Primary Health Care Research & Development

Research

The impact of space and time on interprofessional teamwork in Canadian primary health care settings: implications for health care reform

Ivy F. Oandasana1 c1, Lesley Gotlib Conna2, Lorelei Lingarda3, Allia Karima2, Difat Jakubovicza4, Cynthia Whiteheada5, Karen-Lee Millera6, Natalie Kenniea7 and Scott Reevesa8

a1 Director, Office of Interprofessional Education; Associate Professor and Research Scholar, Department of Family and Community Medicine; Faculty of Medicine, University of Toronto; Academic Family Physician, Family Health Centre (FHC), Toronto Western Hospital, Toronto, Ontario, Canada

a2 Research Associate, Office of Interprofessional Education, at the University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada

a3 Associate Professor, Department of Pediatrics, University of Toronto; Scientist, Wilson Centre for Research in Education at the University of Toronto, Toronto, Ontario, Canada

a4 Assistant Professor, Department of Family and Community Medicine, University of Toronto; Staff Physician, St Joseph’s Health Centre, Toronto, Ontario, Canada

a5 Assistant Professor, Department of Family and Community Medicine, University of Toronto; Staff Physician, Women’s College Hospital, Toronto, Ontario, Canada

a6 Research Associate, Li Ka Shing Knowledge Institute (at time of research); Research Associate, Public Health Agency of Canada; PhD candidate in the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (currently)

a7 Primary Care Pharmacist, St Michael’s Hospital, Toronto, Ontario, Canada

a8 Scientist, Li Ka Shing Knowledge Institute of St Michael’s Hospital; Director of Research, Centre for Faculty Development, St Michael’s Hospital; Scientist, Wilson Centre for Research in Education; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Abstract

Aim This paper explores the impact of space and time on interprofessional teamwork in three primary health care centres and the implications for Canadian and other primary health care reform.

Background Primary health care reform in Canada has emphasized the creation of interprofessional teams for the delivery of collaborative patient-centred care. This involves the expansion and transformation of existing primary health care centres into interprofessional family health teams (FHT) promising to provide patients better access, more comprehensive care, and improved utilization of individual health professionals. Benefits for providers include improved workplace satisfaction and organizational efficiencies. Currently, there is little evidence for how effective interprofessional teamwork happens and little is known about how to create high-functioning teams in the primary health care setting.

Methods We used ethnographic observations and interviews to gain a deep understanding of the nature of interprofessional teamwork. Three academic family health centres participated in a total of 139 h of observation and 37 interviews. Team members in all three centres from the disciplines of medicine, nursing, physiotherapy, occupational therapy, social work, dietetics, pharmacy, and office administration participated in this study.

Findings We found that both the quantity and quality of interprofessional communication and collaboration in primary health care is significantly impacted by space and time. Across our research sites, the physical layout of clinical space and the temporal organization of clinical practice led to different approaches to, and degrees of success with, interprofessional teamwork. Varied models of interprofessional collaboration resulted when these factors came together in different ways. These findings have important implications for the transition to interprofessional family health teams in Canada and beyond.

(Received June 18 2008)

(Accepted March 10 2009)

Key words

  • communication;
  • ethnography;
  • interprofessional teamwork;
  • primary health care;
  • space;
  • time

Correspondence:

c1 Correspondence to: Ivy F. Oandasan (MD CCFP MHSc FCFP), Office of Interprofessional Education at the University Health Network, Toronto Western Hospital, 750 Dundas Street West, Suite. 302 Toronto, Ontario M6J 3S3. Email: ivy.oandasan@uhn.on.ca

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