Isabel Richard Student Paper Award

Aliza Kassam, Dalhousie University, S-LP
Interprofessional Collaboration: Meeting the Challenge

Interprofessional collaboration occurs when members from different professions come together to achieve a common purpose (Oandasan & Reeves, 2005; Carlisle, Copper & Watkins, 2004; Smith & Anderson, 2008; Government of Ontario, 2006; Reeves, 2008). Expertise is added from each professional and it is discussed and assessed in a respectful environment (MacIntosh & McCormack, 2001).The impetus for speech-language pathologists and audiologists to move from a multidisciplinary model of health care delivery (whereby professions work independently toward a common goal) to an interprofessional one is multifaceted (Mu, Chao, Jensen & Royee, 2004). Research continually suggests that interprofessional teams that are functioning effectively achieve more positive outcomes than when services are delivered individually by professions (Morrison, Lincoln, Reed, 2009; Baggs, Phelps, Johnson, 1992; McEwen, 1994). A reason for this is that health care problems are complex. Thus, skills from many fields are required to develop comprehensive care for individuals and their families (Reeves, 2008). McPherson, Headrick and Moss (2001) found that when interprofessionalism exhibits certain facets such as a shared understanding of goals and good communication, outcomes include cost effectiveness and decreased risk of mortality for people with stroke and traumatic brain injury. Interprofessionalism has also shown merits by increasing resource efficiency, particularly in regions of under-staffed health care professionals (Mu et al., 2003). The Canadian Association for Speech-Language Pathologists and Audiologists (CASLPA) further support interprofessional collaboration by stating it is a role and responsibility of these two professions (CASLPA, 2008). Indeed, speech-language pathologists and audiologists should not only be committed to interprofessionalism, but should also understand the barriers to its delivery as well as potential ways of overcoming them.

Although there are many benefits to interprofessional collaboration, there are likewise significant challenges. Among these are that professionals may have limited knowledge and understanding of the roles and responsibilities of other professions (Mu et al., 2003). This can lead to antipathy surrounding scopes of practice of other professionals and thus exacerbate tension. (Carlisle et al., 2004). Rather than working as members of a team, clinicians may become defensive (Carlisle, et al, 2004). Another barrier to interprofessional collaboration is that each health care profession has their own culture, which includes diverging values, beliefs, attitudes and customs. These can be transferred from established members of the profession to new entrants and this is referred to as socialization (Hall, 2005). Socialization impacts interprofessional collaboration because it can isolate professionals from one another, increase stereotypes, or create protectionist attitudes with regards to professional roles (Oandasan & Reeves, 2005). In order to overcome these barriers, education and awareness of different professions is required.

Literature suggests that one way to resolve the challenges associated with poor collaboration may be by introducing interprofessional education (IPE) into training or pre-licensure programs (Oandasan & Reeves, 2005; Reeves, 2008; Howkins & Bray, 2008; Morrison et al., 2009; Carlisle, et al. 2004). IPE is defined as "occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care." (CAIPE, 2002). Hall (2005) raises an interesting point that although students obtain communication skills for interaction with clients and families, skills for speaking with other professions is often omitted. IPE can therefore provide students with specific vocabulary that can facilitate understanding of issues (Hall, 2005). Furthermore, the World Health Organization (1988) has stated that IPE aspires to "prevent the development of a corporate mentality, which is a factor in resistance to interprofessional collaboration". IPE also attempts to reconcile contrasting objectives and reinforce collaborative expertise (Carlisle, et al, 2004). Health Canada has likewise seen the value of IPE. Since the 1990's, this department has supported initiatives related to collaborative health care (Oandasan & Reeves, 2005). As part of the health human resource strategy, the government of Canada has identified that the way in which health care providers are educated is pivotal in ensuring effective interprofessional teams (Health Canada, 2009). In light of this support, a noteworthy study conducted by Morrison, Lincoln and Reed (2009) found that even though IPE is continually developing, speech-language pathology students encounter a significant amount of learning opportunities in interprofessional collaboration. This occurs both though clinical placements and assignments (Morrison et al., 2009). In order to ensure that all health professionals are receiving similar types of learning opportunities, academic institutions and accreditation bodies could require IPE course hours to be fulfilled in order to graduate.

