Kathleen MacMillan

Leadership of interprofessional health and social care teams: a socio‐historical analysis

AIM The aim of this paper is to explore some of the key socio-historical issues related to the leadership of interprofessional teams. BACKGROUND Over the past quarter of a century, there have been repeated calls for collaboration to help improve the delivery of care. Interprofessional teamwork is regarded as a key approach to delivering high-quality, safe care. EVALUATION We draw upon historical documents to understand how modern health and social care professions emerged from 16th-century crafts guilds. We employ sociological theories to help analyse the nature of these professional developments for team leadership. KEY ISSUES As the forerunners of professions, crafts guilds were established on the basis of protection and promotion of their members. Such traits have been emphasized during the evolution of professions, which have resulted in strains for teamwork and leadership. CONCLUSIONS Understanding a problem through a socio-historical analysis can assist management to understand the barriers to collaboration and team leadership. IMPLICATIONS FOR NURSING MANAGEMENT Nursing management is in a unique role to observe and broker team conflict. It is rare to examine these phenomena through a humanities/social sciences lens. This paper provides a rare perspective to foster understanding - an essential precursor to effective change management.

Simulated interprofessional education: An analysis of teaching and learning processes

Simulated learning activities are increasingly being used in health professions and interprofessional education (IPE). Specifically, IPE programs are frequently adopting role-play simulations as a key learning approach. Despite this widespread adoption, there is little empirical evidence exploring the teaching and learning processes embedded within this type of simulation. This exploratory study provides insight into the nature of these processes through the use of qualitative methods. A total of 152 clinicians, 101 students and 9 facilitators representing a range of health professions, participated in video-recorded role-plays and debrief sessions. Videotapes were analyzed to explore emerging issues and themes related to teaching and learning processes related to this type of interprofessional simulated learning experience. In addition, three focus groups were conducted with a subset of participants to explore perceptions of their educational experiences. Five key themes emerged from the data analysis: enthusiasm and motivation, professional role assignment, scenario realism, facilitator style and background and team facilitation. Our findings suggest that program developers need to be mindful of these five themes when using role-plays in an interprofessional context and point to the importance of deliberate and skilled facilitation in meeting desired learning outcomes.

Understanding interprofessional relationships by the use of contact theory

The importance and necessity of interprofessional collaboration (IPC) present challenges for educators as they determine how best to achieve IPC through interprofessional education (IPE). Simulation-based teaching has been shown to enhance students’ understanding of professional roles and promote positive attitudes toward team members; yet, empirical evidence providing direction on the conditions necessary to promote these positive outcomes is lacking. This study used a quasi-experimental design with a pre-/post-test to examine changes in undergraduate healthcare students’ perceptions and attitudes toward IPC following their participation in an interprofessional simulation program. Allports (1954) intergroup contact theory was used to help understand the nature of this IPE workshop and its reported outcomes. Participants included students in the final year of their respective programs (n = 84) such as pharmacy technician, paramedic, nursing and occupational therapy assistant/physical therapy assistant programs. These students were engaged in simulation exercises with interactive contact opportunities. Using the interdisciplinary education perceptions scale, statistically significant increases in positive attitudes in three of four sub-scales were found. An analysis of the structure and format of the workshop suggests that this IPE initiative fulfilled the key conditions suggested by intergroup contact theory. Attention to the key conditions provided by Allports theory in the context of successful intergroup relationships may help provide direction for educators interested in planning IPE initiatives with student groups enrolled in various health programs.

