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The (stalled) progress of interprofessional collaboration: The role of gender
Abstract
Abstract Researchers have demonstrated that team-based, collaborative care improves patient outcomes and fosters safer, more effective health care. Despite such positive findings, interprofessional collaboration (IPC) has been somewhat stunted in its adoption. Utilizing a socio-historical lens and employing expectation states theory, we explore potential reasons behind IPC's slow integration. More specifically, we argue that a primary mechanism hindering the achievement of the full promise of IPC stems not only from the rigid occupational status hierarchy nested within health care delivery, but also from the broader status differences between men and women - and how these societal-level disparities are exercised and perpetuated within health care delivery. For instance, we examine not only the historical differences in occupational status of the more "gendered" professions within health care delivery teams (e.g. medicine and nursing), but also the persistent under-representation of women in the physician workforce, especially in leadership positions. Doing so reveals how gender representation, or lack thereof, could potentially lead to ineffective, mismanaged and segmented interprofessional care. Implications and potential solutions are discussed.
... In a review including 83 studies between 2005 and 2010, Abu-Risch and colleagues [4] concluded that research about IPE in healthcare education has reported primarily on four major themes, partly confirmed by complementary research; a) students' learning [9,14], b) professional roles/ identification [15,16], c) communication [17][18][19], and d) overall satisfaction with IPE [6,14]. However, we would like to add another theme: e) implementation and development [6,20,21]. Still, studies on IPE, and thus also iPBL, group-processes in general, and groups' development specifically are lacking; this is thus a research gap requiring further research [19,22]. ...
... In session 1, the physicians in groups 1, 2 and 4 dominated (18,30] and behaved in a way that is consistent with physician stereotypes [29,[32][33][34]. The nursing and other healthcare students all behaved submissively in the first group session, consistent with the stereotypical role of nurses [15,17,20,26,50]. In the last group session, the physicians no longer dominated; the influence of the other students had increased. ...
... Our results are in accordance with previous research showing that stereotypical professional behavior and preconceived notions about one's chosen profession and its allied professions are deeply rooted and difficult to change [20,27,30,50]. Being locked into professionally stereotypical behavioral patterns may have a negative impact on interprofessional collaboration, suggesting that not all group members' competences are fully exploited [15,16,29,49]. ...
Background
Group processes in inter-professional Problem-Based Learning (iPBL) groups have not yet been studied in the health-care educational context. In this paper we present findings on how group-dynamics, collaboration, and tutor style influence the perception of profession-based stereotypes of students collaborating in iPBL groups. Health-care students are trained in iPBL groups to increase their ability to collaborate with other healthcare professionals. Previous research focusing iPBL in healthcare implies that more systematic studies are desired, especially concerning the interaction between group processes and internalized professional stereotypes. The aim of this study is to investigate whether changes in group processes, collaboration, and tutor style, influence the perception of profession-based stereotypes of physician- and nursing-students.
Methods
The study is a quasi-experimental pre- post-design. The participants included 30 students from five different healthcare professions, mainly medicine and nursing. Other professions were physiotherapy, occupational therapy and speech therapy. The students were divided into four iPBL groups, each consisting of six to nine students and a tutor. Data were collected through systematic observation using four video-recorded tutorials. SPGR (Systematizing the Person Group Relation), a computer-supported method for direct and structured observation of behavior, was used to collect and analyze the data.
Results
Traditional stereotypical profession-based behaviors were identified in the first observed group meeting. Although the groups followed different paths of development, the group-dynamics changed in all groups over the 6 weeks of collaboration. Two of the groups became more cohesive, one became more fragmented and one became more polarized. Stereotypical behaviors became less frequent in all groups. Our findings indicate that tutor behavior has a strong influence on the development of the group’s dynamics.
Conclusion
Our findings strongly suggest iPBL is a means of reducing stereotypical behaviors, and may positively increase members’ ability to engage in inter-professional collaboration. Although the pattern of dynamics took different forms in different groups, we argue that iPBL forces students to see the colleague behind his or her profession, thus breaking professional boundaries. The tutor style significantly influenced the iPBL groups’ development. This study contributes to our field by emphasizing the effect of group-processes in increasing mutual understanding across professions.
... A variety of processes occur in interactions between health care professionals that influence the effective flow of knowledge between them (Khalili et al., 2014). These processes do not always occur smoothly nor efficiently, due in large part to the complex belief systems among health care professionals (Bell et al., 2014). One particularly important belief system is selfefficacy; that is, beliefs in one's capabilities to persist and succeed at doing something specific (Bandura, 1997). ...
... Other key processes influencing interactions at work originate from an individual's gender and profession (Bell et al., 2014;Wilhelmsson et al., 2011). In terms of profession, the nurse-physician relationship is hierarchical (Nair et al., 2012), with nurses stereotypically functioning in deference to physicians (Hendel et al., 2007). ...
... Gender is a social construct that refers to a system that influences behavior and defines power and status relationships between men and women often resulting in inequality (Goktan & Gupta, 2015). Historically, women have been regarded as having less competence than men and as a result their views in decision-making are often overlooked -many argue this persists today even if less explicit (Bell et al., 2014;MacMillan, 2012). Expectation states theory offers a partial explanation of gender inequality in decision-making processes. ...
While gender and professional status influence how decisions are made, the role played by health care professionals’ informational role self-efficacy appears as a central construct fostering participation in decision-making. The goal of this study is to contribute to a better understanding of how gender and profession affect the role of self-efficacy in sharing expertise and decision-making. Validated questionnaires were answered by a cross-sectional sample of 108 physicians and nurses working in mental health care teams. A moderated mediation analysis was performed. Results reveal that the impact of sharing knowledge on informational role self-efficacy is negative for nurses. Being a nurse negatively affects the relation between informational role self-efficacy and participating in decision-making. Informational role self-efficacy is also a strong positive predictor of participation in decision-making for male physicians but less so for female physicians.
... IPBL facilitates the acquisition of collaborative knowledge, skills and attitudes enabling collaborative practice [13]. In a review including 83 studies between 2005-2010, Abu-Risch and colleagues [4] concluded that research about IPE in healthcare education has foremost reported on four major themes, partly con rmed by complementary research; a) students learning [9,14], b) professional roles/identi cation [15,16], c) communication [17,18,19], and d) overall satisfaction with IPE [6,14,21]. However, we would like to add another theme: e) implementation and development [6,21,22]. ...
... In a review including 83 studies between 2005-2010, Abu-Risch and colleagues [4] concluded that research about IPE in healthcare education has foremost reported on four major themes, partly con rmed by complementary research; a) students learning [9,14], b) professional roles/identi cation [15,16], c) communication [17,18,19], and d) overall satisfaction with IPE [6,14,21]. However, we would like to add another theme: e) implementation and development [6,21,22]. Still, studies on IPE, thus also iPBL, and group processes in general and groups' development speci cally are lacking; this is thus a research gap requiring further research [19,23]. ...
... In session 1, the physicians in groups 1, 2 and 4 dominate (18,30] and behave in a way that is consistent with physician stereotypes [29,32,33,34]. The nursing and other healthcare students all behaved submissively in the rst group session, consistent with the stereotypical role of nurses [15,17,20,21,50]. In the last group session, the physicians no longer dominated; the in uence of the other students had increased. ...
Background: Group processes in inter-professional Problem-Based Learning (iPBL) groups have not yet been studied in health-care educational context. In this paper we present findings on how group-dynamics, collaboration and tutor style influence the perception of professional stereotypes of students collaborating in iPBL groups. Health-care students are trained in iPBL groups to increase their ability for collaboration between healthcare professionals. Previous research focusing iPBL in healthcare, infers that more systematic studies are desired, especially concerning interaction between group processes, and internalized professional stereotypes. The aim of this study is to investigate if changes in group processes, collaboration and if tutor style, influence the perception of professional stereotypes of physician- and nurse-students.
Methods: The study is a quasi-experimental pre- post-design. The participants included 30 students from five different healthcare professions, mainly medicine and nursing. Other professions were physiotherapy, occupational therapy and speech therapy. The students were divided into four iPBL groups, each consisting of six to nine students and a tutor. Data were collected through systematic observation using four video-recorded tutorials. SPGR (Systematizing the Person Group Relation), a computer-supported method for direct and structured observation of behavior, were used to collect and analyze data.
Results: Traditional stereotypical professional behaviors were identified in the first observed group meeting. Although the groups followed different paths of development, the group-dynamics changed in all groups over the six weeks of collaboration. Two of the groups became more cohesive, one more fragmented and one more polarized. Stereotypical behaviors became less frequent in all groups. Our findings indicate that tutor behavior has a strong influence on the development of the group’s dynamics.
Conclusion: Our findings strongly suggest iPBL is a mean to reduce stereotypical behaviors, that may positively increase member’s ability for inter-professional collaboration. Although the pattern of dynamics took different forms in different groups, we argue that iPBL forces students to see the colleague behind his or her profession, thus breaking professional boundaries. The tutor style significantly influenced the IPBL groups development. This study contributes to our field by emphasizing the effect of group-processes to increase mutual understanding across professions.
... 354). The nurse-physician relationship is historically patriarchal and is thought to be naturalized and justified by mainstream ideas on gender (Bell, Michalec, & Arenson, 2014). Although women have entered the field of medicine in increasing numbers, men retain the power within the profession (Bell, et al., 2014;Davies, 1996). ...
... The nurse-physician relationship is historically patriarchal and is thought to be naturalized and justified by mainstream ideas on gender (Bell, Michalec, & Arenson, 2014). Although women have entered the field of medicine in increasing numbers, men retain the power within the profession (Bell, et al., 2014;Davies, 1996). ...
... There is a possibility that the feminine stereotyped traits ascribed to nursing are contributing to the maintenance of power hierarchies (Bell, Michalec, & Arenson, 2014). Men have more structural power (derived from their traditional roles in government, business, the military, and medicine) and women have more dyadic power (derived from close relationship influences) (Diekman, Goodfriend, & Goodwin, 2004). ...
Examination of the power dynamics at work in perpetuating health care hierarchy-related interprofessional collaboration barriers is needed to rationally develop strategies for teaching collaborative skills to health care providers. A mixed-methods study employing critical realist grounded theory examined the implicit beliefs, assumptions and power hierarchies related to gendered perceptions of the professions of nursing and medicine by students of those professions. Two focus groups of nursing students (n = 6 and n = 8) and one focus group of medical students (n = 6) and an online survey of both medical and nursing students utilizing the Interpersonal Hierarchy Expectation Scale (Mast, 2005a) (N = 73) provided the data. Focus group data revealed that both nursing and medical students had strongly gender-essentialized beliefs about the social categories of medicine and nursing with nursing as feminine and medicine as masculine. Students ascribed expectations of work performance based on gender with female physicians expected to be more successful in family-oriented roles (pediatrics) and male nurses expected to be more successful in ‘non-nurturing’ roles (surgery). Survey data revealed that both nursing and medical students had the same level of hierarchy expectations. Gendered stereotypes of nurses as communal and physicians as agentic can contribute to the maintenance of components of the health care hierarchy that lead to sub-optimal interprofessional collaborative practice. Understanding students’ essentialist beliefs about the social categories of nursing and medicine can inform effective interprofessional education curriculum development.
... Despite the theoretical identification of determinants and the process of working in a team were widely described, researchers have paid little attention to describing the determinants of ITC (Zwarenstein et al., 2009). For this reason, many authors stated that there is an important need in identifying determinants of ITC to better understand its peculiarities (Bell, Michalec, & Arenson, 2014;Mulvale et al., 2016;Ndibu, Chiocchio, Bamvita, & Fleury, 2019). ...
... Specifically, previous studies have provided some insights in describing how some socio-demographic characteristics (i.e. the micro-level of the ITC input-output-process), such as sex, age, and working experience could have an influence on ITC (Bell et al., 2014). Some authors found positive associations between ITC and working experience or age (Rousseau, Pontbriand, Nadeau, & Johnson-Lafleur, 2017;Sarma, Devlin, Thind, & Chu, 2012), while some authors found that men seemed to be favored in teams of positive ITC over women, showing a nested hierarchy where leaders are mainly men (Bell et al., 2014). ...
... Specifically, previous studies have provided some insights in describing how some socio-demographic characteristics (i.e. the micro-level of the ITC input-output-process), such as sex, age, and working experience could have an influence on ITC (Bell et al., 2014). Some authors found positive associations between ITC and working experience or age (Rousseau, Pontbriand, Nadeau, & Johnson-Lafleur, 2017;Sarma, Devlin, Thind, & Chu, 2012), while some authors found that men seemed to be favored in teams of positive ITC over women, showing a nested hierarchy where leaders are mainly men (Bell et al., 2014). Overall, the interest in socio-demographic determinants of ITC is increasing, but research currently provides diverse results (Ndibu et al., 2019). ...
