Interprofessional collaboration among care professionals in obstetrical care: are perceptions aligned?

Abstract

Introduction: Integrated care requires effective collaboration between different care professionals. To achieve a high level of interprofessional collaboration it is important to discuss and align perceptions of collaboration. In an obstetrical team, obstetricians, midwives and nurses work together in a dynamic and complex care setting. Different professional cultures can be a barrier for effective interprofessional collaboration. Although the different professional cultures in obstetrical care are well known, little is understood about discrepancies in mutual perceptions of collaboration. We aimed to understand how different care professionals in an obstetrical team assess interprofessional collaboration to gain insight into the extent to which their perceptions are aligned. Methods: This cross-sectional study was performed in the north-western region of the Netherlands. Care professionals from five hospitals and surrounding primary-care midwifery practices were surveyed. The respondents consisted of four groups of care professionals: obstetricians N=73, hospital-based midwives, known as clinical midwives N=41, nurses N=154 and primary-care midwives N=109, an overall response rate of 80.8%. We used the Interprofessional Collaboration Measurement Scale IPCMS to assess perceived interprofessional collaboration. The IPCMS distinguishes three subscales: communication, accommodation and isolation. All respondents completed the 13-item questionnaire for each of the other three professions, enabling interprofessional comparisons. Data were analysed using non-parametric tests. Results: Overall, obstetricians rated their collaboration with clinical midwives, nurses and primary-care midwives more positively than these three groups rated the collaboration with obstetricians. The interprofessional collaboration between clinical midwives, nurses and primary-care midwives showed fewer significant discrepancies. Discrepancies in mutual perceptions were most apparent in the isolation subscale. Discussion/Conclusion: We found relevant discrepancies in mutual perceptions of collaboration in obstetrical care in the Netherlands. Especially, discrepant perceptions for the isolation subscale indicate a potential for improving collaborative practice. This scale is about sharing opinions, discussing new practices and respecting each other. Efforts to improve interprofessional collaboration often include team training interventions based on Crew Resource Management CRM. CRM focuses on team performance and coordination by addressing non-technical skills such as leadership, communication and collaboration and by discussing barriers, like differences between professional cultures. These interprofessional team trainings could help to increase shared understanding and reduce discrepancies in perceptions of collaboration. Lessons learned: Research on perceptions of interprofessional collaboration produces relevant insights for design and delivery of integrated care. An environment and tools that enable sharing opinions and discussing practices seem particularly important to support interprofessional collaboration. Limitations: A limitation of this study was the assessment of care professionals as homogenous groups. In addition, the internal consistency of the three subscales varied. This indicates that more research is needed on the translation and validity of the questionnaire in different care settings.