Near misses: Paradoxical realities in everyday clinical practice

This qualitative study was conducted to define and describe what constitutes and contributes to near miss occurrences in the health-care system and what is needed to ensure safer processes of care. Nine health-care organizations (13 sites total) including six academic health sciences centres (acute care, mental health and geriatric) and three community hospitals participated in this study. The final sample consisted of 37 focus groups (86 in the nursing staff only; 62 in the pharmacy staff only; and 99 in the mixed nursing and pharmacy focus groups respectively) and 120 interviews involving 144 health-care consumers. Data were collected using focus groups (health-care professionals) and key informant interviews (health-care consumers). A multi-level content analyses schema (transcription, coding, categorizing, internal consistency, thematic analysis and community validation) was used. Six themes emerged from the multi-level content analyses that combined focus group (health-care professionals) and key informant interview (health-care consumers) data. These themes are discussed under the three original research questions with supporting data derived from codes and categories. Study findings implicate changes for the health-care landscape relative to system, health policy, professional development and quality improvement.

Work, work environments and other factors influencing nurse faculty intention to remain employed: a cross-sectional study.

BACKGROUND Given the role nurse faculty have in educating nurses, little is known about what influences their intention to remain employed (ITR) in academic settings. OBJECTIVES Findings from a nurse faculty survey administered to test a conceptual model of factors hypothesized as influencing nurse faculty ITR are reported. DESIGN A cross-sectional survey design was employed. SETTING We included colleges and universities in Ontario, Canada. PARTICIPANTS The population of Ontario nurse faculty who reported being employed as nurse faculty with the College of Nurses of Ontario (Canada) was included. Of the 1328 nurse faculty who were surveyed, 650 participated. METHODS Participants completed a questionnaire with measures of work, work environment, job satisfaction, burnout and ITR. Regression analyses were conducted to test the model. RESULTS Ten of 26 independent variables explained 25.4% of variance in nurse faculty ITR for five years. These variables included: proximity to retirement, quality of relationships with colleagues, being employed full time, having dependents, satisfaction with work-life balance, quality of education, satisfaction with job status, access to financial support for education from organization, access to required human resources and being unionized. CONCLUSIONS Although not all influencing factors are modifiable, academic leadership should develop strategies that encourage nurse faculty ITR. Strategies that support collegial relationships among faculty, increase the number of full time positions, promote work-life balance, engage faculty in assessing and strengthening education quality, support faculty choice between full-time and part-time work, and ensure adequate human resources required to teach effectively will lead to heightened nurse faculty ITR.

A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning

ABSTRACT Patient discharge is a key concern in hospitals, particularly in acute care, given the multifaceted and challenging nature of patients’ healthcare needs. Policies on discharge have identified the importance of interprofessional collaboration, yet research has described its limitations in this clinical context. This study aimed to extend our understanding of interprofessional interactions related to discharge in a general internal medicine setting by using sociological theories to illuminate the existence of, and interplay between, structural factors and microlevel practices. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers’ perspectives, behaviours, and interactions regarding discharge. Data collection involved observations, interviews, and document analysis. Approximately 65 hours of observations were undertaken, 23 interviews were conducted with healthcare providers, and government and hospital discharge documents were collected. Data were analysed using a directed content approach. The findings indicate the existence of a medically dominated division of healthcare labour in patient discharge with opportunities for some interprofessional negotiations; the role of organizational routines in facilitating and challenging interprofessional negotiations in patient discharge; and tensions in organizational priorities that impact an interprofessional approach to discharge. The findings provide insight into the various levels at which interventions can be targeted to improve interprofessional collaboration in discharge while recognizing the organizational tensions that challenge an interprofessional approach.

Medicine and nursing: a social contract to improve collaboration and patient-centred care?

The call for effective interprofessional collaboration to deliver safe, high quality patient-centred care has echoed across the world for over the past 30 years (e.g. Department of Health, 1996; Institute of Medicine, 2000; World Health Organization, 1988, 2010). Through such calls, it is argued that collaboration can reduce duplication of effort, improve job satisfaction of staff, help overcome fragmentation of service delivery and improve patient safety and quality. While research has indicated that professionals can work in an effective manner spread across the continuum of care, professional biases, boundary protectionism and little opportunity to develop interprofessional competence has made effective collaboration extremely difficult (e.g. Gibbon, 1999; Reeves & Lewin, 2004; Skjorshammer, 2001; Zwarenstein, Goldman, & Reeves, 2009). However, the oldest of the two health professions – medicine and nursing – are particularly imbedded in this problematic relationship. In this editorial, we argue that this combination of historical roles and practice patterns, as well as a lack of understanding of the social contract each profession has with patients, limits broad adoption of effective collaborative practice and impairs patient-centred care.

