Six main themes emerged, described in more detail below (see Table 2).
|Physically close interaction, inclusion of clients and understanding clients’ individual needs
|Quick flow of communication, participation and common approach
|Inclusion of other professions and sectors, and non-hierarchical work
|Capacity for interaction and cooperation, respect for others’ knowledge, commitment to change and utilization of potential
|Purposeful action, enablement of developmental work and boundary-crossing work
|Commitment of management, prioritization, structured action, justification and clear division of work
Physically close interaction, inclusion of clients and understanding clients’ individual needs
A need exists to understand the work of other professionals. “… occupational groups are quite awfully separated from one another, are not familiar with one another’s work. The work that they tangibly do, that is to say they should also be combined so that we get started a greater amount of information” (P2).
Physically close interaction promotes a functional collaboration that enables the exchange of information and reduces communication difficulties. “… this previous idea that work partners working in their own rooms… the exchange of information does not occur then” (P3) and “… it in some way complicates communication when you are in different buildings and are further away” (P4).
The inclusion of clients and understanding of their individual needs is central to promoting collaboration. “Especially in primary care, you must think about who it is who is using our services… that is to say how you really start immediately guiding these patients to the right professional groups” (P3). A holistic view of clients and a broader perspective are needed to address clients’ diverse care needs, which in turn requires collaboration with different healthcare professions.
“Because things are often… especially if it is about a multi-problematic person who uses a lot of services at a healthcare center… it often happens that he/she for example has substance abuse problems and then help is needed for that as well. There are complex cases” (P1).
“It is no longer the case that there is a problem with the left ear but instead the client is a whole, if you want to provide care it does not succeed without collaboration with different healthcare professions… I hope that healthcare and nursing education in the future will specifically highlight this, that what are clients’ needs” (P4).
Quick flow of communication, participation and common approach
The quick and functional flow of communication between different actors is important for the sharing of knowledge and information. “Collaboration between different healthcare professions means to me that… it is easy and quick to consult and ask, to consider things” (P1).
“… we have aimed for quick communication… it is very tiring if you are not used to such continuous communication but it is the only way to in some way [make it work] with the interprofessional team or on the whole [get] information to move… it must get started” (P3).
Inclusion leads to participation, which promotes collaboration. Allowing caregivers to collaborate and feel like important actors in a larger context allows caregivers to present their perspective on a matter and their knowledge. “I think it is important to do it together so that there does not only come dictated instructions that now you do this like this…” (P1) “… it presupposes that the team includes the members who should belong to it and that all resources are used” (P3).
“…at best the collaboration between different healthcare professions has been that we have had all the staff involved in developing… where the staff have gotten to say their own perspective… what helps is to do together with everyone, even if some are not so enthusiastic” (P2).
A common approach also facilitates collaboration. “…there should be common approaches and rules for everyone” (P2) “I miss it more… such purposeful movement in a direction toward that we have [things in common]” (P5).
Inclusion of other professions and sectors, and non-hierarchical work
A need for the inclusion of various other professions and sectors in collaboration was revealed.
“Of course the wider the team is and of course the more different people there are, different professions, the better… you should bring together different professions to get a greater amount of information to continue on” (P1).
Another participant stated:
“…we have a lot of specialization and sometimes we cannot utilize the right profession in handling the matter… that we ourselves try to do when there is an expert somewhere else but how can you utilize that knowledge when we do not know it… professionals who are not in the team remain a little unfamiliar. And then making the most of the situation deteriorates” (P4).
Collaboration also entails more than working within one’s own team. “… I see collaboration between different healthcare professions [as being] much broader than [within] your own team” (P2). More collaboration between mental health, social and substance abuse care services was highlighted.
“We still lack mental health and social services… the support for the team… that we get integrated mental health services, the survival of primary care is otherwise impossible” (P3). “But there is a lot in healthcare that you do not know exists for example knowledge about substance abuse care…” (P4).
The participants mentioned that major changes have occurred over the years and sought to further emphasize the importance of non-hierarchical work as something that promotes collaboration between professions. “… there is no longer such a hierarchical work as there used to be” (P1). “…you are in completely different spheres even if [previously] there was cooperation between different healthcare professions but it is probably so much closer and such… low hierarchical” (P3). Non-hierarchical work has several benefits.
“... if it is traditional top-down leadership then you really do not get the staff involved in any way ... hierarchical leadership leads to the management not hearing what the staff say, mistakes are easily made, setbacks to development projects” (P2).
Capacity for interaction and cooperation, respect for others’ knowledge, commitment to change and utilization of potential
The capacity for interaction and cooperation is needed to develop understanding of the importance of teamwork and thus collaboration. “… it presupposes the capacity for interaction …” (P4). Another participant said:
“It takes understanding of that we are not here to work alone or that this is just my thing but instead this is our common [thing]… to understand that we work as a team… this is not just your work list or your patient but instead it is the team’s common… the idea of a team emanates in some way already from [one’s] educational background…” (P3).
