Interprofessional practice: the path toward openness

ABSTRACT

This article seeks to shed light on the meanings healthcare practitioners attach to practicing interprofessionally and how interprofessional relationships play out in “everyday” practice. It draws on findings from a hermeneutic phenomenological study of health professionals’ lived experience of practice, interpreted in relation to Martin Heidegger’s concept of a path through the dense forest which leads to an open space where there is no predefined path to follow. Analysis of data from in-depth, semi-structured interviews with 12 health professionals from medicine, midwifery, nursing, occupational therapy, physiotherapy, speech and language therapy, and social work suggests that health practitioners come upon the clearing having walked their own track toward practicing interprofessionally. Our argument is that when: getting to know others; genuine dialogue; trust; and respect are in play, a spirit of interprofessional practice flourishes. The ontological view presented, sheds light on the nature of the relationships and the personal qualities that foster a spirit of interprofessional practice in these human-to-human interactions. It highlights how health practitioners need to be free to enact their humanity; to move beyond the “professional” pathway, which encourages them to leave “who they are” at home.

KEYWORDS:

• Interprofessional practice
• health professional practice
• patient centered care
• interprofessional capability

Introduction

Over 60 years ago, Mathewson (1955) described interprofessional practice as a way of working in a relational context, where narrow professional interests are outweighed by a sense of team spirit. That spirit of sharing across discipline boundaries would outweigh professional defensiveness, competitiveness and the desire to control the process. While Mathewson’s emphasis on the relational nature of interprofessional practice remains, practicing interprofessionally is now understood to be a complex and multifaceted phenomenon (Hood, 2015). Amongst that complexity, this article seeks to shed light on how relationships play out in “everyday” practice and the meanings healthcare practitioners attach to interprofessional practice. Complementing research into the implementation challenges and outcomes of interprofessional practice, which have generated scientific understandings of the conditions that foster it, we draw on a hermeneutic phenomenological study of health professionals’ lived experience of practicing interprofessionally (Flood, Hocking et al., 2019). In turning to accounts of real-world experiences, we accept the necessity of learning “from the contingencies, sociality and diversity of everyday clinical practices” (Radomski & Beckett, 2011, p. 100).

Interprofessional practice as working together

Placing the patient at the center of care is at the heart of interprofessional practice, with key proponents globally claiming its centrality to delivering safe, effective, high quality care (Institute of Medicine [IoM], 2015; World Health Organization [WHO], 2010). Additional benefits of interprofessional practice include more sustainable health systems, because working collaboratively reduces fragmentation and duplication in service delivery, along with enhanced patient satisfaction and job satisfaction (Reeves et al., 2013; WHO, 2010). The importance of those outcomes underlines the significance of understanding how to foster the relational, collaborative mode of practice Mathewson (1955) envisaged.

The concept of practicing interprofessionally invokes an ideal of healthcare practitioners seamlessly working together; merging professional perspectives and understandings and complementing individual discipline capabilities with interdisciplinary skills and knowledge (Barrow et al., 2015). For that merging to occur, and despite professional differences and the complexities of the practice world, a degree of rethinking and renegotiating traditional healthcare roles and scopes of practice is required (Goldman et al., 2010; Veerapen & Purkis, 2014). Scholars in the field point to the need for open dialogue, along with reducing hierarchy and managing differences within the team (Laurenson & Brocklehurst, 2011). Interprofessional socialization, a process of bringing health professionals together to learn from, with, and about one another in an open and safe environment, is considered a necessary step in the development of interprofessional qualities, relationships and collaborative practices (Khalili et al., 2013; Stanley et al., 2016).

Being interprofessional involves thinking, feeling and the actual doing of interprofessional practice (Hammick et al., 2009). Learning how interprofessional practice is experienced by those involved in the “thinking,” “feeling” and “doing” is pivotal to supporting and enhancing practice. The lived experience, as suggested by Van Manen (2014), “forms the starting point for inquiry, reflection, and interpretation” (p. 40). As we describe below, glimpses of what it is like to “be” interprofessional can be gained by examining previous research findings, and while studies are generally small-scale and qualitative, they have involved a range of professional groups across diverse practice contexts.

