Interprofessional collaboration: what really blocks it
Nobody disputes that collaboration between the professions would be better. It nonetheless rarely happens — for four reasons, only two of which are in a practice's hands.
Texts on interprofessional collaboration almost always open with a list of its benefits: less duplication, fewer medication errors, shorter routes, better outcomes, more satisfied staff. All true, and it helps nobody, because nobody collaborates badly out of ignorance of those benefits.
The interesting question is the other one: why does it happen so rarely anyway? The answer consists of four obstacles, and they vary in how fixable they are.
Obstacle 1: there is no shared channel
The GP works in her practice system, home care in theirs, the pharmacy in a third, physiotherapy in a fourth. None of these systems talks to the others. Anyone wanting to pass something on reaches for the phone or the fax.
This is the only obstacle that can be solved technically, and it is the largest. A channel everyone involved can reach , without anyone having to use somebody else's system, removes most of the friction — not because it creates new possibilities but because it replaces the attempted calls.
Obstacle 2: it is unclear who decides
As soon as several professions work on one case, the question arises of who makes which decision and who has to inform whom. As long as that is not written down, it gets negotiated afresh every time — and in doubt the message is not sent, because nobody is sure it was their job.
This is fixable, and costs no technology but half an hour and a sheet of paper: for the three most common situations, write down who decides, who is informed, and within what period. No more is needed, and no less will do.
Obstacle 3: coordination is not remunerated
Time spent on coordination is generally not billable. Whoever coordinates does so at the cost of their own time, and that holds for everyone involved simultaneously.
A single practice can change nothing about that. What it can change is the effort per exchange: when a query costs two minutes rather than three attempted calls, the calculation shifts without the remuneration changing.
Obstacle 4: the information arrives too late
The discharge letter arrives when the patient has long since been back in the practice. The pharmacy learns of a medication change after dispensing. Collaboration fails here not on willingness but on sequence.
Collaboration consists in large part of reaching somebody. What fails at that fails not on attitude but on the route.
This too is half solvable. A short message on the same day replaces no report, but it closes the gap in which decisions are otherwise made on an incomplete basis.
What a single practice can do
- 1
Set up a channel before describing processes
Without a route the best agreement is useless. With a route many agreements settle themselves, because asking becomes cheaper than assuming.
- 2
Write down who decides, for three situations
Medication change, discharge from hospital, deterioration at home. Those three cover most of the cases in which several professions are involved.
- 3
Obtain consent once rather than every time
A written consent to exchange between the clinicians takes the legal uncertainty out of every individual case.
What remains is the remuneration problem, and that is not one a practice can solve. Tackling the rest is still worth it: three of the four obstacles are routes and responsibilities, and both are closer to hand than they look.
