Interprofessional collaboration
as a developmental process
Katariina Pärnä
MIMO-seminar 27.2.2013
Themes today
• The Foundation for the Rehabilitation of
Children and Young People (=>context to
collaboration and context to ”Art-Based
Methods in Well-Being”
• Interprofessional Collaboration in the
context of research
• Models f interprofessional collaboration
• Interprofessional collaboration as a
developing process
• The Foundation for the Rehabilitation of
Children and Young People was established in
2000 by the Mannerheim League for Child
Welfare. Both the League and the Foundation are
non-profit-making, non-governmental
organizations concerned with child welfare and
child protection as expressed in the UN
Convention on the Rights of Children and in the
objectives of the Finnish Ministry of Social Affairs
and Health.
• The Foundation comprises the Huvitus Rehabilitation
and Development Center at Yläne (in southwestern
Finland, 65 kilometers north of Turku)
• Huvitus began operations in the summer of 1994.
• The
Foundation
serves about
700 families
annually.
WE WORK WITH
• Families of the child welfare
authorities (psycho-social family
rehabilitation)
• Families with children with
disabilities (reorientation
courses of families, rehabilitation
and coping assessment periods
for young people)
• Families, children and young people for whom individual
rehabilitation has been planned together with a hospital, local
authority or an organization
• Professionals who come to our Center for training
COLLABORATING ORGANIZATIONS
• The Finnish Slot Machine Association
• The Social Insurance Institution
• The Insurance Rehabilitation Agency
• Local authorities throughout Finland
OUR TOOLS
• VIG® (video interaction guidance)
• Theraplay®
• Experiential methods
–
–
–
–
–
Adventure
Outdoor activities
Sports
Music
Arts and handicrafts
• Training of everyday
activities
• Dialogical Network cooperation
EXPERIENTIAL WORKING METHODS
SUCH AS OUTDOOR ADVENTURE,
ARTS AND MUSIC
• Build relations between family
members
• Help restructure the family
• Give children a place and a voice
• Provide opportunities to practice
relational and parenting skills
• Bring family workers into contact
with children and their world of
experience
• Build communication and cooperation between family and
family workers
”Art-based Methods and Well-Being”
Interprofessional Collaboration and research
Research questions:
• How locally cathered interprofessional teams
build cooperative work culture and what
contentual interpretations it receives?
• How employees describe their collaboration, and
what kind of tension and challenges there are?
• What is it as a practice?
• How to support the combining of
employees´competence?
• What kind of developmental process can be
identified in the deepening collaboration?
(Pärnä 2012)
Research design and Data
• The Research design has charasteristics of
- action research
- dewelopmental work research
- case study research
• Empirical data includes
- interviews (7)
- group discussions (10) from the meetings where
employees evaluate the activities implemented during
the project
- documents produced during the project
- work papers and official documents
- field notes
Theory & Analyse
Theory
• System of profssions and their linked ecologies
(Abbott 1988, 2005)
• Relational agency in expertice (Edwards 2009)
• Conceptual analyses of interprofessional
collaboration (D´Amour et. al. 2005, Leathard
2003, Gittling 1994)
Analyse:
- Qualitative content analysis
- Also charasteristics of narrative interpretation
- The analysis combines data-based and theorydirected interpretation
Main Concepts
• Profession
• Boundary work, crossing of boundaries
• Relational agency
• Interprofessional Collaboration
• Process
• Preventive family work
Why to collaborate
• Today the multiple needs of children and their families are
becoming more complex.
• Interprofessional collaboration is usually considered to be
related to challenging customer situations where issues
such as the treatment of a customers disease, problems in
life control or the mapping of learning difficulties require
Efficient collaboration between professionals
• The current political-administrative steering in social and
health services also emphasises the role of
interprofessional collaboration in preventive work, such
as early intervention services for families
• Professionals can learn from the other professionals and
from customers
• It is also possibility to put empowering point of
view in the core of interprofessional
collaboration.
Interprofessional collaboration
• It is very common, even popular, in planning and
governing modern health and social services, as well all
human services.
• As a concept, interprofessional collaboration is widely
used, in various documents it is usually mentioned as a
form or method of collaboration
• Typically it is not specifically defined, but instead its
meaning is taken for granted and it is assumed to be
implicitly understood
• It’s also usually used in very positive meaning– thought is
that interprofessional collaboration gives some extra and
something good for the relationship between partners
• There are also stories about barries and difficulties.