There are however associated challenges with IPE implementation which may be hindering the ability for academic institutions or accreditation bodies to have such requirements. There are several logistical obstacles with IPE. Inequalities in the level of education attained may make it difficult for instruction, as individuals have differing knowledge bases (Oandasan & Reeves, 2005). In addition, whereas some students may be able to draw from clinical experiences, others may not (Pirrie, Wilson, Harden & Elsegood, 1998). Other considerations such as scheduling and accommodating IPE meetings should not be ignored (Pirrie et al., 1998). There are also threats to sustained implementation of IPE (Freeth, 2001). Generally, only a minority of faculty members want to devote resources to interprofessional initiatives. Thus, upon their absence, commitment to initiatives ceases (Hall, 2004). Challenges are also seen in terms of teaching IPE in the clinical setting. Issues such as faculty supervision, resistance to change and funding uncertainty prevail (Cohn, 2007). Pre-licensure IPE also has issues in terms of efficacy. A systematic review by Zwarenstien, Reeves and Perrier (2005) was conducted, and this study concluded that evidence behind the effectiveness of pre-licensure IPE initiatives is unknown. The researches stated that this may be attributed to the fact that IPE is difficult to evaluate (Zwarenstien et al., 2005). Thus, more rigorous studies need to be conducted in order to evaluate the effect of IPE (Zwarenstien et al., 2005).

Beyond the potential solution of IPE as a way to impart information and knowledge about professional competencies, initiatives can take place subsequent to graduation. For example, continuing education experiences could be offered (Reese & Sontag, 2001). Owens, Goble and Gray (1999), conducted a survey with regards to interprofessional continuing education, in which speech therapists were involved. Overwhelmingly, respondents showed an interest in learning in an interprofessional setting. This indicates that there is a demand for these types of initiatives. CASLPA and other associations recently hosted a leadership summit whereby speech-language pathologists, audiologists, physiotherapists and occupational therapists collaborated to find solutions to issues such as access to health care. Initiatives such as that bring different fields together and impart knowledge can break down barriers associated with interprofessionalism.

The way in which professionals communicate both verbally and non-verbally with each other has an impact on collaboration. In a study by Van Ess Coeling and Cukr (2000), three communication styles were identified to be important in interprofessional collaboration. Briefly, a dominant style of communication involves speaking frequently and taking control of the matter (Van Ess Coeling & Cukr, 2000). Contentious speakers communicate in an argumentative way and are quick to challenge an issue (Van Ess Coeling & Cukr, 2000). Finally, an attentive speaker communicates empathetically and deliberately shows that he or she is listening (Van Ess Coeling & Cukr, 2000). This study found that using an attentive style of communication resulted in an increased perception of collaboration, positive patient outcomes and satisfaction amongst health workers (Van Ess Coeling & Cukr, 2000). Thus, certain facets of the attentive style of communication can be taught to health professionals (Van Ess Coeling & Cukr, 2000). This includes such strategies as making eye contact, repeating what was stated to ensure there were no misunderstandings and requesting clarifications (Van Ess Coeling & Cukr, 2000). Although it is the responsibility of every health care profession to ensure effective communication during collaboration, as communication specialists, speech-language pathologists and audiologists can promote this notion further and provide specific strategies if communication break downs occur.

Interprofessional collaboration, when implemented properly, undoubtedly leads to an increase in patient care; thus, it is of incredible value. There are however significant challenges with implementation of interprofessional collaboration including lack of knowledge about other professional roles and negative attitudes toward other disciplines. A possible solution is to develop and encourage interprofessional education during pre-licensure programs. This however has its own set of challenges including logistical constraints and unknown efficacy. Other solutions include offering interprofessional education as part of professional development as well as finding ways to facilitate communication within the work place. Indeed, interprofessional collaboration is a complex issue which requires commitment from several stakeholders including the government, educational institutions and associations. In particular, health care professionals including speech-language pathologists and audiologists must be at the forefront for advocating that their work place incorporates the principles of interprofessional collaboration.

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