Promoting Interprofessional Education and Collaborative Practice in Rural Health Settings: Learnings from a State-Wide Multi-Methods Study
2. Materials and Methods
2.1. Research Design
2.3. Participants and Sampling
2.5. Data Collection
2.7. Ethics Approval
3.1. IPECP Remains a Black Box
I think interprofessional is a definition a lot of people don’t understand well. Multidisciplinary is in that traditional language…we think we’re multidisciplinary, but I feel we are just working in our little silos…(Int 27)
Yes, I mean there’s still a lot to learn about this whole interprofessional collaborative practice but at this stage we’ve just been thrown together and it’s kind of worked.(Int 11)
I know interprofessional practice has been around for a while…but I’m not sure how well understood (it is) within our health service in particular…over the last couple of years or so I think there are probably lots of things that teams are actually doing that you could say that’s a component of interprofessional practice but I guess the understanding of that may not be there either.(Int 7)
I think in an ideal world it would be great before they even started doing anything if they had attended a workshop or at least had a discussion as a team about what they think interprofessional collaborative practice is. So, everyone is very clear about the team, how the team and everyone’s role will function. I think that clarity is really, really key and I think have discussions on things like conflict resolution and collaborative leadership. So that would be an ideal world.(Int 6)
(I am aware of) the Canadian Interprofessional Health Collaborative. We did a few reading booklets and some diagrams on how the model works; the interprofessional education guidelines and the University of Toronto facilitating interprofessional clinical learning…there were also some resources from one of the universities in Sydney.(Int 17)
3.2. Drivers at the System Level
Our team leader is fantastic, she’s very supportive and very approachable…just having that strong support as a lead who is very approachable…and having that stable person is good.(Int 15)
It’s the patients who luck out at the end of the day…. I loved the experiences out there and would have been extremely happy to stay out there if the management was supportive and the difficult personalities were dealt with in an appropriate way.(Int 20)
3.2.2. Structures and Processes That Facilitate or Hinder Collaboration
We have a nice large office where we all are, and we know each other quite well and you can say—hey can I just talk to you about this patient.(Int 27)
And it (co-location) does help. Just yesterday we had this very difficult discharge and I was talking to the NDIS and hospitals in [xx—bigger centre] and consultants…and just the [xx] physio who is out here for three months came around after the phone call and said—hey did you know that we do this at the [xx] hospital and it might work for this patient…and it did.(Int 25)
The co-location can be great in terms of promoting discussion, but it can open it to too much discussion or too much noise in the workplace.(Int 15)
I know there is stuff online. I haven’t looked at it…when you do a course you come back and put it on your bookshelf. You want to use it, but it disappears for some reason. I think our best resource would be setting time aside to discuss it once a month or bring it up at a team meeting or build it up from the team level…what do we want to do in interprofessional practice and go and find the resources for that.(Int 25)
The tricky thing is… all the different disciplines have different lengths of time. The physio blocks are only five weeks, OT students have been here for ten weeks… the psych is six months. So, trying to get them all lined up can be tricky.(Int 15)
I think being practical around looking at one another’s diaries and looking at how you set up your clinics, how they are going to work together if they’ve all got separate diaries… and not a lot of flexibility, it’s going to be hard to do joint sessions, joint therapy….(Int 12)
I think it comes down to time. We were very keen to start working interprofessionally after that [xx] training but we haven’t really gotten together and worked out a plan…we just haven’t organised anything so far as professional development opportunities go, it gets put on the backburner, patient care comes first.(Int 24)
Our team leader has formally set aside time where our clinics have been closed off so we can devote and dedicate this time to developing strategies, actually looking at how we can change our practice to be more interprofessional.(Int 13)
3.2.3. Impact of Rurality
We have to make the best of what we have and the best of people’s skills.(Int 16)
Obviously lots of limited resources…and the requirement to work a bit more collaboratively so you can give the patients good care, still working within the scope of practice but yes I think that’s probably more of a necessity rather than enabled by anything in particular.(Int 7)
…this is one of the best working teams that I’ve been a part of…because it is a small team. You get to know what all of the disciplines are and what their specialty areas are, and you become aware of how to communicate with different people.(Int 26)
