The Social Dynamics of Interdisciplinary Collaboration Across Organizational Boundaries

Theoretical/Conceptual Foundation: Studies of interdisciplinary teamwork in healthcare indicate that collaboration is a contested process in which parties have to learn to work together. However, the process by which this type... [ view full abstract ]

Theoretical/Conceptual Foundation:
Studies of interdisciplinary teamwork in healthcare indicate that collaboration is a contested process in which parties have to learn to work together. However, the process by which this type of learning is enacted remains poorly understood which has hindered the development of collaborative practice across professional and organizational boundaries. We frame the research within Complex Adaptive Systems Theory, focusing our attention on patterns of interactions that are co-evolving within their embedded context in supporting (or not) collaborative behaviours in the delivery of healthcare.

Research Questions: This study examines (1) how learning and knowledge exchange processes unfold within and across interdisciplinary and interorganizational teams, and (2) identifies what factors contribute to the development of effective collaborative practice in primary healthcare settings.

Methods: In depth semi-structural interviews were conducted with a convenience sample of thirteen Community Care Coordinators embedded in multiple interdisciplinary teams of healthcare professionals providing integrated care to patients with complex needs. Interviews were complemented by observations of group meetings and listening-in on patients’ case study group discussions. Results were validated in a focus group of Community Care Coordinators.

Results: The data highlighted that much of what makes collaborative practice successful or challenging is based on the quality of the inter-professional interaction and the type of social engagement determined by attitudes, preferences, and expectations of the individual providers in the interface. Also, how each team member defined and enacted the concept of collaboration and communication in the context of care provisions was important. Interdependence and collaboration among team members generally increased over time as team members recognized the value of others’ knowledge and expertise and became accustomed to drawing on that knowledge in care provisions. Learning occurred through active participation as a collective social process, rather than an individual process without points of contact. Four inter-related behaviors were identified: interaction, feedback, reflection, and self-directed learning as a mutually co-constituted process; as team members jointly engaged with an issue and built their understanding of it together. The results of the study can be used to identify ways to better support healthcare professionals in collaborating for integrated care delivery across professional and organizational boundaries.

Conclusion: This research creates new knowledge about how healthcare professionals learn with, from, and about each other, or why they may fail to do so, in the delivery of integrated care. The results of the study can be used to identify ways, through policy and practice changes, to better support healthcare professionals in collaborating for integrated care delivery as well as to create work environments that facilitate learning and knowledge exchange across organizational and professional boundaries. There have been numerous calls in the literature for additional research in examining interrelated processes that support learning and knowledge sharing patterns, the need for a greater understanding of the conditions necessary for collective learning and the link between participant behavioral interaction and intervention initiatives. This research is moving in this direction to address this gap.