Interprofesional collaboration occurs in a team context [1] and is “a type of professional work which involves different health and social care professions who regularly come together to solve problems or provide services” [2]. Patient-centred care is based on the unique needs of the patient and on the interpersonal relationship with care providers that enables these needs to be understood [3]. Some consider interprofessional collaboration as inherently patient-centred [4]. Furthermore, the blending of interprofessional collaboration in multidisciplinary teams and patient-centered care is a necessary amalgamation when it comes to delivering complex mental health services. Indeed, biopsychosocial roots of mental health problems impact multiple aspects of patients’ lives [5]. A plurality of views from the part of health care professionals are essential for providing all-inclusive, rounded services that meet patients’ complex needs [6, 7].
Interprofessional collaboration in multidisciplinary teams is effective in mental health settings. For example, it is found to improve patient health status and treatment compliance, reduce suicides and clinical errors, boosts professionals’ satisfaction and motivation, lowers admission rates and shortens stays [8-11]. Multidisciplinary teams however face key challenges in implementing interprofessional collaboration such as barriers caused by different professional cultures [12], divergent values [13], and lack of recognition of each others’ roles [14]. Patient-centered care is also intricate to manage [15] as teams need to consider more factors in delivering services. The delivery and implementation of optimal patient-centered care within mental health settings is a real challenge [16]. Collaborative relationships in mental health care teams are difficult to implement, require time, work and supportive structures [17] to address barriers including power differences, time constraints, medical dominance, communication challenges and lack of resources [18-20]. In general people agree: multidisciplinary teams work better for complex patients’ needs but they are challenging to manage for team members [17]. This study addresses some of these challenges by investigating the central role played by collaboration.
The objective of this study is to examine the role of potential correlates of patient-centered care perceptions in multidisciplinary mental health teams. The complexity of multidisciplinary teams calls for a multilevel approach where some variables are at the individual level while others are at the team level. This study will thus examine the role played by two important individual-level attitudes: belief in the benefits of interprofessional collaboration and informational role self-efficacy. This study looks at how collaboration at the team level potentially relates to these variables. Finally, this study examines the role collaboration plays in linking team work role behaviors to team-level patient-centered care perceptions.
Individual- and team-level perspective
Team interactions in general and collaboration in particular are team processes, that is, they are “acts that convert inputs to outcomes through cognitive, verbal, and behavioral activities directed toward organizing taskwork to achieve collective goals” [21]. Specifically, collaboration is the interplay of four processes: teamwork communication, synchronicity, explicit coordination, and implicit coordination [22]. Communication involves effective information exchange. Synchronicity encompasses working with others on time and in time. Explicit coordination involves overt exchanges on role and task assignments and implicit coordination consist of anticipation of others’ needs without resorting to explicit coordination. Processes and the interactions they foster act as a social context impacting team members’ behaviors and attitudes [23, 24].
As such, collaboration might impact two key yet understudied attitudes. First, not all healthcare workers may be absolutely convinced of the benefits of interprofessional collaboration given some of the challenges in multidisciplinary teams. Yet, belief in the benefits of interprofessional collaboration predict job satisfaction, knowledge exchange and trust [25]. Also, belief in the benefits of interprofessional collaboration is associated with patient-centered care perceptions, especially if collaboration is high. Second, interprofessional collaboration cannot be effective if team members are not able to share pertinent information [4] such as their expertise. Informational role self-efficacy is individuals’ beliefs in their capability to communicate their expertise so that it impacts others’ performance [26]. Interestingly, according to San Martin Rodriguez et al. professionals “know very little of the practices, expertise, responsibilities, skills, values and theoretical perspectives of professionals in other disciplines” [27]. It is therefore key to believe one can communicate their own expertise to others on the team, and of course engage in corresponding behaviors. Consequently, we will test the following hypothesis (see Figure 1):
Hypothesis 1: The relationship between (a) belief in the benefits of interprofessional collaboration and patient-centered perception and the relationship between (b) informational role self-efficacy and patient-centered perception that both occur at the individual level will be moderated by collaboration at the team level, such that both relationships will be more positive and stronger.
Team-level perspective
Teams must adapt to face the complexities and challenges of the work they are required to accomplish [28]. As such, “adaptation lies at the heart of team effectiveness” [29]. Challenges are numerous. For example, decision-making in multidisciplinary teams is significantly more difficult than when there is less diversity around the table [30] which requires adaptation. Two intertwined sets of task-related behaviors are important for a team to adapt: adaptivity and proactivity. Team member adaptivity is the extent to which team members deal with, answer, and/or support changes that affect team roles while team member proactivity has to do with how individuals engage “in self-starting, future-directed behavior to change a team’s situation or the way the team works” [31]. Logically team member adaptivity and proactivity should lead to positive outcomes and in the case of multidisciplinary mental health teams it should impact their ability to deliver patient-centered care.
Teamwork implies task, role and resource interdependence [32] and collaboration (as defined above) is how interdependence is enacted. Maynard at al. [28] theorize that action processes mediate the relationship between task-based work and outcomes. In this study this translates into a process such as collaboration being the mechanism through which adaptivity and proactivity is transformed into patient-centered care perceptions. Consequently, we will test the following hypothesis (see Figure 1):
Hypothesis 2: The relationship between team adaptive and proactive behaviors and team-level patient-centered care perceptions will be mediated by collaboration.