Interprofessional team collaboration (ITC) is pivotal for the safety and the quality of healthcare settings, being associated with higher staff and patient satisfaction. However, individual-level determinants (i.e. socio-demographic and working satisfaction) remain currently largely unexplored. This study aimed to describe the overall ITC (i.e. partnership, cooperation, coordination), identifying the individual-level determinants of each ITC domain. This study had a multicentre approach, using cross-sectional data collection. ITC was assessed using the Interprofessional Team Collaboration Scale II, Italian version (I-AITCS II). The determinants of ITC were investigated through multivariable linear regression models. The study results showed significant associations between the same ITC domains, as well as the important role of work satisfaction in determining cooperation and coordination. Physiciansreported more inadequate partnership levels than other healthcare professionals. This study provides insights for future research and gives a useful description of the determinants of ITC for multi-stakeholder healthcare organizations.
... For example, surgery, emergency medicine, and anesthesiology are regarded as higher status than specialties such as pediatrics, primary care, and obstetrics. These intragroup differences historically align with the devaluation of women's expertise, given men who are physicians tend to cluster in higher status specialties and women who are physicians tend to cluster in lower status specialties (Adams, 2010;Bell et al., 2014). ...
... 75% of interviewees were cisgender women, many of whom were in low status positions within healthcare (e.g., nurses compared to surgeons). This is unsurprising, given the persistence of gendered stratification in health organizations (Acker, 1990;Reskin and Roos, 1990) and across specialties (Adams, 2010;Bell et al., 2014). ...
We examine the consequences of rapid organizational change on high and low-status healthcare workers (HCWs) during the COVID-19 pandemic. Drawing on 25 interviews, we found that rapid change can create a sense of social disorder by exacerbating the uncertainty brought on by the pandemic, crystallizing the lack of training to deal with crisis, and upending taken-for-granted roles and responsibilities in health infrastructures. Our work contributes to scholarship at the intersection of organizations, professions, and social studies of medicine. First, we show how organizations that must respond with rapidity, such as during a crisis, sets up workers for failure. Second, hastily made decisions can have monumental consequences in the work lives of HCWs, but with differences based on status. All HCWs had trouble with the rearrangement of tasks and roles. Low status HCWs were more likely to feel the strain of the lack of resources and direct contact with COVID-19 patients. High status HCWs were more likely to experience their autonomy undermined – in the organization and content of their work. In these contexts of rapid change, all HCWs experienced social disorder and a sense of inevitable failure, which obscured how organizations have perpetuated inequalities between high and low status workers.
... The conceptual framework by Mulvale et al. (2016) posited that predictors of IPC can be classified according to individual, team, and organisational levels. Some individual level factors previously tested for association with IPC are age, gender, education, seniority in the profession and team, values, professional identity, speciality, and job satisfaction (Bell et al., 2014;Bookey-Bassett et al., 2017;Canadian Interprofessional Health Collaborative [CIHC], 2010;Chiocchio et al., 2016, Dellafiore et al., 2019McNeil et al., 2013;Pasyar et al., 2018;Rousseau et al., 2017;Wackerhausen, 2009). Some team level factors that have been investigated include decision-making and role awareness of other professions (Baggs & Schmitt, 1997;Dunn et al. 2013;Silen-Lipponen et al., 2002). ...
... Gender. Some authors (e.g., Bell et al., 2014) found that males have a greater extent of IPC as the leaders in an interprofessional team are mainly men. Other studies (e.g., Ulrich et al., 2019) found that women displayed more IPC due to a positive view on teamwork, higher flexibility to a hierarchical healthcare system (Wilhelmsson et al., 2011) or that females enjoy the social and collaborative aspects of IPC more than males (Reynolds, 2003). ...
There is a paucity of research on the interprofessional collaboration (IPC) of Medical Social Workers (MSWs). This study aims to investigate: 1) the MSWs’ perceptions about the extent of their IPC; 2) the individual, team, and organisational level predictors of IPC; 3) whether there are different effects of individual, team, organisational factors on IPC. 171 MSWs from various public healthcare institutions in Singapore, participated in the study. Respondents have a good extent of IPC. They perform the best in flexibility, followed by newly created professional activities, interdependence, collective ownership of goals, and lastly, reflection on process. The predictors of IPC are a combination of individual factors and organisational factors. Hierarchical multiple linear regressions showed that individual level factors are the strongest predictor of IPC whereas organisational level factors are more influential for flexibility and collective ownership of goals. The study has implications for the workplaces and the MSWs.
... Hence, this suggests IPE is seen as a potential threat to the balance between professional roles, as highlighted by Kuper and Whitehead (2012). However, IPE is also seen as a potential threat to gender relations, as shown by Bell, Michalec, andArenson (2014) andFalk Lindh, Hammar, andNyström (2015). The arena for these professional power and gender imbalances are the actual IPE learning environments and activities; the results show how these environments and activities are the means that express IPE within the IPE frame of educational leaders. ...
... Hence, this suggests IPE is seen as a potential threat to the balance between professional roles, as highlighted by Kuper and Whitehead (2012). However, IPE is also seen as a potential threat to gender relations, as shown by Bell, Michalec, andArenson (2014) andFalk Lindh, Hammar, andNyström (2015). The arena for these professional power and gender imbalances are the actual IPE learning environments and activities; the results show how these environments and activities are the means that express IPE within the IPE frame of educational leaders. ...
This paper reports a qualitative study that explored the meanings of interprofessional education (IPE) by comparing and contrasting educational leaders’ perceptions with educational policy documents at an academic health professions education institution in Scandinavia. The study used Goffman’s frame analysis to identify two frames of IPE by illuminating issues related to the definition, rationale, and presentation of IPE. A directed content analysis to identify these three aspects of IPE was conducted on semi-structured interviews with nine educational leaders who were overseeing the development of IPE, as well as on the institution’s regulatory IPE documentation. Differences regarding definition, rationale, and presentation of IPE between the institutional regulatory IPE frame and the IPE frame of the educational leaders were found which implied difficulties for the educational leaders regarding the implementation of IPE. Based on the study’s findings, the paper argues that creating awareness of the differences in meanings of IPE between different perspectives within an academic education institution is an important factor to consider when creating future organisational structures and faculty development programmes in connection to IPE.
... It is notable that an alternative was suggested by males in this course to replace SS learning discussion boards in which students exchange information about their disciplines with an informational short video presenting information on each profession. This suggests a preference by males for more informational content-focused learning over collaboration process, as interactional team learning previously noted (Behrend et al., 2020;Bell et al., 2014;Lindh Falk et al., 2015;Wilhelmsson et al., 2011). These differences alert course designers to intentionally consider formats to deliver content and instructor skills to navigate potential gender-based preferences. ...
Introduction
Interprofessional education (IPE) has been increasingly emphasized as a potential factor in high-quality health care. Despite a rising trend in online IPE courses, less attention has been given to how interactional formats intersect with learner characteristics. This study was to examine the impact of the introductory IPE online course on student attitudes about IPE and identify students’ perceived value of specific instructional course components, such as Student–Student (SS) and Student–Content (SC) aspects, with respect to different academic levels and gender.
Methods
A mixed-methods design was used and involved quantitative data about the attitudes measured by the SPICE-R2 survey and qualitative open-ended questions about students’ opinions. Participants completed the pre- and post-survey, before and after completing an online course.
Results
2,373 students completed the online course and consented to have their responses in this analysis. The two-way ANOVA showed significant effects of academic levels on all three subdomains (Roles, Teamwork, and Outcomes; all p < 0.001), highlighting varied gains across levels, and the qualitative data were confirmatory or confirmatory plus expansive. Students preferred SC more than SS interaction.
Conclusion
This online course was an effective learning activity for improving students’ attitudes toward IPE. Learning components focusing on real-life patient experience was the most valued and thus impactful course component. Mixed method findings highlighted important awareness of the impact of learner characteristics on the perceived value of course components. Tailoring IPE course content and delivery to meet diverse learners’ learning needs and expectations would be more impactful.
... gender-based division) and the division into low and high professional status. [16][17][18][19] Research on medical professions reveals multiple changes in healthcare systems that have had significant impacts on the roles played by HCWs. They include the feminisation of medical professions, 20 the empowerment of patients as a challenge to the sense of professional autonomy, 21 the blurring of the line between the purely medical and administrative aspects of healthcare delivery, 22 the loss of power and autonomy to lay HCWs, 9 re-stratification processes changing the pre-existing hierarchies, 23 the impact of corporate capitalism and the biomedical industry, 24 the neoliberalisation of healthcare systems, 25 and the increasing role of social media and their effect on the doctorpatient relationship. ...
This article analyses the organisation of the mass COVID‐19 vaccination programme in Poland and its consequences for various aspects of the social identity of healthcare workers (HCWs). Based on 31 in‐depth interviews with HCWs, our study reveals the following: (1) Certain elements of the programme (inclusion of other healthcare professionals like pharmacists and laboratory diagnosticians as vaccinators) and the provision of additional infrastructure (pharmacies and shopping malls) may prompt scepticism and criticism in physicians and nurses who feel challenged about their professional autonomy and hierarchies; (2) Given the high levels of professional uncertainty, the implementation of the COVID‐19 vaccination is forcing HCWs to revise their attitude to medical standards, resulting in specific responses and adaptation strategies (ranging from the active involvement in the programme due to the sense of mission, to more or less evident scepticism); and (3) Confronting vaccine hesitancy, both among patients and other HCWs, contributes to the feeling of helplessness, leading to criticism of policymakers.
... Intrapersonal barriers to IPC may also be related to culture, in which individualism is valued over group think and consensus building, or in terms of gender, when women may feel less heard and valued and thus are reluctant to share their ideas. Bell et al. (2014) concur that gender plays a role in the process of establishing and maintaining interprofessional collegiality. They purport that stereotypical ideas exist related to the roles of women in academia, such as that women are less confident than their male counterparts in sharing ideas when working on collaborative projects. ...
Through interprofessional collaboration (IPC), scholars with diverse knowledge and skills enhance the integration and communication of ideas and services in the pursuit of high-quality education. This article explores the structure, process, and outcomes of IPC and proposes recommendations to create a culture of interprofessional collaboration in higher education. Semi-structured interviews were conducted with 17 participants with extensive IPC experience in a research-intensive university. Results regarding IPC were organized around structure-related factors, including physical structure, organizational characteristics, external and internal factors, and group structure, as well as process-related factors, which include intrapersonal, interpersonal, and institutional facilitators and barriers. Outcomes included intrapersonal, interpersonal, and institutional, including drawbacks and benefits. Structure-process-outcomes of IPC inform recommendations to strategically create a culture of IPC in higher education. Transformative culture change begins with the identification of champions of IPC, who spearhead the implementation of IPC goals within an organization’s strategic plan. Policies, procedures, and resources of an organization are needed for successful interprofessional collaborations.
... Las organizaciones de salud no escapan, en este sentido, del carácter patriarcal de la división sexual del trabajo (Kuhn & Wolpe, 1978;Witz, 1990). Los mecanismos de funcionamiento que se operan en su interior remiten a códigos culturales de masculinidad y de feminidad (Allen et al., 2002) que responden a un pensamiento biologicista, es decir, que tratan la división del trabajo como natural, atribuyendo los roles profesionales a cada uno de sus integrantes en base a su sexo (Kuhn & Wolpe, 1978), en base a una dicotomía jerárquica entre razón y pensamiento -codificados como masculinos y públicos-y entre cuerpo y emoción -codificados como femeninos y privados- (Bell et al., 2014;Langendyk et al., 2015;Olson & Brosnan, 2017;Price et al., 2014;Seenandan-Sookdeo, 2012). ...
... Some examples include nursing and medical students who after interprofessional education (IPE) maintain professional stereotypes (Carpenter, 1995) and how nursing and medical students' stereotypical conceptions limit dedication in IPE (Sollami et al., 2015). Gender has also been described as contributing to the maintenance of the hierarchical order of professions in IPL (Bell et al., 2014). Other studies have addressed the development of identity and how gendered processes impacted teamwork and learning (Lindh Falk et al., 2015). ...
Purpose
This study aims to investigate how aspects of the sex/gender were scrutinized in a team’s production of clinical guidelines for psychiatric compulsory care and what the implications were for the final guidelines and for interprofessional learning.
