Using Loose Coupling Theory to Understand Interprofessional Collaborative Practice on a Transplantation Team

Lingard, Lorelei; McDougall, Allan; Levstik, Mark; Chandok, Natasha; Spafford, Marlee M.; Schryer, Catherine F.

doi:10.22230/jripe.2014v3n3a112

Cited by 9 publications

(9 citation statements)

References 26 publications

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“…Hence, a good collaboration between the two doctors is needed, which supposes availability of clinical information, efficient communication and decision autonomy of collaborators. Apart from these factors, studied in various clinical settings [ 1 – 9 ], clear perception of each other’s roles contributes to effective collaboration [ 10 ], as was shown in trauma [ 5 ] and internal medicine [ 11 ] settings, and among junior doctors and nurses [ 12 ]. Clear perception of each other’s roles is far from being obvious however [ 11 ] and misconceptions about roles can create frustration [ 13 ], insecurity [ 14 ], tensions [ 15 ] and conflicts [ 16 – 19 ] within teams.…”

Section: Introductionmentioning

confidence: 99%

Internists’ and intensivists’ roles in intensive care admission decisions: a qualitative study

Cullati

Hudelson

Ricou

et al. 2018

BMC Health Serv Res

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BackgroundIntensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists. Clear perception of each other’s roles is a prerequisite for good collaboration. The objective was to explore how internists and intensivists perceive their roles during admission decisions.MethodsIndividual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. Interviews were analyzed using a thematic approach.ResultsRoles could be divided into practical roles and identity roles. Internist and intensivists had the same perception of each other’s practical roles. Internists’ practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Intensivists’ practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. In complex situations, perceived flaws in performing practical roles could create tensions between the doctors.Intensivists’ identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). These roles could be perceived as emotionally burdensome. Internists’ identity roles were those of leader and partner.ConclusionsDespite a common perception of each other’s practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3438-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Internists’ and intensivists’ roles in intensive care admission decisions: a qualitative study

Cullati

Hudelson

Ricou

et al. 2018

BMC Health Serv Res

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“…Heterogeneous collaboration of humans and nonhumans across medical specialties has received little attention-exceptions include recent work on boundary objects in oncology rounds (Heldal, 2010) and liver transplantation teams (Lingard et al, 2012a(Lingard et al, , 2014. This inattention may perpetuate the assumption that physicians frame all patients' bodies the same way, and therefore that physicians' collaborative practices are unified and representative of a shared lens of 'biomedicalisation' (Clarke, 2010).…”

Section: Teaching Collaborative Entanglementmentioning

confidence: 99%

“…Stronger critiques posit that interprofessionalism masks a managerialist discourse pervading contemporary healthcare that co-opts the hierarchical divisions between healthcare professionals that it is purported to dispel (Finn et al, 2010;Learmonth, 2003). Other work aims to reconceptualise the term altogether, claiming that interprofessional collaboration does not necessarily reflect the complex realities of clinical practice and should not be idealised as a central goal (Lingard et al, 2012a(Lingard et al, , 2014.…”

Section: Introductionmentioning

confidence: 99%

Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure

McDougall

Goldszmidt

Kinsella

et al. 2016

Social Science & Medicine

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Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 "Team Sampling Units" (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams 'disentangled' fluid in order to focus on its physiological function and mobilisation. Teams also used distinct 'framings' of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease.

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“…Complexity theory has been used to study relationships within teams [55,56] and organizations [57][58][59][60]. One ethnographic study of an IP transplantation team described different disciplines as "constellations of intersecting units" whose degree of "coupling" influenced their capacity to adapt and respond to team task demands [55]. Coupling refers to the contrast between autonomy (loose coupling) and interdependence or team responsiveness (tight coupling).…”

Section: Collaborative Teamworkmentioning

confidence: 99%

“…Effective leaders craft team tasks that effectively utilize members' expertise, while reinforcing more tightly coupled team activities with respect to information-sharing, communications, problem-solving and decision-making. From a complexity standpoint, collaborative teamwork represents a team's capacity to respond as a single constellation rather than as autonomous providers [55].…”

Section: Collaborative Teamworkmentioning

confidence: 99%

A Descriptive Account of an Inter-Professional Collaborative Leadership Project

MacPhee

Chang

Havaei

et al. 2014

Administrative Sciences

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A collaborative project between an academic healthcare faculty and a professional development director resulted in the design, delivery and evaluation of an inter-professional collaborative leadership workshop with ongoing leadership development activities. The workshop attendees were five inter-professional teams from one large, urban cancer care center in Taipei, Taiwan. The workshop included didactic instruction complemented with team discussions and interactive exercises. Continued practice was encouraged, such as appreciative inquiry exercises and rotated team leadership. Evaluation involved the use of a cross-culturally validated collaborative practice tool and follow-up interviews and focus groups. Although the formal workshop was a 1-day session, continued organizational support and systematic approaches to collaborative leadership practice in clinical settings were necessary components for transfer of learning from the workshop to real life. This paper will include an overview of the foundational leadership concepts covered in the workshop. The instructional strategies, evaluation methods and outcomes will be discussed. The limitations

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Using Loose Coupling Theory to Understand Interprofessional Collaborative Practice on a Transplantation Team

Cited by 9 publications

References 26 publications

Internists’ and intensivists’ roles in intensive care admission decisions: a qualitative study

Internists’ and intensivists’ roles in intensive care admission decisions: a qualitative study

Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure

A Descriptive Account of an Inter-Professional Collaborative Leadership Project

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