Working and learning together in rural hospitals: Engaging across boundaries to enhance collaborative practice

Author: Lyn Gum

Gum, Lyn, 2017 Working and learning together in rural hospitals: Engaging across boundaries to enhance collaborative practice, Flinders University, School of Medicine

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Abstract

Rural practice in Australia has its own unique challenges with a growing need to provide team-based care. The aim of this three-phase qualitative case study was to explore whether work-based interprofessional education (IPE) promoted interprofessional learning (IPL) and subsequent collaborative practice in three rural hospital settings. An integrative review was undertaken in order to consider previous IPE interventions and explore theoretical and conceptual literature in this field. The review highlighted concerns associated with drawing conclusions from IPE activities. Unique barriers to collaborative practice in rural health services were revealed, such as power imbalances and organizational boundaries. Phase One, established baseline data for each rural hospital setting by exploring everyday practice and perceptions of health professionals and staff working there. The findings for Phase One informed Phase Two which focused on the planning and implementation of work-based IPE activities. Phase Three determined whether there was any impact of the activities on collaborative practice. The analysis explored the relationships between the health professionals in each hospital and contextual factors—communication, interprofessional relations and the environment—with the purpose of being able to contribute to IPE theory. Furthermore, five different types of IPE interventions were analysed under the following headings: venue, seating, attendees and their engagement with the session, session content, IPL, and reactions to the session. Having five different types of IPE interventions allowed for comparison, revealing that contact theory, reflective practice theory and constructivist learning theory all positively contributed to interactive and interprofessional learning. The study revealed the current challenges of rural practice in South Australia from the perspective of health professionals, managers, administrative staff and hotel service workers working in three rural hospitals. The cross-case analysis highlighted the complexity of rural collaborative practice, as well as the difficulties associated with work-based IPE delivery. Four themes were discussed: teamwork in the rural health environment, conceptualising collaborative practice in rural hospitals, sharing of educational experiences, and the impact of physical space on collaborative practice. A dominance of profession-based communities of practices was found to exist within the rural health setting and hindered the IPE–IPL–collaborative practice nexus. Collaborative practice is socially constructed, and therefore may or may not develop in rural health services depending on how well interprofessional learning is understood, supported and attended by all professions. Further research will be needed to explore whether interprofessional communities of practice are a solution to strengthen the IPE–IPL–collaborative practice nexus, in particular how local changes could be supported to promote collective learning.

Keywords: interprofessional education, interprofessional learning, interprofessional, rural practice, collaborative practice, communities of practice, power imbalance, teamwork, communication, case study, rural hospital, health professionals
Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Medicine
Supervisor: Emeritus Professor David Prideaux