Dale Dematteo

The use of systems and organizational theories in the interprofessional field: Findings from a scoping review

Authors have commented on the limited use of theory in the interprofessional field and its critical importance to advancing the work in this field. While social psychological and educational theories in the interprofessional field are increasingly popular, the contribution of organizational and systems theories is less well understood. This paper presents a subset of the findings (those focused on organizational/systems approaches) from a broader scoping review of theories in the organizational and educational literature aimed to guide interprofessional education and practice. A detailed search strategy was used to identify relevant theories. In total, we found 17 organizational and systems theories. Nine of the theories had been previously employed in the interprofessional field and eight had potential to do so. These theories focus on interactions between different components of organizations which can impact collaboration and practice change. Given the primarily educational focus of the current research, this paper offers new insight into theories to support the design and implementation of interprofessional education and practice within health care environments. The use of these theories would strengthen the growing evidence base for both interprofessional education and practice – a common need for its varied stakeholders.

Neophyte facilitator experiences of interprofessional education: implications for faculty development.

The facilitation of learners from different professional groups requires a range of interprofessional knowledge and skills (e.g. an understanding of possible sources of tension between professions) in addition to those that are more generic, such as how to manage a small group of learners. The development and delivery of interprofessional education (IPE) programs tends to rely on a small cohort of facilitators who have typically gained expertise through ‘hands-on’ involvement in facilitating IPE and through mentorship from more experienced colleagues. To avoid burn-out and to meet a growing demand for IPE, a larger number of facilitators are needed. However, empirical evidence regarding effective approaches to prepare for this type of work is limited. This article draws on data from a multiple case study of four IPE programs based in an urban setting in North America with a sample of neophyte facilitators and provides insight into their perceptions and experiences in preparing for and delivering IPE. Forty-one semi-structured interviews were conducted before (n  ==  20) and after (n  ==  21) program delivery with 21 facilitators. Findings indicated that despite participating in a three-fold faculty development strategy designed to support them in their IPE facilitation work, many felt unprepared and continued to have a poor conceptual understanding of core IPE and interprofessional collaboration principles, resulting in problematic implications (e.g. ‘missed teachable moments’) within their IPE programs. Findings from this study are discussed in relation to the IPE, faculty development and wider educational literature before implications are offered for the future delivery of interprofessional faculty development activities.

A critical examination of the role of appreciative inquiry within an interprofessional education initiative

Appreciative inquiry (AI) is a relatively new approach to initiating or managing organizational change that is associated with the ‘positiveness’ movement in psychology and its offshoot positive organizational scholarship. Rather than dwelling upon problems related to change, AI encourages individuals to adopt a positive, constructive approach to managing change. In recent years, AI has been used to initiate change across a broad range of public and private sector organizations. In this article, we report findings from a subset of 50 interviews gathered in a wider study of interprofessional education (IPE) in which AI was employed as a change agent for implementing IPE in a number of health care institutions in a North American setting. A multiple case study approach. (Yin, 2002) was employed in the wider study and semi-structured interviews were undertaken with participants both before their IPE programs and directly afterwards to obtain a detailed understanding of their expectations and experiences of IPE. Interviews were analyzed in an inductive thematic manner in order to produce key emergent themes from each of the IPE programs. A process of re-analysis provided a set of themes which offered an understanding of the role of AI within this IPE initiative. Our findings identify a strong resonance and fit for AI both among the health and social care professionals who participated in this initiative. Numerous individuals commented on the enthusiasm and energy AI engendered, while praising its ability to enhance their working lives and interprofessional relationships. Yet a number of difficulties were also reported. These focused on problems with the translation of the AI process into achievable structural level (e.g. professional, cultural) changes. Based on these findings, the article goes on to argue that the use of AI can overlook a number of structural factors, which will ultimately limit its ability to actually secure meaningful and lasting change within health care.

Consumer‐directed personal assistance and ‘care’: perspectives of workers and ventilator users

‘Consumer‐directed personal assistance’ has been a central tenet of the North American Independent Living Movement since its inception. There is, however, surprisingly little research that explores how consumer‐directed assistance gets played out in practice. We conducted a qualitative study that explored the relationships between disabled ventilator users and their personal support workers (PSWs) in supportive housing environments in Ontario, Canada. The results show that while all participants agreed that they adhered to the philosophies of ‘independent living’ embedded in ‘consumer‐directed personal assistance’, how this was understood and enacted varied considerably. Narrow interpretations focused on the task‐oriented aspects of PSWs’ work, while broader interpretations included interpersonal aspects of care, respect and mutuality. We discuss how a conceptualization of consumer‐directed personal assistance can be elaborated to accommodate a notion of ‘care’ while retaining the core tenets of the independent living philosophy.

