Interprofessional collaboration in the hospital: strategies and meanings

Abstract

Objectives: Interprofessional collaboration is widely advocated in health and social care policies. However, existing research provides a relatively poor understanding of how professionals collaborate or the meanings they attach to their collaborative work. This paper aims to contribute to understanding of this activity by providing an in-depth account of interprofessional collaboration on medical wards in a large teaching hospital. Methods: Ethnographic methods were used, including individual and group interviews with health and social care staff (i.e. doctors, nurses, therapists, social workers; n = 49) and participant observations of ward-based work. Results: The organisation of medical teams, who cared for patients across a number of wards, and the task-oriented nature of medical work, limited opportunities for collaboration with other professionals (e.g. nurses, therapists) who were usually based on a single ward. Consequently, collaboration tended to be task-based, terse and formalistic. Staff employed a range of informal and formal communication strategies to overcome these constraints. Professionals also gave contrasting accounts of collaboration: doctors viewed collaboration primarily as an activity involving work with their medical colleagues, whereas other professionals saw it more as an interprofessional activity. Conclusions: Temporospatial constraints and contrasting notions of 'collaboration' are important factors in shaping the nature of interprofessional collaboration. Policies that promote this activity cannot assume that shared understanding of collaboration exists. They also need to be mindful of the practical constraints that affect collaboration in hospital wards.