Integrated Care and Inter-professional Teamwork: Importance of Local Context and Situated Rationalities of Care Providers

Abstract

Recent years have seen policy makers and practitioners placing an increased emphasis on the development of integrated social health care systems. Whilst commentators of various stripes have argued that cross disciplinary teamwork between care professionals can address the often fragmented patterns of care delivered by separate primary, secondary and tertiary providers, policy makers have generally failed to appreciate the complexity of inter-professional relationships. Research suggests, moreover, that provision is often characterised by rigid and impermeable boundaries that inhibits collaboration and knowledge sharing. This paper begins by highlighting the lack of qualitative empirical research on what integration of healthcare and social care means for professionals responsible for delivering increasingly complex care packages. It then presents findings on multi-disciplinary team (MDT) working in five UK provider organizations (social services, community health care, mental health, voluntary sector and an NHS hospital trust). Whilst we show that MDTs can deliver important ‘boundary spanning’ innovations in service delivery, we also emphasise the highly localised, uncertain and contingent features of multidisciplinary team working. We question rhetoric of transformational change and argue that inter-professional team working is shaped by the exigencies of the local context and by the situational rationalities of different care providers. The concluding part of the paper argues that the emergence of more integrated care is likely to depend on increasingly devolved ways of managing professional expertise and on complex political accommodations between different cultures of care provision. The paper adds to the existing literature on inter-professional teamwork in health and social care highlighting multifaceted realities of integrated care delivery and its impact on professionals themselves.