Design/methodology/approach
The study is a case study, where interviews were conducted and a narrative analysis was used.
Findings
The results reflected how sex/gender arose in a discussion about gender differences when using restraining belts. Furthermore, discussions are presented where profession-specific experiences and knowledge about sex/gender appeared to stimulate interprofessional learning. However, the team’s learning about the complexity of sex/gender resulted in guidelines that emphasized aspects of power and focused on the individual patient. Thus, discussions leading to analysis and learning related to gender paradoxically produced guidelines that were gender-neutral.
Originality/value
The study highlights the potential interprofessional learning in discussions of sex/gender and its complex relation in medicine.
... [21] Moreover, gender was also found to be a factor affecting IPE collaboration. [24] Different professional cultures contribute unique challenges to effective interprofessional collaboration. Thus, strengthening IPE requires a cultural shift by all those who support and lead the healthcare system. ...
Background and objective: Interprofessional education (IPE) is an important step in advancing the education of health professionals. This study aimed to evaluate IPE learning outcomes and satisfaction of students that participated in a school-health program. The program was delivered as a joint collaborative topic among nursing, dental public health, and public health students. We also sought to examine students’ understanding of roles and teamwork, as well as their satisfaction with IPE.Methods: This study had a quasi-experimental design. Third-year nursing students were randomly divided into 2 groups, the IPE and non-IPE groups. All third-year dental public health students and public health students were enrolled in the IPE group. All IPE students were stratified and randomized into interprofessional teams of ten or eleven students. The program included 3 modules: 1) foundational workshops for IPE role clarification in the school-health program and situation analysis of school-health problems, 2) project planning and implementation, and 3) evaluation and sharing. Non-IPE nursing students also received the same 3 modules of the school-health learning program without working in the interprofessional team. A pretest and posttest on school-health theoretical content were completed by both groups of nursing students. In the IPE group, we collected data regarding the understanding of students’ roles within their teams before and after the course. Satisfaction with IPE learning was only asked after the course. Results: The IPE group (n = 164) consisted of 60 nursing, 59 dental public health, and 45 public health students. There were 63 nursing students in the non-IPE group. For knowledge on school health, the nursing students in the non-IPE group had a significantly higher pretest score compared to the IPE group; while there was no significant difference in post-test scores between both groups. All aspects of the interprofessional collaboration among the three health professional student groups in the IPE group increased, with a significant difference for 4 out of 6 aspects. Students were satisfied with the IPE program and wished to extend their time spent in the program.Conclusions: IPE learning provides a better understanding of different healthcare roles and enhanced teamwork between multidisciplinary teams. Incorporating IPE as a learning strategy is recommended for health professional students.
... In alignment with IPE literature, we found that power discrepancies between professional groups played a role in the implementation of IPSE programs [27][28][29]. Additionally, we found that power discrepancies based on status and experience affected how participants and facilitators engaged in IPSE, which has been observed in previous qualitative work on IPSE [8]. ...
Background
Despite the widespread adoption of interprofessional simulation-based education (IPSE) in healthcare as a means to optimize interprofessional teamwork, data suggest that IPSE may not achieve these intended goals due to a gap between the ideals and the realities of implementation.
Methods
We conducted a qualitative case study that used the framework method to understand what and how core principles from guidelines for interprofessional education (IPE) and simulation-based education (SBE) were implemented in existing in situ IPSE programs. We observed simulation sessions and interviewed facilitators and directors at seven programs.
Results
We found considerable variability in how IPSE programs apply and implement core principles derived from IPE and SBE guidelines with some principles applied by most programs (e.g., “active learning”, “psychological safety”, “feedback during debriefing”) and others rarely applied (e.g., “interprofessional competency-based assessment”, “repeated and distributed practice”). Through interviews we identified that buy-in, resources, lack of outcome measures, and power discrepancies influenced the extent to which principles were applied.
Conclusions
To achieve IPSE’s intended goals of optimizing interprofessional teamwork, programs should transition from designing for the ideal of IPSE to realities of IPSE implementation.
... Studies linking collaborative work, sex, and gender are still incipient. A study carried out (12) confirms that gender inequality can contribute to the failure of collaborative practice, as the characteristics of gender status result in different expectations. Health care is often associated with a female role (11) . ...
Objetivo: Analisar a Disposi��ǜo para a colabora��ǜo interprofissional de estudantes de gradua��ǜo. MǸtodo: Estudo transversal, descritivo, realizado com 82 estudantes de dez cursos de gradua��ǜo de uma universidade pǧblica. A inten��ǜo para a colabora��ǜo interprofissional foi verificada atravǸs da Escala Jefferson de Atitudes Relacionadas �� Colabora��ǜo Interprofissional. Resultados: A amostra foi composta na sua maioria por indiv��duos do sexo feminino, na faixa etǭria de 20 anos, entre o 2�� e 4�� semestre da gradua��ǜo. O escore mǸdio da escala utilizada foi de 129,3 pontos. Conclusǜo: No ǽmbito da educa��ǜo, principalmente de n��vel superior, muitas iniciativas de ensinoaprendizagem sǜo realizadas de forma coletiva, o que favorece a percep��ǜo positiva para o trabalho coletivo. A disposi��ǜo para a colabora��ǜo interprofissional dos estudantes apresentou alto escore; nǜo houve diferen��a estat��stica significativa entre os diferentes cursos de gradua��ǜo, sexo e a fase de forma��ǜo.
... In alignment with IPE literature, we found that power discrepancies between professional groups played a role in the implementation of IPSE programs (24)(25)(26). Additionally, we found that power discrepancies based on status and experience affected how participants and facilitators engaged in IPSE, which has been observed in previous qualitative work on IPSE (8). ...
Background: Despite the widespread adoption of interprofessional simulation-based education (IPSE) in healthcare as a means to optimize interprofessional teamwork, data suggest that IPSE may not achieve these intended goals due to a gap between the ideals and the realities of implementation.
Methods: We conducted a qualitative case study that used the framework method to understand what and how core principles from guidelines for interprofessional education (IPE) and simulation-based education (SBE) were implemented in existing in situ IPSE programs. We observed simulation sessions and interviewed facilitators and directors at seven programs.
Results: We found considerable variability in how IPSE programs apply and implement core principles derived from IPE and SBE guidelines with some principles applied by most programs (e.g., “active learning”, “psychological safety”, “feedback during debriefing”) and others rarely applied (e.g., “interprofessional competency-based assessment”, “repeated and distributed practice”). Through interviews we identified that buy-in, resources, lack of outcome measures, and power discrepancies influenced the extent to which principles were applied.
Conclusion: To achieve IPSE’s intended goals of optimizing interprofessional teamwork, programs should transition from designing for the ideal of IPSE to realities of IPSE implementation.
... At the same time as interprofessional collaboration between practitioners and social scientists has increased, so too has interprofessional education and collaboration within medical education contexts more broadly. Sociologists have noted many challenges faced by those developing interprofessional education (IPE) programs, including entrenched, often gendered, status hierarchies (Bell, Michalec, and Arenson 2014). Indeed, these hierarchies permeate not only the collaborations themselves but also the language that medical educators use to write about them ). ...
From 1940 to 1980, studies of medical education were foundational to sociology, but attention shifted away from medical training in the late 1980s. Recently, there has been a marked return to this once pivotal topic, reflecting new questions and stakes. This article traces this resurgence by reviewing recent substantive research trends and setting the agenda for future research. We summarize four current research foci that reflect and critically map onto earlier projects in this subfield while driving theoretical development elsewhere in the larger discipline: (1) professional socialization, (2) knowledge regimes, (3) stratification within the profession, and (4) sociology of the field of medical education. We then offer six potential future directions where more research is needed: (1) inequalities in medical education, (2) socialization across the life course and new institutional forms of gatekeeping, (3) provider well-being, (4) globalization, (5) medical education as knowledge-based work, and (6) effects of the COVID-19 pandemic.
... Interprofessional collaboration in multidisciplinary teams is effective in mental health settings. For example, it is found to improve patient health status and treatment compliance, reduce suicides and clinical errors, boosts professionals' satisfaction and motivation, lowers admission rates and shortens stays [8][9][10][11]. Multidisciplinary teams however face key challenges in implementing interprofessional collaboration such as barriers caused by different professional cultures [12], divergent values [13], and lack of recognition of each others' roles [14]. Patient-centered care is also intricate to manage [15] as teams need to consider more factors in delivering services. ...
Background: The successful combination of interprofessional collaboration in multidisciplinary teams with patient-centered care is necessary when it comes to delivering complex mental health services. Yet collaboration is challenging and patient-centered care is intricate to manage. This study examines correlates of patient-centered care such as team adaptivity and proactivity, collaboration, belief in interprofessional collaboration and informational role self-efficacy in multidisciplinary mental health teams.
Method: A cross-sectional multilevel survey design was used, based on self-administered bilingual validated questionnaires. Participants (N=314) were mental health professionals and managers working in public primary care or specialized mental health services, in inpatient or outpatient settings.
Results: This study showed that belief in interprofessional collaboration’s relationship with patient-centered perceptions is increased in teams with high collaboration. Collaboration is also found as a mediator, representing a process by which team adaptive and proactive behaviors are transformed into positive patient-centered perceptions.
Conclusions: Our results were in line with recent studies on team processes establishing that collaboration is a key component in multilevel examinations of predictors of patient-centered care. In terms of practice, our study showed that multidisciplinary teams should know that working hard on collaboration is an answer to the complexity of patient-centered care. Collaboration is related to the teams’ ability to respond to its challenges. It is also related to individuals’ beliefs central to the delivery of interprofessional care.
... Interprofessional collaboration in multidisciplinary teams is effective in mental health settings. For example, it is found to improve patient health status and treatment compliance, reduce suicides and clinical errors, boost professionals' satisfaction and motivation, lower admission rates and shorten stays [8][9][10][11]. Multidisciplinary teams however face key challenges in implementing interprofessional collaboration such as barriers caused by different professional cultures [12], divergent values [13], and lack of recognition of each others' roles [14]. Patient-centered care is also intricate to manage [15] as teams need to consider more factors in delivering services. ...
Background
The successful combination of interprofessional collaboration in multidisciplinary teams with patient-centered care is necessary when it comes to delivering complex mental health services. Yet collaboration is challenging and patient-centered care is intricate to manage. This study examines correlates of patient-centered care such as team adaptivity and proactivity, collaboration, belief in interprofessional collaboration and informational role self-efficacy in multidisciplinary mental health teams.
Method
A cross-sectional multilevel survey design was used, based on self-administered bilingual validated questionnaires. Participants ( N =314) were mental health professionals and managers working in public primary care or specialized mental health services, in inpatient or outpatient settings.
Results
This study showed that belief in interprofessional collaboration’s relationship with patient-centered perceptions is increased in teams with high collaboration. Collaboration is also found as a mediator, representing a process by which team adaptive and proactive behaviors are transformed into positive patient-centered perceptions.
Conclusions
Our results were in line with recent studies on team processes establishing that collaboration is a key component in multilevel examinations of predictors of patient-centered care. In terms of practice, our study showed that multidisciplinary teams should know that working hard on collaboration is an answer to the complexity of patient-centered care. Collaboration is related to the teams’ ability to respond to its challenges. It is also related to individuals’ beliefs central to the delivery of interprofessional care.
... Interprofessional collaboration in multidisciplinary teams is effective in mental health settings. For example, it is found to improve patient health status and treatment compliance, reduce suicides and clinical errors, boosts professionals' satisfaction and motivation, lowers admission rates and shortens stays [8][9][10][11]. Multidisciplinary teams however face key challenges in implementing interprofessional collaboration such as barriers caused by different professional cultures [12], divergent values [13], and lack of recognition of each others' roles [14]. Patient-centered care is also intricate to manage [15] as teams need to consider more factors in delivering services. ...
Background: The successful combination of interprofessional collaboration in multidisciplinary teams with patient-centered care is necessary when it comes to delivering complex mental health services. Yet collaboration is challenging and patient-centered care is intricate to manage. This study examines correlates of patient-centered care such as team adaptivity and proactivity, collaboration, belief in interprofessional collaboration and informational role self-efficacy in multidisciplinary mental health teams.
Method: A cross-sectional multilevel survey design was used, based on self-administered bilingual validated questionnaires. Participants (N=314) were mental health professionals and managers working in public primary care or specialized mental health services, in inpatient or outpatient settings.
Results: This study showed that belief in interprofessional collaboration’s relationship with patient-centered perceptions is increased in teams with high collaboration. Collaboration is also found as a mediator, representing a process by which team adaptive and proactive behaviors are transformed into positive patient-centered perceptions.
