Factors that facilitate or inhibit interdisciplinary collaboration within a professional bureaucracy

This study was designed to identify factors that facilitate or hinder interprofessional collaboration across discipline lines (interdisciplinary). The "Attitudes Toward Health Care Teams" scale was administered during the Spring and Summer, 1994, to a convenient sample of registered nurses, physicians, social workers, and pharmacists who worked on interdisciplinary health care teams within a large teaching veterans' hospital. There were 200 completed surveys with an overall return rate of 64.7%. ANOVAs and Tukey HSDs statistical tests were ran on the resulting data provided the following results: (1) Physicians were less favorable than the other three groups in their attitudes toward the "quality of care" and the "cost of care" afforded by interdisciplinary teams (.01 level of significance). (2) Physician and pharmacy groups were more favorable than the social work and nurse groups in their perception of the centrality of the physician to the health care team (.01 level of significance). (3) Women were more positive than men about the quality of care and cost of care afforded by interdisciplinary health care teams (significant at the.01 level). (4) Men were more favorable than women toward the centrality of the physician to the health care team (significant at the.05 level). (5) Non-team members rated the physician's centrality higher than persons currently holding membership on teams (.01 level of significance).;In addition, eight undisciplinary focus groups (two from each of four disciplines: Medicine, Nursing, Social Work, and Pharmacy), and two interdisciplinary focus groups, each with five to seven participants, participated in a Total Quality Management (TQM) exercise designed to identify factors perceived by them to either facilitate or inhibit interprofessional collaboration among health care team members. Eight general themes emerged as facilitating factors: (1) a common missing; (2) open communication; (3) patient centered care; (4) competence; (5) commitment; (6) positive attitudes; (7) respect; and (8) leadership. There were 22 themes that emerged as inhibiting factors: (1) lack of leadership; (2) difficult personal behaviors; (3) lack of personal commitment; (4) lack of conflict management; (5) unclear mission; (6) lack of communication; (7) insufficient time and excessive workload; (8) boundary issues; (9) lack of administrative support; (10) lack of respect; (11) incompetence; and (12) lack of structure. The most striking difference found among disciplines was in their concept, and preferred style, of leadership.