What do you mean, ‘negotiating?’: Patient, physician, and healthcare professional experiences of navigating hierarchy in networks of interprofessional care

ABSTRACT

Interprofessional collaborative practice is a phenomenon that can be fraught with power dynamics between professions, within professions, and between professionals and patients. In the literature, the dominant notion is that conflicting viewpoints and interests arising from unequal power dynamics can be resolved through negotiation. This study examined COPD patients, health professionals, and physician experiences of negotiation within 10 interprofessional collaborative COPD care teams. Physicians, patients, and healthcare professionals each had strikingly different conceptions and experiences of negotiating their perspective with other team members. Our study suggests that negotiation is an idealized notion rather than a relational process embedded in interprofessional collaborative practice. Importantly, we found that the ability and opportunity to negotiate one’s perspective is heavily influenced by one’s position in the workplace division of labor and professional hierarchy. We conclude that “negotiation” is only one approach among many in navigating interprofessional relations. Further, the rhetorical and ideological appeal of “negotiation” may overstate its role in interactions in interprofessional care settings, and lead to a misunderstanding of the power dynamics at play. It may be naïve to assume team members can control their situation through the competitive assertion of their individual perspective in a rational debate. Unfortunately, adopting the language of negotiation uncritically may not offer relevant solutions to structural and collective problems within a healthcare workplace.

KEYWORDS:

• Interprofessional network
• COPD care
• Negotiation
• Hierarchy
• power dynamics
• qualitative study

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding was provided by the Social Sciences and Humanities Research Council of Canada Insight Development Grant (2018-2020), and the Hal Kettleson Hematology Research Fund

Notes on contributors

Graham Macdonald

Graham Macdonald is a PhD Candidate in Rehabilitation Sciences at the University of British Columbia.

Sevinj Asgarova

Dr. Sevinj Asgarova is a research associate at the Centre for Health Education Scholarship Mary Berger is a research assistant at the Centre for Health Education Scholarship, University of British Columbia.

Wendy Hartford

Wendy Hartford is a PhD Candidate in Rehabilitation Sciences at University of British Columbia.

Sayra Cristancho

Dr. Sayra Cristancho is an Associate Professor in the Department of Surgery and Faculty of Education at University of Western Ontario, and a Scientist at the Centre for Education Research & Innovation.

Laura Nimmon

Dr. Laura Nimmon is an Associate Professor of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia and a Scientist at the Centre for Health Education Scholarship.