Episode #9: Interprofessional Collaboration: The Upside of Hierarchy

Interprofessional Collaboration:  The Upside of Hierarchy

Introduction to Episode:

Relationships are a critical element of interprofessional collaboration. 

In today’s episode, we discuss hierarchy and partnership within the context of interprofessional collaboration in the healthcare setting. 

There is a long history in the evolution of the health professions and how they work together that is rooted in social class and gender differences.

There is extensive literature describing the status inequities and power imbalances between physicians, nurses and other health professionals that exist today.

Historically these differences resulted in a hierarchical power structure within healthcare with the physician in the most superior position of the structure.  Interprofessional collaboration and team processes challenge this hierarchical power structure.

Health professionals bump up against the tension between hierarchy and partnership every day as they try to work in collaborative ways.

When we experience hierarchical relationships as negative or as a problem, it’s natural to want to move away from the experience and toward the opposite, a more partnering relationship.   

There is an upside to hierarchical relationships that we are at risk of losing if we over emphasize partnerships. 

We need both hierarchical and partnering relationships to establish a healthy interprofessional collaborative culture. 

Episode Summary Points:

·         Long history of cultural, class and gender issues underlying current interprofessional collaboration

challenges

·         Power authority within hierarchical structure of healthcare is challenged by interprofessional team

processes

·         Lack of clarity on professional boundaries

·         The term hierarchy brings up negative feelings/emotions

·         Discuss this relationship using neutral terms vertical (hierarchy) and horizontal (partnership)

relationships

·         Cardiac arrest as an example of leveraging hierarchy and partnership (vertical/horizontal) polarity

·         When in the downside of hierarchical (vertical) relationship it is often seen as a problem to solve

·         Positive outcomes of vertical (hierarchy) relationship

·         What’s at risk if you over emphasize horizontal (partnership) relationships

·         Action steps to achieve positive outcomes of both vertical and horizontal relationships

·         Focusing on the shared purpose can help relieve tension and open people up to positive attributes of

each pole

 Teaching Points:

·         Both types of relationships are necessary to establish an interprofessional collaborative culture

·         Engage in dialogue to uncover the “rightness” of each type of relationship

·         Recognize your preference pole and blind spots

·         If you are in a position of power be aware of how your preference can influence how well or poorly

this polarity is leveraged

·         Use Polarity Thinking™ framework and language to explore current realities and establish complete

picture of reality

References:

Alexarian, J.A., Kitto, S., Rak, K.J., & Reeves, S. (2015). Beyond the team:  Understanding interprofessional work in two North American ICUs. Critical Care Medicine, 43(9):  1880-1886 

Goldman, S., Reeves, S., Wu, R., Silver, I., MacMillan, K., & Kitto, S. (2016).  A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning.  Journal of Interprofessional Care, 30(2):  217-225.  doi:  10.3109/13561820.2015.1072803 

Hall, P. (2005). Interprofessional teamwork:  Professional cultures as barriers. Journal of Interprofessional Care, Suppl 1:  188-196. 

Hewitt, G., Sims, S., & Harris, R. (2014).  Using realist synthesis to understand the mechanisms of interprofessional teamwork in health and social care.  Journal of Interprofessional Care, 28(6):  501-506.  doi:  10.3109/13561820.2014.939744 

Lingard, L., McDougall, A., Levstik, M., Chandok, N., Spafford, M. M., & Schryer, C. (2012).  Representing complexity well: A story about teamwork, with implications for how we teach collaboration.  Medical Education 46: 869–877 doi:10.1111/j.1365-2923.2012.04339.x 

Orchard, C. A., Curran, V., & Kabene, S. (2005).  Creating a culture for interdisciplinary collaborative professional practice.  Medical Education Online, 10(1):  4387.  https://doi.org/10.3402/meo.v10i.4387. 

Wesorick, B. (2016). Polarity Thinking in Healthcare:  The Missing Logic to Achieve Transformation. Amherst, MA, HRD Press, Inc.  

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