Conclusions: Our results were in line with recent studies on team processes establishing that collaboration is a key component in multilevel examinations of predictors of patient-centered care. In terms of practice, our study showed that multidisciplinary teams should know that working hard on collaboration is an answer to the complexity of patient-centered care. Collaboration is related to the teams’ ability to respond to its challenges. It is also related to individuals’ beliefs central to the delivery of interprofessional care.
... Individual and joint leadership development, in addition to being informed by relevant theoretical perspectives, needs to take into account demographic variations (eg, gender and leadership level) and systemic issues. As in our study, more women are in DCL roles 45 and face different challenges and utilize different strategies for success-partially attributable to physician power structures in healthcare 46,47 and the hierarchical relationship between physicians and nurses. 48 It is important the organizations be deliberate in identifying the appropriate talent suitable for dyad leadership based upon underlying motivations and aptitudes. ...
The use of a dyad leadership model involving a physician co-leader and a co-leader with a different background, the dyad co-leader, is gradually increasing in Healthcare Organizations (HCOs). There is a paucity of empirical studies on various aspects of this model. This study's aim was to identify challenges and strategies for success in the dyad leadership model in healthcare. Through a mixed-methods approach utilizing focus groups, surveys, and semi-structured interviews, perceptions of 37 leaders in one HCO at different hierarchical levels were analysed based on their lived experiences. The challenges and success strategies spanned personal, interpersonal, and organizational domains. The areas requiring attention included mindsets, competencies, interpersonal relationship, support, time, communication, and collaboration. In addition, the importance of organizational context addressing its structure, strategy, operations, and culture was highlighted. The findings from this study may be used for praxis, development, and implementation of dyad leadership.
... Interprofessional collaboration in multidisciplinary teams is effective in mental health settings; it improves patient health status and treatment compliance, reduces suicides and clinical errors, boosts professionals' satisfaction and motivation, lowers admission rates and shortens stays [8][9][10][11]. But in spite of this, multidisciplinary teams must surmount challenges such as barriers caused by different professional cultures [12], divergent values [13], and lack of recognition of each others' roles [14]. ...
Background: The combination of interprofessional collaboration in teams and patient-centered care is a necessary amalgamation when it comes to delivering complex mental healthy care and services. Yet collaboration is challenging and patient-centered care is intricate to manage. This study examines the impact of predictors of patient-centered care such as team adaptivity and proactivity, collaboration, belief in interprofessional collaboration, informal role self-efficacy in multidisciplinary mental health teams.
Method: Cross-sectional multilevel design using self-administered bilingual validated questionnaires.
Results: This study showed that belief in interprofessional collaboration’s impact on patient-centered perceptions is increased in teams with high collaboration. We also showed that collaboration is a mediator; that is, a process by which team adaptive and proactive behaviors are transformed into positive patient-centered perceptions.
Conclusions: In terms of research our results are in line with recent theorising on team processes and specifically established collaboration as key in a multilevel examination of predictors of patient-centered care perceptions. In terms of practice, we showed that multidisciplinary teams should know that working hard on collaboration as an answer to the complexity of patient-centered care impacts the teams’ ability to respond to its challenges but also impacts individuals’ beliefs central to the delivery of interprofessional care.
... It has been argued that because of institutionally embedded occupation-based (as well as race-, ethnicity-, and genderbased) status stratification, Allport's condition of equal status is relatively unfeasible (Bell et al., 2014;Michalec et al., 2017). However, it is apparent that healthcare practitioners, regardless of profession, are working together and are striving for the same goal: to save patients and prevent the spread of the virus. ...
There is evidence to suggest enhanced teamness, heightened interprofessional values and practices, and even the potential for dilution of occupational status hierarchies within healthcare practice and delivery during the time of COVID-19. It is essential that we study these emergent changes using the lens of multilevel theory to better understand these recent developments and their current and future implications for interprofessional practice, education, and policy. Within this article, we first offer a brief overview of secondary data to highlight these COVID-19-specific shifts to provide context and perspective. We then outline prominent micro, meso, and macro-level theories, and propose accompanying rudimentary hypotheses and related general research questions to help guide, and ideally accelerate IPE and IPCP research related to this crisis. Our goal is to not only spotlight key areas for future research during and post COVID-19 but also provide a “starter kit” to encourage more theory-driven research (and theory-expansion) in the IPE and IPCP fields.
... Eason (2013) uses the word to refer to using a novel teaching method, as in the integration of simulation into basic science courses. To other researchers (Bell, Michalec, & Arenson, 2014;Sternlieb, 2015), integration means bringing other aspects of professionalism, like interdisciplinary teamwork or reflective practices, into the medical school curriculum. ...
Introduction
Integration has been recognized as an important aspect of medical education. After transitioning from a discipline‐specific to a systems‐based preclinical curriculum, we examined faculty perceptions of the integrated approach and also whether it would lead to better anatomy knowledge retention.
Methods
To understand faculty perspectives, we reviewed curricular materials, interviewed block directors, and observed educational sessions. We analyzed knowledge retention through a 27‐question anatomy test, comparing scores from the last class of the discipline‐based curriculum and the first two classes of the integrated curriculum.
Results
Planning integrated content involves purposeful ordering, is challenging for faculty, and requires additional resources. Evaluation of the integrated approach for anatomy content demonstrated a significant increase in knowledge retention (p = .012; 56.28% vs. 63.98% for old vs. new curriculum).
Conclusions
This study helps the understanding of what is required for curricular integration. Our anatomy evaluation results corroborated the view that contextually embedded information is easier to learn and retain.
... Der Pflegeberuf wurde aufgrund seiner emotionalen und fürsorglichen Aufgaben feminisiert [33]. Bell et al. [34] begründen die hierarchischen Strukturen im Gesundheitswesen mit gesellschaftlich tief verwurzelten Geschlechterstereotypen, die auf die Gesundheitsberufe übertragen wurden. ...
Zusammenfassung
Hintergrund Intersektionalität beschreibt die Zusammenhänge unterschiedlicher Formen und Dimensionen von Diversität. Intersektionale Ansätze können helfen, Forschungsergebnisse zu erklären, deren Validität zu verbessern und wirksame Gesundheitsprogramme abzuleiten.
Ziel Der Beitrag hat zum Ziel aufzuzeigen, wie Intersektionalität in die Forschung implementiert werden kann.
Methoden In einem Workshop wurde ein Fall aus einer Feldbeobachtung intersektionell nach einem Modell von Bilge analysiert. Reflexionen wurden verschriftlicht und in einem iterativen Prozess ergänzt.
Ergebnisse Drei zentrale Themen wurden identifiziert: (1) Autonomie und Würde im Umgang mit der Körperlichkeit und Nacktheit einer Patientin, (2) professionelle Interaktionen am Beispiel fehlender gemeinsamer Entscheidungsfindung und Behandlungsplanung sowie (3) Reflexivität am Beispiel voreingenommener Perspektiven der Akteure.
Schlussfolgerungen Die verwendete Methodologie kann dazu dienen, Sensibilität hinsichtlich Diversität und Intersektionalität in der medizinischen Forschung zu fördern.
... patient health, patient experience) while minimizing cost and error. A second avenue of inquiry, based on conflict theories, examines the differential construction and enactment of collaboration by different groups, particularly the different professions (Baker, Egan-Lee, Martimianakis, & Reeves, 2011;Bell, Michalec, & Arenson, 2014;Haddara & Lingard, 2013;Kuper & Whitehead, 2012;Whitehead, 2007). Authors working in this tradition tend to critically problematize collaboration, focusing on the divergent interests, practices, systems of knowledge and discourses that produce, reinforce or challenge interprofessional hierarchies. ...
Collaboration has achieved widespread acceptance as an indispensable element of healthcare delivery in recent decades, despite modest evidence for its impact on healthcare outcomes. Attempts to understand this seeming paradox have been based mostly in functionalist or conflict-theoretical approaches. Currently lacking, however, is an articulation of how collaborative ideals are embedded in broadly shared beliefs about what healthcare is and how it operates. In this article, we examine how language used in the CanMEDS competency framework and in two guides for Family Health Teams construct idealized versions of rational, autonomous physicians and primary care organizations, respectively. Informed by phenomenological sociology and neo-institutional theory, we characterize these documents as elements of formal structure, the putative “blueprints” for healthcare planning and activity. Drawing on this analysis, we argue that these documents and “collaborative” formal structures in general, not only function as tools to make healthcare more collaborative, but also create an appearance of “real” collaboration, independently of the realities of practice. We argue that they thus instill confidence that the current healthcare system functions according to deep-seated societal values of justice and progress. We conclude by emphasizing the potentially distorting influence of this onefforts to understand and improve healthcare.
... Inadequate IPC has been associated with medication errors, patient safety problems, team conflict and patient mortality [10,11]. Thus, there is a great need for research identifying variables associated with IPC, particularly in mental health (MH) primary care teams (PCTs) but also in MH specialized service teams (SSTs) [12,13]. MH service reforms have been introduced [14,15] with the aim of improving interdisciplinary teamwork [16][17][18]. ...
Background:
This study has two aims: first, to identify variables associated with interprofessional collaboration (IPC) among a total of 315 Quebec mental health (MH) professionals working in MH primary care teams (PCTs, N = 101) or in specialized service teams (SSTs, N = 214); and second, to compare IPC associated variables in MH-PCTs vs MH-SSTs.
Methods:
A large number of variables acknowledged as strongly related to IPC in the literature were tested. Multivariate regression models were performed on MH-PCTs and MH-SSTs respectively.
Results:
Results showed that knowledge integration, team climate and multifocal identification were independently and positively associated with IPC in both MH-PCTs and MH-SSTs. By contrast, knowledge sharing was positively associated with IPC in MH-PCTs only, and organizational support positively associated with IPC in MH-SSTs. Finally, one variable (age) was significantly and negatively associated with IPC in SSTs.
Conclusions:
Improving IPC and making MH teams more successful require the development and implementation of differentiated professional skills in MH-PCTs and MH-SSTs by care managers depending upon the level of care required (primary or specialized). Training is also needed for the promotion of interdisciplinary values and improvement of interprofessional knowledge regarding IPC.
... The findings from this present study approach gender from a different perspective and suggest both threatening and utilitarian aspects from a working professional standpoint rather than student based. The genderbased observations of some participants help direct future conversation toward suggestions that a primary mechanism hindering interprofessional collaboration is the broader status differences between men and women (Bell, Michalec, & Arenson, 2014). ...
Interprofessional learning (IPL) is a dynamic process. It incorporates adult learning principles and requires active participation. Contemporary paramedic care typically involves collaboration with other health-care professionals. However, little is known about how paramedics work and construct meaning within this interprofessional milieu. Rural areas, where professional collaboration is well illustrated, provide an opportune setting from which to conduct the examination of IPL and paramedic care. Twenty-six participants took part in this investigation. Participants were paramedics and other professionals involved in collaboration in rural locations across the state of Tasmania, Australia. Rural Tasmania provided a diverse range of paramedic practice for investigation, including traditional (pre-hospital) care, extended care, volunteer services, and hospital-based practices. A grounded theory approach was adopted, and semi-structured interviews used to collect critical incidents in which participants described effective and less effective episodes of collaboration. Memos were kept during the research process. Analysis of data followed a process of initial and then focused coding from which the main concepts could be determined. From 75 episodes of collaboration, three main concepts emerged to create a theory of IPL and paramedic care. Relationships included reciprocity and respect, as well as professional acknowledgment. Cooperation recognized professionals as interdependent practitioners adopting open communication. Operational barriers identified contextual features under which professionals work, with constituent categories of protecting turf, and workplace culture. The findings provide new insight into IPL and paramedic care. Hierarchy, professional dominance, and gender disparity emerged as barriers to IPL. Knowledge and skills were shared between professions and this influenced how individuals interacted within interprofessional teams. A successful collaboration produced a clinical environment where patient care was informed by contributions from all team members.
... 66 However, the typical stereotypes about how men and women perform in groups and relate to each other were not reflected in these results. 67,68 As opposed to Profiles 3 and 4, consisting of IPC "champions," the group with the poorest IPC score (Profile 1) had the worst scores on five of the six Individual characteristics, namely, affective commitment toward the team, mutual trust, knowledge sharing, knowledge integration and the highest score on team conflict, as well as the lowest score on organizational support (Structural characteristics). Profile 1 also had the second worst score on participation in decision-making (Interactional characteristics) and on belief in benefits of interdisciplinary collaboration (Individual characteristics). ...
