Issues in Mental Health Nursing

ISSN: 0161-2840 (Print) 1096-4673 (Online) Journal homepage: [Link]/journals/imhn20

Interprofessional Collaborations for Improved

Health Care

Michelle Cleary RN, PhD, Andrew Foong RN, PhD, [Link]., Rachel
Kornhaber RN, PhD, Loyola McLean BA, MBBS (Hons), FRANZCP, PhD, Dip
Psychodynamic Psychotherapy, Cert ATP & Denis C. Visentin PhD

To cite this article: Michelle Cleary RN, PhD, Andrew Foong RN, PhD, [Link]., Rachel
Kornhaber RN, PhD, Loyola McLean BA, MBBS (Hons), FRANZCP, PhD, Dip Psychodynamic
Psychotherapy, Cert ATP & Denis C. Visentin PhD (2019) Interprofessional Collaborations
for Improved Health Care, Issues in Mental Health Nursing, 40:12, 1045-1048, DOI:
10.1080/01612840.2019.1655367

To link to this article: [Link]

Published online: 06 Nov 2019.

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ISSUES IN MENTAL HEALTH NURSING
2019, VOL. 40, NO. 12, 1045–1048
[Link]

COMMENTS, CRITIQUE AND INSPIRATION COLUMN

Interprofessional Collaborations for Improved Health Care

Michelle Cleary RN, PhDa , Andrew Foong RN, PhD, [Link].a , Rachel Kornhaber RN, PhDa ,
Loyola McLean BA, MBBS (Hons), FRANZCP, PhD, Dip Psychodynamic Psychotherapy, Cert ATPb,c,d,e , and
Denis C. Visentin PhDf
a
School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, Australia; bBrain and Mind Centre, Faculty of Medicine
and Health, The University of Sydney, Sydney, Australia; cConsultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, Australia;
d
School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia; eWestmead Psychotherapy Programme for Complex
Traumatic Disorders, Western Sydney Local Health District, Parramatta, Australia; fSchool of Health Sciences, College of Health and Medicine,
University of Tasmania, Sydney, Australia

Edited by support high-quality care for improved patient outcomes

Michelle Cleary, RN, PhD (Horsfall, Cleary, & Hunt, 2010). While individuals have dif-
College of Health and Medicine, University of Tasmania, ferent roles and responsibilities, members of a team need a
Sydney, NSW, Australia shared understanding of how their actions align with organ-
isational goals (Gittell, Godfrey, & Thistlethwaite, 2013;
Health service environments are by nature large, dynamic Kozlowski & Ilgen, 2006). Shared objectives require distrib-
and complex. To achieve any much-needed health care uted decision-making, responsibility and authority.
reforms requires effective health care collaborations to over- There are enablers and barriers to fully realise true IPC
come these complexities (Bosch & Mansell, 2015). This within health services. Each profession has unique character-
involves individuals or groups undertaking shared and par- istics, approaches and professional expertise which may be
ticipative decision-making and sharing authority and viewed as complementary, but which may also at times be
responsibility (Morley & Cashell, 2017). Effective health ser- challenging. The size of the collaboration may impact effect-
vice collaborations support communication between health iveness, with small teams having limited diversity, while