A fundamental aspect of the experience is understanding what tasks others perform and how they are done (Harrod et al., 2016). Understanding, respecting and valuing each other’s roles, responsibilities and unique contribution (Wilson et al., 2016), provides a basis for dialogue, which is “the essence of successful interdisciplinary working” (McCallin, 2004, p. 28). Framed more experientially, “dialogue” means opportunities to engage with others, get to know them, and be neighborly without the attachment of social roles or titles (Stephens, 2014). Dialogue that fosters interprofessional practice implies that team members demonstrate effective interpersonal skills, reflect on their practice, and perceive themselves and others as being competent (Barrow et al., 2015; Hellman et al., 2016).

An essential characteristic of the interprofessional practice experience is a shared and consistent approach to care that is patient rather than profession focused (Sommerseth & Dysvik, 2008; Thomson et al., 2015). Creating a culture of caring has been identified as an underlying facilitator of interprofessional practice (Wei et al., 2020), as well as elements such as having common goals, role blurring, shared accountability and opportunities for collaborative decision-making (Hood, 2015; Moe & Brataas, 2016). Sustaining that level of interprofessional working requires team members to support one another and continually nurture interactions, through collaborative attitudes of being positive, responsive and open to differing perspectives and skills (Croker et al., 2012; O’Brien et al., 2009). This may be especially true in relation to new graduate health practitioners (Hellman et al., 2016), whose feelings of “incompetence and unpreparedness is humiliatingly visible and their sense of self frequently violated” (Veerapen & Purkis, 2014, p. 223). Additional barriers to collaboration are created by pervasive interprofessional stereotypes and preconceptions, which drive ineffective communication and behaviors that promote conflict within a team (Thomson et al., 2015; Veerapen & Purkis, 2014).

Trusting each other as people is widely believed to be central to interprofessional collaboration (Hellman et al., 2016; Schwartz. et al., 2011). Feelings of trust and security develop when relationships between team members are prioritized, in turn enhancing opportunities for collaborative dialogue and decision-making (Larsen et al., 2017; Merrick et al., 2014). Trust is built over time (Schwartz. et al., 2011), fostered by a focus on the patient and his/her needs and feeling valued and respected by other team members (Larsen et al., 2017). Lack of trust can have wide reaching implications; impacting a practitioner’s ability to actively engage with the team (Doriccah Peu et al., 2014). For example, new graduate nurses’ confidence to participate in interprofessional teams has been found to be underpinned by mutual trust, respect and supportive relationships (Pfaff et al., 2014). At the core is who the person is and the individual interpersonal capabilities he/she brings to interprofessional encounters (Croker et al., 2012).

This body of research confirms the complexity of interprofessional practice, the interpersonal nature and inter-relatedness of each of the elements drawn from the above studies, and how, in the end, it hinges on the individuals that make up a health team. What it does not reveal is how the elements come together in the moment of delivering care, or how these elements work together to promote an environment where the spirit of interprofessional practice is in play. Therefore, the question that guided this article was “what does it mean to practice in the spirit of interprofessional practice?” In addressing the question, we first turn to philosophical understandings of how people come together and encounter each other to achieve a common purpose. We outline the study from which this discussion draws inspiration, sharing stories that open up the experience of being an interprofessional practitioner. The discussion draws our ideas together, offering a description of the spirit of interprofessional practice, as it is encountered in the complexity and messiness of everyday practice.

Philosophical basis

Heidegger (1993) writes of the path through the dense forest which leads to a clearing, an open space where there is no predefined path to follow. We suggest that health practitioners from each discipline come upon the clearing having walked their own track. Their undergraduate educational processes have kept them separate. Their job description likely relates to the roles and skills that belong to their discipline. Such expectations are ready-made, like the forest path. In walking the path through the trees there is little call to “think,” for the way takes one forward, each step keeping to the path.

Imagine a small group of such people, each from a different discipline, leaving their path as they step into the open clearing. The light shines in. The way ahead is not clear. As they gather, perhaps they recognize each other as people sharing a predicament. To find their way out they may need to draw on each other’s skills and wisdom. Their own discipline recedes into the background. What matters has changed. It is a situation rich in possibilities. It calls for thinking, for openness to each other.

