What's so great about rehabilitation teams? An ethnographic study of interprofessional collaboration in a rehabilitation unit

Abstract

Objective: To explore team structures, team relationships, and organizational culture constituting interprofessional collaboration (IPC) in a particular rehabilitation setting; to develop a description of IPC practice that may be translated, adapted, and operationalized in other clinical environments.

Design: An ethnographic study involving: Field observations: 40 hours, over 4 weeks, daily activities, 7 interprofessional meetings, 3 care planning meetings, 1 business meeting, and 3 family meetings; Individual observations: a physiotherapist, an occupational therapist, and a social worker individually observed for 45 minutes to an hour; and Interviews: 19 participants, 11 professions, 27 informal, 5 formal interviews. Data analysis consisted of an iterative process involving coding field notes for themes by 3 members of the research team by qualitative analysis software.

Setting: Single inpatient spinal cord rehabilitation care unit in a Canadian urban academic rehabilitation hospital.

Participants: Purposive convenience sample of core team, more than 40 professionals: physiatrist, over 21 nurses, 3 physiotherapists, 3 occupational therapists, 2 social workers, chaplain, psychologist, therapeutic recreationist, program assistant, program manager, pharmacist, advanced practice leader, 6 students (1 pharmacy, 4 registered nurse, and 1 psychology), and on-site community organizations. After university and hospital ethical approvals, all staff members were recruited to participate in the study.

Interventions: Not applicable.

Main outcome measures: Not applicable.

Results: Recurrent examples of IPC fit 2 dominant themes: team culture (divided into leadership, care philosophy, relationships, and the context of practice) and communication structures (both formal and informal).

Conclusions: IPC practice in rehabilitation care is supported by clinical, cultural, and organizational factors. This understanding of daily IPC work may guide initiatives to promote IPC in other clinical team settings.