (2011) note that the reason that many healthcare professionals are discipline-specific narrows down to their curricula. Healthcare curricula are very discipline-specific, which does not leave enough room for individuals to learn about other healthcare disciplines which challenge collaborative practice. As such, it reduces the scope of knowledge as to the roles of other health professions, which creates an atmosphere in which stereotypes thrive simply because individuals from other fields do not know better.

There are various enablers of collaborative practice that were noted in the course of the placement. A key enabler that was noted was the key role that leaders play in encouraging interprofessional practice. It goes without saying that subordinates tend to follow the path that has been charted by their leader. In the context of interprofessional practice, if the leader frustrates the efforts of collaborative practice, then interprofessional collaboration will not thrive. Conversely, if and when the leader is a proponent of interprofessional practice, then individuals are more inclined to work together. During the placement, it was noted that the leadership of the healthcare facility were key proponents of interprofessional practice more so since it helped in improving patient outcomes, improved healthcare quality, and patient safety. The World Health Organization (2013), notes that leaders who are passionate about interprofessional education and collaborative practice, who are skilled communicators who are able to communicate the importance of IPE and CP are invaluable to encouraging interprofessional practice. Bennet et al. (2011) note that without the presence of strong leaders, the probability of interprofessional practice being successful reduces very successful.

During the placement, the key leaders encouraged collaborative practice. However, a key role that they played revolved around lobbying the administration to create an institutional and work culture that supports interprofessional practice. Reeves and Freeth (2002) observe that healthcare professionals who work in healthcare facilities where the interprofessional practice is part of the institutional and work culture tend to thrive in such facilities. In the placement, interprofessional practice was relatively supported by the administration. Some scenarios warranted interprofessional practice, while others did not. If and when the situation required collaborative practice, the administration was willing to help in terms of resources, but in other situations, they had to be lobbied so that they could advance the help that was needed. Additionally, the presence of a shared mission and vision had positive effects on interprofessional practice. Chambers et al. (2010) note when an interprofessional group has a shared mission and vision, they are more inclined to collaborate with each other, and that helps mitigate any conflict that could and/or would occur. A shared vision and mission are essential to interprofessional education and collaborative practice.

It is possible to focus so much on the enablers and disablers of interprofessional practice that one forgets that the service user should always remain central to all processes. According to Reeves et al. (2013), the purpose of interprofessional education and collaborative practice is to aid in delivering high-quality patient care more so if the patient is experiencing a very complex condition. As such, it is important that health and social care professionals are trained to work together in an effective manner that will improve the quality of care, improve patient safety, and have an overall positive effect on patient outcomes. Therefore, while it is important to continue to pursue interprofessional education and collaborative practice, it should not be done at the expense of service users. However, Reeves et al. (2013) note that the pursuit of IPE and CP has positive ripple for effects for service users since healthcare professionals will be working together so that they can offer better healthcare. It is still important to reiterate that it is the service user who must always be at the centre of all process. If and when, interprofessional practice is not pursued for its own purposes alone but for the overall good of the service user, there shall be positive ripple effects on the whole healthcare service. All in all, the placement showed that there are various enablers and barriers to interprofessional practice, and they shall always exist in any given healthcare facility. Nevertheless, it is important to ensure that enablers are more than barriers since that will help encourage interprofessional education and collaborative practice.

This second section is a reflective piece in which I will identify my strengths and areas of development as a future professional in collaborative practice. I will make various references to group activities and how I was involved as well as how that participation has increased my understanding of collaboration. However, before expounding on my experiences, it is important to state that the reflective model that shall be used for this portion of the paper is the Atkins and Murphy reflective model. Atkins and Murphy (1994) came up with the model in 1994, and its purpose was to be applied for reflective writing within the healthcare profession, specifically nursing. La Trobe University (2019) notes that Atkins and Murphy’s reflective model has five steps. First, one must become aware of their uncomfortable feelings and thoughts or become aware of their new experiences. Second, one must describe their thoughts and feelings as well as talk about the unique and key features revolving around the feelings or the situation. Third, one should analyze the feelings and the relevant knowledge as it pertains to the situation; one must also challenge any assumptions that they may hold as well as imagine and explore any alternatives as it pertains to the situations. Fourth, one must evaluate the relevance of the knowledge that they have analyzed and reviewed how it explains the issue or how it would solve the problems. Fifth, one must identify the learning that has occurred. It is important to note that the learning does not simply end with step five, but that the reflective model is cyclical since it can be applied to a variety of scenarios within the same experience.