The challenge of achieving interprofessional collaboration: Should we blame Nightingale?

The goal of implementing true interprofessional collaboration within the health care system seems to be elusive. The historical role of medicine as primary clinical leader and decision maker is particularly entrenched in the Western health care system. Florence Nightingale, the acknowledged founder of modern, Western nursing, is often blamed for the subservient role of nursing and other female-dominated health and social care professions. Is it fair to lay the blame on Nightingale? This paper seeks to place Nightingale in context and to revisit her own words to explore the Victorian world in which she worked as a social reformer. It argues that Nightingale made pragmatic compromises to gain acceptance for the new profession of nursing; that these compromises had unanticipated consequences that persist – but are not unchangeable.

Editorial: Interprofessional education and collaboration: the need for a socio-historical framing

Introduction The goal of implementing effective interprofessional education (IPE) and interprofessional collaboration (IPC) within the health care system continues to be elusive. One of the ways in which we may be able to inform this challenge could be to examine the socio-historical roots of the health and social care professions. Recently, one of us explored the continuing influence of Florence Nightingale – the nineteenth century founder of modern, western nursing whose role in developing organizational structures for nursing may have inadvertently sown the seeds of the adversarial relationship between medicine and nursing (MacMillan, 2012). The nature of this relationship was effectively described by Stein (1967) in his ‘‘doctor–nurse game’’, which went on to be the subject of numerous papers (e.g. Keddy, Jones, Burton, & Rogers, 1986; Reeves, Nelson, & Zwarenstein, 2008). However, the historical roots of this relationship have played a relatively small role in the analysis or proposed solutions to the current state of IPE and IPC. Nightingale is often blamed for the subservient role of nursing to medicine, but it is only in examining the context in which Nightingale’s reforms originated – through an historical lens – that we can fully appreciate the rational underpinnings and then begin to formulate mitigating strategies to overcome legacy relationships that lack contemporary relevance. We recently posited that there may be similar socio-historical roots to other interprofessional tensions and conflicts that may be impairing our ability to implement IPE and IPC if we are unaware of them or if we do not make them part of our dialogue (Reeves, MacMillan, & van Soeren, 2010). As a result, we issued a call for papers to encourage colleagues to examine historical IPE and IPC issues from a range of different perspectives. The subsequent seven papers (described below) provide an illuminating range of socio-historical accounts related to IPE and IPC developments. We were deliberately broad in our interpretation of the term ‘‘socio-historical’’, since many professions have recently emerged and do not have a substantial body of published or even grey literature, to draw from. Together, these papers open a door into a different approach for examining IPE and IPC and its implementation. The authors have provided a range of examples of methods to explore and analyze the impact of the past on the present and the future of IPE and IPC. Indeed, they may also encourage other colleagues to carry out similar analyses to further extend the interprofessional discourse in this area.

What near misses tell us about risk and safety in mental health care.

How service providers and service users view near misses in their daily practice within the rubric of patient safety events is not well understood. Further no studies were located that explored near misses specifically in mental health settings in Canada. In this context, a qualitative study was undertaken to gain insight into how service providers and service users (mental health clients or their family members) experienced and defined near misses. Eight (8) focus groups (n= 88) with service providers and 28 semi-structured interviews with service users were conducted at three mental health care organizations. Content analysis was employed to the dataset that elucidated that near misses were (1) safety threats and vulnerabilities associated with experiencing mental illness; and (2) acts that avert harm and prevent something from happening. Findings are compared to what is currently known about in safety. Implications of findings for practice, research and policy are delineated.