Heidegger, 2001 tells us that “clearing” means “to be open” (p. 13), with some suggesting this notion is Heidegger’s “entire philosophy in a nutshell” (Harman, 2007, p. 3). We argue that this same notion of being open is at the heart of the spirit of interprofessional practice, and “does not exist only for the person who speaks; rather, anyone who listens is fundamentally open. Without such openness to one another there is no genuine bond” (Gadamer, 2013, p. 369).

How then do health professionals free themselves from the well-trodden forest path to join with colleagues in the clearing? How do they see each other as coming to know the person behind the professional label? How do they think and work together in a way that enhances patient-centered care? When openness to one another is free to ripen and grow, genuine bonds are forged. New enriched paths of care are made specific to each person. The spirit of interprofessional practice flourishes.

The study

The hermeneutic phenomenological study that inspired this paper sought to reveal what it means to “be” and “become” an interprofessional health professional (Flood, Hocking et al., 2019). The interpretation of health professionals’ experience of working with people from other disciplines opens up and creates new ways of viewing and understanding the phenomenon of interprofessional practice (Koskinen & Lindström, 2013). Our goal, in dwelling with events, as experienced in everyday life, was to gain deeper understanding of the nature of interprofessional practice, one that would ring true to practitioners themselves. This study was approved by the Auckland University of Technology Ethics Committee (ref no: 14/321).

In-depth, semi structured interviews were conducted with 12 consenting health professionals from medicine, midwifery, nursing, occupational therapy, physiotherapy, speech and language therapy, and social work. The interviews, which were recorded and transcribed, used a conversational style to ask about practitioners everyday experience with others; the times when their practice had felt truly “interprofessional.” The telling of stories which express experiences of a phenomenon reveals its meaning, and when written down enables thorough examination and interpretation of meaning structures within the stories (Lindseth & Norberg, 2004). Prolonged immersion in the transcripts allowed rich and diverse stories of experience and meaning to emerge. The interpretative process focused on accounts strongly linked to ways of “being” interprofessional, with many unifying themes announcing themselves as important. The interpretation gained greater depth and clarity through the process of writing and rewriting, with ongoing reflection and discussion ensuring the analysis stayed connected to the meanings emerging from the text.

Hermeneutic phenomenology provides an approach uniquely positioned to support inquiry into the complex phenomenon of interprofessional practice. It allowed us to stay close and attuned to the ontological nature of the phenomenon, to uncover the hidden, to question, to remain open to the possibilities, and to move closer to the essential meanings that emerged. It is not a quest to find the answers. Rather, “to truly understand phenomenology requires developing an appreciation for the philosophies that underpin it” (Neubauer et al., 2019, p. 91). We were mindful of the need to hold the philosophical foundations “as a beacon to light the journey” (Smythe, 2012, p. 12). The guiding philosophical notions that underpinned this study were drawn from Heidegger and Gadamer. Further details of the study design, ethical considerations, methodology and methods are available in two previous publications (Flood, Hocking et al., 2019; Flood, Smythe et al., 2019).

Stories of being interprofessional

Below are experiences of participants who came upon the clearing having walked their own path. Those who deviate from the path bring with them an openness to others and other ways of seeing the world; a sense of care (solicitude) for others; and a patient/¹ whanau-centric, as opposed to a profession-centric approach.

Openness

Working in a spirit of interprofessional practice involves being open to others, to trying new things, to the merging of roles, to the letting go or freeing up. There are boundaries, but there is an openness at the edges. There is “play” in openness, where there is openness to some things and not others. This “play” in openness is shown by Paula, a nurse working in a specialist nationwide service for children with rheumatological concerns.

Probably the first and only time in my career where the team really felt like it worked extremely well was when I worked in this service. Although we had set roles within the team, there was also a lot of crossover of our roles. We reached a point over a period of time where our roles were quite interchangeable … So, for example, the physiotherapist wouldn’t necessarily make recommendations about medications, that was perhaps more what I would do, however there came a point where she felt comfortable having talked to me so many times around this issue, to give certain advice to the patients. She would always communicate and check with me that the advice she was giving was right and we would communicate that way around … It’s okay to be precious about some of the things you do in your profession, but it’s also okay to let go of some of that stuff sometimes too.