Objectives
This study aims at identifying profiles of mental health professionals based on individual, interactional, structural and professional role characteristics related to interprofessional collaboration.
Methods
Mental health professionals (N = 315) working in primary health care and specialized mental health teams in four Quebec local service networks completed a self-administered questionnaire eliciting information on individual, interactional, structural and professional role characteristics.
Results
Cluster analysis identified four profiles of mental health professionals. Those with the highest interprofessional collaboration scores comprised two profiles labeled “highly collaborative female professionals with fewer conflicts and more knowledge sharing and integration” and “highly collaborative male professionals with fewer conflicts, more participation in decision-making and mutual trust.” By contrast, the profile labeled “slightly collaborative professionals with high seniority, many conflicts and less knowledge integration and mutual trust” had the lowest interprofessional collaboration score. Another profile positioned between these groups was identified as “moderately collaborative female psychosocial professionals with less participation in decision-making.”
Discussion and conclusion
Organizational support, participation in decision-making, knowledge sharing, knowledge integration, mutual trust, affective commitment toward the team, professional diversity and belief in the benefits of interdisciplinary collaboration were features associated with profiles where perceived interprofessional collaboration was higher. These team qualities should be strongly encouraged by mental health managers for improving interprofessional collaboration. Training is also needed to promote improvement in interprofessional collaboration competencies.
... Contrastingly, the female participants demonstrated a preference for remaining focussed on the clinical care, seeing leadership posts as part of a natural progression rather than something to seek directly. This reinforced the lower value of "caring" in healthcare and female expectations of themselves (Tracey and Nicholl, 2007;Bell et al., 2014). Other studies have looked at the effect of race on men in nursing and concluded that the glass escalator is a racialized concept and that black male nurses experience 'glass barriers' to riding the glass escalator (Wingfield, 2009) though one study has reported that Asian Registered Nurses earn more than their white counterparts in the USA (Moore and Continelli, 2015). ...
Aims and objectives/background:
Nursing is a predominantly female profession. This is reflected in the demographic of nursing around the world. Some authors have noted that despite being a gendered profession men are still advantaged in terms of pay and opportunity. The aim of this study was to examine if the so called glass escalator in which men are advantaged in female professionals still exists.
Design and method:
Descriptive statistics of the routinely collected national workforce datasets from across the UK central repositories and mining of a bespoke data set that has been curated which focuses on the activity of specialist advanced practice clinical nurses.
Results:
Even in a gendered occupation such as nursing the advantage of men in terms of pay is apparent with men being over-represented at senior Bands compared to their overall proportion in the UK nursing population. From the bespoke dataset there also seem to be an advantage in term of faster attainment of higher grades from the point of registration.
Conclusion and relevance to clinical practice:
Reward and remuneration are essential to the workforce. This work reveals a gender differential towards men in higher paid nursing work. The drivers for this are complex and further work is required to determine the factors associated with career progression with men in nursing, and the rate limiting factors with the female workforce.
... Collaboration increases innovation and the speed of innovation delivery (Inoue & Liu, 2015) and enhances performance and creativity (DeCusatis, 2008;Hoegl & Gemuenden, 2001). Collaboration in diverse teams has also been shown to improve the safety and effectiveness of healthcare delivery (Bell, Michalec, & Arenson, 2014). Diverse teams have many benefits including higher collective intelligence, defined as their capacity to perform a variety of tasks well (Chickersal, Tomprou, Kim, Woolley, & Dabbish, 2017). ...
It is essential to consider the study of emotions in institutionalized elderly people and how they affect their adaptation and quality of life. The objective was to analyze the relationship between adaptation, quality and enjoyment of life and emotional intelligence in institutionalized elderly people. Participants were 27 elderly people (15 men) from an institutionalized center of the Region of Murcia, aged between 67 and 92 years. The instruments used were: The Brief Inventory of Emotional Intelligence for Senior Citizens (EQ-I-M20); The Beliefs about Enjoying Life Questionnaire; And the Quality of Life Assessment Questionnaire in Residential Context (CECAVIR). The results showed the existence of relationships between the fact of the moment and the emotional intelligence as well as the quality of life. The study determines the need to evaluate and promote Emotional Intelligence in the early elderly because of the relevant role in the enjoyment of life and quality of life.
... Collaboration increases innovation and the speed of innovation delivery (Inoue & Liu, 2015) and enhances performance and creativity (DeCusatis, 2008;Hoegl & Gemuenden, 2001). Collaboration in diverse teams has also been shown to improve the safety and effectiveness of healthcare delivery (Bell, Michalec, & Arenson, 2014). Diverse teams have many benefits including higher collective intelligence, defined as their capacity to perform a variety of tasks well (Chickersal, Tomprou, Kim, Woolley, & Dabbish, 2017). ...
The U.S. can regain its global advantage in Science, Technology, Engineering, and Mathematics (STEM) fields by increasing our national talent pool. However, there are barriers to increasing the talent pool, including a persistent and pervasive pattern of implicit and explicit biases. These biases prevent opportunities for talented women and underrepresented minorities to contribute to STEM and contribute to workplace climates that are characterized by mistrust and low collegiality. Bias also reduces the likelihood of having diverse teams, which are higher in collective intelligence and are more innovative. Here we present the foundation of a new model that integrates the building of emotional and social competencies that drive team effectiveness. Our goal is to enhance such competencies in adults to foster better collaborative and creative capacities. We hypothesize that by building skills in emotional understanding and management, self-awareness, and social perspectives, team members will experience greater connectedness and collective intelligence. These skills in hand, the STEM climate will be more welcoming, and will have the foundation needed for inclusive excellence and innovative discovery.
... gender bias (Sy, Amante, Guanlao, Pangilinan, & Villanueva, 2017;Wilhelmsson, Ponzer, Dahlgren, 1 Timpka, & Faresjö, 2011). At present, female health care professionals are becoming more vocal 2 about their underrepresentation and lack of opportunities in leadership positions especially with the 3 rise of feministic and liberal philosophies (Bell, Michalec, & Arenson, 2014). Unfortunately, the 4 roles of male health professionals are relatively portrayed as being dominant, more privileged, and 5 more focused on earning rather than caring (Hall, 2005). ...
Background: Mental health care has recently been a priority health program in the Philippines as evident in the present lobbying of the “Mental Health Act of 2016“. In spite of these developments, the existence and quality of interprofessional collaboration among Filipino Mental Health Professionals remain unexamined.
Purpose: The aim of this paper is to assess the quality of IPC (IPCQ) and examine what variables affect it. Method: Through a respondent-driven sampling, a survey research design was given to a group of Filipino Mental Health Professionals. The survey asked the demographic profile and the perceptions on the quality of IPC through the Collaborative Practice Assessment Tool-Revised (CPAT-R) which is a 21-item tool with 7-point Likert scale and five factors: 1) patient/community-centered care, 2) collaborative communication, 3) inter- professional conflict, 4) role clarification, and 5) environment.
Results/discussion: Findings revealed that 44 out of 51 (86.3%) participants experienced IPC in their practice; they generally assessed their teams with good quality (Mdn = 5.5). Despite having agreeable collaborative communication (Mdn = 6.3), teams have a subdued ability in interprofessional conflict (Mdn = 4.5). Conclusion: IPC is a concept that must be seen as not gender-biased, a strategy that should be implemented deliberately with long-term goals, and a competency that develops in a non-linear progression. Having a pro- fessional obligation to collaborate enhances agreeability towards IPC, while lack of role clarification within the team reduces it.
... Likely contributing to this misfit was the DIF for gender displayed by this item. Bell, Michalec, Arenson 32 have posited the significant influence of gender on IP care stems from the societal status of women and the traditional gender-norms for professions such as medicine and nursing. These status differentials may be borne out in the responses to this IEPS item. ...
Purpose
Measurement of interprofessional practice perceptions of students is commonplace in the health professions education literature. There are a range of questionnaires available for researchers to use however the psychometric properties of these vary substantially. The Interdisciplinary Education Perception Scale (IEPS) has been widely used and multiple researchers have published alternative factor structures. The present study sought to build on this work by evaluating the psychometric properties of the IEPS using Rasch analysis.
Method
Three-hundred and nineteen students in two Australian osteopathy programs completed the IEPS as part of a larger project into interprofessional education. The measurement properties of the questionnaire were evaluated using Rasch analysis and reliability estimations were also generated for the IEPS.
Results
Fit to the Rasch model was achieved by modifying the original 18 item scale, however this was not unidimensional. Subsequent analysis using an alternative factor structure from the literature achieved Rasch model fit and was unidimensional. The final model produced an eight item version of the IEPS (IEPS8) with appropriate psychometric properties, including the ability to create a valid total score. 3
Discussion
The questionnaire developed as a result of the Rasch analysis provides researchers with a short, psychometrically sound measure of perceptions of their own profession and how their profession works with others. The results also provide an opportunity to explore perceptions pre-post intervention IPE interventions using an interval-scale measure compared to an ordinal one. Researchers are encouraged to utilise this version of the IEPS in future research as it has the potential to be able to discriminate between levels of perception of their own profession and how their profession works with others.
Research on public sector outsourcing primarily focuses on costs and quality, whereas studies investigating the consequences for personnel exposed to outsourcing are scarce. Based on increased competition and private ownership, this study hypothesizes that outsourcing negatively affects employee job engagement and burnout, with more adverse consequences when job demands are high and resources are limited. With unique survey and administrative data, the study compares outcomes for outsourced employees and public employees in similar jobs. The analysis shows that outsourced employees have significantly lower engagement and higher burnout, while further analysis shows that outsourced employees are worse off when job demands are high but equally or less affected when job demands are low. Finally, the analysis shows that outsourcing has significant, adverse consequences for less resourceful employees. The results advance our understanding of how outsourcing influences public personnel and highlights the uneven distribution of consequences across employees.
This chapter presents some proposed theories to adapt for teamwork and collaborative practice. The constitution and design of teams and team-based learning are discussed elsewhere, while this chapter outlines the theoretical models on how teams work and how effectively team members play their roles and responsibilities in order to provide quality care. The concept and scope of teamwork is portrayed in some details, particularly in relevance to health system and generally in relation to the social system. Furthermore, more emphasis is placed on interaction between social system and health care system, because it is evident that both are closely related and in itself ensures collaborative care as a valued health service to the recipients. Although this chapter is primarily concerned with theories of interprofessional collaboration (IPC), however, a good deal of interprofessional education (IPE) has also been described to build a nexus between the two ends of the interprofessional approaches.
Existing theories proposed for team-based learning (TBL) among students, and for team working among professionals are reviewed as a guide to develop efficient teams for interprofessional education and collaborative practice (IPECP) programs. The enabling and disabling factors towards effective team dynamics are also described. Moreover, an outline of the association of different factors in relation to situation, personal attributes, and contextual frames is suggested. At the end, some limitations and challenges in the application of TBL and teamwork theoretical models are described, as found in the relevant literature.
Background & Aims Lower self-efficacy of female nurses compared to male nurses has been reported in several studies. One of the consequences of low self-efficacy is reduced quality of patient care, especially in challenging situations. Mindfulness exercises may improve self-efficacy by reducing stress. This study aims to determine the effect of Mindfulness exercises training on the self-efficacy of female nurses.
Materials & Methods In this experimental study, participants were 60 female nurses working in Afshar Hospital in Yazd, Iran in 2019, who were selected using a convenience sampling method and randomly assigned into two groups of intervention and control. The Mindfulness exercises training was performed at eight two-hour sessions in the intervention group. The control group did not receive any intervention. The data were collected using a demographic checklist and Sherer (1982)’s general self-efficacy scale, and analyzed in SPSS software, version 19 using descriptive and inferential statistics (chi-square test, independent t-test, and paired t-test).
Results The two groups were matched for demographic characteristics (age, work experience, and education level). The mean self-efficacy score was not significantly different between the control (47.23±5.65) and intervention (46.36±3.89) group before the intervention (P=0.49). After the intervention, the mean score reached 47.86±4.91 in the control group and 50.40±5.33 in the intervention group. However, based on the independent t-test results, no significant difference was observed between the two groups (P=0.06).
Conclusion The Mindfulness exercises training do not exert any significant effect on the self-efficacy of female nurses. More studies are recommended in this field by examining the intervening factors, using a follow-up period, and providing intervention for a longer period.
Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.
Purpose:
Despite growing interest in shared leadership models, autocratic physician leadership remains the norm in health care. Stereotype and bias limit leadership by members of other professions. Furthermore, traditional views of effective clinical leadership emphasize agentic behaviors associated with male gender. To shift the prototypical concept of a leader from a male physician to a more inclusive prototype, a better understanding of prototype formation is needed. This study examines leader prototypes and their development among resident physicians through the lens of leadership categorization theory.
