What is ‘Collaborative Practice’ anyway?

Collaborative practice, interprofessional care, interdisciplinary care...these are phrases that get kicked around a lot in health literature, conferences and board meetings. The PEIHSC held a forum in May 2008 called the ‘Collaborative Practice forum’, so you would think that when the new Executive Director at the PEIHSC called me into his office to talk about our next year of activities and asked if I could define collaborative practice that I could give a pretty good answer, right? Well, I found myself stumbling to come up with a clear definition of how collaborative practice and interprofessional care differs from how the majority of health facilities currently operate.

I went back to an article I wrote on this subject in one of our newsletters where I quoted a definition of collaborative practice by Carol P. Herbert. She defines collaborative practice in her article “Changing the culture: interprofessional education for collaborative patient-centred practice in Canada” as “the continuous interaction of two or more professionals or disciplines, organized into a common effort, to solve or explore common issues with the best possible participation of the patient.” But what makes a practice truly collaborative, and how does that definition distinguish a collaborative practice from any other practice?

At its core, interprofessional care has to do with breaking down walls and making a shift from autonomy to interdependency. Individuals engaged in collaborative practice are mutually dependant on each other and are aware of each others’ expertise. Power is shared among team members, including the patient. Making this shift might mean the actual removal of physical walls and changing a practice into an open concept space with minimal or zero private office space. It will certainly mean instituting practices that promote collaboration and the sharing of information – multidisciplinary rounds for example, where the practitioners in a collaborative practice facility meet to discuss and recommend steps for a particular client’s care, often with the participation of that client.

James and I recently met with two individuals who were instrumental in setting up a collaborative practice facility here in Charlottetown. Something about the facility that struck both of us as a defining characteristic of interprofessional care was the adoption of a horizontal communication structure. Adopting a philosophy of horizontal communication blurs the lines between roles, removes traditional boundaries and promotes the deliberate exchange of knowledge, skills and expertise.

Getting back to Carol Herbert’s definition of collaborative practice, I think that three of the key concepts in that definition are “continuous interaction”, “organization” and “patient participation.” I’m sure that almost any health worker would agree that they interact with other health professionals to solve and explore common issues for their patients. Continuous interprofessional interaction that is organized by means of institutional policies and models of care, which includes the client as a contributing member of the team is what really distinguishes interprofessional care.Of course, that’s just my opinion. We’d like to hear yours.

Cheers,
Mark