Abstract
BackgroundThe move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients.MethodsA comparative case study was conducted to examine the dynamics of role construction on two interprofessional primary health care teams. The data collection included interviews and non-participant observation of team meetings. Thematic content analysis was used to code and analyze the data and a conceptual model was developed to represent the emergent findings.ResultsThe findings indicate that role boundaries can be organized around interprofessional interactions (giving rise to autonomous or collaborative roles) as well as the distribution of tasks (giving rise to interchangeable or differentiated roles). Different influences on role construction were identified. They are categorized as structural (characteristics of the workplace), interpersonal (dynamics between team members such as trust and leadership) and individual dynamics (personal attributes). The implications of role construction were found to include professional satisfaction and more favourable wait times for patients. A model that integrates these different elements was developed.ConclusionsBased on the results of this study, we argue that autonomy may be an important element of interprofessional team functioning. Counter-intuitive as this may sound, we found that empowering team members to develop autonomy can enhance collaborative interactions. We also argue that while more interchangeable roles could help to lessen the workloads of team members, they could also increase the potential for power struggles because the roles of various professions would become less differentiated. We consider the conceptual and practical implications of our findings and we address the transferability of our model to other interprofessional teams.
Highlights
The move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers
These points of divergence include the origins of the two teams, the models of primary health care and the age of the teams. Both teams – located in different provinces in Canada but operating within similar regulatory frameworks - provide primary health care services including consultations, diabetes care, hypertension management and blood monitoring (INR reviews). These two cases show similarities in the types of professions found on their teams for example, nurse practitioners (NPs), registered nurses (RNs), registered practical nurses (RPNs), dieticians, social workers and pharmacists, and in the size of the teams that were studied
“One of the interesting things that we found and worked through was the whole ‘grabbing-and-letting-go’ process because there are a lot of similar tasks in the roles [of NPs and RNs]...How we worked to build a process was to keep reminding the nurse practitioners in this model that you are similar to a family doctor and those RNs are similar to the nurse practitioners
Summary
The move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. Interprofessional collaboration is increasingly being promoted as a mechanism to respond to the challenges of the health care system by reducing costs, improving quality of care, and improving staff retention and job satisfaction [1] Accompanying this trend towards teamwork are issues around the management of professional necessity of synergizing professional roles, suggest the need to better understand how roles are constructed on interprofessional health care teams. Through the thematic content analysis of interview and observation data obtained from two primary health care teams, we have generated a model to reflect the elements of role construction
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