The impact of space and time on interprofessional teamwork in Canadian primary health care settings: implications for health care reform

Abstract

Aim: This paper explores the impact of space and time on interprofessional teamwork in three primary health care centres and the implications for Canadian and other primary health care reform. Background: Primary health care reform in Canada has emphasized the creation of interprofessional teams for the delivery of collaborative patient-centred care. This involves the expansion and transformation of existing primary health care centres into interprofessional family health teams (FHT) promising to provide patients better access, more comprehensive care, and improved utilization of individual health professionals. Benefits for providers include improved workplace satisfaction and organizational efficiencies. Currently, there is little evidence for how effective interprofessional teamwork happens and little is known about how to create high-functioning teams in the primary health care setting. Methods: We used ethnographic observations and interviews to gain a deep understanding of the nature of interprofessional teamwork. Three academic family health centres participated in a total of 139 h of observation and 37 interviews. Team members in all three centres from the disciplines of medicine, nursing, physiotherapy, occupational therapy, social work, dietetics, pharmacy, and office administration participated in this study. Findings: We found that both the quantity and quality of interprofessional communication and collaboration in primary health care is significantly impacted by space and time.Across our research sites, the physical layout of clinical space and the temporal organization of clinical practice led to different approaches to, and degrees of success with, interprofessional teamwork. Varied models of interprofessional collaboration resulted when these factors came together in different ways. These findings have important implications for the transition to interprofessional family health teams in Canada and beyond.

First Things First: Foundational Requirements for a Medical Home in an Academic Medical Center

“…Our findings are consistent with Oandasan et al, who found that space has a substantial effect on "the quantity and quality of inter-professional communication and collaboration in primary health care." 36 We found that technology that allows for real-time communication in clinic, such as IM, was especially important in these circumstances. These issues highlight the need, particularly in large complex settings, to carefully consider how to best use space and technology to foster teamlet communication.…”

Designing Clinical Space for the Delivery of Integrated Behavioral Health and Primary Care

“…3 Increasingly, practices nationally and internationally are integrating mental health and physical services to improve quality, experience, and coordination of care for people with complex or co-occurring conditions. 9,10 However, few studies have examined how practice layout or professional proximity fosters or impairs coordination among professionals in practices integrating care. To date, research in this area suggests that merely placing professionals in the same building does not enable team-based care.…”

“…To date, research in this area suggests that merely placing professionals in the same building does not enable team-based care. 9 Proximity of professionals working in the same location shapes professionals' feelings of isolation 10 as well as rates of engaging other professionals in patient care. 11 Therefore, the purpose of this study was to describe the observed spatial designs in 19 diverse practices integrating primary care and behavioral health and to identify how physical space and clinician proximity was connected to the behaviors of PCCs and BHCs working on these teams.…”

Using Ethnographic Methods to Understand Change in Interprofessional Practice

“…For example, a recurring comment from participants to the ethnographer was around the perception of a physician-centeredness and hierarchy of professions within the practice. Although this was not a new finding as compared to what emerged from data collected prior to the intervention [12], the use of ethnographic methods uncovered how participants' views of physiciancenteredness and hierarchy had shifted. Informal interviews probed participants for specific examples of what physician-centeredness and hierarchy now looked like and how it affected teamwork: "Can you give me an example of a recent time when you experienced the presence of the professional hierarchy?"…”