Interprofessional collaboration: rethinking traditional teams

It happened to me last week when a doctoral student working in interprofessional collaboration shared this article with me: “Teamwork on the rocks: Rethinking interprofessional practice as networking”.

Dow and colleagues, “found little evidence of interprofessional teams; rather they found the existence of ‘networks of electronic collaboration among the healthcare professionals caring for each patient’ and that the ‘size and complexity of these networks provided some startling insights into the barriers to interprofessional practice”. (source)

This idea of “distributed” healthcare teams is very close to the way we see the healthcare ecosystem at Braver. And the fact that the authors of a scientific article recognize these ideas and propose taking them further excites me immensely. As though, suddenly, our intuition had a foundation.

Becoming a good collaborator in the healthcare system therefore requires skills that may be very different from what we learn in our interprofessional collaboration courses. These courses, focused on the skills needed to work within a more “traditional” team, potentially leave out an entire aspect of collaboration. These teams I call “traditional” represent a large proportion of what we find across different sectors of the workforce: they are small, distinct and fairly fixed. Of course, this type of team also exists in healthcare, and all clinicians experience it in one way or another. However, the authors highlight that this type of team is not enough to describe interprofessional collaboration.

Network-based collaboration (“networking”)

These interprofessional networks working around patients are, quite simply, clinicians who need to coordinate and exchange information.

Rather than working in discrete teams, healthcare professionals often work in large, heterogeneous, and dynamic groups as well as networks. (Source)

Although this network-based interprofessional practice has existed for many years, particularly in primary care, we are seeing it become increasingly common throughout the system. What is interesting about this change is that it seems to coincide with another shift currently happening in the healthcare ecosystem: providing more care in the community through better-coordinated teams. Whether it is hospital-at-home care, intensive home care, community paramedicine or even the Primary Care Access Point, there are many examples of this movement.

And all of this is also consistent with what most people want: to be well at home. Put all this in an environment with an aging population and a very real labour shortage, and we are witnessing an acceleration in the transformation of our healthcare system.

This transition is making multidisciplinary care teams increasingly dispersed between the hospital and the community. They are also becoming more diverse, and grey areas around reserved activities are increasingly common. The result: network-based collaboration is inevitable for every healthcare professional.

Now that we recognize this is what teamwork in healthcare looks like, how do we apply these concepts in the real world?

Doing things differently

It is no small task.

Even within a small, fixed, distinct team, collaboration can be difficult. So imagine working as a team with people you do not know well and very rarely meet in person.

Here are the ideas the authors share with us:

Generalised network competency for all healthcare professionals: Healthcare professionals need to understand the size and complexity of healthcare networks. In addition, they need to recognise the pathways through which information flows and by which care is shaped, especially as the evolving needs of patients restructure their networks and the individual healthcare professional’s role in care.

Enhanced network competency for the most central healthcare practitioners: Certain individuals tended to be more central to the healthcare networks of each patient. These individuals have increased responsibility for integrating information from across the network in order to best meet the needs of patients

Optimal networks through system redesign: While the two suggestions above focus on training, our findings and additional research could shape process interventions such as the design of the EHR, creation of team huddles, or shared approaches to documentation.

(Source)

I would humbly add a few ideas for consideration:

💡 The ability to optimize communication for the other person rather than for yourself.

💡 Having a shared communication infrastructure.

💡 A shared goal aligned with the patient's needs

I want to emphasize that last point. Despite all the diversity and movement within these large care teams surrounding the patient, let us not forget our common ground: the patient. This is the only anchor that remains fixed within a dynamic care team. Having a shared direction helps combat inertia. That direction is too often lost from view, obscured by our egos, our biases and our unjustified protectionism.

This article makes me want to look to the future and build tomorrow's ecosystem. But part of me looks back and wonders why academia has overlooked this type of collaboration for so many years. If this way of working was present in primary care all along, why did we fail to see it? Does this reflect biases in healthcare academia? Do our hospital-affiliated research centres have an overly “hospital-centric” view of our system?

Whatever the answer, now we know.