professionals, and this is known as interprofessional collab- larger structures may have difficulties coordinating a shared
oration (IPC) (Clark & Greenawald, 2013). IPC is defined as and cost-effective service (Horsfall et al., 2010; Shortell
“an interpersonal process characterized by healthcare profes- et al., 2004). It is important that interconnected health serv-
sionals from multiple disciplines with shared objectives, ices are not merely an aggregation of disparate elements,
decision-making, responsibility, and power working together departments and disciplines. There must be a development
to solve patient care problems” (Petri, 2010, p. 79). Such is of an interdisciplinary culture dependent on leaders and pol-
the importance of IPC that the World Health Organization icy makers. Each discipline has its own worth, identity and
(2010) has identified its vital role in education and practice scope of practice, however each must recognise that health
to mitigate the global health workforce shortage and facili- service delivery is not the domain of one “hero-professional”
tate achievement of the health-related Millennium group (Horsfall et al., 2010, p. 282).
Development Goals. IPC may be achieved through The perceived hierarchies of professions can impede the
approaches that foster mutual trust and respect, dialogue, implementation of interprofessional interventions (Rice
with an understanding and recognition of the skills, expert- et al., 2010). Health service workplaces are by nature com-
ise and duties of the health service collaborators. petitive, and disciplines are instinctively protective of their
Collaborations can occur at any level, including within domains, so it is important for leaders to champion an
and between organisations, requiring new thinking regarding inclusive and collegial team approach. In order to achieve
partnerships, interdependencies, and power (Green & effective IPC, organisations require a structure with an expli-
Johnson, 2015). Experiences will differ between and within cit vision, mission and goals. Both objectives and systems
an organisation. Collaborations can be further identified as need to be able to adapt and respond to the emergence and
intersecting, integrated, or a hybrid of both. Intersecting solution of problems. Communication and positive relation-
teams have discipline-specific approaches, with team proc- ality supports opportunities for information exchange, which
esses learned in an ad hoc manner with strong discipline may be enabled or inhibited by workplace design and
loyalties. Integrated teams have team leaders with a strong innovative technologies (Todaro, 2005). To ensure healthy
orientation towards the collaborative process (Croker, Higgs, functioning of organisations and to meet evolving chal-
& Trede, 2009). Effective teamwork, as a result of successful lenges, teams are needed which exhibit information-sharing,
collaboration, has positive impacts on health care systems to and can adapt to new concepts, practices and approaches to

