Factors influencing the interdisciplinary collaboration in health and social care According to several authors (Abramson, Mizrahi, 2003; Payne, 2000), collaboration among professionals focused on health and social care is currently a necessary step toward improving and enhancing the provision of health and social services to patients/clients. Each of the professionals (physician, social worker) brings their own perspective on the client’s situation - the physician a medical one and the social worker a social one. Social workers provide a comprehensive view of problems and situations, emphasizing the social causes and consequences of illness and the need to cope with illness in a broader context (Dhooper, 2012).

According to Bronstein (2003), trends in social problems and professional practice bring with them the inability to serve clients effectively without collaboration with professionals from different disciplines. Collaboration with workers from other helping professions, according to Musil (2013), follows from the focus of social work on using various types of opportunities and overcoming various types of barriers to coping with problems in interactions between clients and their social environment. Collaboration with workers from other helping professions and mediating their help to clients is an inseparable part of social work.

On the individual level, people may have difficulty understanding illness and the recommended treatment because of mental or physical disability, low literacy, or a language barrier. Many health conditions and treatments are very complex, and social workers may be required to explain these issues to patients and their families (Browne, 2012).

Collaboration is when two or more people (often groups) work together through the exchange of ideas and thinking in order to achieve a common goal. With changes and advances in technology, such as high-speed internet, web-based programs, file sharing, emails, and videoconferencing, collaboration is considered a productive way of solving problems (Hill, 2003).

From a psychological perspective, collaboration or cooperation is a type of social interaction. It is a basic form of social behavior. Collaboration means joint effort aimed at achieving benefit for all who participate in it (Heywood, 2003).

Characteristics of collaboration:

  • Collaboration is voluntary. People cannot be forced to use a specific style in their interactions with others.
  • Collaboration requires parity among participants. The contribution of each person is valued, and each person likewise has equal authority in decision-making.
  • Collaboration is based on mutual goals. Professionals do not necessarily have to share all collaborative goals; one goal is sufficient if it is specific and important enough to keep their shared attention.
  • Collaboration depends on shared responsibility in decision-making. Collaborators must take responsibility for actively engaging in the decision-making activity.
  • Individuals who collaborate share resources. Sharing resources of time, knowledge, and materials can increase a sense of belonging among professionals.
  • Individuals who collaborate share responsibility for outcomes. Whether the results of collaboration are positive or negative, all participating individuals are responsible for the outcomes (Friend, Cook, 2009).

Model of interdisciplinary collaboration

Bronstein (2003) presented a model that contains elements of interdisciplinary collaboration. The model is intended to identify the components of successful collaboration between social workers and members of other disciplines. This framework consists of interdisciplinary processes in five key areas:

  1. Interdependence - points to the dependence of professionals in mutual interaction when creating shared goals and tasks in the intervention process.
  2. Newly created professional activities - refer to acts of collaboration, the creation of programs and structures that can achieve more than would be possible if the same professionals worked independently.
  3. Flexibility - means the adaptability of all members of the professional team to changing conditions of intervention.
  4. Collective ownership of goals - leads to the emergence of shared responsibility for the entire intervention process and its outcomes.
  5. Reflection on the process - refers to collaborators’ shared consideration of the collaboration process (Bronstein, 2003).

Factors influencing interdisciplinary collaboration in health and social care

Bronstein (2003) specified four groups of factors that create the conditions for the existence or non-existence of interdisciplinary collaboration in social work.

  1. Perfect knowledge of one’s own professional role is a condition for performing any profession, even more so in helping professions. According to Bronstein (2003), the ideal form of this factor includes commitment to the setting of a specific organization, loyalty to social work as a profession, respect for colleagues, and an ecological, holistic view of practice related to the profession of social worker.- Structural characteristics include interdisciplinary collaboration in managing casework. The organization’s culture determines its possibilities, the necessary formal procedures, the autonomy of individual professions, and the overall time and space devoted to collaboration in intervention. - Personality characteristics of members of the professional team influence interdisciplinary collaboration through the way professional roles are applied in practice by professionals. - History of collaboration reflects each member of the professional team’s experience with interdisciplinary collaboration in the given organization. Bronstein (2003) points out that the tradition of collaboration in an organization is decisive for its non/use in the intervention process. A positive experience of members of the professional team with mutual collaboration in the organization strengthens professional relationships, which subsequently advances the way interdisciplinary collaboration is applied and used in intervention to a higher level (Fig. 1).

Figure 1 - Factors influencing interdisciplinary collaboration (source: Bronstein, 2003)

Reeves et al. (2010) present the following factors influencing interdisciplinary teamwork:

  1. Relational factors - professional performance, hierarchy, socialization, team composition, team roles, and team processes.
  2. Process factors - time and space, routines and rituals, information technology, unpredictability, urgency, complexity, and task delegation.
  3. Organizational factors - organizational support, professional associations, and fear of conflict management.
  4. Contextual factors - culture, diversity, gender, political will, and economics.**

Bronstein (2003) and Reeves et al. (2010) described collaboration factors influencing the existence or non-existence of interdisciplinary collaboration. This is more of a general overview of factors. Other authors (e.g., Roberts, 1989; Gehlert, 2012; Abramson, Mizrahi, 2003) addressed collaboration factors more specifically and in terms of whether they support or hinder interdisciplinary collaboration.

