Interprofessionality as the field of interprofessional practice and interprofessional education: an emerging concept.
ABSTRACT This paper proposes a new concept and a frame of reference that should permit the development of a better understanding of a phenomenon that is the development of a cohesive and integrated health care practice among professionals in response to clients' needs. The concept is named "interprofessionality" and aims to draw a clear distinction with another concept, that of interdisciplinarity. The utilization of the concept of interdisciplinarity, which originally concerns the development of integrated knowledge in response to fragmented disciplinary knowledge, has caused some confusion. We need a concept that will specifically concern the development of a cohesive practice among different professionals from the same organization or from different organizations and the factors influencing it. There is no concept that focuses clearly on this field. Interprofessionality concerns the processes and determinants that influence interprofessional education initiatives as well as determinants and processes inherent to interprofessional collaboration. Interprofessionality also involves analysis of the linkages between these two spheres of activity. An attempt to bridge the gap between interprofessional education and interprofessional practice is long overdue; the two fields of inquiry need a common basis for analysis. To this end, we propose a frame of reference, an interprofessional education for collaborative patient-centred practice framework. The framework establishes linkages between the determinants and processes of collaboration at several levels, including links among learners, teachers and professionals (micro level), links at the organizational level between teaching and health organizations (meso level) and links among systems such as political, socio-economic and cultural systems (macro level). Research must play a key role in the development of interprofessionality in order to document these linkages and the results of initiatives as they are proposed and implemented. We also believe that interprofessionality will not be pursued without the requisite political will.
- SourceAvailable from: Sylvain Boet[Show abstract] [Hide abstract]
ABSTRACT: Simulation-based education allows experiential learning without risk to patients. Interprofessional education aims to provide opportunities to different professions for learning how to work effectively together. Interprofessional simulation-based education presents many challenges, including the logistics of setting up the session and providing effective feedback to participants with different backgrounds and mental models. This paper aims to provide educators with a series of practical and pedagogical tips for designing, implementing, assessing, and evaluating a successful interprofessional team-based simulation session. The paper is organized in the sequence that an educator might use in developing an interprofessional simulation-based education session. Collectively, this paper provides guidance from determining interprofessional learning objectives and curricular design to program evaluation. With a better understanding of the concepts and pedagogical methods underlying interprofessional education and simulation, educators will be able to create conditions for a unique educational experience where individuals learn with and from other specialties and professions in a controlled, safe environment.Medical Teacher 07/2014; · 2.05 Impact Factor
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ABSTRACT: With the ongoing implementation of the Patient Protection and Affordable Care Act (Public Law No: 111–148, March 23, 2010) and its impact on the evolving health care system, this article will focus on 4 broad domains of change that the education and training community in psychology must address to ensure that the next generations of health service psychologists are prepared to not just succeed, but lead those changes in health care. Interprofessionalism, workforce analysis and development (including practice settings), finances (reimbursement, health care cost offset, and advocacy), and professional accountability (including accreditation, competency, evidence-based care, specialization, identity and self-definition, and autonomy) will be discussed. Each domain reflects demands for both affordable care and enhanced accountability in the developing health care system. Recommendations for curricular content and clinical training modifications are offered. (PsycINFO Database Record (c) 2014 APA, all rights reserved)Training and Education in Professional Psychology 01/2014; 8(2):83. · 1.58 Impact Factor
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ABSTRACT: The implementation of a bachelor degree in "Interprofessional Health Care" at the University of Heidelberg, Germany has fostered the need to evaluate the impact of this innovative programme. The Readiness for Interprofessional Learning Scale (RIPLS) was developed by Parsell and Bligh (1999) to assess student's attitudes towards interprofessional education. The RIPLS consists of 19 items and four subscales were identified by McFadyen McFadyen (J Interprof Care 19:595-603, 2005): "teamwork and collaboration", "negative professional identity", "positive professional identity" and "roles and responsibilities". The RIPLS has been translated into a number of languages and used in a variety of different educational settings. A German version of the RIPLS was not available. Aim of the study was the translation of the RIPLS into German and testing of internal consistency.BMC Medical Education 07/2014; 14(1):145. · 1.41 Impact Factor
Interprofessionality as the field of interprofessional
practice and interprofessional education: An emerging
DANIELLE D’AMOUR1& IVY OANDASAN2
1Faculty of Nursing, University of Montreal, FERASI Centre, Groupe de recherche interdisciplinaire en
sante ´ (GRIS), Montre ´al, Que ´bec, and2Department of Family & Community Medicine, and Family
Health Research Unit, University of Toronto, Ontario, Canada
This paper proposes a new concept and a frame of reference that should permit the development of a
better understanding of a phenomenon that is the development of a cohesive and integrated health care
practice among professionals in response to clients’ needs. The concept is named ‘‘interprofession-
ality’’ and aims to draw a clear distinction with another concept, that of interdisciplinarity. The
utilization of the concept of interdisciplinarity, which originally concerns the development of integrated
knowledge in response to fragmented disciplinary knowledge, has caused some confusion. We need a
concept that will specifically concern the development of a cohesive practice among different
professionals from the same organization or from different organizations and the factors influencing it.
