Making it real: the institutionalization of collaboration through formal structure

Abstract

Collaboration has achieved widespread acceptance as an indispensable element of healthcare delivery in recent decades, despite modest evidence for its impact on healthcare outcomes. Attempts to understand this seeming paradox have been based mostly in functionalist or conflict-theoretical approaches. Currently lacking, however, is an articulation of how collaborative ideals are embedded in broadly shared beliefs about what healthcare is and how it operates. In this article, we examine how language used in the CanMEDS competency framework and in two guides for Family Health Teams construct idealized versions of rational, autonomous physicians and primary care organizations, respectively. Informed by phenomenological sociology and neo-institutional theory, we characterize these documents as elements of formal structure, the putative "blueprints" for healthcare planning and activity. Drawing on this analysis, we argue that these documents and "collaborative" formal structures in general, not only function as tools to make healthcare more collaborative, but also create an appearance of "real" collaboration, independently of the realities of practice. We argue that they thus instill confidence that the current healthcare system functions according to deep-seated societal values of justice and progress. We conclude by emphasizing the potentially distorting influence of this on efforts to understand and improve healthcare.

Evaluation of interprofessional student teams in the emergency department: opportunities and challenges

“…Collaboration in practice is the norm. Placement structures that embody the ideal of collaborative care in real clinical settings, as described by Miller and Paradis [ 31 ] can be instituted as evidenced in this study. Reframing clinical placements, or aspects thereof, will allow students to experience the realities and the possibilities for their own future roles in collaborative clinical practice.…”

“…Reframing clinical placements, or aspects thereof, will allow students to experience the realities and the possibilities for their own future roles in collaborative clinical practice. In addition, observing genuine collaboration in practice provides students with powerful role models and the perception that teamwork is the dominant norm - as has been suggested [ 30 , 31 ].…”

‘It benefits patient care’: The value of practice-based IPE in healthcare curriculums

“…Overall, competencies framed around observable behaviours are more useful than broad statements of desirable traits [91] which may be di cult to observe and evaluate [92]. Furthermore, ambiguous phrasing of expectations can lead to a policy-practice chasm between what is perceived to be occurring based on formal documents and what is actually happening in practice [93]. The danger with this situation is that complacency may set in, with lip-service being paid to practice-base IPE in the absence of meaningful integration into curriculums.…”

The wolf you feed: Challenging intraprofessional workplace‐based education norms

“…Strengthened by the notion of role boundaries, education and training silos have persisted. Furthermore, epistemic and organisational boundaries have obstructed successful interprofessional collaboration 63,64 . Although boundary work and boundary crossing have been described as excellent learning opportunities, 65 to date those opportunities are rarely harnessed.…”