Collaborative practice: a grounded theory of connecting in community rehabilitation
Penney, Pauline Ruth
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Worldwide, healthcare provision is under pressure. Increasing demand for services combined with a shortage of healthcare workers and resources means innovative ways of working are needed. Interprofessional collaborative practice provides one way of managing this need, with research indicating benefits for clients, teamwork, and resource management. Despite this, errors in interprofessional working continue to occur in practice. The consequences of this are not only resource inefficiency, but also adverse client events, with many examples of failures in interprofessional working highlighted in reports from the New Zealand Health and Disability Commission and other international patient safety reports. Therefore, developing understanding of collaborative practice is an important area of research. While previous studies have explored collaborative practice in the areas of hospital care, in-patient rehabilitation, mental health, and palliative care, less is known about collaboration in the community setting. To rectify this knowledge gap, this constructivist grounded theory provides a theoretical explanation of collaborative practice in community settings, which can be used to inform clinical practice, education, and further research. Data was gathered from 39 interviews of healthcare workers, and from 22 hours of field observations with two rehabilitation teams. This was then analysed using constant comparative analysis. From the analysis a substantive theory of connecting was constructed, its three main theoretical categories being liaising, forming-reforming, and guarding behaviours. Three key findings emerged that contribute new knowledge to the field. Firstly, the central challenge healthcare workers faced in interprofessional community work was found to be complexity management. This involved managing the interlinked areas of client complexity, relational complexity, and situational complexity. Secondly, connecting was established as an essential process HCWs used in order to enhance collaboration and manage the different aspects of complexity in community work. Thirdly, it was clear in the research that interprofessional work in the community necessarily encompasses interagency work. The latter was poorly coordinated however, producing barriers to collaborative practice that resulted in clients and their families often needing to coordinate their own care across agencies. The research findings lead to some important conclusions for future health workforce development. Enabling interprofessional work in the community health environment requires clear processes and structures that enhance collaborative practice. However, these processes and structures were understood and operationalised differently by healthcare workers and team leaders. The processes also differed from the approach reflected in policy documents. The theory of connecting developed in this research assists in clarifying these differences, and contributes to knowledge by explaining the context, strategies and perspectives healthcare workers use that result in improved collaborative practice.