There is no concept that focuses clearly on this field. Interprofessionality concerns the processes and
determinants that influence interprofessional education initiatives as well as determinants and
processes inherent to interprofessional collaboration. Interprofessionality also involves analysis of the
linkages between these two spheres of activity. An attempt to bridge the gap between interprofessional
education and interprofessional practice is long overdue; the two fields of inquiry need a common basis
for analysis. To this end, we propose a frame of reference, an interprofessional education for
collaborative patient-centred practice framework. The framework establishes linkages between the
determinants and processes of collaboration at several levels, including links among learners, teachers
and professionals (micro level), links at the organizational level between teaching and health
organizations (meso level) and links among systems such as political, socio-economic and cultural
systems (macro level). Research must play a key role in the development of interprofessionality in order
to document these linkages and the results of initiatives as they are proposed and implemented. We
also believe that interprofessionality will not be pursued without the requisite political will.
Keywords: Interprofessional education, interprofessional collaboration, interprofessionality, framework.
Interprofessional education and interprofessional collaboration have not often found a place
in the education and practices of health professionals. The papers in this supplement provide
several perspectives on this situation. Our focus, however, has been to arrive at a
comprehensive appraisal of the elements of a collaborative patient-centred practice. Our
reflection has led us to formulate some propositions with respect to ‘‘interprofessionality’’.
We are effectively proposing a new concept. The goal of the paper is three folds: (1) to draw
Correspondence: Danielle D’Amour, RN, PhD, Associate Professor, Faculty of Nursing, 2375 Co ˆte-Ste-Catherine Road,
Montre ´al, Que ´bec, H3T 1A8, Canada. Tel: +15143437578. Fax: +15143432306. E-mail: email@example.com
Journal of Interprofessional Care, (May 2005) Supplement 1: 8–20
ISSN 1356-1820 print/ISSN 1469-9567 online # 2005 Taylor & Francis Group Ltd
a real and useful distinction between this new concept of interprofessionality and the current
use of interdisciplinarity, (2) to propose a definition of interprofessionality, and (3) to
propose a framework that identifies the processes and determinants of interprofessionality
and links those components in a clear and concrete way that is research based.
Interdisciplinarity versus interprofessionality
Interdisciplinarity is a response to the fragmented knowledge of numerous disciplines. Each
discipline is based on a sum of organized knowledge, and the emergence of numerous
disciplines has resulted in an artificial division of knowledge that does not match the needs
of the researchers who are investigating complex research areas (Gusdorf, 1990; Klein,
1990). Interdisciplinarity wishes to reconcile and foster cohesion to this fragmented
knowledge. As a result, whole new disciplines may emerge.
In the same manner that disciplines have developed, so too have numerous professions,
defined by fragmented disciplinary specific knowledge. Each profession owns a professional
jurisdiction or scope of practice, which impacts the delivery of services. This silo-like
division of professional responsibilities is rarely naturally nor cohesively integrated in a
manner which meets the needs of both the clients and the professionals. The notion of
interprofessionality is useful to direct our attention to the emergence of a more cohesive and
less fragmented interprofessional practice. This does not imply the development of new
professions, but rather a means by which professionals can practice in a more collaborative
or integrated fashion. This distinction separates interprofessionality from interdisciplinarity.