Openness involves keeping the dialogue going, evidenced by the ongoing communication between Paula and the physiotherapist. They were not constrained by traditional professional boundaries or multidisciplinary approaches. They showed a comportment (demeanor), of openness, a necessary prerequisite for understanding which shifted the focus from a profession-centric position toward the patient, “ … to move beyond the near-sightedness of our own individual perspectives and toward more universal points of view with regards to the subject matter” (Vilhauer, 2013, p. 77).

Solicitude

Working in the spirit of interprofessional practice, requires solicitude, which can be described as an authentic mode of being with others. It is a continual process of involvement with, and concern for the welfare of others that comes before indifference or self-interest (Giles, 2008; Heidegger, 1962). How solicitude shows itself as “care” is revealed through some of the participants’ stories of working together. The following narrative from Ricardo, a nurse working in mental health, shows his solicitous nature; his concern for others guides the manner in which he chooses to engage. Ricardo’s solicitude drives his desire to get to know, better understand and learn from others.

The main thing I enjoy about nursing is just the way of dealing with people. I’ve always been a people person. I’ve always wanted to meet, or just learn from people, learning who people are. I think there’s a lot of value in that. Because the more you meet people the more you can enrich yourself, because you get to experience a life that you couldn’t possibly have experienced if you hadn’t met them. Working as a nurse, you deal with so many patients, with so many different backgrounds. You get to experience the hardship that they’ve gone through, how messy their lives have been, and comparing my life with them I’m quite privileged actually. You just get to appreciate that the more you go through life the more accountable you are to your own actions, yeah.

Ricardo intentionally gets-to-know-others, and in the getting-to-know-others he shows his solicitous nature. This solicitude, a call from within himself, drives his actions and how he comports himself in caring for others. In solicitude, Ricardo shows a way of “seeing” the other, a way of seeing which allows him to better understand the other as well as himself. In this narrative Ricardo sought to understand others by learning about their background; he actively sought to enrich this understanding. Heidegger would call this authentic mode of care-for, “Rucksicht.” Rucksicht, in caring for someone, is a considerate regard that comes from looking back upon the person’s world, a world that needs to be taken care of, for and with the person (Heidegger, 1962; King, 2001). Looking back guides Ricardo’s future actions in his authentic caring. What is also apparent in this narrative is an understanding that lies in looking toward something, another way of “seeing” which Heidegger calls “Nachsicht.” It is a way of seeing the other that helps the person move toward managing and caring for his/herself. There is a sense that Ricardo understands the need to care for another requires a looking back at where the person has come, their past/previous experiences, in order that he may better prepare that person to manage, to care for themselves toward the future.

Patient/Whānau centeredness

A common feature that stood out through the stories was how the health professionals involved all paid attention to the patient. A focus on the patient appears to be at the heart of working in a spirit of interprofessional practice. In Paula’s account of good interprofessional teamwork, the patient is clearly central. Coming together for and with the patient provided the platform for the provision of high-quality care.

I guess the key things for me to ensure positive outcomes for the patients are good team communication, clear goals, and being respectful of the different clinical points of view. We all want the same thing for the patient but we’re all coming with different hats on, we see things differently because of the information we have about that person. It’s only the wrapping around of all those different disciplines that can bring about really truly positive outcomes. It’s like the elite service isn’t it? The patient can’t go home if those people aren’t talking to each other and the patient can’t get better if those people aren’t all working together. We have to all be working together as a team, with the patient in the centre of it. When the team is functioning well you get a lot of good work done for the patient and you can see really positive outcomes.

The mode of being-with others, within the team Paula describes, is one where they act out of solicitude; where what matters most is the patient. When concern is focussed on the patient, it changes how the team works, drawing them together in a unity of purpose; wrapping them around the person. They are open to possibilities and other points of view. Paula describes a team working in unison, a team with a shared focus and vision that brings and keeps them working together. She draws attention to each member of the healthcare team having different knowledge, skills and perspectives, yet when good communication and respect for one another exist, the “wrapping” of the different team members around the patient is possible, enabling them to receive the benefit of multiple points of view; the “elite service.”

