Does activity theory help our understanding of teamwork, leadership and interprofessional collaboration?

Abstract

Background and purpose The literature identifies the lack of a conceptual underpinning to interprofessional education and collaborative practice, linking this to the failure of many initiatives to improve such practice. Many reported educational initiatives, typically in uni-professional contexts, relate to teaching non-technical skills (teamwork, leadership and communication) where the inability of professionals to work together is manifested in practice. We report on an ongoing research study in New Zealand which aims to enhance our understanding of the complexities of professional, collaborative practice by identifying the perceptions and experiences of doctors and numes at different stages of their professional career about teamworking, collaborative practice, working interprofessionally, leadership and followership.

Methodology In stage one of the study, we interviewed and carried out a questionnaire survey of newly graduated doctors and nurses working in secondary care, exploring their perceptions and understandings of leadership and teamworking. In stage two, 40 face-to-face, individual, semi- structured interviews were carried out in 2011-12 with senior doctors and nurses working in two clinical settings in a large urban hospital. Data generated were analysed with a framework developed using activity theory enhance understanding of interprofessional teamworking.

Results Health professionals work in multiple teams with competing needs and conflicting values. Loyalty to the professional team often overrides other considerations leading to dysfunction and sabotage. Patient advocacy is used to challenge other professionals and enable collaborative practice.

Contemporary teaching of 'teamwork' or 'communication’ in uni-professional training may enhance understanding but is unlikely to improve interprofessional 'collaboration’ in practice', as it fails to address how health professionals actually work in contemporary health services. An activity theory based framework is used to consider how the context of care might affect clinicians' conceptualisation of collaboration with other professionals, members of their own profession (intra-professional working) and members of other professions (inter- professional working). The nature and interviewees' perceptions of 'collaboration' in different specialties is also explored. To achieve improved patient care, we discuss how different pre- qualifying education and ongoing professional development is needed to help health professionals achieve greater understanding of the complexity of interprofessional teamworking and the loci of power, control, and authority. Such development requires changing ways of thinking about identity formation, how different professionals perceive healthcare, the influence of the specialty and the location of professionals' healthcare work.