Respect and understanding for others’ knowledge was strongly emphasized as an important component for the development of collaboration. “All professions are needed but more so that we understand what each can give to exactly that moment ... or to a certain situation” (P3). “It presupposes mutual trust between professionals. That you appreciate and trust others’ expertise” (P4). Sharing knowledge with one another was considered enriching.
“… the fact that you probably will get a lot more out of it when there are perspectives from different areas… and gives faith that if we share information or knowledge and take courageous responsibility for other people’s domains so I think it will save time and resources…” (P5).
It was noted that commitment to change was needed by all those involved in a situation, project or team. “…in a collaborative project there must be people who have the best knowledge of the matter, everyone must be given the opportunity to develop” (P2). Open conversation, commitment to change and understanding are needed, because change is an ongoing process. “…the development starts from a general state of will, atmosphere. A willingness that you will do and you will see the client as a goal…” (P4).
The utilization of potential is also needed to develop collaboration. One participant said: “The starting point for you being able to really utilize knowledge is the utilization of potential in order to benefit clients” (P4). The importance of highlighting own knowledge and contribution to collaboration were also emphasized. Support is needed to facilitate the ability and opportunity of staff to contribute their knowledge during collaboration.
“…[Staff] need to experience that their care leader trusts them and what they do… that they get to feel that you appreciate their work… to further enable and recognize their own and subordinates’ potential and make it visible for the teams… it is part of the care leader’s role to promote each professional’s skills. And what benefit it has for the team” (P3).
Purposeful action, enablement of developmental work and boundary-crossing work
Purposeful action and the enablement of developmental work were highlighted.
“The fact that it is possible to develop collaboration together with the staff… that you give the opportunity to delve into the matter… from the organization the goals and the opportunity to be able to prioritize collaboration [in]to your own work… Support to enable cooperation” (P2).
The participants even experienced that boundary-crossing work was needed to increase understanding for other sectors and the skills inherent to other sectors. “… we work in our own compartments… we must become aware of what is going on in different units in order to be able to guide residents in the municipality” (P5). “…you should get away from these sectors… where you ‘live’ especially in larger organizations” (P4). Engaging in boundary-crossing work requires the ability to “step outside” one’s “comfort zone”. “…a leap into the unknown can often give rise to resistance at first… until you realize that it works and that it is a good thing” (P1).
The development of collaboration between different healthcare professions was considered to be beneficial for clients, staff and the organization. It was perceived to lead to better care and care quality for clients. Also, that effective collaboration allowed the “voice” of all parties to be heard and facilitated the more efficient management of work. “…for clients it is valuable to have an interprofessional team that takes care of their things” (P1). Another revealed: “… I see the collaboration between different healthcare professions [as being] important for clients’ better care and quality assurance” (P4).
Commitment of management, prioritization, structured action, justification and clear division of work
The participants noted that the commitment of management and the organization were needed. Management and the organization must demonstrate openness and provide a clear picture of their expectations and goals for the development of collaboration. They even stated that care leaders lead by example and highlighted that staff can have difficulty developing collaboration if their care leaders do not support boundary-crossing work.
“Before there can be broader cooperation between different healthcare professions for staff it must [be] owned and be a goal for all care leaders, management and organization… it must be the organization’s and management’s view that such collaboration is realized and developed… until it also engages upper management and own care leaders” (P2).
Leadership plays an essential role in how development projects are presented and received. “…even that how you present this type of reforms... and how it then should be processed to get all professionals alongside so well that they understand the benefits of it… when everyone is involved in it it works” (P1).
Prioritization of the development of collaboration must occur for change to be possible. “…challenges occur naturally when resources are insufficient, in other words there is too much pressure so then it easily happens that things do not progress” (P1). The participants experienced that time was needed for change as well as the enablement of the prioritizing of collaboration in one’s actions. “…it [collaboration] needs clear goals, purposefulness, prioritization, all vision far to the future, planned… it must be prioritized in the sequence” (P2).
Time, structured action and well-thought-out planning are needed to develop collaboration and collaborative processes.
“… it presupposes that everyone is clear about what the lodestar is, i.e., what we strive for and what the goal is. And the way there… You must in an open manner write out these steps and how the thought is that we achieve the goals” (P5).
Justification of why developing collaboration is important, including explanation of the new things collaboration can entail for one’s work and for clients, is needed. The participants perceived that is important to be clear and certain that everyone understands collaboration in the same way and to have information about the development of collaboration visible for all. To facilitate the workload, all staff are needed in the development of collaboration as well as a clear division of work.
“… I have such a perception that [the development of collaboration between different healthcare professions] does not really progress under its own flag but that there must be someone responsible for it. … care leader or a named responsible person…” (P5).