Mutual understanding in multi-disciplinary primary health care teams

Abstract

Empirical research on multi-disciplinary health care teams has yet to explore the development of mutual understanding between team members in the course of their collective clinical decision-making. This paper addresses this gap in the literature directly by examining changes in mutual understanding and the extent to which its facilitation is shared by individual members of multi-disciplinary health care teams. A Habermasian theoretical framework is used to operationalize mutual understanding. Social network analysis is used to analyze survey data on team-based clinical decision-making collected from multi-disciplinary health care teams in a Canadian province. The results of the study indicate that mutual understanding between team members ebbs and flows over the course of their collective clinical decisions. Further, as the extent of mutual understanding within the team increases, its facilitation becomes more equally shared among team members. The paper closes by specifying a practical outcome of the future work: a typology of clinical decisions that health care teams are able to use as an evaluation tool to assess how effectively they are making collective clinical decisions. As an evaluation tool, the typology would foster open and deliberative discussion, enable critical self-reflection, and thereby further enhancing mutual understanding within the teams.

Keywords:

• Multi-disciplinary health care teams
• team-based clinical decision-making
• knowledge exchange
• collective work organization

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

1.The NOC-S system classifies all occupations performed according to skill type and skill level. Within each of the 10 different skill types such as management occupations, occupations in social science, education, government service and religion, sales and service occupations, there are numerous 3-digit level categories. The classification system takes into account the tasks, duties, degree of responsibility and complexity of work, and the products made and services provided. By focusing on the work performed, the groupings on the basis of skill level (within each of the 10 skill type categories) tend to be homogeneous because the nature of the work performed determines the education, training, experience or inherent talents required.

2.For the purposes of calculating an occupational distance between each pair of occupations, the NOC-S occupation codes, the skill type and skill level of each are compared. For each skill level difference, a value of one is added to the distance measure. If the two occupations differ in skill type, a value of one is added to the distance measure. Note: pairs of team members with the same occupation are assigned a “1” as the distance value to ensure non-zero values for occupational distance (to allow for multiplication of the reciprocal of occupational distance in the formula for mutual understanding).