In the health domain, interprofessionality is a response to the realities of fragmented health
care practices. Professionals come from different disciplines and from different health care
organizations, each carrying different conceptualizations of the client, of the clients’ needs,
and the type of response needed to address the clients’ numerous and complex health care
situations. Interprofessionality is defined as the development of a cohesive practice between
professionals from different disciplines. It is the process by which professionals reflect on
and develop ways of practicing that provides an integrated and cohesive answer to the needs
of the client/family/population. Interprofessionality comes from the preoccupation of
professionals to reconcile their differences and their sometimes opposing views and it
involves continuous interaction and knowledge sharing between professionals organized, to
solve or explore a variety of education and care issues all while seeking to optimize the
patient’s participation. The care provided to the patient and the patient’s willingness to
participate are key factors in this approach. Interprofessionality requires a paradigm shift,
since interprofessional practice has unique characteristics in terms of values, codes of
conduct, and ways of working. These characteristics must be elucidated. We believe it
important to acknowledge this unique point of view by proposing the concept of
interprofessionality. The fact that no term currently exists to capture this particular
phenomenon is symptomatic of the state of the knowledge in this area. The concept of
interprofessionality makes it possible to specifically study the interprofessional nature of an
intervention be it in the field of education or of practice.
The development of interprofessionality implies a better understanding of the
determinants and processes that influence interprofessional education and interprofessional
practice. It also involves the understanding of the links between these two spheres of activity.
Our hypothesis is that we cannot develop interprofessional practice that will produce
Interprofessionality: An emerging concept
improved results in health care delivery simply by pursuing the work in those two areas
separately. We need to look at education and practice across the professions and how
education and practice are interdependent upon each other in order to enhance patient-
centred care. Interprofessionality is then an education and practice orientation, an approach
to care and education where educators and practitioners collaborate synergistically.
Interprofessionality also concerns the environment of practice and the determinants and
processes that support a cohesive practice. In this way managers and professionals would
benefit from working together. Again our hypothesis is that interprofessional practice cannot
be developed on the will of only professionals or only managers. Interprofessionality involves
continuous interaction between professionals and managers, in order to understand the
appropriate environmental conditions for the development of interprofesionality.
Interprofessionality will be better understood through practice and research. It has the
potential to open up a field of inquiry to fully understand the processes and determinants of
interprofessional education and of interprofessional practice. To this end, we propose the
framework of ‘‘Interprofessional Education for Collaborative Patient-centred Practice
(IECPCP)’’ based on the research work done for Health Canada (Oandasan, D’Amour,
Zwarenstein et al., 2004). This frame of reference can be seen as a first milestone in the
development of this emerging area of inquiry linking interprofessional education with
interprofessional practice. It is an evolving framework and denotes that much needs to be
learned in this area, this is why it should remain flexible and adapt to changes in education
and health systems.
This IECPCP framework should help to identify the determinants and processes that
influence educational programs to teach about interprofessional practice as well as the
determinants and processes that influence the adoption of interprofessional practice within
the health system. Moreover, this framework opens the door to understanding the linkages
between these two worlds and the still relatively unknown process of cross-fertilization at
work between them. At this point in time, published work on either subject does not
mention a frame of reference such as the one we propose. Through effective analysis and
implementation of the proposed framework, best practices and better patient-centred care
outcomes are hypothesized to be achieved. These results, however, can only be proven
through a process of formalized evaluations and research.
Within this paper the terms ‘‘patient’’ and ‘‘client’’ have been used interchangeably, and
include the family or community when appropriate. The client/patient/family/community is
conceived of as a partner in care delivery, not simply as the recipient or consumer of care.
The term ‘‘professional’’ includes the different types of workers who provide the patient/
client with preventive, curative and rehabilitative care.
Interprofessionality and IECPCP Framework
As mentioned, the IECPCP framework is designed to highlight the linkages between
interprofessional education and collaborative practice (Figure 1). The framework is made of
two circles: the first circle for education and a second for practice. The first includes factors
that affect a health professional learner’s capacity to become a competent collaborative
practitioner. It highlights micro (teaching), meso (institutional) and macro (systemic)
factors. The learner is at the core of the first circle and is affected by all the factors that
influence his or her ability to gain the competencies needed to be able to work
collaboratively with other health care professionals.