…with some disciplines, there is only one of that team member. If they go on holidays, usually they don’t have any backfill. If someone’s on leave, there is no one from that discipline to go to.(Int 15)
…as sole clinicians in rural or remote…we are out in different towns almost every day and we are not really in the same place at the same time…I guess not having regular meetings or everyone not being present at the same time.(Int 17)
I think it’s just the disconnect that we sometimes have as a team…because all are on outreach… at four or five locations around the health service which makes it difficult to have them at the same place at the same time unless its coordinated.(Int 18)
3.3. The Power of an Individual to Make or Break IPECP
3.3.1. Characteristics of a Pro-IPECP Healthcare Worker
I think we all get along quite well. We respect each other and as we respect each other’s space and when we need assistance, we all get together…being sensible, supportive and respectful of each other.(Int 9)
We see ourselves as a team first and our clinical step next…it’s just beautiful it works so well. There is no ego and we wrap around the patient, whatever they need, whatever angle needs to be addressed, for whatever reason, the person is just there.(Int 25)
I think there is a bit of a hierarchical kind of thing…you know the whole thing of that doctor/nurse hierarchical stuff…when you get to be in a certain position then you really don’t have to fill in your progress notes that well and you can use abbreviations and you can write badly and nobody pulls you up on it….which doesn’t really enhance interprofessional practice.(Int 1)
I feel sometimes we are very multi-disciplinary and sometimes we are interprofessional. So, it depends on who I am working with as to about whether it’s more interprofessional or multi-disciplinary.(Int 12)
Sometimes the risk of working with other people we’ve tried to do interprofessional with they don’t want to work together, or they really don’t care about what my role does, they just want to get in there and do their job.(Int 12)
3.3.2. Targeted IPECP Professional Development and Follow-Up
You can really tell the difference in people who have had training in that really collaborative practice versus more siloed practice and how willing they are able to share elements of care and responsibility.(Int 13)
…important for the team to have some training on what interprofessional practice is….I guess training in team building activities to improve the team dynamics and team communication.(Int 26)
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Interview guide
- Information about the interviewee’s team
- Can you please start by describing how your team operates?
- When a patient is referred to your team, what processes are followed to progress this referral and patient care?
- Would you classify your team as multidisciplinary or interprofessional? (definition of terms is in the fact sheet emailed to you)
- How does interaction between team members take place in relation to client care?
- Can you give me an example of the best interprofessional/collaborative practice that you have witnessed in your team?
- Probes—at rounds, case conferences, discharge planning meetings
- What processes does your team use to resolve conflicts between members?
- What professional development opportunities, if any, does your team have that incorporates upskilling in interprofessional collaborative practice? Give examples
- team work, role clarification, conflict resolution, communication, collaborative leadership (information on interprofessional team and practice has been provided to you in the fact sheet)
- What interprofessional collaborative practice resources have you/team members accessed? Do you know of any other existing interprofessional collaborative practice resources that you can access?
- How do you/your team go about student placements in your unit?
- Combined interprofessional tutorials
- Shared teaching of students from different professions
- Peer learning—students learning with students from different professions or programs
- Enablers to interprofessional education and collaborative practice
- What are some factors that have enabled you/your team to work collaboratively/in an interprofessional way?
- Management/organisational factors
- Training/Professional Development
- Barriers to interprofessional education and collaborative practice
- What are some factors that have hindered collaborative working in your team?
- People factors (position, discipline, personality)
- Workplace culture/organisational factors etc
- Has working in a regional/rural health setting impacted on your/your team’s ability to work in a collaborative way? If yes, in what way
- For another team setting up interprofessional collaborative practice, what recommendations or suggestions do you have?
- Do you have any further comments on what we have discussed so far?
- WHO. Framework for Action on Interprofessional Education and Collaborative Practice. World Health Organization. Human Resources for Health. 2010. Available online: http://www.who.int/hrh/resources/framework_action/en/ (accessed on 28 January 2021).