Fourfold

It appears from the data, that fundamental to a spirit of interprofessional practice being able to flourish is a climate, a mood that arises from the comportment of those present (Heidegger, 1962). As already indicated above, this way of practicing prioritizes the needs of the person as to what matters most. It involves practitioners who bring solicitude and authentic care (Heidegger, 1962), and who are aware of the limits of their own expertise. They are open to possibilities that practitioners from other disciplines may be able to enhance and expand their own contribution. Thus, patient-centeredness, solicitude and openness are already-there, as practitioners enact a spirit of interprofessional practice through knowing others, trust, respect and authentic dialogue.

Heidegger (1993) referred to the notion of a fourfold, which contains dimensions that are interdependent and cannot be considered individually. The stories below describe four dimensions that were identified by participants as present when interprofessional practice flourished, all of which form an interconnected whole and include knowing others, trust, respect and genuine dialogue. One cannot exist without the other, which Heidegger, 1962 referred to as equiprimordiality. Each of these four dimensions mirror one another; and when talking about one, the other three come into play (Harman, 2009; Heidegger, 1993). Interprofessional practice is the thing that gathers the fourfold, allowing a space for these four dimensions to unfold, be free to “ripen,” to be what they are (Heidegger, 1993).

Knowing others

Heidegger would say “it is true that in everyday being-together-with-others, this primary understanding of the other, as well as of oneself, is often covered over and distorted, so that to know each other requires a ‘getting-to-know-one-another’” (King, 2001, p. 76). In the clearing, where openness, solicitude and patient centeredness already reside, Amanda, an emergency department medical doctor, describes the importance of knowing other team members.

What made the team work well were the people and the relationships within the team. There were people in the team who knew each other. In the knowing of other’s strengths and weaknesses, there is an ease about how things will work. You know they have the skills to do the job in that situation and you don’t need to think about it or check up on them or worry about them feeling out of depth and not being able to tell you, and they also know what information you need to know about what they are doing. It enables some trust; it creates an ease and sense of relative calm.

Amanda described a team coming together in the care of the patient and how this coming together for the patient was aided by knowing one another. In Amanda’s experience, knowing others in the team facilitated a sense of trust and this trust allowed her to focus on the job at hand without being unnecessarily concerned about what others were doing. There was an already-there understanding that came from the establishment of a trusting relationship. The knowing of others felt comfortable, it made her job easier, it brought a sense of calm to the situation. It did not require as much effort because there was an unspoken understanding, a familiarity with how the other person works. Knowing others in the team, having a relationship, made working together easier.

Trust

Mutual respect and trust are fundamental to relationships. They provide the essential conditions for good interpersonal relationships, where no one feels threatened (Mathewson, 1955). Getting to know others facilitates the development of trust. Jenny, a physiotherapist, described the importance of developing relationships based on trust.

Another key factor for the success of the interdisciplinary team I worked in was … being able to trust other professionals. Like, in the acute setting, you get good at looking across the bed, making eye contact, ‘I’m terrified, what are we going to do?’ You don’t say anything, you just look at your colleague and you get good at recognising these facial expressions and understanding where you’re going and you intervene on behalf of each other.

Jenny recognized that in order to build an effective relationship that would benefit the patient, she needed to trust others. In this trusting comes a knowing, and in the knowing, there comes an ease and unspoken understanding. In this unspoken moment of shared understanding, there is a look, recognition, and a shared knowing that brings people together. The moment shared creates a sense of togetherness, a sense that it will be okay because we are in this together. Such moments come when trust is present; moments to be treasured.

Respect

A central quality for “being” interprofessional is having “due regard for the feelings, wishes, or rights of others” or respect (Hammick et al., 2009; Lexico, 2020).

Amy, an occupational therapist working in palliative care, talks of an open and respectful relationship with a physiotherapy colleague and how this invites a collaborative approach to their practice.

When I was locuming in a community based palliative care service, I worked closely with a physio. We came to know each other through reading the shared client notes, seeing what each other was doing and having those casual conversations, ‘Oh so you’re seeing such and such, so am I, well what have you noticed, what have I noticed’ … so that kind of formal and informal collaboration that happens. There was just a respect and acknowledgement on both sides and a clear focus on the client and getting the best outcomes for them. Yeah, so that was really nice. It helped that we had an existing open, positive, and respectful relationship, so we knew one another and how each other worked.