Method:
One researcher conducted semi-structured interviews with anesthesia and internal medicine residents at a single institution, asking participants to describe their ideal team leader and comment on the video-recorded performance of either a male or female nurse practitioner (NP) leading a simulated resuscitation. Interview questions explored participants' perceptions of NPs as team leaders and how these perceptions developed. The researchers conducted deductive analysis to examine leadership prototypes and prototype formation, and inductive analysis to derive additional themes.
Results:
The majority of residents described a male physician as the ideal resuscitation team leader. Exposure to male physician leaders, and lack of exposure to NP leaders, contributed to this prototype formation. Residents described a vicious cycle in which bias against female and NP leaders diminished acceptance of their leadership by team members, resulting in decreased confidence and performance, further aggravating bias.
Conclusions:
These results provide suggestions for interventions that can help shift the leadership prototype in health care and promote shared leadership models. These include increasing exposure to different professionals of either gender in leadership roles and increased representation in educational materials, education about effective leadership strategies to create awareness of the benefits of shared leadership, and reflection during team training to increase awareness of bias and the backlash effect faced by individuals whose behaviors counter established stereotypes.
To provide nurse-led interprofessional practices in a healthcare setting, carrying out effective research that identifies the trends and characteristics of interprofessional education is necessary. This study aimed to objectively ascertain trends in the field through text network analysis of different types of interprofessional education literature. Titles and thesis abstracts were examined for terms "interprofessional education" and "nursing" and were found in 3926 articles from 1970 to August 2018. Python and Gephi software were used to analyze the data and visualize the networks. Keyword ranking was based on the frequency, degree centrality, and betweenness centrality. The terms "interprofessional," "education," "student," "nursing," and "health" were ranked the highest. According to topic analysis, the methods, provided programs, and outcome measures differed according to the research field. These findings can help create nurse-led research and effective future directions for interprofessional education pathways and topic selection. This will emphasize the importance of expanding research on various education programs and accumulating evidence regarding the professional and interdisciplinary impact these programs have on undergraduate and graduate students.
Aim
To analyze the glass elevator in nursing, evaluating this concept within the conceptual context of nurse managers’ perceptions of gender.
Background
Glass elevator is defined as the rapid promotion of men to upper positions in certain professions in which women comprise the majority, such as nursing.
Methods
Data were collected from 134 nurse managers. Participants selected one of four resumes belonging to four virtual candidates for an open management position. They, then completed the Perception of Gender Scale.
Findings
Nurse managers mostly selected men among the four candidates submitted to them for promotion to upper positions. None of the nurse managers’ characteristics caused a statistically significant difference regarding the gender of the candidate they selected. No statistically significant difference was found between the perception of gender scores of those who selected female or male candidates.
Conclusions
Men are two times more likely to be selected than women when selecting candidates for promotion with the same qualifications. This was not caused by the decision makers’ or nurse managers’ personal and professional characteristics nor their perceptions on gender.
Implications for Nursing Management
The psychological mechanisms that operate the ‘glass elevator’ in favor of men should be analyzed in greater depth.
Purpose:
To examine the impact of professional background and gender of a resuscitation team leader on residents' perceptions of leadership skills.
Method:
The authors video-recorded a scripted, simulated resuscitation scenario twice, with either a male or female team leader. They copied each video and labeled the leader as physician (MD) or nurse practitioner (NP), creating four conditions: female NP, female MD, male NP or male MD. The authors recruited resident participants from five specialties at four institutions; they randomly assigned residents to view one version of the video and rate the team leader's performance using the Ottawa Crisis Resource Management (CRM) Global Rating Scale in an online survey. The authors conducted two-way ANOVA to examine interactions between team leader gender and profession on CRM ratings.
Results:
One hundred sixty residents responded (89 female, 71 male). A statistically significant main effect of team leader gender on residents' ratings was found in 2 of the 6 CRM domains: leadership (F1,156 = 6.97, P = .009) and communication skills (F1,156 = 8.53, P = .004), due to lower ratings for female than male leaders (5.29 ± 0.95 vs 5.74 ± 1.17; 5.05 ± 1.20 vs 5.57 ± 1.06). There was no effect of profession on ratings and no significant interaction between profession and gender of the team leader on ratings for any of the domains.
Conclusions:
These findings indicate bias among residents against females as team leaders. Mitigating such bias is essential to successfully establish shared leadership models in health care.
Public programs such as Medicaid offer highly circumscribed access to health care for low‐income patients in the United States. This article describes the work of a variety of health care staff who manage specialized cancer care for publicly insured patients who have difficulty gaining or maintaining program eligibility or for uninsured and undocumented patients who are excluded from state programs. I highlight the moral distress that occurs when clinic employees become individually responsible for reconciling policies that limit patients’ access to care. I conclude that responsibility for securing access to cancer care for structurally vulnerable patients frequently falls to safety net clinics and that patients’ financial constraints are visible to particular types of staff, such as non‐licensed health care staff and non‐physician providers, who may experience this distress disproportionately. [cancer, moral distress, undocumented immigrants, public insurance, health policy] This article is protected by copyright. All rights reserved
Interprofessional teamwork is touted as essential to positive patient, staff, and organizational outcomes. However, differing understandings of teamwork and divergent professional cultures amongst healthcare providers influence the success of teamwork. In labour and delivery, nurse-physician teamwork is vital to safe, family-centered maternity care. In this focused ethnography, the perceptions of obstetrical nurses were sought to understand nurse-physician teamwork and the features that facilitate or impede it. These nurses acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision-making. They described myriad ways in which they navigated traditional power dynamics and smoothed working relationships with physicians, such as circumventing disrespectful behaviors, venting with each other, highlighting their own autonomy, using tactical communication, and managing unit resources. According to these nurses, key facilitators of functional nurse-physicians relationships were time, trust, respect, credibility, and social connection. Further, the nature of their working relationships with physicians influenced their perceptions regarding intent to stay, workplace morale, and patient outcomes.
Aims
To explore attitudes of acceptance of male nurses and examine correlations between female nurses’ levels of acceptance and certain demographic variables.
Background
Collaboration and teamwork are essential skills for the nursing profession and for successful healthcare environments. Attitudes of acceptance between male and female nurses can impact the ability to sustain these skills and influence nursing satisfaction.
Methods
Female (n=251) and male (n=60) nurses from three medical centers in or near a large, Midwestern city participated. Data were collected via an anonymous online survey using the Sexist Attitude Inventory.
Results
Male nurses’ attitudes of acceptance of male nurses were greater than female nurses’ attitudes of acceptance. A small, positive correlation was found between the female nurse's level of education and her acceptance of male nurses. Male and female nurses’ responses were also significantly different on 35% of the inventory items‐providing areas of focus for relationship improvement.
Conclusions and Implications for Nursing Management
The significant difference between male and female nurses’ acceptance of male nurses necessitates further investigation. Addressing male/female perspective differences on professional work issues may improve both groups’ work experience, job satisfaction, and acceptance of all nursing colleagues, regardless of gender.
This article is protected by copyright. All rights reserved.
This study identified variables associated with interprofessional collaboration (IPC) among 315 mental health (MH) professionals working in primary health care (PHC) and specialized teams, within four Quebec (Canada) local service networks (LSNs). IPC was measured with a validated scale, and independent variables were organized according to a four-block conceptual framework that included Individual, Interactional, Organizational and Professional Role Characteristics. Bivariate and multiple linear regression analyses were performed. Five variables were associated with Interactional Characteristics (knowledge sharing, knowledge integration, affective commitment toward the team, team climate, team autonomy), and one variable with Professional Role (multifocal identification) and Individual Characteristics (age), respectively. Findings suggest the importance of positive team climate, knowledge sharing and knowledge integration, professional and team identification (multifocal identification), team commitment and autonomy for strengthening IPC in MH teams. These results suggest that team managers should remain alert to behavioral changes and tensions in their teams that could signal possible deterioration in IPC, while promoting IPC competencies, and interdisciplinary values and skills, in team activities and training programs. As well, the encouragement of team commitment on the part of senior professionals, and support toward their younger counterparts, may enhance IPC in teams.
Many organizations are making a deliberate effort to use teams to carry out work as an alternative to more traditional, hierarchical approaches to defining jobs or supervising employees. The authors posit that structure and composition of work teams are likely to systematically affect group dynamics of such teams. Using the related frameworks of social identification theory and embedded intergroup relations theory, they examine the proposition that greater diversity of team member characteristics and larger team size negatively affect members' perceptions of team integration. Hypotheses were tested on 1,004 individuals working on 105 interdisciplinary treatment teams in a national sample of 29 Department of Veterans Affairs psychiatric hospitals. Five of six hypotheses received support for at least one of three dimensions of team integration examined in this article. The strongest support was found for the effects of diversity on perceptions of team functioning. Results are generally consistent with the basic premise of the embedded intergroup relations model: As teams become more diverse along most identity group and organizational group characteristics, intergroup relations among team members suffer and perceived level of team integration declines. The authors offer several suggestions about how managers and team leaders might use these findings to improve team integration.
In this article, I argue that gender is a primary cultural frame for coordinating behavior and organizing social relations. I describe the implications for understanding how gender shapes social behavior and organizational structures. By my analysis, gender typically acts as a background identity that biases, in gendered directions, the performance of behaviors undertaken in the name of organizational roles and identities. I develop an account of how the background effects of the gender frame on behavior vary by the context that different organizational and institutional structures set but can also infuse gendered meanings into organizational practices. Next, I apply this account to two empirical illustrations to demonstrate that we cannot understand the shape that the structure of gender inequality and gender difference takes in particular institutional or societal contexts without taking into account the background effects of the gender frame on behavior in these contexts.
Participants viewed a videotape of either a male or female confederate delivering a persuasive message using a high task, social, submissive, or dominant nonverbal style. Participants were influenced more after viewing the social and task styles than the dominant or submissive styles. Participants liked task and social confederates more than dominant confederates and considered submissive confederates to be less competent than the other 3 styles. Although both likableness and competence were predictive of influence, likableness was a more important determinant of influence for female than male speakers when the audience was male. Consequently, with a male audience, women exhibiting a task style were less influential and likable than men exhibiting that style. Men were not more influential than women when displaying dominance. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Self-reflection and reflective practice are increasingly considered as essential attributes of competent professionals functioning in complex and ever-changing healthcare systems of the 21st century. The aim of this study was to determine the extent of students' awareness and understanding of the reflective process and the meaning of 'self-reflection' within the contextual framework of their learning environment in the first-year of their medical/dental education. We endorse that the introduction of such explicit educational tasks at this early stage enhances and promotes students' awareness, understanding, and proficiency of this skill in their continuing life-long health professional learning.
Over two years, students registered in first-year pathology at the University of Saskatchewan were introduced to a self-reflection assignment which comprised in the submission of a one-page reflective document to a template of reflective questions provided in the given context of their learning environment. This was a mandatory but ungraded component at the midterm and final examinations. These documents were individually analyzed and thematically categorized to a "5 levels-of-reflection-awareness" scale using a specially-designed rubric based on the accepted major theories of reflection that included students' identification of: 1) personal abilities, 2) personal learning styles 3) relationships between course material and student history 4) emotional responses and 5) future applications.
410 self-reflection documents were analyzed. The student self-awareness on personal learning style (72.7% level 3+) and course content (55.2% level 3+) were well-reflected. Reflections at a level 1 awareness included identification of a) specific teaching strategies utilized to enhance learning (58.4%), b) personal strengths/weaknesses (53%), and c) emotional responses, values, and beliefs (71.5%). Students' abilities to connect information to life experiences and to future events with understanding were more evenly distributed across all 5 levels of reflection-awareness.
Exposure to self-reflection assignments in the early years of undergraduate medical education increases student awareness and promotes the creation of personal meaning of one's reactions, values, and premises in the context of student learning environments. Early introduction with repetition to such cognitive processes as practice tools increases engagement in reflection that may facilitate proficiency in mastering this competency leading to the creation of future reflective health professionals.
Interprofessional Education (IPE) is now spreading worldwide and many universities are now including IPE in their curricula. The aim of this study was to investigate whether or not such student characteristics as gender, previous working experience in healthcare, educational progress and features of the learning environment, such as educational programmes and curriculum design, have an impact on their open-mindedness about co-operation with other professions.