- Lufiyya, M.N.; Chang, L.F.; McGrath, C.; Dana, C.; Lipsky, M.S. The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes based literature published between 2010 and 2018. PLoS ONE 2019, 14, e0218578. [Google Scholar]
- Thylefors, I.; Persson, O.; Hellstrom, D. Team types, perceived efficiency and team climate in Swedish cross-professional teamwork. J. InterProf. Care 2005, 19, 102–114. [Google Scholar] [CrossRef] [PubMed]
- Jones, A.; Jones, D. Improving teamwork, trust and safety: An ethnographic study of an interprofessional initiative. J. InterProf. Care 2011, 25, 175–181. [Google Scholar] [CrossRef] [PubMed]
- Barr, H.; Hammick, M.; Freeth, D.; Koppel, I.; Reeves, S. Evaluating Interprofessional Education: A UK Review for Health and Social Care; BERA/CAIPE: London, UK, 2000. [Google Scholar]
- Croker, A.; Brown, L.; Little, A.; Squires, K.; Crowley, E. Developing and maintaining collaborative practice: Exploring perspectives from dietetics and speech pathology about ‘what workds well’. Nutr. Diet. 2019, 76, 28–37. [Google Scholar] [CrossRef] [PubMed][Green Version]
- O’Carroll, V.; McSwiggan, L.; Campbell, M. Health and social care professionals’ attitudes to interprofessional working and interprofessional education: A literature review. J. InterProf. Care 2016, 30, 42–49. [Google Scholar] [CrossRef][Green Version]
- Hall, P. Interprofessional teamwork: Professional cultures as barriers. J. InterProf. Care 2005, S1, 118–196. [Google Scholar] [CrossRef] [PubMed]
- Morgan, S.; Pullon, S.; McKinlay, E. Observation of interprofessional collaborative practice in primary care teams: An integrative literature review. Int. J. Nurs. Stud. 2015, 52, 1217–1230. [Google Scholar] [CrossRef]
- Golom, F.D.; Schreck, J.S. The journey to interprofessional collaborative practice—Are we there yet? Pediatric Clin. N. Am. 2018, 65, 1–12. [Google Scholar] [CrossRef] [PubMed]
- Harrod, M.; Weston, L.E.; Robinson, C.; Tremblay, A.; Greenstone, C.L.; Forman, J. ‘It goes beyond good camaradier’: A qualitative study of the process of becoming an interprofessional healthcare ‘teamlet’. J. InterProf. Care 2016, 30, 295–300. [Google Scholar] [CrossRef]
- Soemantri, D.; Kambey, D.R.; Yusra, R.Y.; Timor, A.B.; Khairani, C.D.; Setyorini, D.; Findyartini, A. The supporting and inhibiting factors of interprofessional collaborative practice in a newly established teaching hospital. J. InterProf. Educ. Pract. 2019, 15, 149–156. [Google Scholar] [CrossRef]
- McNeil, K.; Mitchell, R.; Parker, V. The paradoxical effects of workforce shortages on rural interprofessional practice. Scand. J. Caring Sci. 2015, 29, 73–82. [Google Scholar] [CrossRef]
- Spencer, J.; Woodroffe, J.; Cross, M.; Allen, P. ‘A golden opportunity’:Exploring interprofessional learning and practice in rural clinical settings. J. InterProf. Care 2015, 29, 389–391. [Google Scholar] [CrossRef] [PubMed]
- Gum, L.F.; Sweet, L.; Greenhill, J.; Prideaux, D. Exploring interprofessional education and collaborative practice in Australian rural health services. J. InterProf. Care 2020, 34, 173–183. [Google Scholar] [CrossRef]
- Keshmiri, F.; Moradi, K. Perceptions of Iranian emergency department directors of interprofessional leadership: An interview study. J. InterProf. Care 2020, 34, 747–755. [Google Scholar] [CrossRef]
- Scotland, J. Exploring the philosophical underpinnings of research: Relating ontology and epistemology to the methodology and methods of the scientific, interpretive and critical research paradigms. Engl. Lang. Teach. 2012, 5, 9–16. [Google Scholar] [CrossRef][Green Version]
