- Professional identity
A categorisation and differentiation of a profession
When our professional identity is threatened, we tend to fall back on stereotypical and (usually negative) social categorisations of our profession and that of others, which can cause conflict if we are working within a team of professionals from varying fields. During conflict, team dynamics can become toxic and may require increased time investment (Bajnok et al., 2012). However, an investment in an interprofessional team, by appropriate management of the team, is rewarding. It creates efficiencies within an organisation and ultimately improves care delivery.
- Interprofessional team
A group of professionals from different disciplines working collaboratively in an integrated team to draw on individual and collective skills and experiences
Working with a variety of different professionals in a team allows sharing of expertise and perspectives to meet the common goal of providing quality care to patients within a healthcare setting. This form of teamwork is commonly known as interprofessional collaborative practice and involves ‘health professionals working collaboratively in integrated teams to draw on individual and collective skills and experiences across disciplines’ (Clarke & Hassmiller, 2013, p. 334). An example of the types of professions that could make up an interprofessional health team is provided in Figure 10.1.
Figure 10.1 Example of an interprofessional team within an acute care setting. Adapted from N. Gopee & J. Galloway (2009). Leadership and management in healthcare. Thousand Oaks, CA: Sage.
Teams with professional boundaries
There are many terms used within healthcare to indicate the context within which health professionals work together. Similarly, there are many models for the facilitation of teamwork proposed in the literature. In addition to these models, leaders need to consider the impact that the role of each team member has on team effectiveness and interactions. Three models identified by Mumma and Nelson (2002) are multidisciplinary, interdisciplinary and transdisciplinary teams, which are discussed below.
Multidisciplinary teams
Multidisciplinary teams have discipline-specific goals. There are clear boundaries between disciplines, and effective communication is essential for success and to ensure that crossover of workloads does not occur. This model involves each discipline working within the parameters of its profession to provide appropriate patient-centred care.
- Multidisciplinary team
A group of professionals from different disciplines working collaboratively with clear disciplinary boundaries
Interdisciplinary teams
In contrast to multidisciplinary teams, interdisciplinary teams collaborate to identify patient goals and use an expanded problem-solving model that goes beyond discipline-specific boundaries in order to maximise patient outcomes. This model involves working together to achieve common outcomes and may mean holding regular patient-centred meetings with representatives from a variety of disciplines in order to maximise patient outcomes through a collaborative patient care approach.
- Interdisciplinary team
A group of professionals from different disciplines working closely together to achieve common outcomes through regular meetings using a collaborative patient care approach and not bound by discipline-specific boundaries
Transdisciplinary teams
Transdisciplinary teams tend to work across boundaries between disciplines and have the flexibility to minimise duplication of effort. However, this model takes the most work to manage in terms of effective communication and teamwork.
- Transdisciplinary team
A group of professionals from different disciplines working collaboratively across boundaries with flexibility between disciplines to minimise duplication
Teams with role-related boundaries
In addition to interprofessional teams that are delineated by professional boundaries there are teams that are delineated by their role – for example, clinical leaders, managers and practitioners (or clinicians). These roles can exist within and across professions, making leading this type of interprofessional team more challenging. For example, the principal concerns of practitioners and those of managers are distinct (Edwards, Kornacki & Silversin, 2002; Edwards, Marshall, McLellan & Abbasi, 2003), as is evident in Table 10.1.