Profession
“ In the strictest sense of the term [profession], a high-status
occupation composed of highly trained experts performing a
very specialized role in society. A profession has exclusive
possession of competence in certain types of knowledge and
skills crucial to society and its individual clients.
The special intensive education and necessary discipline develops
a strong in-groups solidarity and exclusiveness. Every
profession, on the basis of its monopoly of knowledge and skills
and its responsibility for the honor and perpetuation of the
profession, tends to feel that it is by itself capable of
formulating its ethics and judging the quality of its work.
Thus professional groups tend to reject the control of the public or
clients they serve. Nevertheless, a profession is, of course,
influenced by the public it professes to serve, and its shaped by
the needs of other interest groups and by the demands of
other professional organizations.”
(A Modern Dictionary of Sociology, Theodorson et al. 1970)
System of professions
• Theory about Professions (Abbot 1988)
” How abstract is abstract enough to
be professional” (Abbott 1988, 9)
• Competition between professions
• Jurisdiction (claims to classify the problem
-> interference -> treatment)
• Amalgamation < = > division
• Boundary work
Boundary work and
crossing the boundaries
• Boundary work are at the core of interprofessional
collaboration
• Professions have different ways to react;
amalgamation or division (horisontal or vertical)
(Abbott 1988)
• Boundaries between professionals and boundaries
between professionals and users (see Arnkil 1992)
• Collaborative learnig: shared understanding and
shared reality (Leinonen et al. 2006)
• New teams/professionals need to mediate their
collaboration at the boundaries, recognised the
boundary space and boundary zones (Edwards 2010)
Relational agency (Edwards 2010)
• Relational agency of professional practice
• Expertice is created as a result of the relations
between professionals and between professionals
and customers
• Professions develop, create their practices and
change in relation to one another
- interactional expertice
- contributory expertice ; interprofessional
negotiation
(interview -> discussion -> conversation)
Interprofessional collaboration
• The concept of interprofessional
collaboration is often used as describing
the method or approach of working
(Isoherranen 2005, Morrow et al. 2005, Larivaara & Taanila 2004).
• Interprofessional vs. intraprofessional
collaboration
• Inter (between), multi (many)
• Lot of related concepts
Interprofessional collaboration:
Definitions
”The term ´interprofessional collaboration´ is the
key term that refers to interaction between the
professionals involved, albeit from different
backrounds, but who have the same joint goals in
working together.” (Leathard, 2003)
”The term collaboration conveys the idea of sharing
and implies collective action oriented toward a
common goal, in a spirit of harmony and trust.”
(D´Amour et al. 2005)
Five stage model of collaboration
(Gitling et al. 1994)
1. Assesment and goal setting
2. Determination of a collaborative fit
3. Identification of resources and reflection
4. Project refinement and iImplementation
5. Evaluation and feedback
Structuration model of
interprofessional collaboration (D´Amour et al.
2005)
4.
Governance
-Managemenet
- common practice
1.
Finalization
3.
Formalization
2.
Interiorization
Interprofessional Collaboration:
Core of Concepts (D´Amour et al. 2005, rewiev)
Concepts related to
collaboration
- type of relations
- interaction between
partners
- sharing, partnership
interdependency,
power, process.
