Providers' perspectives on collaboration

Abstract

Objective: Changes in models of health care are required to better meet the needs of diverse, underserved patient populations. Collaboration among providers is one way to promote accessible, comprehensive and continuous care in healthcare organizations. This paper describes the quantitative findings from two time points that examined providers' views of collaboration among a sample of diverse personnel (e.g. clinical nurses, social workers, dental providers, mental health providers, clerical staff, medical assistants, public health staff, and administrators) within a federally qualified nurse managed health care centre in the United States.

Methods: The quantitative arm of a mixed-method study is presented in this paper. Two instruments, the Collaboration and Satisfaction About Care Decisions Scale and the University of the West of England Interprofessional Questionnaire (comprised of 4 subscales-Communication and Teamwork Scale, Interprofessional Learning Scale, Interprofessional Interaction Scale, and Interprofessional Relationships Scale) were administered to providers at baseline and three to eight months following six same discipline focus group discussions on collaboration, in order to evaluate whether participating in the focus group discussions changed providers' views of collaboration. A summary of the focus group data which were published elsewhere is additionally summarized to help provide insight to the quantitative findings. Thirty-nine staff participated.

Results: Paired t-tests revealed that only one scale out of the five, Collaboration and Satisfaction About Care Decisions Scale (33.97 at time one and 37.45 at time two), significantly and positively changed after the focus group discussion (p=0.046). Providers' views on collaboration ranged from positive to moderate views of collaboration; most measures revealed a non-significant improvement after the focus group discussions. Staff with some graduate school reported the greatest satisfaction with decisions for the patient, and those with high school reported the lowest satisfaction with decisions for the patient. Respondents with a graduate degree had the most positive views of interprofessional relationships, whilst those with either a high school degree or bachelor's degree had the most negative views of interprofessional relationships. ANOVAs by professional role revealed the least positive views of collaboration for provider groups with lower levels of education, with upper administration reporting the most positive views on collaboration.

Conclusion: Although the discussion generated by the focus groups was expected to facilitate communication, and research has suggested that communication between providers facilitates collaboration, only one subscale evaluating providers' views of collaboration positively and significantly changed after the focus group discussion. The wide range of views on collaboration suggests there are diverse perspectives on collaboration among the staff based on professional roles and levels of education, with upper administration and those with higher levels of education reporting the most positive views of collaboration and staff with lower levels of education reporting more negative views of collaboration. A major limitation of this study was a low time two return among support staff, comprised of primarily African American women. Due to their marginalized professional and racial status, future research needs to explore the perspectives of this important and often overlooked group of staff.

Keywords: collaborative care; health disparities; hierarchy.