CONTACT Michelle Cleary [Link]@[Link] University of Tasmania, Corner Church & Glover St, Lilyfield, Sydney, NSW 2040, Australia.
ß 2019 Taylor & Francis Group, LLC
1046 M. CLEARY ET AL.

health service delivery (Cleary, Kornhaber, West, McGarry, maintaining relationships across disciplines. In the absence
& Visentin, 2019; Garman, Fitz, & Fraser, 2006). Where of a deliberate approach to interprofessionalism, the trad-
these conditions exist, improved organisational effectiveness itional roles and relationships will remain the norm (Clark
is more likely to result (Horsfall et al., 2010). To this is & Greenawald, 2013).
added a need to build and repair working relationships, in There is much to be learnt regarding effective strategies
order to manage the vicissitudes of stress and traumatic and barriers to the implementation of evidence-based prac-
events, which abound in health work settings, and to man- tice, which is dependent on both interprofessional education
age conflict and competition creatively, humanely and with and interprofessional collaboration (Brandt, Lutfiyya, King,
vitality and to repair the inevitable relational wounds that & Chioreso, 2014; Zwarenstein & Reeves, 2006). Research
can arise from working together. tends to be discipline specific, in both its generation and
There are several benefits of teamwork and IPC, not all consumption, limiting translation. Interventions in interpro-
of which are immediately apparent. These include optimis- fessional education and collaboration should also be eval-
ing resources, finding solutions, improving service delivery uated using outcomes that appropriately assess evidence-
and outcomes, meeting needs, improved access to services based care (Zwarenstein & Reeves, 2006). While many
and information, and developing a sense of community. trends in health care improvements have been fleeting, the
Research demonstrates that improving collaborative commu- intersection of interprofessional practice, knowledge transla-
nication between health disciplines increases staff satisfac- tion, and evidence-based practice is here to stay
tion, decreases staff turnover and has a direct effect on (Zwarenstein & Reeves, 2006). Knowledge-translation and
patient outcomes including the potential to decrease mortal- collaboration interventions both aim to improve health care
ity and morbidity rates, improved access to care, and processes and outcomes. Approaches to evidence-based
decreased length of hospital stay (Bosch & Mansell, 2015; practice by any one discipline may neglect to consider
Boyle & Kochinda, 2004; Green & Johnson, 2015). However, impediments associated with interprofessional relations.
there are costs associated with implementing IPC. The Hence, IPC, by improving relationships and understanding,
requirements of participation are not negligible, needing supports the implementation of evidence-based practice
time and resource commitment that may be perceived as (Zwarenstein & Reeves, 2006).
outweighing the benefits of the collaboration (Perrault, Researchers can also benefit from collaborating, to inte-
McClelland, Austin, & Sieppert, 2011). Creating successful grate and share information, techniques, and perspectives
collaborations is not straightforward, and may encounter from specialisations to solve problems beyond the scope of a
significant opposition from the organisation, disciplines and single discipline (Green & Johnson, 2015). Each discipline
individuals (Green & Johnson, 2015). Small collaborations must appreciate the limitations of working within a research
can be fostered by shared interdisciplinary supervision, silo, including competition for limited research resources
building cohesion at the level of the multidisciplinary team reducing knowledge dissemination. Interprofessional
(Moloney et al., 2018). Successful international collabora- research can uniquely approach chronic and complex health
tions, such as The Cochrane Collaboration ([Link]. care problems, allowing engagement in broader projects and
org) and The National Clinical Guideline Centre ([Link]. providing access to methodological and content expertise.
[Link]), have yielded valuable research and practice evidence The generation of a collaborative research infrastructure will
with a widespread influence on health policy and provide continue after the completion of an individual project and
beacons to what can be achieved through IPC. the dissemination of its findings. A team approach to
Interprofessional collaboration is not just a goal but a research has long lasting effects with new insights and novel
requirement of contemporary health care, however engage- approaches gained and normalises IPC and interprofessional
ment in collaborative practice may at times fall short of research among wider peer groups. An interdisciplinary
expectations (Thannhauser, Russell-Mayhew, & Scott, 2010). track record positions a team and the individuals who
Collaboration is an interpersonal process, relying on rela- engage in the collaboration for future research success
tionships between professionals within a team. This requires (Green & Johnson, 2015).
a willingness on behalf of the individuals to collaborate, the An interprofessional approach begins with education
presence of mutual trust and respect, and a commitment to within and across the disciplines, which provides a context
effective communication (San Martın-Rodrıguez, Beaulieu, and perspective of one’s own discipline and how it fits with
D’Amour, & Ferrada-Videla, 2005). Relationship building is others within the health care and broader community.
vital to this endeavour, including sharing credit for achieve- Interprofessional education is a broad concept and has
ments, empowering champions, and committing meaningful numerous approaches, characterised by shared learning by
time for discussion and decision making (Perrault et al., health care practitioners or students of across professions
2011). Since professionals operate in complex health care with the aim to develop collaborative practice (Baker et al.,
systems, organisational capabilities are also key. Managers 2008). Interprofessional education aims to develop health
and policy-makers need to consider IPC as a fundamental care students by collaborative teaching to develop them as
requirement of their organisational structures when imple- interprofessional practitioners. A collaborative practice-ready
menting change (San Martın-Rodrıguez et al., 2005). health worker has the skills and desire to work as part of an
Support from leadership includes providing a vision, cham- interprofessional team (World Health Organization, 2010).
pioning effective collaboration, and developing and Programmes may involve interprofessional team building
 ISSUES IN MENTAL HEALTH NURSING 1047