The second circle is comprised of processes and factors that affect patient care outcomes
in collaborative practice settings. Again, the micro (interactional), meso (organizational) and
D. D’Amour & I. Oandasan
macro (systemic) factors are highlighted. The circle shows the processes through which
health professionals structure their collaboration. These processes are complex since they
concern human interaction between professionals from different world-views within a
complex changing environment. The patient is at the core of the second circle, and his or her
health care outcomes will be affected by the professionals’ collaborative practice. To be
effective, patient-centred care must address the needs of the patients and their wishes, in that
their readiness and willingness to collaborate in their care must be understood.
Research, including evaluation, informs both interprofessional education and collabora-
tive patient-centred practice. It provides feedback that encompasses micro, meso and macro
levels and helps stakeholders bring improvements to both the educational and practice
environments. Below is a description of each of the components of the framework.
1. Interdependency between interprofessional education and collaborative practice
If interprofessionality is to be studied, it is necessary to make a distinction between
educational initiatives to enhance learner outcomes and collaborative practice to enhance patient
outcomes. Creating such a distinction within the framework provides an opportunity for
stakeholders, like the government, licensing bodies, hospital and academic institutional
leaders, educators, learners, health professionals and the public, to examine the factors that
influence specific outcomes of both fields while acknowledging their interdependence.
Separating education from practice provides clarity about the structural determinants and
processes affecting the advancement of interprofessionality at both a micro and meso level.
At all levels, but perhaps even more so at the macro level, stakeholders must recognize the
interdependent nature of interprofessional education and collaborative practice. With this
theoretical understanding, distinctions between these two fields can be made yet its linkages
Figure 1. Interprofessional education for collaborative patient-centred practice.
Interprofessionality: An emerging concept
clearly understood. This theoretical understanding is the underpinning that can pave the
way for advancement of this complex domain.
Interprofessional education requires collaborative practice settings where learners can be
exposed to educational experiences. It is believed by many that if we train competent
collaborative practitioners, more collaborative practice settings will be developed over time.
With increased numbers of settings, more opportunities for learning and teaching
collaboration are envisioned. Hence practice is linked with education.
Zwarenstein, Reeves and Perrier (2005) have found that there is mounting evidence that
studied to date. However, in this same review,little evidence that formalized interprofessional
education initiatives, particularly at the pre-licensure level, has improved patient care
outcomes. Caution must be noted in interpreting this finding as linking pre-licensure
education with patient care outcomes is not an easy task. The framework which we propose,
illustrates that there are many factors that act as determinants for collaborative practice to be
realizedofwhich D’Amour,Ferrada-Videla,SanMartı ´nRodrı ´guezandBeaulieu(2005)have
ably described. There are those that question the necessity to find evidence of effectiveness of
collaborative practice and interprofessional education and whether we must expend energy in
researching outcome measures. Yet, this information can drive change and indeed can
influence health care professionals and those in leadership positions within government and
health/academic institutions to make strategic decisions to supportive initiatives to enhance
interprofessional education for collaborative patient-centred practice.
2. Interprofessional education to enhance learner outcomes
Interprofessional education to enhance learner outcomes highlights the learners as central to
interprofessional educational processes (Figure 2) (Oandasan & Reeves, 2005). The
interface between the learner and the educator is an essential element of interprofessional
education. Within our framework we situate socialization issues as a key component that
must be addressed in the development of interprofessional education. By socialization we
mean that the professional and cultural beliefs and attitudes that develop among health
professionals can affect their willingness to collaborate with other health professionals
(Perkins & Tryssenaar, 1994; Zungalo, 1994). Learners enter health professional programs
with already formed stereotypes of their own professional identity and stereotypes of others
(Tunstall-Pedoe, Rink & Hilton, 2003). This identity can be further shaped by their
educators/mentors, who act as role models (Gill & Ling, 1995; Parsell & Bligh, 1998;
Waugaman, 1994). Therefore, the professional beliefs and attitudes of educators with
respect to collaborative practice play a critical role in student training. Students, in turn,
influence educators, and there may be a bi-directional socialization process that occurs over
time and across generations. This is depicted by the bi-directional arrows between the
learner and the educators in the left hand circle. Educators can either be enablers or barriers
to learners’ opportunities to gain collaborative competencies. Recognizing that professional
and cultural beliefs and attitudes are often fostered through system influences like the media
and through public perceptions, we situate professional values and beliefs as a macro- issue
within our framework as well as a micro issue that must be acknowledged between learners
and educators. This will be further discussed later in this paper.
Teaching factors (micro level) and institutional factors (meso level) can influence the
professional beliefs and attitudes of faculty and learners towards interprofessional ways of
learning and practicing. These micro and meso level factors, which are integral components
of interprofessionality, are interactional. This is depicted in Figure 2 by four small arrows in
D. D’Amour & I. Oandasan
the circle: they are dynamic and hence represent a circular motion. The factors influence
and inform each other, and may act as catalysts or barriers. Oandasan and Reeves (2005)
provide an in-depth description of each of the factors that are listed below in their paper
found within this supplement:
2.1 Teaching (or micro level) factors include:
Learning context, which encompasses how to teach interprofessional collaboration and
addresses questions of the ‘‘who, what, where and when’’ of interprofessional education.
Faculty development, which addresses: the faculty’s needs to learn how to facilitate
interprofessional education and how to recognize one’s own professional beliefs and
attitudes towards collaboration.
2.2 Institutional factors (or meso-level)
In this instance, institutions are defined as higher-education academic institutions or
academic hospital environments. Without the development of a vision of interprofessionality
at the institutional level, it will be difficult to mobilize the need for change. Hence
administrators and leaders must be actively involved in moving the IECPCP agenda at their
institutions. This is consistent with the literature on change management captured by
Ginsburg and Tregunno (2005) in their review of the literature on organizational change.
The following institutional facets can influence interprofessional educational opportunities:
Leadership and resources, which include: administrators with the power to move the
agenda forward by providing resources and champions to carry the vision.
Figure 2. Interprofessional education: Processes and outcomes.
Interprofessionality: An emerging concept
Administrative processes, which comprise: the methods for implementing initiatives,
including logistical decisions and financial incentives.
2.3 Interprofessional education outcomes.
As discussed earlier, it is important to have clinical settings where collaborative practice is
modeled for learners. Through the inquiry of interprofessionality, a body of knowledge will
be created that describes the types of competencies that are required of health practitioners to
work optimally in collaborative practice settings. This body of knowledge can be utilized to
help describe the competencies that need to be taught. At this time these competencies (or
the knowledge, skills, attitudes) shared by collaborative practitioners are still being defined.
Much can be learned from two literature reviews on the conceptual models of collaboration
and on the determinants of collaboration in this supplement (D’Amour et al., 2005; San
Martı ´n Rodrı ´guez, Beaulieu, D’Amour & Ferrada-Videla, 2005). From these literature
reviews, specific processes and determinants are identified. As they are grounded in empirical
research, we feel they can aid educators in understanding the types of competencies that
learners should obtain to function collaboratively. An extrapolation of these processes and
determinants can provide an understanding of some of the knowledge (group functioning,
roles and responsibilities of different professionals...), skills (communication and reflective
practice, leadership...) and attitudes (mutual respect, willingness to collaborate, openness to
trust...) that should be learned. Clear competencies or learner outcomes are necessary for
the development of formalized teaching innovations at both pre-licensure and post-licensure
levels.Moreresearch will be required to help furtherdefine these competencies for the future.
Few formal learning opportunities at the pre-licensure level currently exist to teach health
professionals to be collaborative practitioners. Yet, there are many health professionals who
have acquired collaborative competencies without formal training, working in health care. It
is for this reason that a dashed arrow can be found within the framework extending from the
learner competency outcome box to the collaborative practice setting circle (Figure 1). By
identifying health professionals who are working collaboratively, we are able to learn from
them and can operationalize ways of teaching and practicing collaboration based upon
research findings from the practice settings from which they work.
2.4 Post-licensure teaching and learning for health professionals.
There have been many formalized educational methods used to enhance post-licensure
health professional’s opportunities to acquire specific interprofessionality competencies as
found in the Jet Review (Freeth, Hammick, Koppel, Reeves & Barr, 2002). Some of these
methods fall under the categories of staff development, faculty development and still others
in the area of continuous quality improvement initiatives (CQI). There is some debate
particularly, within medical education, over the specific terminology that should be used to
describe educational methods within the post-licensure arena: should it be called
professional development or continuing medical education? We have chosen to use the
term ‘‘professional development’’ to depict types of educational methods that can be used to
teach collaborative competencies to post-licensure health professionals, because it under-
scores the practitioner’s role as a learner. Learners can thus be either within the pre-
licensure or post-licensure levels of training but the micro and meso-level factors that need
to be addressed related to interprofessional education initiatives remain consistent.