Medical and nursing students at two Swedish universities were invited to fill in the Readiness for Interprofessional Learning Scale (RIPLS). Totally, 955 students were invited and 70.2% (n=670) participated in the study. A factor analysis of the RIPLS revealed four item groupings (factors) for our empirical data, but only one had sufficient internal consistency. This factor was labelled "Team Player".
Regardless of the educational programme, female students were more positive to teamwork than male students. Nursing students in general displayed more positive beliefs about teamwork and collaboration than medical students. Exposure to different interprofessional curricula and previous exposure to interprofessional education were only to a minor extent associated with a positive attitude towards teamwork. Educational progress did not seem to influence these beliefs.
The establishment of interprofessional teamwork is a major challenge for modern healthcare. This study indicates some directions for more successful interprofessional education. Efforts should be directed at informing particularly male medical students about the need for teamwork in modern healthcare systems. The results also imply that study of other factors, such as the student's personality, is needed for fully understanding readiness for teamwork and interprofessional collaboration in healthcare. We also believe that the RIPL Scale still can be further adjusted.
The purpose of our study was to use a student-centred approach to develop an online video learning resource (called 'Moo Tube') at the School of Veterinary Medicine and Science, University of Nottingham, UK and also to provide guidance for other academics in the School wishing to develop a similar resource in the future.
A focus group in the format of the nominal group technique was used to garner the opinions of 12 undergraduate students (3 from year-1, 4 from year-2 and 5 from year-3). Students generated lists of items in response to key questions, these responses were thematically analysed to generate key themes which were compared between the different year groups. The number of visits to 'Moo Tube' before and after an objective structured practical examination (OSPE) was also analysed to provide data on video usage.
Students highlighted a number of strengths of video resources which can be grouped into four overarching themes: (1) teaching enhancement, (2) accessibility, (3) technical quality and (4) video content. Of these themes, students rated teaching enhancement and accessibility most highly. Video usage was seen to significantly increase (P < 0.05) prior to an examination and significantly decrease (P < 0.05) following the examination.
The students had a positive perception of video usage in higher education. Video usage increases prior to practical examinations. Image quality was a greater concern with year-3 students than with either year-1 or 2 students but all groups highlighted the following as important issues: i) good sound quality, ii) accessibility, including location of videos within electronic libraries, and iii) video content. Based on the findings from this study, guidelines are suggested for those developing undergraduate veterinary videos. We believe that many aspects of our list will have resonance in other areas of medicine education and higher education.
It has been suggested that as many as 23,000 in-hospital cardiac arrests in the UK could be prevented with earlier detection and intervention (Hodgetts et al., 2002). Cases of 'failure to rescue' are often linked with difficulties relaying and interpreting information across occupational and professional boundaries. Standardised communication protocols have been recommended as a means of enabling the transmission of concise, salient information, licensing and empowering the individual to overcome established hierarchies in speaking out and asking for help. This paper critically examines the current discourse around such protocols. We find that there is a paucity of evidence regarding the complex relationship between social contexts, individual applications of these protocols and short- and long-term impact on safety and 'failure to rescue' rates. The paper highlights the complexities of the underlying power dynamics that are located within gendered and occupational hierarchies and explores the role of standardised communication protocols as a potential boundary object. The paper discusses the potential for these protocols to inter-relate and act as a mediating boundary object between nursing and medical staff, enabling understanding and sharing of cultural context.
Research on barriers to professional advancement for women in academic medicine has not adequately considered the role of environmental factors and how the structure of organizations affects professional advancement and work experiences. This article examines the impact of the hierarchy, including both the organization's hierarchical structure and professionals' perceptions of this structure, in medical school organization on faculty members' experience and advancement in academic medicine.
As part of an inductive qualitative study of faculty in five disparate U.S. medical schools, we interviewed 96 medical faculty at different career stages and in diverse specialties, using in-depth semistructured interviews, about their perceptions about and experiences in academic medicine. Data were coded and analysis was conducted in the grounded theory tradition.
Our respondents saw the hierarchy of chairs, based on the indeterminate tenure of department chairs, as a central characteristic of the structure of academic medicine. Many faculty saw this hierarchy as affecting inclusion, reducing transparency in decision making, and impeding advancement. Indeterminate chair terms lessen turnover and may create a bottleneck for advancement. Both men and women faculty perceived this hierarchy, but women saw it as more consequential.
The hierarchical structure of academic medicine has a significant impact on faculty work experiences, including advancement, especially for women. We suggest that medical schools consider alternative models of leadership and managerial styles, including fixed terms for chairs with a greater emphasis on inclusion. This is a structural reform that could increase opportunities for advancement especially for women in academic medicine.
How does gender inequality persist in an advanced industrial society like the United States, where legal, political, institutional, and economic processes work against it? This book draws on empirical evidence from sociology, psychology, and organizational studies to argue that people's everyday use of gender as a primary cultural tool for organizing social relations with others creates processes that rewrite gender inequality into new forms of social and economic organization as these forms emerge in society. Widely shared gender stereotypes act as a "common knowledge" cultural frame that people use to initiate the process of making sense of one another in order to coordinate their interaction. Gender stereotypes change more slowly than material arrangements between men and women. As a result of this cultural lag, at sites of social innovation, people implicitly draw on trailing stereotypes of gender difference and inequality to help organize the new activities, procedures, and forms of organization that they create, in effect reinventing gender inequality for a new era. Chapters 1 through 3 explain how gender acts as a primary frame and how gender stereotypes shape interpersonal behavior and judgments in contextually varying ways. Chapters 4 and 5 show how these effects in the workplace and the home reproduce contemporary structures of gender inequality. Chapters 6 examines the cultural lag of gender stereotypes and shows how they create gender inequality at sites of innovation in work (high-tech start-ups) and intimate relations (college hook-ups). Chapter 7 develops the implications of this persistence dynamic for progress toward gender equality.
This article describes micro-macro processes through which simple structural conditions cause a nominal characteristic such
as gender or race to acquire independent status value. These conditions are sufficient but not necessary and may or may not
be involved in the actual historical origin of a given characteristic's status value. The argument assumes that a nominal
characteristic becomes correlated with a difference in exchangeable resources. Blau's (1977) structural theory specifies the
effects of the distribution of resources and the nominal characteristic on the likely characteristics of interactants in encounters.
Expectation-states theory describes the situational beliefs about worthiness that develop among the resulting types of interactants.
I combine the two theories to show where the nominal characteristic is likely to be connected with such situational beliefs,
how this connection is affected by transfer and diffusion among types of interactants, and how this process can produce consensual
beliefs in the characteristic's status value.
In this article, the author describes sweeping changes in the gender system and offers explanations for why change has been uneven. Because the devaluation of activities done by women has changed little, women have had strong incentive to enter male jobs, but men have had little incentive to take on female activities or jobs. The gender egalitarianism that gained traction was the notion that women should have access to upward mobility and to all areas of schooling and jobs. But persistent gender essentialism means that most people follow gender-typical paths except when upward mobility is impossible otherwise. Middle-class women entered managerial and professional jobs more than working-class women integrated blue-collar jobs because the latter were able to move up while choosing a "female" occupation; many mothers of middle-class women were already in the highest-status female occupations. The author also notes a number of gender-egalitarian trends that have stalled.
Gender scholars draw on the “theory of gendered organizations” to explain persistent gender inequality in the workplace. This theory argues that gender inequality is built into work organizations in which jobs are characterized by long-term security, standardized career ladders and job descriptions, and management controlled evaluations. Over the past few decades, this basic organizational logic has been transformed. In the so-called new economy, work is increasingly characterized by job insecurity, teamwork, career maps, and networking. Using a case study of geoscientists in the oil and gas industry, we apply a gender lens to this evolving organization of work. This article extends Acker’s theory of gendered organizations by identifying the mechanisms that reproduce gender inequality in the twenty-first-century workplace, and by suggesting appropriate policy approaches to remedy these disparities.
Notwithstanding the growing numbers of women entering the professions and considerable public debate concerned with equal opportunity and barriers to women's advancement, attempts to theorise the relation between gender and profession within the discipline of sociology remain relatively rare. This paper draws on recent work on the gendering of organisation and bureaucracy to suggest that a key issue for consideration is not so much the exclusion of women from work defined as professional, but rather their routine inclusion in ill-defined support roles. This adjunct work of women, it is argued, facilitates the `fleeting encounter' of professional practice, thereby resting on, and celebrating, a specific historical and cultural construction of masculinity and a masculinist vision of professional work. In an era where professions are under unprecedented public scrutiny, sociological attention to their renewal needs to recognise that a key feature of profession, as presently defined, is that it professes gender.
How can we explain the persistence of gender hierarchy over transformations in its socioeconomic base? Part of the answer lies in the mediation of gender inequality by taken-for-granted interactional processes that rewrite inequality into new institutional arrangements. The problems of interacting cause actors to automatically sex-categorize others and, thus, to cue gender stereotypes that have various effects on interactional outcomes, usually by modifying the performance of other, more salient identities. Because changes in the status dimension of gender stereotypes lag behind changes in resource inequalities, interactional status processes can reestablish gender inequalities in new structural forms. Interactional sex categorization also biases the choice of comparison others, causing men and women to judge differently the rewards available to them. Operating in workplace relations, these processes conserve inequality by driving the gender-labeling of jobs, constructing people as gender-interested actors, contributing to employers' discriminatory preferences, and mediating men's and women's perceptions of alternatives and their willingness to settle for given job outcomes.
In spite of feminist recognition that hierarchical organizations are an important location of male dominance, most feminists writing about organizations assume that organizational structure is gender neutral. This article argues that organizational structure is not gender neutral; on the contrary, assumptions about gender underlie the documents and contracts used to construct organizations and to provide the commonsense ground for theorizing about them. Their gendered nature is partly masked through obscuring the embodied nature of work. Abstract jobs and hierarchies, common concepts in organizational thinking, assume a disembodies and universal worker. This worker is actually a man; men's bodies, sexuality, and relationships to procreation and paid work are subsumed in the image of the worker. Images of men's bodies and masculinity pervade organizational processes, marginalizing women and contributing to the maintenance of gender segregation in organizations. The positing of gender-neutral and disembodied organizational structures and work relations is part of the larger strategy of control in industrial capitalist societies, which, at least partly, are built upon a deeply embedded substructure of gender difference.
In this article, the author describes sweeping changes in the gender system and offers explanations for why change has been uneven. Because the devaluation of activities done by women has changed little, women have had strong incentive to enter male jobs, but men have had little incentive to take on female activities or jobs. The gender egalitarianism that gained traction was the notion that women should have access to upward mobility and to all areas of schooling and jobs. But persistent gender essentialism means that most people follow gender-typical paths except when upward mobility is impossible otherwise. Middle-class women entered managerial and professional jobs more than working-class women integrated blue-collar jobs because the latter were able to move up while choosing a “female” occupation; many mothers of middle-class women were already in the highest-status female occupations. The author also notes a number of gender-egalitarian trends that have stalled.
From about 1850, American women physicians won gradual acceptance from male colleagues and the general public, primarily as caregivers to women and children. By 1920, they represented approximately five percent of the profession. But within a decade, their niche in American medicine--women's medical schools and medical societies, dispensaries for women and children, women's hospitals, and settlement house clinics--had declined. The steady increase of women entering medical schools also halted, a trend not reversed until the 1960s. Yet, as women's traditional niche in the profession disappeared, a vanguard of women doctors slowly opened new paths to professional advancement and public health advocacy.
Drawing on rich archival sources and her own extensive interviews with women physicians, Ellen More shows how the Victorian ideal of balance influenced the practice of healing for women doctors in America over the past 150 years. She argues that the history of women practitioners throughout the twentieth century fulfills the expectations constructed within the Victorian culture of professionalism. Restoring the Balance demonstrates that women doctors--collectively and individually--sought to balance the distinctive interests and culture of women against the claims of disinterestedness, scientific objectivity, and specialization of modern medical professionalism. That goal, More writes, reaffirmed by each generation, lies at the heart of her central question: what does it mean to be a woman physician?
The relationship between gender and professionalisation is a neglected one, and female professional projects have been overlooked in the sociology of professions. The generic notion of profession is also a gendered notion as it takes what are in fact the successful professional projects of class-privileged male actors at a particular point in history and in particular societies to be the paradigmatic case of profession. Instead, it is necessary to speak of `professional projects', to gender the agents of these projects, and to locate these within the structural and historical parameters of patriarchal-capitalism. Professional projects are projects of occupational closure, and a model of occupational closure strategies is needed which captures both the variety of strategies that characterise these projects and the gendered dimensions of these strategies. Such a model is set out and distinguishes between exclusionary, demarcationary, inclusionary and dual strategies of closure. This model is substantiated with material drawn from the emerging medical division of labour in the late nineteenth and early twentieth centuries.
