Development and Testing of a Conceptual Framework for Interprofessional Collaborative Practice
INTRODUCTION Validated conceptual frameworks are needed to guide interprofessional research in order to build a systematic body of knowledge of interprofessional collaborative practice (ICP) A conceptual framework derived from an extensive review of the interprofessional literature was developed. In the framework, constructs that include personal factors (i.e. beliefs in interprofessional collaboration, flexibility, trust, cooperation, and communication skills) and situational factors (i.e. leadership, empowerment, and support structures) are posited to influence effective ICP. ICP is conceptualized as understanding of roles, interdependence, knowledge exchange, and collective ownership of goals. Consequences of ICP include improved patient, organizational, and team and personal work behaviours and attitudes. METHODS A preliminary study was conducted to determine the relationships among the constructs in the conceptual framework with a sample of 117 interprofessional practitioners in Manitoba, Canada. Participants completed a survey derived from modified existing measures. RESULTS Exploratory factor analyses provided construct validity for the measures, and Cronbach alpha reliabilities were acceptable. CONCLUSION There is encouraging preliminary empirical support for the conceptual framework with trust, cooperation, communication skills, and support structures predictors of ICP, and ICP a predictor of all outcomes identified in the framework. Received: 12/13/2013 Accepted: 05/27/2014 Published: 09/23/2014 (c) 2014 Stutsky et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP Interprofessional Collaborative Practice ORIGINAL RESEARCH 2(2):eP1066 2 Introduction The interprofessional literature has been described as atheoretical (Reeves et al. 2011) Elements of interprofessional collaboration are poorly conceptualized, and a consistent theoretical framework to guide research and build a body of evidence to inform interprofessional education (IPE) and interprofessional collaborative practice (ICP) is missing (Reeves et al. In this paper, we present a conceptual framework for ICP derived from an extensive review of the existing interprofessional literature. The results of a preliminary study designed to test the validity of this framework in a Canadian healthcare setting are described. Literature Review/Conceptual Framework Numerous databases including PubMed, Scopus, Embase, CINAHL, and PsycInfo were searched to examine theoretical and research papers relating to IPE and ICP. Main keywords included interprofessional collaboration, interprofessional relations, interdisciplinary collaboration, interprofessional education, teamwork, and patient care team. Of the 900 electronic abstracts reviewed, only research based papers were selected for further review. Our proposed conceptual framework for ICP (see Figure 1, following page) was formulated by synthesizing concepts from 97 research papers and key national and international reports. We posit antecedents, that include personal and situational factors, influence ICP. ICP in turn results in a variety of consequences including improved work behaviors and attitudes, organizational outcomes, and patient outcomes. See Table 1 (page 3) for definitions/ descriptions of terms. Antecedents of ICP Researchers identified several antecedents to ICP. We separated the antecedents into personal factors that are controlled internally by an individual, and situational factors that professionals are exposed to within the workplace that either support or deter ICP. For ICP to be successful, interprofessional practitioners must first truly believe in the concept of ICP (Oandasan Reeves, 2005; Parker Oliver, Wittenberg Lyles, Day, 2007) and have experience with being able to negotiate an interprofessional plan when disagreements occur (Bronstein, 2003; McGrail, Morse, Glessner, Gardner, 2009) Relational skills are a precursor to ICP (McGrail et al. 2009) and interprofessional practitioners must have already developed strong cooperation (Gaboury, Lapierre, Boon, Moher, 2011) and communication skills (Atwal Caldwell, 2002; Havens, Vasey, Gittell, Lin, 2010) Trust is critical, and according to D'Amour, Goulet, Labadie, San Martin Rodriguez, and Pineault (2008) ICP is possible only when there is trust in each other's competencies. D'Amour et al. claim that professionals place themselves in vulnerable positions all the time and take risks in trusting each other; however, when there is high uncertainty or low trust, professionals will avoid collaboration and hold onto their own responsibilities for patient care. Overall, it is important that individuals are comfortable with themselves and their own competencies before relying on others (Clark, 2011) Situational antecedents