The perceived experiences of primary healthcare professionals in Ireland: interprofessional teamwork in practice.

Abstract

International trends indicate that countries promote and encourage the use of interprofessional teams as the preferred approach to delivering healthcare services to address the health and social care needs of their citizens. Healthcare policy reflects a universal acceptance of the efficacy of interprofessional teamwork. Healthcare organisations implement support mechanisms to stimulate and encourage professional interactions. Teamwork is associated with a range of positive outcomes and is deemed to be beneficial for patients, professionals and service providers. It has gained credibility in terms of the quality of care provided, levels of effectiveness and organisational efficiencies. Despite these recommendations interprofessional teamwork in healthcare has remained elusive in practice. There is criticism of its arbitrary application across healthcare settings and a lack of understanding related to the complexities and challenges involved therein. In 2001, the Irish Government published its Primary Care Strategy which placed interprofessional teamwork central to the delivery of health and social care services in Ireland. Currently there are 423 teams in place. Primary healthcare professionals were assigned to teams, membership and full participation was assumed. However there is significant reporting related to the lack of progress in terms of embedding interprofessional teamwork in practice. This study examined the levels of interprofessional teamwork achieved. It also examined the factors that may have facilitated or inhibited teamwork progress. A partially mixed methods sequential study design was employed, conducted in two phases: a quantitative survey examined the relationships between and predictors of collaborative behaviour (n=493), and a qualitative interview study examined the experiences of primary healthcare professionals of teamwork and the perceived facilitators and barriers that exist (n=26). Results from phase one indicated moderately positive scoring for collaborative behaviour. The perceived benefits of teamwork was the strongest predictor of collaborative behaviour, however the benefits score was the lowest, suggesting professionals do not experience adequate beneficial effects of teamwork in practice. Profession was of significant influence and there was a dearth of organisational support and resources in place. The results from the interviews conducted in phase two revealed four major themes; Conflict & Consensus, Them & Us, Implementation Paradox and Resourced to Fail. The interview data highlighted a significant ideological disparity between the medical and allied health professions which challenges engagement. In terms of the organisation, a severe lack of funding, appropriate infrastructure and a clear team governance framework has created barriers for teamwork. However most damaging is the lack of organisational awareness and understanding, mandatory application of a rigid team model and lack of consultation as perceived by the professions. This situation has resulted in considerable levels of negative emotions and a breakdown of trust. The findings are discussed with reference to the extant literature and a number of recommendations for future progress are outlined.