Perspectives of personal support workers and ventilator-users on training needs §

OBJECTIVES Ventilator-users living in the community have significant personal care needs that are largely provided by paid personal support workers (PSWs). As part of a larger qualitative study exploring relationships between ventilator-users and PSWs, this project explored training experiences and needs of PSWs from the perspectives of both groups. METHODS Individual semi-structured interviews conducted with 10 PSWs and 10 ventilator-users living in Support Service Living Units in Ontario, Canada were tape recorded, transcribed verbatim and analyzed for emerging themes. RESULTS Training experiences of PSWs varied significantly from on-the-job training, to a formal college diploma in personal care. While none received formal training in the specific care needs of ventilator-users such as tracheal suctioning, ventilator monitoring and tracheotomy care, all recommended improved training in this area. Their perspectives varied on whether training should be delivered in a formalized program or through individualized on-the-job training. CONCLUSIONS Despite differing perspectives on optimal training methods for PSWs, participants identified the need for initial and ongoing training to address specific needs of ventilator-users. PRACTICE IMPLICATION We recommend the development of standardized PSW training modules adaptable for use in formal and on-site training programs that can accommodate a variety of learning styles and needs.

Introducing first year students to interprofessionalism: Exploring professional identity in the “enterprise culture”: A Foucauldian analysis

This paper explores the experiences of, and thoughts on, interprofessional learning and care of first year health science students at a large Canadian university within a broad socioeconomic context. We apply discourse analysis to survey data collected to evaluate an introductory interprofessional event involving first year students from a variety of health professions. Follow-up focus-group interviews were conducted to gain greater understanding of student issues and concerns emerging from the survey, providing a second source of data. A significant paper entitled, “Education, enterprise culture and the entrepreneurial self: A Foucauldian perspective” by Peters (2001) provides an historical and theoretical framework for this paper. Peters notes the changing nature of professionalism and global crises in public institutions under neoliberalism as governments divest themselves of social responsibility, shifting it onto individuals through increased privatization and focus on entrepreneurialism. In exploring the thoughts and experiences of students through the historical lens of a shifting professional discourse and changing cultural and political environment, a unique view of professionalism and this interprofessional project comes to light. Reflective of the paradigm shift that Peters documents, there was evidence of students “internalizing” responsibility for a sustainable health care system through acquisition of interprofessional knowledge and behaviours.

Translating collaborative knowledge into practice: findings from a 6-month follow-up study

Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Canada, Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada, Wilson Centre for Research in Education, University of Toronto, Toronto, Canada, Centre for Faculty Development, St Michael’s Hospital, Toronto, Canada, Department of Psychiatry, University of Toronto, Toronto, Canada, and Centre for Interprofessional Education, University of Toronto, Toronto, Canada

Catalyzing and sustaining communities of collaboration around interprofessional care: An evaluation of four educational programs

Given the complexity of patients’ needs and a shifting health care environment, effective interprofessional collaboration (IPC) is regarded by many as essential to the delivery of high quality patient care (e.g., Health Canada, 2003; Department of Health, 2002). Interprofessional relationships can, however, be undermined by boundary infringements, a lack of understanding of one another’s roles, limited communication and poorly coordinated teamwork (e.g., Reeves & Lewin, 2004). Interprofessional education (IPE) is increasingly being seen as a key approach to improving poor collaboration (e.g., Health Canada, 2003; Department of Health, 2002). It is argued that because professionals have been traditionally trained in isolation from one another they are often not equipped with the attitudes, skills or knowledge to work effectively in interprofessional teams. IPE for both students and professionals is advocated as a way to address this problem. A growing body of evidence, generated from systematic review work (e.g., Barr et al., 2005) has indicated that IPE can help foster a range of attributes required for effective collaboration. To encourage health care workers in Ontario, Canada to work collaboratively to improve job satisfaction, achieve efficiencies within the health care system and enhance the delivery