that either support or deter ICP include leadership (Canadian Interprofessional Implications for Interprofessional Practice Healthcare leaders can use the proposed conceptual framework as a guide for facilitating interprofessional collaborative practice in organizations to enhance patient safety and quality. Interprofessional education can be strengthened with a validated framework for interprofessional collaborative practice. With a validated framework, clinical professionals will become more aware of the importance of individual attitudes and behaviors and team interactions to improving patient safety and quality H IP ISSN 2159 1253 Health Interprofessional Practice commons.pacificu.edu/hip 2(2):eP1066 3 Health Collaborative [CIHC] 2010; D'Amour et al. 2008; Oandasan Reeves, 2005) empowerment (Tresolini Pew Fetzer Task Force, 1994) and support structures (Clark, 2011; McGail et al. 2009) Both central and local leadership is needed to promote collaboration, eliminate barriers (D'Amour et al. 2008) and promote an effective team culture (Clark, 2011) Leadership is also needed to create an empowering environment that includes having access to information, support, resources, and the opportunity for growth and mobility (Kanter, 1977; 1997) Support structures necessary for ICP include having adequate time for sharing knowledge and patient related information (Atwal Caldwell, 2002; Clark, 2011; Gaboury, Bujold, Boon, Moher, 2009) and integrating daily collaborative behaviors into dayto day functioning (Ottawa Hospital, n.d. Support can also take the form of emotional support, helpful advice, or hands on assistance from superiors, peers, or interprofessional practitioners (Kanter, 1977; 1997) Additional support structures include having formal procedures and mechanisms for facilitating dialogue (Parker Oliver et al. 2007) such as written policies and/or guidelines and various educational opportunities such as in services and grand rounds. Interprofessional Collaborative Practice The World Health Organization (2010) defines collaborative practice as occurring "when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers, and communities to deliver the highest quality of care across settings" (p. 13) This definition is consistent with the model of Relationship Centered Collaborative Care (RCC) that includes three key relationships necessary for effective patient care: (a) the patient practitioner relationship, (b) the practitioner practitioner relationship, and (c) the community practitioner relationship (Tresolini Pew Fetzer Task Force, 1994) In the patient practitioner dimension, the essential role of the patient as a partner in the interprofessional care process is emphasized, while in the practitioner practitioner dimension, collaboration among healthcare providers is stressed. In the community practitioner dimension, the need Figure 1. Conceptual framework for interprofessional collaborative practice H IP Interprofessional Collaborative Practice ORIGINAL RESEARCH 2(2):eP1066 4 Table 1. Survey Subscales, Definition/Description, Sample Survey Items, Final Number of Survey Items, and Alpha Reliabilities Scales/Subscales Definition/Description Sample Survey Items Final a Antecedents: Personal Beliefs in IPC2 Extent to which professionals identify strengths in interprofessional collaboration. At my workplace, interprofessional collaboration is a better answer than non collaborative care to meet the patient's/family's biopsychosocial needs. 4 0.88 Flexibility1 "Deliberate..role blurring..and includes reaching productive compromises in the face of disagreement" (Bronstein, 2003, p. 300 301) I am willing to take on tasks outside of my job description when that seems important. 2 0.69 Trust2 The confidence and reliance that interprofessionals have with one another. I never have to double check information given to me by other team members. 5 0.83 Cooperation2 The manner in which interprofessionals work together for a common goal. I coordinate my efforts with professionals from other disciplines. 2 0.67 Communication3 The ease and effectiveness with which interprofessionals communicate with each other. I find it easy to ask the advice of others in my team. 3 0.68 Antecedents: Situational Leadership3 A team leader's ability to foster ICP and "set and communicate clear goals and expectations and facilitate their implementation" (Temkin Greener et al. 2004, p. 481) The team leader fosters professionals from different disciplines to work together. 3 0.76 Empowerment5 Having access to information, support, resources, and the opportunity for growth and mobility (Kanter, 1977; 1997) Overall, my current work environment empowers me to accomplish my work in an effective manner. 2 0.87 Support Structures1,4 Having the physical space, time, policies and procedures, and formal mechanisms to support ICP. Within my w