The team dynamic was guided by Tuckman’s theory of team development, which states that team development is a five-fold process. First, there is forming. Forming occurs when the team is assembled, and each member is given the role that they are going to play. Our team was formed, and each member was given the role that they are going to play. I noticed that people tended to operate in an autonomous manner at the onset. The reason is that people did not know each other well enough to trust each other’s competencies in various fields of discussion. Due to the lack of bonding, majority of the time was spent getting to know each other and being aware of each other’s strengths and weaknesses which would guide how the work was going to be distributed. The leader of the team played a very big role during the formation of the team since they had to guide the interactions because people were not yet comfortable talking to each other. Additionally, we formed a Facebook group, which was the primary mode of communication regarding the presentation, group work, and any absences that may have occurred due to unforeseen circumstances.

The second part of the process is storming. Storming occurs when individuals start pushing against the boundaries placed during the formation of the team. A team is made or broken during the storming phase because conflicts tend to appear during this stage. The storming phase was quite interesting to see within the team I was in since different ideas and work styles tended to compete for ascendancy during this time. The most overt issue was when some people in the team challenged the authority of the leader that we had chosen. Another issue is that some people felt that their workload was heavier when compared to other people. They failed to realize that they were selected for that part because they were the ones that were most competent. Being the older and mature one, I handled the conflicts better and focused on completing our module and doing the presentation well. Also, I felt that the members expected too much from me on the day of the presentation considering that they undermined my knowledge at the beginning, so I ended up doing slightly more and held the group together. Given that we completed the module shows that the team survived the storming part of the team process.

The third part of the process is norming. The norming stage occurs when people gradually resolve the various differences by acknowledging the various strengths and weaknesses of the individual members. By this stage, the team members knew each other well enough to socialize and help each other by providing constructive feedback. I noticed that people developed a stronger commitment to the team, which increased the effectiveness of the tasks being carried out. Additionally, when some individuals would not contribute effectively to the team, the other members would inform them that they are not carrying their own weight and that the overall success of the team is influenced by the contribution of each member. The leader’s job was easier during this time since people were cooperating. There was an intersection between the storming and norming process. When new information came up, individuals tended to revert back to the conflict experienced during the storming stage. Therefore, there was a constant tension between the storming and norming stages.

The fourth part of the process is performing. The performing stage occurs when team members put in the work that is required of them, and it leads to the achievement of the team’s goals, which in this case was the presentation. The performing part of the process was experienced, the closer we got to making the presentation. At the beginning of the module, the deadline for the presentation seemed like an abstract date that was far away. However, the closer we got to the date, the more serious people became with the roles they were playing in the team. Additionally, I noticed that members were more serious when telling other individuals that they are not doing their tasks. The team members understood that if one of the members failed to do their part, then it would result in the failure of the whole team and that influenced people to work hard. The performing stage was relatively easy since people focused on their work, which left little time for conflict.

The last part of the process is adjourning. Adjournment basically means that teams come to an end. The adjournment of the team occurred when the module was fulfilled and the presentation made. The team members went their separate ways, but there are those that had formed “tribes” within the group, so it is possible that their interactions will continue outside the team dynamic. As an aside, tribalism occurred during the storming process. The people who felt that their workload was bigger, those who were against the leader, and those that felt some people were not carrying their own weight tended to band together. I did not feel that I was a part of any of the mini-groups within the overall group because people disregarded the knowledge that I brought to the table. All in all, the team experience was challenging, but we managed to fulfil the objective of the team, which was to finish the module and give a presentation.

In terms of my strengths and the areas of development as a future professional in collaborative practice, I noted that a key area of development should be in relation to understanding the role of other healthcare professionals. I noticed that I only had a tenuous grasp on the role that other healthcare professionals play, which means that I did not appreciate what they did. It made me understand the role of integrated module units that would encompass diverse healthcare professions in which the students get to understand the roles that the others play (Carpenter and Dickinson 2016). I believe that would help break people from the cocoon of their professional and help them understand others. It would also help people realize that no single health profession is better than the other. If one of the healthcare professions was taken away from the equation, then the quality of care would be affected negatively, and outcomes would also shift negatively. My key strength is that I want to learn, and I am genuinely interested in understanding the roles that other healthcare professionals play in the healthcare paradigm. By learning, I will be able to be a better future professional in collaborative practice. I have learnt that it is important to persevere and be determined when challenging decisions or when trying to help clients with their cases.

Conclusion

In conclusion, interprofessional practice is important, and it is supported by interprofessional education and collaborative practice. As in all things, there enablers and barriers to interprofessional practice. The enablers include but are not limited to strong leaders, an administrative and organizational culture of interprofessional practice, and a shared mission and vision. The barriers include but are not limited to stereotyping other professionals, thinking that other professions are better than other professions, having curricular that is solely discipline-focused, and a lack of understanding of what other disciplines and healthcare professions do. In relation to myself, I learned a lot in the groups which I was placed and about how interprofessional practice is important for a better quality of healthcare and for better healthcare outcomes. As such, interprofessional practice is very important for different healthcare professions but more so for the service users.

References

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