Making it real: the institutionalization of collaboration through formal structure

ABSTRACT

Collaboration has achieved widespread acceptance as an indispensable element of healthcare delivery in recent decades, despite modest evidence for its impact on healthcare outcomes. Attempts to understand this seeming paradox have been based mostly in functionalist or conflict-theoretical approaches. Currently lacking, however, is an articulation of how collaborative ideals are embedded in broadly shared beliefs about what healthcare is and how it operates. In this article, we examine how language used in the CanMEDS competency framework and in two guides for Family Health Teams construct idealized versions of rational, autonomous physicians and primary care organizations, respectively. Informed by phenomenological sociology and neo-institutional theory, we characterize these documents as elements of formal structure, the putative “blueprints” for healthcare planning and activity. Drawing on this analysis, we argue that these documents and “collaborative” formal structures in general, not only function as tools to make healthcare more collaborative, but also create an appearance of “real” collaboration, independently of the realities of practice. We argue that they thus instill confidence that the current healthcare system functions according to deep-seated societal values of justice and progress. We conclude by emphasizing the potentially distorting influence of this on efforts to understand and improve healthcare.

KEYWORDS:

• Organizational studies
• interprofessional collaboration
• institutional analysis
• health services research
• phenomenology
• interagency

Acknowledgments

The authors wish to thank Aria Birze, Madison Brydges, Andrea Carson, Patricia Leake and Victoria Whyte for comments on previous drafts of this article. The content is the sole responsibility of the authors.

Declaration of interest statement

The authors report no conflicts of interest.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. In truth, these ideals, and the early social reforms in which they were encoded (e.g. property rights, voting), still excluded large segments of the population.

2. Canada has a single-payer health insurance system, in which the federal government distributes funding to the provinces who then administer their own insurance programs. Services are not provided directly by public employees but by providers operating independently or within private organizations.

Additional information

Funding

This work was supported by the Social Sciences and Humanities Research Council (SSHRC) through an Insight Development Grant (# 430-2016-00927) and the Canada Research Chair in Collaborative Healthcare Practice.

Notes on contributors

Daniel W. Miller

Daniel W. Miller is an independent Research Associate, working at the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON.

Elise Paradis

Elise Paradis is Assistant Professor (status only) at the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON.