How Health Care Complexity Leads to Cooperation and Affects the Autonomy of Health Care Professionals

Abstract

Health professionals increasingly face patients with complex health problems and this pressurizes them to cooperate. The authors have analyzed how the complexity of health care problems relates to two types of cooperation: consultation and multidisciplinary teamwork (MTW). Moreover, they have analyzed the impact of these two types of cooperation on perceived professional autonomy. Two teams were studied, one team dealing with geriatric patients and another treating oncology patients. The authors conducted semi-structured interviews, studied written documents, held informal discussions and observed the teams at work. Consultation was most likely to take place when a patient had multiple problems. However, if these problems were interrelated, i.e. the solution for one problem interfered with solving another, then MTW was favored. The same was true when the available information was equivocal such that there were conflicting interpretations of a problem. How the professionals perceived the relationship between complexity and the need to cooperate depended on their expertise, their occupational background, and their work orientation. Consultation did not affect the professional autonomy of the health care professionals. MTW however did decrease the perceived level of professional autonomy. The extent to which this occurred seemed to depend on the quality of the interpersonal relations within the team. The findings can help in selecting the most appropriate and efficient type of cooperation based on the complexity of a patient's problems. They can also help team leaders to stimulate reflection and feedback processes, and medical trainers to develop competencies among students related to such teamwork behaviors.

A Theoretical Lens for Revealing the Complexity of Chronic Care

“…The relationship between care complexity and cooperation is important, since a fit between the complexity of the demand for health care and the intensity of cooperation would indicate a positive reciprocity between the quality of health care and efficiency (Molleman et al 2008). …”

Ethics and Policy for Interprofessional Scopes of Practice: Preparing Bariatric Care Teams

“…2 The increasing complexity of healthcare has resulted in a need for intensified cooperation across the health professions for sake of coordination. 3 Even so, calls for collaborative care meet with resistance because of the kind of professional socialization and training that health specialists have historically been given. 3 This education has traditionally been independently conducted in isolation, often with one program or school of thought in competition with others.…”

“…3 Even so, calls for collaborative care meet with resistance because of the kind of professional socialization and training that health specialists have historically been given. 3 This education has traditionally been independently conducted in isolation, often with one program or school of thought in competition with others. 2 Collaborative care will always be difficult absent the development of new patterns of communication quite apart from this paradigm-patterns that can allow cooperation and coordination to flourish across professional boundaries.…”

“…Also, the paradigm shift implied by collaborative care can seem a threat to the autonomy of medical professionals, resulting in limited willingness to engage in teamwork. 3 As perceived threats to professional autonomy increase, so too does conflict, which can grow to imperil the patient's health status. 3 Morbidly obese patients present multiple health problems requiring knowledge and skills from a variety of health professions and medical specialists.…”

“…3 As perceived threats to professional autonomy increase, so too does conflict, which can grow to imperil the patient's health status. 3 Morbidly obese patients present multiple health problems requiring knowledge and skills from a variety of health professions and medical specialists. 4 The very nature of these problems demands a holistic approach to care based on interrelatedness, since treatment of a single health issue so easily affects yet another physiological system.…”