A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings

ABSTRACT

By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.

KEYWORDS:

• Hierarchy
• hospitals
• multidisciplinary care team
• power
• quantitative
• survey

Acknowledgements

The authors would like to thank Dr Emma Nicholson and Dr Robert Fox for providing their expertise during the planning phase of this systematic review.

Availability of data and material

Data used in this study is available through the journal articles cited herein.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13561820.2023.2168632

Additional information

Funding

This research is part of the Collective Leadership and Safety Cultures (Co-Lead) research program which is being funded by the Health Research Board (RL-2015–1588). Funding sources were not involved in any stage of the review process in relation to data collection, data analysis, and the interpretation of the data.

Notes on contributors

Lisa Rogers

Dr. Lisa Rogers is an Assistant Professor at UCD Centre for Research, Education, and Innovation in Health Systems (UCD IRIS) in the School of Nursing, Midwifery, and Health Systems in University College Dublin, Ireland. She is a registered nurse, whose research interests include healthcare team dynamics and implementation science. Dr. Rogers holds a BSc. in General Nursing, MRes in Clinical Research and a PhD in Nursing, Midwifery, and Health Systems.

Shannon Hughes Spence

Shannon Hughes Spence was a research assistant at UCD IRIS in the School of Nursing, Midwifery, and Health Systems while writing this paper. Currently, she is a PhD student at the South East Technological University (SETU), Ireland. Her PhD focuses on young women’s experiences in the night time economy in Ireland, covering themes such as power, resistance, risk and safety. Hughes Spence holds a BA (Hons) in Community and Youth Development and a MSc in Sociology.

Praveenkumar Aivalli

Praveenkumar Aivalli is a PhD student at the UCD IRIS at the School of Nursing, Midwifery and Health Systems in University College Dublin, Ireland. His research interests include health policy and systems research, realist evaluation, implementation research, health system strengthening and quantitative epidemiological methods. He is an Ayurvedic Physician by profession and holds a post-graduate qualification in Public Health.

Aoife De Brún

Dr. Aoife De Brún is Assistant Professor at the UCD IRIS in the School of Nursing, Midwifery and Health Systems in University College Dublin, Ireland. She is a registered Chartered Psychologist with the British Psychological Society with experience of multi-disciplinary projects in health research. Her research interests include a range of topics in applied health and organisational psychology including team dynamics, collective leadership, and quality and safety in healthcare. Dr De Brún holds a BA(Hons) in Psychology and a PhD in Social Sciences.

Eilish McAuliffe

Prof Eilish McAuliffe is Professor of Health Systems at UCD and the Director of the UCD IRIS in the School of Nursing, Midwifery, and Health Systems. Her research activity is primarily focused on strengthening health systems. Utilising interdisciplinary approaches to identify problems in existing service provision, particularly in the areas of leadership, teamwork and organizational culture, she co-designs and evaluates new models and approaches to improve the quality and safety of healthcare. Prof McAuliffe holds a BSc. in psychology, an M.Sc. in Clinical Psychology, an MBA and a PhD in Health Strategy.