We examine the impact of team, organizational, and societal status characteristics on interaction patterns in long-term work groups. Data are from 2077 respondents representing 224 research and development teams drawn from 29 large corporations. Hypotheses based on status characteristic theory are supported: Both external (organizational and societal) and internal (team) status characteristics affect team interaction. When status within a team is controlled, only one external characteristic has a significant positive effect. Team status, in turn, is significantly affected by each of the external characteristics studied. While most of these external characteristics may reflect a team member's past performance, gender, when past performance is controlled, also has an independent effect on team status with males being accorded higher status. This suggests that competence and performance are not the sole bases for team status. Status processes in enduring work teams behave very much like those observed in ad hoc groups: Beliefs associated with diffuse status characteristics affect the ordering of interaction.
Since the release of the 1988 World Health Organization report on the need for interprofessional education (IPE) programs, various forms of IPE curricula have been implemented within institutions of higher education. The purpose of this paper is to describe results of a study using the Readiness for Interprofessional Learning Scale (RIPLS) to compare physician assistant (PA) students with other health professions students.
The RIPLS survey was completed by 158 health professions graduate students, including 71 PA students, at a small northeastern university in the fall of 2010. Students were enrolled in either counseling psychology, occupational therapy, physical therapy, or PA studies. Students completed the RIPLS survey, demographic questions, and a question regarding experience with the health care environment.
PA students scored significantly lower on three of the four subscales of the RIPLS survey, as well as lower in total score. Females of all health professions scored significantly higher on the RIPLS total score and on the Teamwork and Collaboration subscale than did males. Students with prior exposure to the health care system as a patient or as an immediate family member of a patient scored significantly higher on the Negative Professional Identity subscale than did students without such exposure.
Results indicate that PA students may value interprofessional collaboration less than other health professions students. Also, there may be gender and experiential differences in readiness for interprofessional learning. These findings may affect the design of IPE experiences and support integration of interprofessional experiences into PA education.
reeves s., macmillan k. & van soeren m. (2010) Journal of Nursing Management18, 258–264 Leadership of interprofessional health and social care teams: a socio-historical analysis
Aim The aim of this paper is to explore some of the key socio-historical issues related to the leadership of interprofessional teams.
Background Over the past quarter of a century, there have been repeated calls for collaboration to help improve the delivery of care. Interprofessional teamwork is regarded as a key approach to delivering high-quality, safe care.
Evaluation We draw upon historical documents to understand how modern health and social care professions emerged from 16th-century crafts guilds. We employ sociological theories to help analyse the nature of these professional developments for team leadership.
Key issues As the forerunners of professions, crafts guilds were established on the basis of protection and promotion of their members. Such traits have been emphasized during the evolution of professions, which have resulted in strains for teamwork and leadership.
Conclusions Understanding a problem through a socio-historical analysis can assist management to understand the barriers to collaboration and team leadership.
Implications for nursing management Nursing management is in a unique role to observe and broker team conflict. It is rare to examine these phenomena through a humanities/social sciences lens. This paper provides a rare perspective to foster understanding – an essential precursor to effective change management.
The aim of this paper is to examine how the structural influence of gender affects nurses in their working lives. Gender segregation exists both within and between the occupations of medicine and nursing. It is largely founded on the social construction of a skills/caring dichotomy. An analysis of how the gender of nurses and doctors affects their interactions with co-workers reveals that the increasing proportion of female doctors has attenuated power differences between the two occupations. Examination of nurses' attitudes to gender demonstrates that they are very aware of the problem, despite a tendency to accept credentialist justifications of inequality. As a result of this they are becoming more assertive. The issue of sexual stereotyping is addressed and it is noted that popular mythology about sexual relations between doctor and nurses is highly misleading. Privatised aspirations are having a decreasing influence over nurses' working lives. In conclusion, while gender inequality is losing some of its power in nurse-doctor relationships, it is becoming an increasingly significant factor in the relationship between male nurse managers and female workers.
The goal of implementing true interprofessional collaboration within the health care system seems to be elusive. The historical role of medicine as primary clinical leader and decision maker is particularly entrenched in the Western health care system. Florence Nightingale, the acknowledged founder of modern, Western nursing, is often blamed for the subservient role of nursing and other female-dominated health and social care professions. Is it fair to lay the blame on Nightingale? This paper seeks to place Nightingale in context and to revisit her own words to explore the Victorian world in which she worked as a social reformer. It argues that Nightingale made pragmatic compromises to gain acceptance for the new profession of nursing; that these compromises had unanticipated consequences that persist - but are not unchangeable.
More than a trait of individuals, gender is an institutionalized system of social practices. The gender system is deeply entwined with social hierarchy and leadership because gender stereotypes contain status beliefs that associate greater status worthiness and competence with men than women. This review uses expectation states theory to describe how gender status beliefs create a network of constraining expectations and interpersonal reactions that is a major cause of the “glass ceiling.” In mixed-sex or gender-relevant contexts, gender status beliefs shape men's and women's assertiveness, the attention and evaluation their performances receive, ability attributed to them on the basis of performance, the influence they achieve, and the likelihood that they emerge as leaders. Gender status beliefs also create legitimacy reactions that penalize assertive women leaders for violating the expected status order and reduce their ability to gain complaince with directives.
Interprofessional teamwork is widely advocated in health and social care policies. However, the theoretical literature is rarely employed to help understand the nature of collaborative relations in action or to critique normative discourses of teamworking. This paper draws upon Goffman's (1963) theory of impression management, modified by Sinclair (1997), to explore how professionals 'present' themselves when interacting on hospital wards and also how they employ front stage and backstage settings in their collaborative work. The study was undertaken in the general medicine directorate of a large NHS teaching hospital in England. An ethnographic approach was used, including interviews with 49 different health and social care staff and participant observation of ward-based work. These observations focused on both verbal and non-verbal interprofessional interactions. Thematic analysis of the data was undertaken. The study findings suggest that doctor-nurse relationships were characterised by 'parallel working', with limited information sharing or effective joint working. Interprofessional working was based less on planned, 'front stage' activities, such as wards rounds, than on ad hoc backstage opportunistic strategies. These backstage interactions, including corridor conversations, allowed the appearance of collaborative 'teamwork' to be maintained as a form of impression management. These interactions also helped to overcome the limitations of planned front stage work. Our data also highlight the shifting 'ownership' of space by different professional groups and the ways in which front and backstage activities are structured by physical space. We argue that the use of Sinclair's model helps to illuminate the nature of collaborative interprofessional relations within an acute care setting. In such settings, the notion of teamwork, as a form of regular interaction and with a shared team identity, appears to have little relevance. This suggests that interventions to change interprofessional practice need to include a focus on ad hoc as well as planned forms of communication.
Despite the evidence from the literature of the benefits of collaboration, a collaborative practice model in the acute-care setting remains the exception rather than the dominant practice. The purpose of this study was to evaluate attitudes toward collaboration among nurses and physicians practicing in an acute care community hospital. The sample included 118 nurses and 53 physicians. Background variables of gender, age, education, experience, practice setting, cultural background, and time to interact were examined to determine if they influenced attitudes towards collaboration. The results indicated that both physicians and nurses expressed positive attitudes towards collaboration but that there was a significant difference on two of the underlying factors: shared education and physician authority. The study may serve as a baseline for future research, specifically focused on interventions to enhance collaboration.
"Must be judged as a landmark in medical sociology."âNorman Denzin, Journal of Health and Social Behavior "Profession of Medicine is a challenging monograph; the ideas presented are stimulating and thought provoking. . . . Given the expanding domain of what illness is and the contentions of physicians about their rights as professionals, Freidson wonders aloud whether expertise is becoming a mask for privilege and power. . . . Profession of Medicine is a landmark in the sociological analysis of the professions in modern society."âRon Miller, Sociological Quarterly "This is the first book that I know of to go to the root of the matter by laying open to view the fundamental nature of the professional claim, and the structure of professional institutions."âEverett C. Hughes, Science
The nursing profession has fewer racial and ethnic minority groups than the United States population, at large (Campbell, n.d.). Racial/ethnic minority students have lower admission and retention rates than White non-Hispanic students. A review of strategies reveals that to recruit and retain racial/ethnic minority students, schools of nursing will have to use interventions that reach diverse student populations, make connections with middle and high school students, support students during the application process, and mentor current students.
Research shows that interprofessional collaboration has become an important factor in the implementation of effective healthcare models. To date, the literature has not focused on the collaboration between medical doctors and complementary and alternative medicine (CAM) healthcare practitioners, an example of interdisciplinary collaboration called integrative healthcare (IHC). Drawing on in-depth, semi-standardized interviews conducted with 21 practitioners working in Canadian IHC clinics, this paper explored and interpreted how IHC is experienced by those working in Canadian IHC clinics. The interview questions and analysis were guided by the Input, Process, Output conceptual framework drawn from the organizational management theory (McGrath, J. E. (1964). Social psychology: A brief introduction. New York: Holt, Rinehart and Winston.) to study collaboration within teams. We found that constructs contributing to collaboration included practitioners' attitudes and educational background, as well as external factors such as the healthcare system and financial pressures. Major processes affecting collaboration included communication, patient referral and power relationships. These determinants of collaboration were found to result in learning opportunities for practitioners, modified burden of work and ultimately, higher affective commitment toward the clinic. These constructs serve as a guide for further investigation of interprofessional collaboration within an IHC clinic. This exploration of interprofessional collaboration in IHC identified a broad array of key factors associated with interprofessional collaboration. These factors are critical to better understand the functioning of IHC clinics, and provide guidance for creation or maintenance of successful clinics.
The problem addressed in this paper is how nurse-doctor power relations are manifested in a hospital setting. A review of the literature identified four major ideal types of interaction between nurses and doctors in decision-making processes. These were unproblematic subordination, informal covert decision making, informal overt decision making and formal overt decision making on the part of nurses. Each of these types was tested against empirical data gained from participant observation of interactions between the nurses and doctors working in an intensive care unit and a general medical ward. It was concluded that while both the unproblematic subordination and the informal covert decision-making types of interaction appeared superficially to be used frequently, closer examination revealed that, with the exception of nurse-consultant interactions, nurses were less dependent on these subordinate modes of interaction than much of the literature suggested. Formal overt decision making, despite official encouragement, was also infrequently utilized. However, it was noticed that senior nurses especially used informal overt strategies to involve themselves in decision-making sequences. Use of such strategies had the effect of reducing though not eliminating the power differential between doctors and nurses.
The purpose of this historical research was to explore the evolution of the doctor-nurse relationship. Specifically, older nurses were interviewed regarding their nursing interactions with physicians approximately 50 years ago. A grounded theory approach was employed to analyse the data. Inherent to the difficulties nurses experienced was the dominant power position assumed by doctors in the health profession. The data give added insights into the development of this relationship. It was found that because nurses were educated primarily by doctors and because they were hired by doctors if they were considered to be 'good' nurses, a sex role stereotype of the nurse emerged. Historically these roles have influenced and continued to influence the nursing profession.
The disciplines of nursing and medicine are expected to work in unusually close proximity to one another, not just practising side by side but interacting with one another to achieve a common good: the health and well-being of patients. This selective review of literature addresses some of the issues arising from the frequently controversial subject of the nurse-doctor relationship and seeks to draw out the principal themes emerging from the application of sociological theory to the nurse-doctor relationship and research into its operation in clinical settings. Particular attention is paid to the 'doctor-nurse game', a stereotypical pattern of interaction, first described in the 1960s, in which (female) nurses learn to show initiative and offer advice, while appearing to defer passively to the doctor's authority. This pattern of interaction seems less common in clinical practice today but the problem remains of each profession having ideal expectations of one another which inevitably fall short as a result of differing views of qualities of doctors and nurses to be valued.
Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.
Background:
The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved.
Objectives:
This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century.
Design:
A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods.
Findings:
Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed.
Conclusions:
These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision.
Interpersonal relations and group processes: Nonverbal behavior, gender and influence
- L.L. Carli
- LaFleur, S.J.,
- C.C. Loeber
- L.L. Carli
- LaFleur, S.J.,
- C.C. Loeber
Women in a women?s job: The gendered experience of nurses. Sociology of Health & Illness
- S Porter
Are female students in general and nursing students more ready for teamwork and interprofessional collaboration in healthcare?
- M Wihelmmson
- S Ponzer
- L Dahlgren
- T Timpka
- T Faresjo
- Flexner A.