Collaboration in healthcare: much more than faxes and phone calls!

Photo by Anne-Sophie Beaudoin

Consider Raymond, for example. Raymond, like all human beings, has unique bio-psychosocial needs that are more or less complex. His living situation has a direct influence on the manner and intensity of collaboration that should be the focus of his treating professionals.

In 2013, the year that I began practicing physiotherapy, I used to listen and ask questions to my patient, but I was often more interested in observing them with my own eyes and hands than actually listening to them. It was like trusting my professional skills first and then matching it with what the patient was saying. This objective physical evaluation is an important part of a good physiotherapy evaluation, but it is not necessarily more valuable than what the patient says. In the course of my postgraduate training, I gained an understanding of how important it is to pay attention to what your patient has to say. I discovered how every question I asked my patient was of enormous value and how listening to my patient added value to my approach. Back then, I was characterized by this saying, "Listen to your patient and he will tell you where it hurts, listen to him further and he will also tell you how to treat him". This saying is likely not applicable across all disciplines, but in my case, it turned out to be quite accurate most of the time and changed the way I perceived my own role as a professional.

Later on, when I started developing a secured health communication tool and delved deeper into the world of interprofessional collaboration, I reactivated my first impulse, to position health professionals at the core of the collaborative decision-making process. I first looked at interprofessional collaboration from a health professional's perspective. This, of course, was a very enriching experience and by no means a mistake, as it provided us with a good understanding of the context of practice and the difficulties that professionals face in collaborating with each other. But this perspective somewhat constrained my understanding of collaboration.

Last fall, in an effort to better understand the reality of healthcare professionals, I had a meeting with a medical professor to exchange ideas on our respective projects. We were discussing interprofessional collaboration and he said to me, "The health professional should adjust the way he or she collaborates for each patient". What an obvious and yet useful insight! At this point, I remembered Raymond and his recurring and crippling back condition. I also thought about how lonely he had been since his spouse had passed away, how overwhelmed he had been by the requirements of his job, and how heavily dependent he had been on painkillers. Raymond didn't simply need physiotherapy. He was in need of a team that would work together in an effective and efficient way, with all the intricacies of the person that he is.

As healthcare professionals, we adapt to our patients and strive to offer them the most appropriate therapeutic approach for their needs. But I also believe that, as overworked and overwhelmed health professionals, we occasionally crystallize our collaborative efforts.

But how can we not crystallize it? How can we avoid rendering our collaboration more rigid, while maintaining an effective process? In many cases, recalling the theoretical concepts behind certain approaches enables us to take a fresh look at our own actions.

Intention to collaborate

As I mentioned earlier, the complexity of the situation of the patient is going to guide the healthcare professional in the appropriate style of collaboration, and more specifically in what is called the intention to collaborate. In other words, the more complex the situation, the greater the collaborative intentions of the professionals involved. The following is a list of ways to define the different levels of intention to collaborate (from least to greatest):

1. Informing
2. Exchanging information
3. Consulting on disciplinary objectives
4. Sharing decisions and actions in connection with a common goal

Type of collaboration

The second dimension of collaboration that should be influenced by the patient's situation is the type of interaction that the professional emphasizes when dealing with others. Once again, the more complex the patient's situation, the more the interaction would require interdependence between the two professionals.

The following is a breakdown of each of these interactions (from the most independent to the most dependent):

1. Independent practice
2. Parallel practice
3. Practice by consultation/reference
4. Collaborative practice
5. Shared Service and Care Practice

Degree of knowledge sharing

The final aspect that is shaped by the patient's situation is the degree to which disciplinary knowledge is shared. The more complex the patient's situation, the more likely it is that the health professional will be constrained by his or her own disciplinary expertise. In this case, the pooling of each professional's respective expertise will enable the construction of a collective understanding of the needs of the patient.

The different degrees of disciplinary knowledge sharing are the following (from the smallest to the largest):

1. Unidisciplinarity
2. Multidisciplinarity
3. Interdisciplinarity

Needless to say, all of these concepts can only be realized if the environment is favorable and if healthcare professionals are equipped with a specific set of collaborative, particularly social, skills.

To summarize, the lack of knowledge and the materialization of our collaborative practice have major implications for our healthcare system. Every week, I encounter examples in which an insufficient degree of collaboration has a detrimental impact on the life of a Québécois. Each week, we shell out thousands of dollars simply because we have not properly communicated. With each passing week, I expect to do a better job of improving this communication in order to deliver simple and effective means for better collaboration.