D. D’Amour & I. Oandasan
earlier, what has been hypothesized by many, but not yet proven is the idea that education to
provide collaborative competencies to both pre-licensure and post-licensure health profes-
sionals will improve patient care outcomes if the professionals work in an environment that
supports collaborative practice. More research is needed to come to a definitive conclusion.
3. Collaborative practice to enhance patient outcomes
Collaborative practice to enhance patient care outcomes highlights the patient/client as central to
collaborative processes. As indicated in the circle the professionals and the patient/client are
in an interdependent relation. Figure 3 lists the key elements of a collaborative practice in
health care organizations. Such practice takes various forms and the make-up of each team
depends on the complexity of the needs that it addresses. The circle depicts the interactional
processes and organizational factors that have to be taken into account when professionals
3.1 Needs of the patient/client and task complexity.
Patients are at the center of collaborative care, since they are the initial reason for the
interdependency between professionals (Evans, 1994; Henry, Schmitz, Reif & Rudie, 1992;
Liedtka & Whitten, 1998). Patients are at the same time active members of the team and
recipients of the care provided by the team (Golin & Ducanis, 1981). According to these
authors, the patients’ needs determine the interactions between professionals (Golin &
Ducanis, 1981). Their privileged position in the team nevertheless depends on their
willingness and ability to participate in the planning and delivery of health care. However,
D’Amour et al. (2005) found little evidence that researchers had conceptualized the client or
Figure 3. Collaborative practice: Processes and outcomes.
Interprofessionality: An emerging concept
family as participants in interprofessional collaboration. Attention will clearly need to be
paid to this area as interprofessionality is developed.
This focus on patient is necessary but not sufficient. The collaborative practice is above all
processes made of complex interactions: interactions between individuals and interactions
between individuals and the organization which present many constraints to individual
action. The literature review of the frameworks on collaboration in this supplement
(D’Amour et al., 2005) has identified seven frameworks of collaboration among which three
present stronger theoretical and empirical bases that can help to understand the processes
and determinants of collaboration (D’Amour, Goulet, Pineault, Labadie, & Remondin,
2004; Sicotte, D’Amour & Moreault, 2002; West, Borrill & Unsworth, 1998) The three of
them could possibly be used to fit in this framework of IECPCP to tackle the issue of
collaborative processes since most of them integrate the perspective that collaboration is
made up of processes influenced by human relationships and organizational constraints. We
choose to draw on D’Amour’s model, which is a strong model that expresses our way of
conceptualizing collaboration (D’Amour, Sicotte & Levy, 1999). D’Amour’s model
proposes four dimensions to collaborative processes, two of which are related to human
interactional processes and two that are tied to organizational factors.
3.2 Interactional processes.
As far as the interactional dimensions are concerned, sharing common goals and a common
vision are of prime importance (Cohen & Bailey, 1997; Evans & Dion, 1991; Liedkta &
Whitten, 1998). Shared patient-oriented goals emerge when the team is focused on the
patient/client, but at the same time one must recognize the diverse interests and the
asymmetry of power of the various partners in care and the negotiations that result (Corser,
1998; Henneman, 1995; Sullivan, 1998). The other interactional dimension refers to the
bonds that develop between team members and their willingness to work together, elements
that contribute to a sense of mutual trust among the health professionals working in a team.
In order to build trusting relationships, professionals must know each other personally and
professionally (Das & Teng, 1998; Jones & Georges, 1998; Williams, 2001). To know each
other professionally means to be familiar with each other’s conceptual models, roles and
responsibilities. Collaboration is not possible if this basic requirement is not fulfilled. It
allows participants in the team to transcend their inclination towards exclusive professional
‘‘turfs’’ and share common professional territories.
3.3 The organizational factors.
However, it is important to recognize that collaboration exists not only within a team, but
also in the context of a larger organizational setting and more and more frequently, between
organizations as in health care network, which exercises significant influence on the team.
