Interprofessional Collaboration - Why And How
Why is this so important?
In the traditional health care model, practitioners are trained to adopt the social and educational perspectives of their chosen discipline. Each disciplinary perspective incorporates a unique set of theoretical and practical principles that shape clinical practice (D’Amour, Ferrada-Videla, Rodriguez, & Beaulieu, 2005). Highly trained and skilled professionals may be aware of but not truly knowledgeable about other disciplines that serve a shared population of people. Moreover, many work environments are not conducive to wide-scale coordination. The unfortunate result is a segmented system that has been proven difficult to reform (D’Amour et al., 2005). On a more concrete level, this lack of synergy has resulted in may problems that directly impact the people who we are all trying to help:
- Errors that could otherwise be avoided
- Family confusion due to conflicting or inconsistent information
- Omission of referrals that should have been made
- Redundant or paradoxical services
- Reduced patient outcomes
- Lack of optimization of services
If this is such a big problem, why haven't we already fixed it?
There are significant challenges that practitioners face when it comes to implementing true collaborative practice.
One substantial barrier is the current model of reimbursement. The fee-for-service reimbursement model has worked sufficiently for parallel service delivery, however time spent co-treating and meeting with professional collaborators is not always compensated (Rodgers & Nunez, 2013). This reduces incentive to prioritize collaboration, and even sparks competition to earn what compensation is available (Rodgers & Nunez, 2013). In my experience with private clinics, most insurance companies will not reimburse for collaborative sessions because the professional to client ratio would be 2:1. This is unfortunate, because many children could maximize their response to treatment if dually treated (such as occupational and speech therapy).
There are also a number of less structural but equally robust barriers to allied treatment. Functionally, it is difficult to coordinate schedules, especially when coming from different locations of service. There are also social caveats that obstruct progress. For example, the lack of intimate knowledge and/or respect of different professional contributions can lead to perceived hierarchical standings. For example, a doctor, nurse, and SLP in the hospital all have different but critical roles in their patient's recovery. The doctor’s extensive medical knowledge, the SLP’s expertise in swallowing, and the nurse’s intimate knowledge of the client must all be valued equally and incorporated into the treatment plan. If any of those team members feels devalued, the triad of care is compromised.
What can we do to support progress?
This is clearly an issue that requires global coordination towards systemic change. Fortunately, there are a number of things that professionals can do right now to promote better collaborative practice.
- Practice respect for autonomy, nonmaleficence, beneficience, and justice towards each other (Ewashen et al., 2013). Part of this includes building a sense of equal value for each professional’s contribution (Interprofessional Collaboration, 2008; Rodgers & Nunez, 2013). In other words, we need to strive not only to work with but also to develop genuine regard for one another. Each background is unique, but that does not make it superior or inferior in the grand scheme of things.
- Interdisciplinary research can also enrich services, if indirectly. By interlacing the background knowledge, resources, and efforts of professionals from more than one field, researchers can participate in better quality research. Among the benefits are more robust funding opportunities, fewer abandoned research projects, increased efficiency and research capacity, broader researcher input, and increased rapport among researchers (Johnston, 2011). By working together to optimize the evidentiary base of knowledge that drives services, researchers can model not only the beneficence of interprofessional collaboration, but also the value in respecting the contributions of allied fields. The production of research that incorporates more than one field of interest could also help facilitate interdisciplinary clinical application of that knowledge.
- Multidisciplinary teamwork is already catching on in a number of settings. When professionals from different health or social care disciplines coordinate regularly for problem solving and direct services, it is referred to as interprofessional practice (IPP) (Rodgers & Nunez, 2013). There are numerous scenarios in which this practice is intuitively beneficial. For example, applied behavior analysis (ABA) therapists and SLPs commonly work with children with autism spectrum disorder in ways that overlap. If during speech therapy the child is being asked to use one sign language approximation for “go”, and in ABA the child is being asked to use a different gesture for “go”, both services are being negated. It is logical that communication between the ABA therapist and the SLP could streamline results to the benefit of the practitioners as well as the child.
- Assessment is also being looked at as a service that should include multiple allied professionals. Interdisciplinary assessment teams are being called on to ensure that results are as accurate and well-rounded as possible (Constantinidou, Wertheimer, Tsanadis, Evans, & Paul, 2012; Prelock, Beatson, Bitner, & Broder, 2003).
- Interprofessional Education (IPE) has emerged as an effective strategy for supporting interprofessional collaboration and regard. By engaging in reciprocal learning activities, professionals can break down the barriers and spread the value of their own disciplines while gaining knowledge about the work of their colleagues (Lee, Pettigrew, O’Sullivan, Henn, & O’Flynn, 2013; Oandasan, & Reeves, 2005; Prelock, 2013; Rodgers & Nunez, 2013).
Constantinidou F., Wertheimer J.C., Tsanadis J., Evans C., & Paul D.R. (2012). Assessment of executive functioning in brain injury: Collaboration between speech-language pathology and neuropsychology for an integrative neuropsychological perspective. Brain injury, 26(13-14), 1549-1563.
D’Amour, D., Ferrada-Videla, M., Rodriguez, L.S.M., & Beaulieu, M.D. (2005). The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of interprofessional care, 19(1), 116-31.
Ewashen, C., McInnis-Perry, G., & Murphy, N. (2013). Interprofessional collaboration-in-practice: The contested place of ethics. Nursing Ethics, 20(3), 325-335. doi:10.1177/0969733012462048
Johnston, J., & Truluck, C.A. (2011). Writing & research. Interprofessional Collaboration. Radiologic Technology, 83(1), 97-99.
Lee, A., Pettigrew, C., O’Sullivan, C., Henn, P., & O’Flynn, S. (2008). Strategies for Interprofessional Education in Health and Social Care. Powerpoint presented at the Speech-Language Hearing Association
Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal Of Interprofessional Care, 1921-38. doi:10.1080/13561820500083550
Prelock, P. (2013, June 01). From the President: The Magic of Interprofessional Teamwork. The ASHA Leader. Retrieved from http://www.asha.org/Publications/leader/2013/130601/From-the-President--The-Magic-of-Interprofessional-Teamwork.htm
Prelock, A., Beatson, J., Bitner, B., & Broder, C., (2003). Interdisciplinary Assessment of Young Children With Autism Spectrum Disorder. Language, Speech, and Hearing Services in Schools 34, 194-202. doi:10.1044/0161-1461(2003/016)
Rodgers, M., & Nunez, L. (2013). From My Perspective: How Do We Make Interprofessional Collaboration Happen? The ASHA Leader. Retrieved from http://www.asha.org/Publications/leader/2013/130601/From-My-Perspective--How-Do-We-Make-Interprofessional-Collaboration-Happen.htm