STILL SUFFERING FROM THE ‘SILO EFFECT’: LINGERING CULTURAL BARRIERS TO COLLABORATIVE CARE

Abstract

This research project sought to draw out the contesting definitions of collaborative care among professional subgroups in maternity services. The paper contrasts medical and social models of knowledge and reports on qualitative evidence from midwives and doctors in Australian hospitals. The evidence indicates that collaborative care is welcomed by both midwives and doctors but that there remains a lingering residue of the ‘silo effect’ of the ‘old’ professionalism, characterized by hierarchical relations, divergent philosophies and competing domains. Although a ‘new professionalism’ has emerged that challenges the old hierarchies and professional dependencies, it too harbours lingering residues of the former dichotomy between midwives and obstetricians. These tensions and enmities will need to be resolved before genuine collaboration may take full effect. The objective is a relationship- focused model of care that transcends professional or woman-focused models. The ‘new’ professionalism may be expedited through mediation strategies, a version of which is the ‘sociological intervention method’ discussed in this article.1