Elsevier

Journal of Professional Nursing

Volume 24, Issue 4, July–August 2008, Pages 218-227
Journal of Professional Nursing

Original article
Collaborative and Interdisciplinary Health Care Teams: Ready or Not?

https://doi.org/10.1016/j.profnurs.2007.06.013Get rights and content

Collaborative team-based practice within an interdisciplinary health service environment is an important consideration for the nursing profession. Policy directions suggest that collaborative professional skills can address complex client needs within a framework of primary health care and social accountability for health service quality, cost, and access. The pursuit of collaborative and interdisciplinary care is generally agreed to be a worthy goal. However, implementation methodologies and outcomes related to collaborative and interdisciplinary care remain elusive within a rapidly changing health care environment. This article provides a critical analysis of the multiple historical, political, economic, and social professionalization challenges associated with the achievement of collaborative team-based practice. The author argues that it is not feasible to implement broad-based team structures at the present time. Considerable effort would be required to prepare disciplines to function as a team and to address fragmented services, equitable service funding, and procurement of resources to sustain team efforts. Strategic and influential use of power and knowledge may support the efforts of nurse leaders in practice, education, research, and administration to effect change for the development of collaborative and interdisciplinary practice.

Section snippets

Historical Bureaucratic Fragmentation and Specialization of Health Care Services

Compartmentalization of health services emanates from medical specialization associated within traditional acute care systems (Cooper, Carlisle, Gibbs, & Watkins, 2001). Consequent service fragmentation is associated with authoritative and hierarchical structures (Bergman et al., 1997, McWilliam et al., 2001, Orchard et al., 2005), resulting in the prioritization of provider needs over client needs (Leatt et al., 2000, Lenkman & Gribbins, 1994, Shortell et al., 1996), unnecessary time

Consequences for the Health Care Consumer

Leatt et al. (2000) reported that consumers desire ready access to a preferred service provider and quality care. Lack of a coordinated team approach to access and referral may not only impede fulfilling these expectations but also increase isolation and marginality (Aronson & Neysmith, 2001) as well as service costs (Di Matteo & Di Matteo, 2001) for socioeconomically and disadvantaged people. For example, given the diversity of community-based health care teams (Gantert & McWilliam, 2004),

Strategies for Nursing Leadership

Although, overall, it does not seem pragmatic to implement health care teams at this point in time, a tremendous opportunity exists for the nursing profession to lead the change for successful development of collaborative and interdisciplinary practice. In essence, all nurses within practice, academic, and administrative contexts are required to work in collaborative and interdisciplinary environments. Their respective capacities, communication skills, and holistic practice perspectives provide

Nurse Faculty and Researchers

Nursing faculty must first be trained in collaborative methodology and then begin to collaborate with other faculty disciplines as well as participate in teaching collaborative and interdisciplinary approaches. As care becomes more interdisciplinary and collaborative in nature, the role of faculty must of necessity change (Larsen & Baumgart, 1992, Wylie & Wagen-Heintz, 2004) to support unique service delivery methodologies. Faculty will be required to participate within collaborative and

Administrative Leadership

The nurse manager must be able to skillfully navigate in many different interdisciplinary and intersectoral contexts, assess whether the values of collaborative and interdisciplinary teams are congruent with organizational goals, embrace transformation efforts to foster team-based service, and be flexible and creative in the management of interdisciplinary human and fiscal resources. During times of system resource realignment, the nurse manager must articulate the work values as well as

Conclusions

Although collaborative and interdisciplinary team practice has been promoted as a future imperative for the delivery of increasingly complex health and social care, the precise nature, methodology, and outcomes of team functioning are unknown. Prior to the implementation of this well-reasoned and widely applauded direction, systematic planning is required to address many potential implementation challenges and to develop effective strategies and policy for this change. The funding of

Acknowledgments

The author wishes to acknowledge the invaluable guidance and support provided during the development of this article by Dr. Carol McWilliam, Professor, School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.

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