Delivery of interdisciplinary integrated care is central to contemporary health policy. Hospitals worldwide are therefore attempting to move away from a functional organisation of care, built around discipline-based specialisation, towards an approach of delivering care through multidisciplinary teams. However, the mere existence of such teams may not guarantee integrated and collaborative work across medical disciplines, which can be hindered by boundaries between and within professions. This paper analyses the boundaries that affect collaboration and care integration in newly created multidisciplinary teams. Empirical data are drawn from an ethnographic research conducted in the sub-intensive stroke unit of an Italian public hospital. Data collection involved 180 h of observations and conversations with 42 healthcare providers. Findings show that disciplinary boundaries hinder both intra-professional and inter-professional collaboration. Doctors from different disciplines adopt different, and sometimes conflicting, clinical approaches, doctors and nurses construct discipline-specific professional identities, and conflicts emerge between doctors and nurses from different disciplines over the regulation of the medicalenursing boundary. Achieving collaboration and integration between professionals from different disciplines may be particularly challenging when the group with less institutional power (nurses, in this case) has developed a high level of expertise on the needs of the patients targeted by the team. Effective interdisciplinary work thus requires not only bridging boundaries within the medical professional group, but also addressing the dynamics of resistance in merging doctors and nurses with different disciplinary backgrounds. In the paper, we summarise these results in a framework that contributes knowledge to the field of professional boundaries in healthcare while offering practical insights to forge new interdisciplinary relationships, which are more embedded in the daily experience of care providers.

(2016). Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care [journal article - articolo]. In SOCIAL SCIENCE & MEDICINE. Retrieved from http://hdl.handle.net/10446/209402

Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care

Scaratti, Giuseppe
2016-01-01

Abstract

Delivery of interdisciplinary integrated care is central to contemporary health policy. Hospitals worldwide are therefore attempting to move away from a functional organisation of care, built around discipline-based specialisation, towards an approach of delivering care through multidisciplinary teams. However, the mere existence of such teams may not guarantee integrated and collaborative work across medical disciplines, which can be hindered by boundaries between and within professions. This paper analyses the boundaries that affect collaboration and care integration in newly created multidisciplinary teams. Empirical data are drawn from an ethnographic research conducted in the sub-intensive stroke unit of an Italian public hospital. Data collection involved 180 h of observations and conversations with 42 healthcare providers. Findings show that disciplinary boundaries hinder both intra-professional and inter-professional collaboration. Doctors from different disciplines adopt different, and sometimes conflicting, clinical approaches, doctors and nurses construct discipline-specific professional identities, and conflicts emerge between doctors and nurses from different disciplines over the regulation of the medicalenursing boundary. Achieving collaboration and integration between professionals from different disciplines may be particularly challenging when the group with less institutional power (nurses, in this case) has developed a high level of expertise on the needs of the patients targeted by the team. Effective interdisciplinary work thus requires not only bridging boundaries within the medical professional group, but also addressing the dynamics of resistance in merging doctors and nurses with different disciplinary backgrounds. In the paper, we summarise these results in a framework that contributes knowledge to the field of professional boundaries in healthcare while offering practical insights to forge new interdisciplinary relationships, which are more embedded in the daily experience of care providers.
articolo
2016
Liberati, Elisa Giulia; Gorli, Mara; Scaratti, Giuseppe
(2016). Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care [journal article - articolo]. In SOCIAL SCIENCE & MEDICINE. Retrieved from http://hdl.handle.net/10446/209402
File allegato/i alla scheda:
File Dimensione del file Formato  
Invisible walls - social science & medicine 2016.pdf

Solo gestori di archivio

Versione: publisher's version - versione editoriale
Licenza: Licenza default Aisberg
Dimensione del file 276.78 kB
Formato Adobe PDF
276.78 kB Adobe PDF   Visualizza/Apri
Pubblicazioni consigliate

Aisberg ©2008 Servizi bibliotecari, Università degli studi di Bergamo | Terms of use/Condizioni di utilizzo

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10446/209402
Citazioni
  • Scopus 146
  • ???jsp.display-item.citation.isi??? 130
social impact