- Orchard, C.; Pederson, L.L.; Read, E.; Mahler, C.; Laschinger, H. Assessment of Interprofessional Team Collaboration Scale (AITCS): Further Testing and Instrument Revision. J. Contin. Educ. Health Prof. 2018, 38, 11–18. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Thematic analysis. In APA Handbooks in Psychology®. APA HANDBOOK of Research Methods in Psychology, Vol. 2. Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological; Cooper, H., Camic, P.M., Long, D.L., Panter, A.T., Rindskopf, D., Sher, K.J., Eds.; American Psychological Association: Washington, DC, USA, 2012; pp. 57–71. [Google Scholar] [CrossRef]
- Croker, A.; Hudson, J.N. Interprofessional education: Does recent literature from rural settings offer insights into what really matters? Med. Educ. 2015, 49, 880–887. [Google Scholar] [CrossRef] [PubMed]
- Cragg, B.; Jelley, W.; Burrows, M.; Dyer, K. Implementing and sustaining a rural interprofessional clinical education program. J. Res. InterProf. Pract. Educ. 2013, 3, 1–16. [Google Scholar] [CrossRef][Green Version]
- Ginsburg, L.; Tregunno, D. New approaches to interprofessional education and collaborative practice: Lessons from the organizational change literature. J. InterProf. Care 2005, S1, 177–187. [Google Scholar] [CrossRef] [PubMed]
- Mulvale, G.; Embrett, M.; Razavi, S.D. ‘Gearing up’ to improve interprofessional collaboration in primary acre: A systematic review and conceptual framework. BMC Fam. Pract. 2016, 17, 83. [Google Scholar] [CrossRef][Green Version]
- Humphreys, J.; Wakerman, J.; Wells, R.; Kuipers, P.; Jones, J.; Entwistle, P.; Harvey, P. Improving Primary Health Care Workforce Retention in Small Rural and Remote Communities: How Important is Ongoing Education and Training? Canberra: Australian Primary Health Care Research Institute. 2007. Available online: https://rsph.anu.edu.au/files/humphreys_25_final_pdf_23410.pdf (accessed on 28 January 2021).
- Chamberlain-Salaun, J.; Mills, J.; Usher, K. Terminology used to describe health care teams: An integrative review of the literature. J. Multidiscip. Healthc. 2013, 6, 65–74. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Martin, P.; Pighills, A.; Sinclair, L. Healthcare workers’ understanding of interprofessional education and collaborative practice in regional health settings: A survey study. J. InterProf. Educ. Pract. 2021, in press. [Google Scholar]
|Participant Characteristics||N (25)|
|Nutrition and Dietetics||4|
|Nature of role:|
|Both clinical and management||2|
|Other (e.g., admin, health promotion)||2|
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Martin, P.; Pighills, A.; Burge, V.; Argus, G.; Sinclair, L. Promoting Interprofessional Education and Collaborative Practice in Rural Health Settings: Learnings from a State-Wide Multi-Methods Study. Int. J. Environ. Res. Public Health 2021, 18, 5162. https://doi.org/10.3390/ijerph18105162
Martin P, Pighills A, Burge V, Argus G, Sinclair L. Promoting Interprofessional Education and Collaborative Practice in Rural Health Settings: Learnings from a State-Wide Multi-Methods Study. International Journal of Environmental Research and Public Health. 2021; 18(10):5162. https://doi.org/10.3390/ijerph18105162Chicago/Turabian Style
Martin, Priya, Alison Pighills, Vanessa Burge, Geoff Argus, and Lynne Sinclair. 2021. "Promoting Interprofessional Education and Collaborative Practice in Rural Health Settings: Learnings from a State-Wide Multi-Methods Study" International Journal of Environmental Research and Public Health 18, no. 10: 5162. https://doi.org/10.3390/ijerph18105162