The two dominant organizational dimensions of the model are governance and
formalization. Governance is, in that respect, a key element, and it includes the role played
by leadership. Different levels of leadership should be considered, such as central, local and
expert leadership. In the context of interprofessionality, collective leadership and
interprofessional leadership need thorough study (Denis, Lamothe & Langley, 2001). The
formalization dimension refers to structuring clinical care in a more systematized way.
Efforts to formalize include the development of information exchange, protocols,
procedures... (Bodewes, 2002; Freeth et al., 2002; Sicotte et al., 2002). These efforts
constitute a key element of the organizational dimension, since they clarify expectations.
D. D’Amour & I. Oandasan
The interactional and organizational factors influence one another. This is indicated by
small arrows inside the circle, which are meant to represent circularity in the relationship
between interactional and organizational factors.
Other factors external to the organization must also be taken into account, such as the
structure of health care delivery and the degree of integration between different
organizations. On a broader level, structures such as those found in professional and
educational systems have a significant impact on the development and regulation of
professional boundaries. These boundaries can be among the main obstacles to
collaboration in the health care system, and can promote a competitive mindset in
professionals instead of fostering a spirit of collaboration (Abbott, 1988). On the other hand,
social values and/or societal pressures can drive innovative ways of working and can compel
professionals to be more open to new orientations and new approaches to practice.
3.4 Outcomes of collaboration.
According to the literature review on the models of collaboration (D’Amour et al., 2005),
interprofessional collaboration has a four-fold impact that takes into consideration patient,
professional, organizational and system outcomes (Corser, 1998; D’Amour et al., 2004;
Miller, 1997; West et al., 1998). The effects of collaboration on patient outcomes are
discussed by Zwarenstein, Reeves and Perrier (2005). Providers’ outcomes take the form of
job satisfaction (Corser, 1998; D’Amour et al., 2004; Miller, 1997) and team member mental
health (West et al., 1998). Health organizations also benefit from collaborative care, since
professionals work more efficiently (West et al., 1998). The expected effects on the overall
health care system are reduced cost and greater responsiveness (D’Amour et al., 2004).
4. Systemic factors – macro level
As captured by Ginsburg and Tregunno (2005) change management strategies need to be
explored that would affect systemic changes at the macro level. These efforts would include
creating a shared vision for health, social and educational systems that would be in keeping
with interprofessionality. Ideally, policies developed by various levels of government would
support interprofessional education for collaborative patient-centred practice. For example,
decision makers could reflect upon the structural and financial segregation of post-
secondary health professional training programs and consider ways to alleviate the current
climate of segregation between professions. The professions themselves have a role in
impacting change particularly through health professional regulatory bodies. These bodies
are responsible for defining scopes of practices and dealing with issues of liability. They can
positively influence interprofessionality through policy implementation which may impact
how professionals choose to practice. Lastly, accreditation at institutions where health
professionals work or are trained can act as powerful forces for change and can be a strong
lever for advancing interprofessionality if they choose to monitor for collaborative practice
and structured interprofessional educational activities.
Earlier it was mentioned that the interface between health professional educators and
learners should consider the effects of both parties’ professional cultural values. Often health
professionals fail to recognize that they carry with them stereotypes or misconceptions of
other health professionals that negatively impact opportunities to teach and/or practice
collaboration. The effect of professional cultural values at the micro level of teaching is
important to take into consideration. However, as discussed earlier, it has been found that
learners enter their educational programs with cultural beliefs, attitudes and values about the
Interprofessionality: An emerging concept
profession they are entering, developed well before they have engaged in formal training.
Recognizing this reality, we felt that it was important to acknowledge that professional socio-
cultural beliefs are prevalent at both a macro level and a micro level. At the macro level,
professional socio-cultural beliefs weave its effects into the meso and micro levels of both
education and practice. As noted earlier however, we feel it important to particularly note its
effect at the educator/learner interface, as role modelling is so important to learners.
However, patients/clients or the public are also affected by professional stereotypes that
prevail systemically. They are often developed through the media or inherited historically.
This public perception of the roles of health professionals can impact the comfort level of
individuals in seeing health professionals other than, for example, a physician within a team,
as point of first contact within the health care system.