Concepts related to team
- Human context in which
collaboration takes place
- Collaboration within the
teams can be described
on the continuum of
professional autonom ->
different teams:
- multi,
- inter,
- trans
Different facets of sharing
•
•
•
•
•
•
Shared responsibilities
Shared decision-making
Shared healt care philosophy
Shared data
Shared planning and intervention
Shared professional perspectives
Partnership
•
•
•
•
•
gollegial-like relationship
Authentic and constructive
Open and hones communication
Mutual trust and respect
Be aware of and value the contributions
and perspectives of the other professionals
• Partners pursue a set of common goals
• Specific outcomes
Interdependence
• Mutual dependence
• Collaboration requires that professionals be
interdepent rather than autonomous
• Interdependencu arises from a common desive to
address the patients/ckients needs
• Complexity oh health/social problems demands
the expertice of each og the professionals on the
toeam
• Individual contributions are maximized / the
outpu of the whole becomes much larger than
the sum of inputs from each part
• Collective action
Power
• Collaboration is seen as a true partnership
characterized by the simultaneous empowerment
of each participant
• Power is based on knowledge and expertice
(rather than on functions or titles)
• Power is a product of the relationships and
interactions between team members
• In order to maintain actual and perceived
symmetry in power relationships, collaborative
interaction is required
• Power cannot be separeted from the relationship
througt wich it is exercised
Process
•
•
Collaboration is seen as
a dynamic or transforming process
the structure of collective act
The collaboration process may follow very
comcrete steps, such as negotiation and
compromise in decision-making or shared
planning and intervention
• ”Professional boundaries be transcended if each
of participants is to contribute to improvements
in client care while duly considering the qualities
and skills of the other professionals.” (D´Amour et al. 2005)
Interprofessional collaboration:
remember your own colour and
mix it with other
But in worsiest case, it looks odd
But in best way it gives possibilities for
clients and professionals
Interprofessional collaboration
as a process (Pärnä 2012)
Requires of collaboration
Identification
of customeroriented
cooperation
need
Trust and
willingness to
cooperation
Crossing the
professional
boundaries
Target-orientation and structurally leaded
collaboration
Plan
together
Effective interprofessional
collaboration
Do together
Evaluate
together
Empowering
clients and
professionals
Developing
professional skills
and organisational
structures/cultures
Refrences
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Abbott, A.(1988) The system of Professions. An essay on the Division of Expert Labor. The University
of Chicago Press, London.
Arnkil, E. (1992) Sosiaalityön rajasysteemit ja kehitysvyöhyke. Jyväskylä studeis in education,
psychology and social research 85, Jyväskylän yliopiston monistuskeskus and Sisäsuomi Oy,
Jyväskylä.
D´Amour, D., Ferrada-Videla, M., Rodriguez, L. & Beaulieu, D. (2005) The conceptual basis for
interprofessional collaboration: Core concepts and theoretical frameworks. Jounal of
Interprofessional Care, vol 19 (S1): 116-131. Taylor & Francis Ltd.
Edwards, A. (2010) Being an Expert Professional Practitioner. The relational Turn in Expertice.
Springer, London.
Gitling, L.N., Lyons, K. & Kolodner, E. (1994) A model to build collaborative research or educational
teams of health professionals in gerontology. Educational Gerontology, vol 20, 15-34.
Hall, P. (2005) Interprofesional teamwork: Professional cultures as barriers. Journal of
Interprofesional Care, Vol 19, S1, 188-196. Taylor & Frances Ltd.
Isoherranen, K. (2005) Moniammatillinen yhteistyö.
Larivaara, P.& Taanila, A. (2004) Towards interprofessional family-oriented teamwork in primary
sevices: the evaluation of an educational programme. Journal of Interprofessional Care, vol 18, pp.
153-163, Taylor & Francis Ltd.
Leathard, A. (2003) Models for interprofessional collaboration. In Leathard, A. 8edit.)
Interprofessional collaboration. From Policy to Practice in Health ans Social Care. Brunner &
Routledge, New York, 3-119.
Leinonen, P., Järvelä, S. & Häkkinen, P. (2006) Yhteisöllinen oppiminen ja tietoisuustyökalut
hajautetun tiimityön kontekstissa. Teoksessa Toivainen, H. & Hänninen, H. (edit.) Rajanylitykset
työssä. Yhteistoiminnan ja oppimisen uudet mahdollisuudet. PS-kustannus, helsinki. 138-162.
Morrow,G., Malin, N. & Jennigs, T. (2005) Interprofessional team working for child and family
referral in a Sure Start local programme. Journal of Interprfessional Care, vol. 19(2): 93-101. Taylor
& Francis Ltd.
Pärnä, K. (2012) Kehittävä moniammatillinen yhteistyö prosessina. Lapsiperheiden varhaisen
tukemisen mahdollisuudet. Turun yliopisto. Turun yliopiston julkaisuja. Sarja C, osa 341. Scripta
Lingua Fennica Edita. Uniprint Oy. Turku.
Thank you !
• For further information, pleace contact by
e-mail: katariina.parna@mll.fi
• www.lastenkuntoutus.net
Have a nice spring!