Abramson and Mizrahi (1996) divide collaboration factors into those that "contribute to positive collaboration and those that contribute to negative collaboration" (Abramson, Mizrahi, 1996, p. 270).

They include, for example, respect for collaborators, similar perspectives relating to the case, and good quality communication among the positive factors. They include the following barriers to collaboration among the negative factors: conflicts between collaborators, role competition, role ambiguity, unclear role definitions, differences in the professional socialization process, communication problems, and physician dominance (Abramson, Mizrahi, 2003). The authors grouped these positive and negative factors and created "constructs that reflect specific aspects of collaboration: aspects relating to the case, experiences with collaborators, interaction among collaborators, and collaborators' competencies" (Abramson, Mizrahi, 1996, p. 276).

Figure 2 - Positive and negative factors of collaboration according to Abramson, Mizrahi (1996, 2003) (source: Gabrielová, 2015)

According to Roberts (1989), collaboration between physicians and social workers is influenced above all by the relationship these participants have with each other. In her view, this relationship is tense because of the existence of opposing (conflicting) values.

She identified these opposing values in five areas:

  1. Quantity versus quality - the biophysical orientation of physicians may conflict with the psychosocial orientation of social work. While physicians primarily focus on saving and prolonging life, the professional effort of social workers is aimed at improving the quality of life of individuals, groups, and families.- Patient autonomy - physicians are responsible for setting treatment, for the treatment itself, and for what is best for the patient. Social workers respect the patient as an autonomous being who participates in setting the therapeutic plan. - Hard and soft data - physicians focus in their profession on objective "hard data", that is, the results of physical and laboratory examinations. Social work considers the patient to be a fundamental component of the therapeutic process. It considers subjective "soft" data (patients' statements, value system) more important than objective data. Social workers often do not even have objective data available that they could take into account when assessing the patient’s situation. - Professional responsibility toward patients with emotional problems - dealing with patients' emotional problems is an inseparable part of the profession of social worker. Physicians, on the other hand, are insensitive to or put off by patients with emotional problems. The cause is seen in fatigue, which can affect the level of acceptance and tolerance. - Different perspectives on roles in the interdisciplinary team - while social workers are educated and trained to collaborate with other professions, physicians are trained to have an unquestionably leading role in any multidisciplinary team (Roberts, 1989).

In the previous section, attention was given to foreign authors and their characteristics of factors of interdisciplinary collaboration.

In the Slovak Republic, the issue of interdisciplinary collaboration has been addressed, for example, by Repková et al. (2011), who identified barriers to intersectoral collaboration and principles for strengthening strategic approaches to collaboration in connection with the creation and functioning of a coordinated or integrated system of long-term care services.

Barriers to intersectoral collaboration include:

  1. Structural barriers - different organization and financing of health and social interventions, insufficient coordination of legislation in the area of health and social care.
  2. Procedural barriers - diversity of legal and institutional systems for assessing needs and legal entitlements, disconnected databases on dependent older citizens in individual systems, a weak tradition of involving users/patients and their families in the creation of social service plans at the community and individual levels.
  3. Financial barriers - differences in financial mechanisms/bases, differences between stocks and flows of resources.
  4. Professional barriers - own professional interest and autonomy and interdisciplinary competition over domains; competing ideologies and values; threats to job security; conflicting views of the client's/consumer's interests and tasks.
  5. Status and legitimacy barriers - own professional interest and autonomy and inter-organizational competition over domains; differences in legitimacy between elected and appointed agencies.

Principles for strengthening strategic approaches to collaboration include:

  1. Shared vision - specifically defines what is to be achieved in terms of user-oriented goals; clarifies the purpose of collaboration as a mechanism for achieving such goals; and mobilizes efforts concerning goals, outcomes, and mechanisms.
  2. Clarity of roles and responsibilities - establishes and agrees on "who does what" and proposes organizational measures through which roles and responsibilities are to be fulfilled.
  3. Appropriate motivations and rewards - supporting behavior within the organization in line with agreed goals/responsibilities, using self-interest for collective goals.
  4. Accountability for joint work - monitoring achieved successes in relation to the established vision; making individuals and agencies accountable for fulfilling predetermined tasks and responsibilities; and providing feedback and control of the vision, responsibilities, motivation, and their mutual relationships (Repková et al., 2011).

Conclusion

Several authors (e.g., Gehlert, 2012; Browne, 2012; Dhooper, 2012) emphasize the importance of the broader social environment of the ill person - the network of relationships, support from loved ones, and the person's mental state, all of which subsequently affect the overall health condition. Given this fact, we can state that collaboration among professionals focused on health and social care is a basic prerequisite for caring for the client/patient.

Knowledge of the factors that influence interdisciplinary collaboration can contribute to improving mutual relationships and communication among the professionals mentioned above in achieving the common goal - solving the health and social aspects of the patient/client’s life situation.

Author: Mgr. Jana Gabrielova, PhD. The author works as an assistant professor at the Department of Social Work, College of Polytechnics Jihlava. This article was created within the Internal Grant Project of VŠPJ entitled "Conceptualization of collaboration between physicians and social workers in health-social teams". List of bibliographic references

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