Struggling to Maintain Professional Identities When Engaging in Inter-professional Teamwork to Deliver Integrated Care

Abstract

Introduction: Inter-professional teamwork in healthcare usually involves various professions within healthcare reflecting the complexity of the phenomenon of inter-professional teamwork. While previous research studies have highlighted the benefits of such an approach to healthcare delivery, a number of research studies have also highlighted the challenges faced by these inter-professional teams when working together. Furthermore, focusing on professional identity of involved professionals in such work settings has been marked as an area of scholarship that needs more research. The concept of professional identity remains of interest both in practice and academia due to its primary importance to organisations of professional work. Studies have shown the effect professional identity has on inter-professional teamwork and professional interactions where it acts as either an enabler or a constraint depending on the context. Traditionally, inter-professionalism has been synonymised with de-professionalisation or deskilling of professionals, challenging their professional authority which can result in feeling of loss of professional expertise among the involved professionals. Aim of research: With the introduction of new models of integrated care in the UK, there is huge pressure on the healthcare sector and professional groups operating within it to change their practices, values and professional outlooks that ultimately affect their identities, in order to provide efficient, integrated and holistic care to patients. Identity becomes an issue when professionals go through phases of organisational and institutional changes and the introduction of new professional roles and practices that impede on already held views about that profession and thus needs to be studied in light of recently introduced initiatives of joined up services and integrated care provision mechanisms. Findings, Discussion and Conclusion: This research paper draws from a study conducted in nine newly created integrated teams in a county in UK. Whilst initially teams were mainly composed of physical and mental health professionals, social care also joined in later. This research paper highlights the impact of institutional and organisational level changes, i.e. introduction of an integrated model of care delivery for elderly and frail patients, on professional identities of health (physical and mental) and social care professionals working in a multidisciplinary environment in inter-professional teams. We assert in this research that professional identities and professional routines are not independent of the socio-historical and institutional context in which they take place. These professional identities are enabled and constrained by an institutional, organisational and social environment which legitimises aspects of these identities by providing interpretive frameworks and material/social resources for validating these identities and roles. We further contend that the institutional environment for these professionals was an active force that pushed them to go through the process of professional identity change but also provided them tools to negotiate through this process protecting their identity and professional autonomy, while re-defining professional boundaries that consequently affected micro-level activities of inter-professional teamwork.