The framework highlights the need to foster collaboration with the involvement of patients/
clients and health care professionals, learners and educators and institutional leaders and
setting priorities and demonstrating flexibility in providing support and funding for
interprofessional education and collaborative practice initiatives at a meso- institutional level
and enhancing competencies and work environments to support collaborative practice and
education at a micro level, this framework helps to highlight the determinants required for
transformation. Health professionalsworkingtogether underthisframeworkmayrequirenew
roles and responsibilities that may affect the current scope of practices as they work together
directly impacting patient care. This framework provides the rationale that collaborative
not necessarily improve patient/client, provider, organization and system outcomes if micro-
meso- and macro- level support are not aligned at practice settings. With the concept of
interprofessionality, this framework proposes some of the determinants required for both
education and practice to positively impact outcomes including patient care.
5. Research to inform and evaluate
Research is an important factor that must be recognized within this evolving framework. The
findings from rigorous research in this area will underpin our understanding of
interprofessionality and can advance this area further in the future. The large arrows in
the framework (Figure 1) represent a circular motion, highlighting the iterative feedback
loop that crosses all micro, meso and macro levels for categories of both interprofessional
education and collaborative practice. The arrows also recognize that research in
interprofessional education can inform research in collaborative practice, and vice versa.
Research informs and can evaluate the processes involved in interprofessionality.
We are still acquiring a body of knowledge on interprofessional education and
collaborative practice. Through additional research from different paradigms, we will be
able to expand the knowledge base of interprofessionality. Developing clear outcomes and
benchmarks through the application of rigorous methodologies in both the learning and
practice environments will produce a better understanding of interprofessionality and its
outcome in these settings. Further research in this field is needed to provide guidance with
respect to which populations can benefit from a collaborative approach, which health
professionals should be involved, and how health professionals should collaborate with each
other. The answers to these questions will help inform strategies employed in the teaching
environment and help trainees become competent collaborative practitioners.
Research in the area of interprofessional education and collaborative practice has had few
frameworks that could serve as guides in developing research questions and methodologies.
D. D’Amour & I. Oandasan
The dissemination of findings has been haphazard, and there have been problems achieving
are widely disseminated and that the methodologies used are written in a way that they are
easily understood and reproduced (Hammick, 2000; Freeth, Hammick, Koppel et al. 2002).
Conclusions and recommendations
We have proposed interprofessionality as a new concept and a new area of inquiry, to make
explicit the links between two inseparable fields of study, interprofessional education and
collaborative practice. Through the IECPCP framework, we propose an integrated vision of a
group of factors derived from the structures that influence interprofessionality and from the
collaborative processes that will enable educators and practitioners from different professions
to work together. The framework specifically includes the clients as partners in care delivery.
This important partnership has not yet been fully recognized in interprofessional education
and practice. The foundations of this framework will be built through research. Without
research, the concepts proposed cannot be rigorously developed, implemented and tested. As
a result, transformation of health care systems to support interprofessional education for
collaborative patient centred practiced may be delayed. The research methods used must be
able to cross and intersect all of the determinants at the macro, meso and micro levels to
ensure that the answers needed to move interprofessionality forward are addressed. Key
decision-makers and policy-makers can use the research findings to develop policies that will
ultimately improve collaboration by impacting all three levels identified in the framework.
We would like to conclude on the fact that this scientific and theoretical agenda has to be
supported by political stakeholders since many factors that influence interprofessionality
have political components. If we are to advance interprofessionality, there is a need for
collaboration among educators, practitioners, researchers, policy-makers and the public.
These stakeholders must believe that fundamental change is needed.
The authors would like to thank Health Canada through the Office of Nursing Policy that
coordinates the ‘‘Interprofessional Education for Patient Centred Care’’ initiative and
provided the funding for the environmental scan and literature review that culminated in the
development of the conceptual framework presented in this paper. We would like to give
special thanks to Leticia San Martin Rodriguez and Marcela Ferrada Videla who brought a
major contribution to discussions related to the numerous iterations of the framework. We
would also like to thank our colleagues who were part of the overall research team: Louise
Nasmith, Merrick Zwarenstein, Marie-Dominique Beaulieu, Scott Reeves, Keegan Barker,
Carmela Bosco, Margaret Purden, Lianne Ginsberg, Deborah Tregunno and Laure Perrier
whose work provided the substrate from which this framework was envisioned. In addition,
special acknowledgement must be made of Yanick Maufrand who was instrumental in the
graphic design of the framework.
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