skills, developing a working knowledge of other professions, “Collaborations and partnerships are, in the broadest
implementing person-centred care, identifying the import- sense, connections between and among people and groups
ance of workplace culture, and developing interprofessional to share interests and concerns, and create visions for the
clinical skills. Interprofessional learning aims to develop an future” (Todaro, 2005, p. 137). Despite the benefits of
understanding of other discipline roles within the health collaboration, poor approaches to collaboration can
care setting while maintaining and indeed reinforcing the adversely impact health service delivery and patient care
unique identity of their own (Bridges, Davidson, Odegard, (Zwarenstein, Goldman, & Reeves, 2009). The best
Maki, & Tomkowiak, 2011). Education, clinical practice and approaches rely on a commitment to accepting the values
research are interrelated, with all benefiting both individu- and ethics required for collaboration with mutual respect
ally and in combination from collaboration (Green & for the expertise of others, and an awareness of their
Johnson, 2015). unique professional roles and responsibilities. Teamwork
Practitioners are embedded in complex healthcare envi- invests in building relationships to contribute to safe health
ronments where the provision of safe care relies on healthy care and repairing them when inevitable ruptures occur.
interprofessional practice. In the practice setting, individuals Research in health setting collaborations creates physical
within professions work in very different ways and might and structural opportunities, and requires a psychologically
not always deliberately engage in a team approach to care. supportive environment and appropriate training (Morley &
Training is integral in the development and enhancement of Cashell, 2017).
effective teamwork but can also make practitioners aware of The complex interprofessional nature of health care deliv-
the impact that shared approaches have on both working ery means that development of each professional group has
relationships, and for patient care. This process should not broader effects in health services, as it indirectly impacts the
be left to occur after registration and in the early years of work of many other practitioners. Hence, consideration
practice. Fostering interprofessional collaborations during should be given to the needs of all professional groups in
the education of health professionals generates an under-
the health care workplace. At the outset, we should consider
standing of the roles that they play in the healthcare system
whether initiatives and activities can have a multi-profes-
and consideration of the ways to foster healthy collaboration
sional approach and hence be supported by interprofessional
and problem-solve inevitable conflicts. This provides a basis
education and staff development. Change rarely occurs in
for further enhancements which can be developed by the
isolation, with the practice of one profession requiring the
organisations in which they work (McComb & Simpson,
engagement of others. Workplaces which engage in IPC
2013). In these days, when Trauma-Informed Care is the
activity will be well-positioned to meet future health service
responsibility of both individual practitioners and the system
challenges (Zwarenstein & Reeves, 2006).
(Kezelman & Stavropoulos, 2012), practitioners and systems
Given the known benefits of IPC, we need to consider
can suffer vicarious traumatisation; collaborative work can
how prepared and committed organisations, disciplines and
be broken down by trauma, but can also offer protective
individuals are to this endeavour. Professionals need to be
and restorative processes (Cleary & Hungerford, 2015;
Moloney et al., 2018). open and courageous in their willingness to embrace team-
Interprofessional education is a fundamental pedagogical work, committed both to shared values and to work with
approach, with many factors contributing to the success of dif- those with a different perspective to embark on a shared
ferent approaches (Buring et al., 2009). Coordination of inter- journey (van Schaik, O’Brien, Almeida, & Adler, 2014).
professional experiences must be given priority in curricula. This may involve prioritising the organisational goals
Leaders in each discipline are needed to coordinate cross-dis- ahead of one’s personal approach or actively and creatively
ciplinary activities. There are many barriers to this including working on meaningful synthesis or compromise (Cleary,
trivialities such as timetables, workloads, and scheduling of West, Saghafi, Lees, & Kornhaber, 2019). Collaboration is
staff in different organisational areas. Such an initiative a current need given the burden of chronic and complex
requires dedicated and skilled educators across settings health conditions, requiring a team approach to care.
(Bridges et al., 2011). Perhaps obvious places to begin might “Times are changing, silos are falling, national health bur-
be where shared content is clear, as in the basic clinical sci- dens are being shared, and it is going to take much more
ence and also teaching around the therapeutic alliance and than a single practitioner or paradigm to solve the serious
team dynamics. Students trained in such programmes are health care issues confronting humanity today and in the
more likely to engage in collaborative interprofessional teams future” (Green & Johnson, 2015, p. 8). Interprofessional
and also develop respect and have positive relationships with collaboration is both challenging and rewarding. To fully
others (Bridges et al., 2011). The factors associated with inter- realise the benefits, we must understand each other’s
professional education and collaborative practice initiatives training, scope of practice, and discipline-specific skills sets
have been identified as: developing shared terminology; having and learn to value and nurture the relational spaces
discipline champions and external support; a consideration of between us.
the effects of professional culture; and understanding imple-
mentation requirements (Barker, Bosco, & Oandasan, 2005).
An aspect of external support is the setting of clear training
Disclosure statement
goals in the curricula set by professional organisations. Authors declare that there is no conflict of interest.
1048 M. CLEARY ET AL.

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