Amy describes a respect for her physiotherapy colleague that included an awareness and understanding of each other’s unique and shared roles and responsibilities; of their common purpose, and of the best way to work together for the person. Feeling respected and trusted, significantly influenced how they provided care for their patients. Having respect for one another and being treated respectfully opened the way for dialogue between the disciplines, which brought about an inclination and openness to engage in genuine dialogue.

Genuine dialogue

Genuine dialogue, for Gadamer, 2013, is when two people try to come to an understanding, a conversation where there is an openness to truly accept the other’s point of view and to understand what the other is saying. As Grondin (1994) asserts “only in conversation, only in confrontation with another’s thought that could also come to dwell within us, can we hope to go beyond the limits of our present horizon” (p. 125). Dialogue reveals something about its participants. Those involved in the dialogue are changed during these encounters, they are forced to see things differently as prejudices are revealed and initial assumptions are challenged and modified (Lawn & Keane, 2011).

Amy, who had previously worked in a mental health team environment, describes an experience of working collaboratively in the provision of group-based care, where the team actively engaged in dialogue and were then able to act out of their broadened horizons.

I worked at an inpatient unit for children, adolescents, and family/whanau experiencing difficulties with their mental health. An expected part of the allied health team’s role in this unit was facilitating groups. Previously groups had been run with little collaboration between the disciplines. We had a really lovely team consisting of social workers, psychologists, occupational therapists, nurses, and cultural support at that time. We met together regularly and decided it would be much more valuable, with better outcomes for our client group, if we provided the groups together, recognising that we all had different strengths that we could offer. We planned the groups together and divided the tasks up depending on our interests, expertise, and comfort level, so we had really clear roles. Afterwards we would always meet and talk about what we’d done well and what we could do differently next time.

This team was open to working together; they engaged in dialogue, and in dialogue became aware of the limitations in their own background understandings; in this case, that more could be achieved together than it could be on one’s own. Through an iterative process of dialogue, the team were challenged to enlarge their background understandings, to broaden their horizons, which improved their understanding and approach to caring for their patients (Polkinghorne, 2000). This opened the way for collaborative practice to take shape, to be sharpened and modified through ongoing questioning and reflection.

Discussion

From the “already-thereness” of being open to working together, there is a gathering of ways-of-being that come into play. These “ways” are not pre-thought or preplanned. They simply happen in the moment. Heidegger (1971) talks of the notion of the fourfold where aspects of our everyday life come together. While we can name each one, we cannot talk of one without at the same time drawing in understandings of the other. From the gathering comes the outpouring, the moment of the practice encounter. Thus, when Ricardo, or any other health professional, has a conversation with a team member that goes beyond information sharing, it can become an authentic dialogue, with each person open to hearing the ideas and opinions of the other. In this way trust is built as each listens attentively and recognizes the other has something useful to offer. This trust builds into respect. Each now turns to the other, respecting their expertise as being “more” than they could offer on their own. Yet this gathering is not necessarily in logical sequential order. It may be that in a moment of practice one person witnesses the other doing something that wins their respect, leading to intentionally setting about getting to know each other better. It may be that they have a common friend. The trust is already-there before they come to know each other. The authentic dialogue may arise following an episode of crisis where, although neither know each other, their care to the patient throws them into an urgency of deciding what to do.

Our argument is that when 'getting to know others', 'genuine dialogue', 'trust', and 'respect' are in play with each other, arising from whatever the moment of practice calls forth, then the spirit of interprofessional practice flourishes. Practitioners have met each other in “the clearing.” Something happens “more than” discipline specific tasks being enacted.

Why does it matter that health professionals meet together in the clearing, in the openness of coming to know each other, of building trust and respect, and of engaging in genuine dialogue? Sheehan (2014)explains the significance of the clearing from a Heideggerian perspective. We interpret this in the context of this article:

1. The “clearing” must first be there before thinking can move to seeing a person’s care “as” something that could be done “this” way or “that”. The “as” personalizes, contextualizes and gathers together possibilities.

2. In the “thrown-open clearing” (p. 265) there is ontological truth. This is where practice happens in the reality of people, place, resources, time and mood, as opposed to the theoretical notions of how it “ought” to happen.

