Summary:

Changes in Health and Social Care (HSC) service organisation have led to increased team working between different professionals and the blurring and overlapping of traditional professional role boundaries. Public inquiries into deaths of children at the Bristol Royal Infirmary2, the death of Victoria Climbie3 and more recently Peter Connelly4 have demonstrated that HSC teams do not always collaborate optimally, leading to a lack of continuity, and serious errors, in care.

Article:

Changes in Health and Social Care (HSC) service organisation have led to increased team working between different professionals and the blurring and overlapping of traditional professional role boundaries. Public inquiries into deaths of children at the Bristol Royal Infirmary2, the death of Victoria Climbie3 and more recently Peter Connelly4 have demonstrated that HSC teams do not always collaborate optimally, leading to a lack of continuity, and serious errors, in care. The Department of Health (DoH) and other UK HSC regulatory bodies responded to these concerns by radically reforming HSC professionals’ training to include interprofessional education and national benchmarks to enhance interprofessional collaboration.5-10 Interprofessional education (IPE) and its role in enhancing interprofessional collaborative practice (IPC) extend beyond national boundaries, as highlighted by the WHO Framework for Action on Interprofessional Education and Collaborative Practice11 that promoted the need for a collaborative-ready workforce worldwide. The Framework makes recommendations on how to achieve this, emphasising the need for national contextualisation. Critics of the WHO Framework call for more concrete guidelines12. We assert that these will arise by developing strong theoretical frameworks to articulate and test Framework recommendations.
Despite developments in IPE and IPC policy at national and global levels, there is a research deficit on the effectiveness of IPE, its underlying processes, and its bearing on collaborative interprofessional practice. Evidence is particularly elusive on the complex issues of professionalization and professional hierarchies. Significant research investment is required to support future policy direction. Much of this shortfall is attributed to the largely atheoretical status of existing enquiry13-17.
Theories that underpin development and delivery both of IPE and IPC are important for researchers who hope to build a high quality evidence base. Theories will interrelate IPE/IPC constructs and definitions towards an overall explanation of these phenomena, adding substance to the current observations and descriptions of interprofessional learning18. This should subsequently guide research and evaluation designs, which to date, are accused of being superficial, descriptive and theory-less with little justification given for why certain areas of the programme are being evaluated and no understanding of the outcomes or potential processes that may be at work within these19.
To counteract these criticisms, researchers have began to search other disciplines--to date sociology, psychology and education--for theories that may have utility in the field of IPE and IPC2,20 This resulted in a superabundance of theories on ‘offer’. However, few have been applied, tested or successfully implemented in practice settings. Theory in IPE and IPC need space to evolve and rise to the forefront of the research, policy and HSC practitioners’ agendas.
Despite the importance of theory to IPE/IPC research as well as practice and policy, and the plethora of theories that may have utility in this field, the emphasis on this theoretical aspect has limited appeal to many practitioners (medical educators as well as clinicians). This is symptomatic of the practice–academic-theory divide and the barriers to integration of theory into practice that keep this in place21. We argue that testing and application of these theories, and making these more accessible and applicable to practitioners, is essential to better understand interprofessional collaborative behaviours and how to manipulate these through practice and educational interventions, the ultimately goal being enhanced patient safety.
Dr Sarah Hean, Associate Professor, Bournemouth University, Chair, In-2-Theory Network
[email protected]
IN-2-THEORY: interprofessional theory, scholarship and collaboration
The task of raising the importance of theoretical undepinnings in research, policy and HSC practitioners’ agendas is the remit of a new international network: In-2-Theory. Its specific remit is to develop social science theory, and explore its practical application, in interprofessional collaborative practice (IPC) and interprofessional education (IPE). It aims to build sustainable working relationships with international colleagues to strengthens theoretical underpinnings of IPC and IPE and bridge the gap between theory and practice. Stakeholders include educators, practitioners, service users and researchers from a range of health, social care and psycho-social disciplines.
An invitation
The convening group of this special interest group would like to invite MedED world members to join In-2-theory Special Interest group pages in Medworld and contribute to the discussions and activities of this group or contact Dr Sarah Hean [email protected] for further discussion.
Some recommended reading
Hean, S., Craddock, D. and O'Halloran, C.(2009) Learning theories and interprofessional education: a user's guide. Learning in Health and Social Care, 8 (4). pp. 250-262.
Hean, S., Craddock, D. Hammick, H. (2012) Theoretical insights into interprofessional education Vol. 34, No. 2 , Pages 158-160
Hean, S. Craddock, D. Hammick, M. (2012) Theoretical insights into interprofessional education: AMEE Guide No. 62, Medical Teacher 2012 34:2, e78-e101
REFERENCE LIST
1. Lewin K (1951). Field theory in social science: Selected theoretical papers. New York, NY: Harper & Row
2. Department of Health (2001). Learning from Bristol: The report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary. London: Stationery Office, Department of Health
3. Department of Health (2003) Victoria Climbie – Report of an Inquiry by Lord Laming. London: Stationery Office, Department of Health.,
4. Department of Education (2010) Haringey local safeguarding children board serious case review ‘child a’ : London: Department for Education
5. Department of Health (2001) Working Together – Learning Together: A framework for lifelong learning for the NHS. London: HMSO.
6. Department of Health (2002) Reform of social work education and training. London: Department of Health.
7. General Medical Council (2009) Tomorrow’s Doctors Available at: http://www.gmcuk. org/education/undergraduate/tomorrows_doctors_2009.asp (Accessed 27/08/2010)
8. General Social Care Council (2002) Accreditation of universities to grant degrees in social care. London, GSCC.
9. Health Professions Council (2005) General Standards of Proficiency. London, Health Professions Council.
10. Nursing and Midwifery Council (2004) Standards of proficiency for pre-registration nursing education. London: Nursing and Midwifery Council.
11. WHO (2010) Framework for Action on interprofessional education and Collaborative practice, Geneva: WHO
12. Barr, H. (2010) Commentary: WHO Framework for Action, Journal of Interprofessional Care, 24(5): 475–478
13. Craddock, Deborah (2010) Pre-registration interprofessional education: an evaluative study using podiatry as an exemplar. University of Southampton, School of Health Sciences, Doctoral Thesis.
14. Hean S, Craddock D and O’Halloran C. (2009) Learning Theories and Interprofessional Education: A User’s Guide Learning in Health and Social Care 8(4):250-262
15. Clarke P. What would a theory of interprofessional education look like? Some suggestions for developing a theoretical framework for teamwork training 1. Journal of Interprofessional Care 2006;20(6):577-589.
16. Freeth D, Hammick M, Koppel I, Reeves S, Barr H. (2002) A critical review of evaluations of interprofessional education. London: LTSN-Centre for Health Sciences and Practices.
17. Barr H, Koppel I, Reeves S, Hammick M, Freeth D. (2005) Promoting Partnership for Health. London: Blackwell Publishing and CAIPE.
18. Parahoo K.(2006) Nursing Research: Principles, Process and Issues. London: Palgrave Macmillan.
19. Brazil K, Ozer E, Cloutier MM.(2005) From theory to practice: improving the impact of health services research. BMC Health Services Research 5(1)
20. Colyer H, Helme M, Jones I. (2006) The theory-practice relationship in interprofessional education. London: Higher Education Academy Health Sciences and Practice.
21. D’Onofrio, C.N.(1992) Theory and empowerment of Health Education Practitioners, Health Education Quarterly, 19 (3),385-40

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