| Clinicians | Managers |
|---|---|
| Patient or client outcomes | Patient experience |
| Individual patients or clients | Population or organisation |
| Optimum care for each patient or client | Managing competing claims |
| Professional autonomy | Public accountability |
| Self-regulation | Systems |
| Evidenced-based practice | Fair allocation of resources |
| Personal responsibility | Delegation |
| Role clarity | Role ambiguity |
| Explicit knowledge | Tacit knowledge |
There are deep differences in clinicians’ and managers’ backgrounds, as well as varying concerns, which give rise to ‘unavoidable conflict between the reductionist approach to medicine and the messy political and complex world of policy’ (Edwards et al., 2002, p. 837). For example, practitioners’ work is rooted in biological sciences, based on cause-and-effect relationships and has a strong academic focus. clinicians are responsible for their own individual patients and enact professional discretion in treatment decisions; they tend to think operationally, work to short timeframes and function in a professional culture. In contrast, managers draw from economic, financial, social and behavioural sciences, which operate in a more qualitative paradigm. Their focuses are groups and populations, and they tend to base their decisions on rational or legal policy. Managers think strategically, plan for distant time horizons and work well in teams. They function in a task-and-role culture (Parkin, 2009). Consequently, because of the differences in the paradigms in which they work, practitioners and managers may not always agree with each other on core matters.
For leaders, it becomes important to consider the frame of reference that their team members may be using in order to lead effective interprofessional teams. To try to respond to these differences in reference points, organisations have begun to embed the hybrid clinical manager role into practice. Hybrid clinical managers in a healthcare environment are medical doctors who work in a dual clinical and managerial role in order to bridge the differences between managers and practitioners (Kippist, 2013). They are discussed further below.
Leadership of interprofessional teams
Resource deficiencies, changing expectations of clients and tightened funding outcomes have caused the leadership of interprofessional teams to become more important and prevalent in the health sector globally. In the United Kingdom, the practice has long been advocated for its ability to support clients with complex needs (Trivedi et al., 2013). Similarly, within Australia, hospitals are increasingly pushing for interprofessional teams in order to maximise productivity (Novak & Judah, 2011). Yet leading these teams can be a difficult and challenging experience, especially as communication styles differ, and leadership styles need to be flexible in order to support such diverse teams.
Successful team dynamics are achieved when members see their role as important to the team and when there is between team members open communication, existence of autonomy and equality of resources (Morrison, 2007). Further, a blending of professional cultures is necessary, which includes sharing skills and knowledge to improve the quality of patient care (Bridges et al., 2011).
To be successful, leaders of interprofessional teams must demonstrate integrated care, which involves training and education, open communication and mutual respect (Interprofessional Education Collaborative Expert Panel, 2011). In addition, Clarke and Hassmiller (2013) propose four key competencies for successful interprofessional collaborative practice: understanding and demonstrating values and ethics of interprofessional practice throughout the organisation and unit, espousing clear roles and responsibilities for each team member, providing clear interprofessional communication and encouraging effective teams and teamwork. The following list contains important guidelines for leaders of interprofessional teams:
- Identify key stakeholders and know who matters most.
- When problem-solving, be sure to examine the diversity within the team in order to provide varying perspectives for members, meaning decisions will be more widely accepted.
- Understand how team members respond to conflict and expectations.
- Work towards understanding and valuing the benefit of individuals’ differences and appreciating all contributions.
- Avoid assumptions that all professional groups act and respond in the same ways.
- Avoid labelling.
- Recognise similarities between team members.
- Treat resistance as a form of communication.
- Seek out different experiences from the majority and from those who matter most.
- Pay close attention to verbal and non-verbal communication.
- Ask for clarification to avoid assumptions.
- Assist those in minority groups to be successful by including them in informal networking within the team culture.
Working within an interprofessional team is not easy and requires strong leadership to be successful. This is because working in a team calls for cooperation, understanding and the use of effective communication (Burzotta & Noble, 2011). Strong leadership of such a team requires the following values and traits to be established by the leader within the team before collaboration begins: responsibility, accountability, coordination, communication, cooperation, assertiveness, autonomy, and mutual trust and respect (Bridges et al., 2011; Burzotta & Noble, 2011; Clarke & Hassmiller, 2013). Development of the softer skills of management is also needed to be an effective interprofessional team leader.
- Integrated care
A team approach involving training and education, open communication and mutual respect (Interprofessional Education Collaborative Expert Panel, 2011)
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