Collaboration: The devil’s in the detail

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• Marion E. Broome, PhD, RN, FAAN

The world is good and the people are good… And we’re all good fellows together…

Byron

Over the past decade there has been a tremendous shift in the calls for collaboration across disciplines. The majority of these focus on enhancing collaboration as a vehicle for improving the quality of care and patient safety. Some of these reports are a decade old. Yet, as I read many of the more recent reports calling for greater collaboration, and I watch how health professionals in the education, research and practice worlds really carry out their daily work, I fear we still have miles to go before we can “sleep”.

Collaboration has been defined “as a mutually beneficial and well-defined relationship entered into by 2 or more (organizations) individuals to achieve common goals…shared responsibility…mutual authority and accountability, and sharing of resources and rewards.”¹ Communication, purpose, resources, environment, process and structure are all critical variables described in the literature as integral to successful collaborations, whether they be individuals working on one team or communities working together.¹, ², ³ Yet others who study teamwork and collaboration in the health professions point out that perceptions of actual collaborative behaviors differs depending on who you are on the collaboration continuum. Several studies have documented that physicians tend to rate the level of collaboration as 30–50% higher than the same nurses they work (collaborate?) with—even in areas of practice in which most of us assume there must be cohesive relationships and teamwork (eg, surgery, critical care)⁴, ⁵, ⁶…Surprise, Surprise….

To be sure, there are many points of light in the movement calling for greater collaboration across health professions. Some of these initiatives begin in the early stages of educational preparation for each profession and extend to and through the leaders in each profession. These include The Relationship Center Care Initiative based on the Pew-Fetzer Commission Report 2; the Institute for Health Care Improvement Health Professions Education Consortium conferences⁷; and the Transforming Care at the Bedside Project supported by the Robert Wood Johnson Foundation.⁸ All of these provide exemplary models of how it should and could be. Yet, there seems to be little widespread traction gained in terms of the development of curricula across health professions—either before or after licensure in each discipline—that will enable future practitioners to engage as full partners in these new models of care. The relatively recent emphasis on interdisciplinary research is another arena in which there seems to be little progress, despite concentrated efforts on the part of many individual scientists to build collaborative, multidisciplinary research teams as they conceptualize, implement and disseminate their research. The latest illustration of the lack of meaningful integration of nurse scientists was clearly evidenced in the recent call for Clinical and Translational Science Awards (CTSAs)⁹ applications. Stories of meaningful collaboration and success on the CTSAs are far exceeded by those in which nurse scientists were clearly relegated (if involved at all) to second-tier responsibilities—even when their research credentials and funding records far outweighed those chosen for key leadership positions from other disciplines.

Many of us have experienced the incredible sense of satisfaction which results from being involved in meaningful interdisciplinary experiences in which the whole was truly greater than the sum of the parts. “Magic happened” as each individual brought their unique perspective, knowledge and skills to bear on a “problem”. In the 1970’s there were several concerted efforts to develop interdisciplinary courses across several health disciplines. Having developed and taught in several of these, it was clear to me very early-on that they were doomed to fail. Other than the strong beliefs and commitment of the individual faculty and students, the barriers seemed insurmountable. Students were usually required to take the course as an elective, courses taught were often viewed by other faculty as “soft courses” such as family-centered care, ethics, etc, and the faculty involved had to shape their courses around markedly different academic calendars. From the “outside looking in” these collaborations did not look easy. They still don’t.

As I reflect on these past experiences, on what things look like today, and listen to the desires of many to actually collaborate in teams across education and practice settings, I think it is time that we consider the “what’s in it for me” question. And, for nurses, the “who me?” question also has to be dealt with. What exactly do nurses bring to the collaborative relationship? What role do the leaders in various disciplines play in creating the environment and incentives for individuals to work together for a common goal? What are the common goals across health science disciplines? What role should accrediting bodies play in mandating interdisciplinary programs? What can health systems and regulating bodies contribute to this discussion?

Can one force collaboration? Probably not, but some leaders can reallocate resources to support and reward processes and outcomes that build collaborations which recognize contributions from all disciplines and each individual’s potential for leadership—irrespective of the initials behind their name. It has been my observation that it is often easier to shift one’s perspective and develop additional skills when funding is available to support different ways of thinking and skill development. In our discipline, our leaders must prioritize our efforts and place our resources in initiatives that will in fact move us ahead as equal partners in the collaborative movement. This has to happen at all levels—from the individual school in their educational programs all the way to the governing boards of our professional associations. Any less will, one more time, leave us “tweaking” what already exists and will ultimately result in nurses and the discipline of nursing staying in its supportive (rather than leadership) position.

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References 

1. Mattessich PW, Monsey BR. Collaboration: What makes it work—A review of factors influencing successful collaboration. 1992;Available at: www.eric.edu.gov. Accessed December 10, 2006
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2. In:  Greiner AC,  Knebel E editor. Health professions education: A bridge to quality. Institute of Medicine; 2003;p. 192
   • View In Article
3. Croasdale M. Re-writing the hidden curriculum: Keeping empathy alive ((AM News)). 2006;Available at: www.ama-assn.org/amednews.com. Accessed on April 24, 2006
   • View In Article
4. Harris T, Treanor C, Salisbury ML. Improving patient safety with team coordination: Challenges and strategies of implementation. JOGN Nurs. 2006;35:4
   • View In Article
5. Makary MA, Sexton JB, Freischlag JA, Holzmueller CG, Millman EA, Rollin L, et al. Operating room teamwork among physicians and nurses: Teamwork in the eye of the beholder. J AM Coll Surg. 2006;202:5;745-52
   • View In Article
6. Bratt MM, Broome M, Kelber S, Lostocco L. Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses. Am J Crit Care. 2003;9:5;307-17
   • View In Article
7. http://www.ihi.org/IHI/Topics/HealthProfessionsEducation/EducationGeneral Last accessed December 10, 2006.
   • View In Article
8. http://www.rwjf.org/files/publications/other/transformingCareAtBedside.pdf Last accessed December 190, 2006.
   • View In Article
9. http://www.ncrr.nih.gov/clinicaldiscipline.asp Last accessed December 10, 2006.
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