There is so much rhetoric in the health sector about the importance of collaboration, multidisciplinary approaches and teamwork. But there are many barriers to translating the rhetoric into reality.
In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports on a study that makes timely and relevant reading for Medicare Locals’ staffers and others involved in primary health care reform. No doubt the results will also be of interest to patients, particularly those with diabetes or other chronic conditions requiring long-term, multidisciplinary management.
University of NSW researchers interviewed 45 health service providers from 19 organisations in a rural city (including fee-for-service practices and block funded public sector services) and eight patients, with the aim of exploring the influence of power dynamics and trust on collaboration between health professionals involved in managing diabetes.
The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus
Olga Anikeeva writes:
The primary health care sector is critically important in diabetes care, as diabetes is the second most frequent chronic condition managed in general practice and the most frequent reason behind referrals to other health care providers in Australia.
In order to effectively manage type 2 diabetes, patients require access to well coordinated care from health professionals including GPs, specialists, educators, dieticians, optometrists and podiatrists.
The authors used a qualitative case study approach to explore the experiences and perceptions of participants involved in providing or receiving care for type 2 diabetes. Data were collected through semi-structured interviews that were audio recorded, transcribed and thematically analysed.
Three themes emerged that related to power dynamics between health professionals. The first of these was the use of power by health professionals to protect their autonomy.
GPs maintained their autonomy by engaging in a low level of collaboration with allied health professionals. They rarely consulted and collaborated with other providers, with little two-way communication.
The second theme was power dynamics between private and public sector providers. Collaboration between GPs and public sector professionals was complicated and both groups strived to maintain their authority over matters that they considered to be their area of expertise. GPs had little formal authority or responsibility for the management or care coordination of patients in public sector health services.
The final theme was health professionals’ maintenance of power by reducing their dependency on other health professionals. This was achieved through two major approaches: choosing partners with whom they had cooperative relationships and reducing their collaboration with health professionals outside their organisation.
Thus, despite the intention of government policies to support more shared decision-making, there is little evidence that this occurs in practice.
The major trust themes identified in the study were related to role perceptions, demonstrated competence and the importance of good communication for the development of trust.
The level of trust was positively related to the extent to which roles and role boundaries were accepted. The roles of and role boundaries between and within professional groups and services are changing and evolving. The uncertainty associated with these changes has an effect on the level of trust and mistrust.
The study highlights the notion that collaboration across organisational boundaries remains challenging. Power dynamics and trust affect the strategic decisions made by health professionals regarding whether to collaborate, with whom and to what extent.
• Dr Olga Anikeeva is Research Associate, Primary Health Care Research & Information Service (PHC RIS)
McDonald J, Jayasuriya R, Harris MF (2012). The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus. BMC Health Services Research, 12:63
This article, which can be accessed at http://www.biomedcentral.com/1472-6963/12/63/abstract, features in the 22 March 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.
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