3. In the clearing the fourfold comes into play. People come to know each other, build trust and respect, and engage in genuine dialogue. This is not a list of things that happen. Rather all of this happens in an indivisible way. To know “is” to trust which “is” to respect, which “is” to be drawn into a deeper level of conversation. That is, “the relatedness is the clearing itself … a unique and undividable unitary phenomenon” (p. 269).

4. From the openness, the meaning of how care could play out, of how health professionals could embrace the spirit of interprofessional practice, of how roles could adapt and respond, becomes the gift to patient-centered care. In short, the clearing “is the primordial source – the ‘gifting’ – of the possibility of meaningfulness” (p. 272).

Recommendations for practice

An ontological approach by its very nature does not seek to arrive at a “method” of how practice ought to happen. We are talking rather about what “does” happen in an unthinking manner. The key is the already-thereness that each person brings to a practice encounter. There is something about who and how they are which underpins their comportment, their way of being. This comportment is shaped from birth, influenced by undergraduate educational experiences, mindful of expectations of leaders and colleagues within each practice setting.

To achieve robust interprofessional practice is no quick fix. It is about entry criteria into undergraduate health programmes that go beyond academic marks to look for qualities of openness. Curricula need to be designed to give students opportunities throughout their programme to work alongside students from other disciplines, learning the value of openness, patient-centered care and the nature of solicitude. Assessment of student performance must be attentive to such qualities. Within the practice setting, leadership must exemplify the espoused values. Great interprofessional teamwork needs to be captured in stories that are told and celebrated, while clearly showing how a difference is made through open, trusting, respectful and genuine teamwork. There are ways of fostering people coming to know each other: shared tea rooms, interprofessional forums, and social events. Growing a spirit of interprofessional practice takes time, commitment and care.

Conclusion

The ontological view provided in this article has shed light on how relationships play out in “everyday” practice and the qualities necessary for fostering a spirit of interprofessional practice, of openness in these human-to-human interactions. It has highlighted the need for health practitioners to be free to enact their humanity; to move beyond the path, which holds professionalism in a box and encourages them to leave “who they are” at home. In order to foster a spirit of interprofessional practice, there needs to be an ethos that signals, gives permission, and values health practitioners to work in this way. When people are free to be as good as they can be with one another, interprofessional practice becomes so much more than a mode of practice. It imbues a spirit of care and commitment that transforms piecemeal practice into collective synergy, which impacts the patient and care providers as a meaningful, responsive experience.

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The authors have no financial or non-financial competing interests to report.

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Notes on contributors

Brenda Flood

Brenda is a senior lecturer at the Auckland University of Technology (AUT), where she is an interprofessional education and practice development leader within the Faculty of Health and Environmental Sciences. Brenda’s doctoral research explored health professionals’ experiences of interprofessional practice, with the aim of illuminating insights from these experiences to inform interprofessional learning.

Liz Smythe

Liz Smythe has a long history of working with postgraduate students within an interprofessional culture of learning. Liz brings expertise in Heideggerian hermeneutic phenomenology.

Clare Hocking

Clare Hocking works within the Department of Occupational Science and Therapy at the Auckland University of Technology. She is the Executive Editor of the Journal of Occupational Science and co-author of the World Federation of Occupational Therapist’s minimum standards for the education of occupational therapists. Clare’s research interests include occupational science, human rights, and strategies people with a health condition devise to facilitate participation in everyday occupations.

Marion Jones

Marion Jones is Professor of Interprofessional Learning and past Dean of University Graduate Research School at Auckland University of Technology, New Zealand.  Along with supervising Doctoral Students she has  been involved in co-editing four books on interprofessional leadership and practice.  The first book- “Leadership Development for Interprofessional Education and Collaborative Practice”- Forman, Jones and Thistlethwaite was published in 2014, the second volume 2015, 3rd 2016 and the 4th volume “Sustainability and Interprofessional Collaboration” in 2020.

Notes

1. Whānau – “extended family, family group, a familiar term of address to a number of people – the primary economic unit of traditional Māori society. In the modern context the term is sometimes used to include friends who may not have any kinship ties to other members.” (https://maoridictionary.co.nz)