Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

Abstract

Context

A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood.

Objective

To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices.

Design

Collaborative synthesis of 12 mixed methods studies.

Setting

Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec).

Methods

We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they were influenced by local context.

Results

There was a diverse range of complex reforms seeking to foster interprofessional teamwork in the care of patients with chronic disease. The impact on communication and relationships between different professional groups, the roles of nursing and allied health services, and the expressed satisfaction of PHC providers with their work varied more within than between jurisdictions. These variations were associated with local contextual factors such as the size, power dynamics, leadership, and physical environment of the practice. Unintended consequences included deterioration of the work satisfaction of some team members and conflict between medical and nonmedical professional groups.

Conclusion

The variation in impacts can be understood to have arisen from the complexity of interprofessional dynamics at the practice level. The same characteristic could have both positive and negative influence on different aspects (eg, larger practice may have less capacity for adoption but more capacity to support interprofessional practice). Thus, the impacts are not entirely predictable and need to be monitored, and so that interventions can be adapted at the local level.

Keywords:

• interprofessional care
• primary health care
• teamwork
• research synthesis

Supplementary material

Table S1 Example of summary matrix used to compare impacts across studies and jurisdictions

Acknowledgments

This study was funded by a Catalyst Grant from the Canadian Institutes of Health Research (Grant No 212271). Dr Crabtree’s time was supported in part by a Senior Investigator Award from the National Cancer Institute (K05 CA140237). Dr Levesque was supported through a career award Chercheur-boursier clinicien – junior 1 from the Fonds recherche Québec – Sante (FRQ-S).

Author contributions

Mark F Harris and Jenny Advocat contributed to the conception, analysis, and interpretation of the data and drafting and revision of the manuscript. Benjamin F Crabtree, Jean- Frederic Levesque, William L Miller, Jane M Gunn, William Hogg (co-chief investigator), Cathie M Scott, Sabrina M Chase, and Lisa Halma contributed to the conception, analysis, and interpretation of the data and critical revision of the manuscript.

Grant M Russell was co-chief investigator, coordinated the project, and contributed to the conception, analysis, and interpretation of the data and critical revision of the manuscript. All authors have given final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

The authors declare no conflicts of interest.