Interdisciplinary teamwork and collaboration in health care are assuming greater importance as changes in social and economic conditions, demographics, and diseases converge to focus attention on models of health care delivery. Many major health care reform initiatives in government and in the private sector have emphasized elimination of duplication and fragmentation through referrals, networking, and coordination. In today's climate of cutbacks, managed care, and deprofessionalization, the efficiency of the health care system will increasingly depend on the ability of social workers, physicians, and other health care providers to collaborate effectively in the provision of services to patients.
This article presents a subset of data from a larger study that explores the nature of social worker-physician collaboration in hospital settings. The article will focus on positive and negative collaborative experiences between social workers and physicians to identify factors that facilitate successful collaboration and factors that impede it. We asked members of both professions to share their best and worst experiences with the other profession, expecting that extreme examples would help us address two research questions:
First, do the two professions identify similar or different factors in describing their experiences. In other words, are there universal collaborative factors, or does each profession have distinct and separate priorities in evaluating collaborative experiences? Based on our knowledge of differential socialization processes, we hypothesized that social workers and physicians would value different aspects of their experiences. Second, do positive and negative experiences evoke similar or different reactions with respect to the contribution of various factors? We hypothesized that respondents would emphasize different factors in evaluating their positive and negative experiences. Answers to these two questions can increase understanding of collaboration; help professionals improve collaborative skills; and contribute to the development of a well-coordinated, collaborative model of patient care.
Impediments to Collaboration
Much of the literature on collaboration has a negative emphasis, focusing on the obstacles to effective interdisciplinary functioning, particularly in team situations. Conflict among collaborators as a result of varying professional or personal perspectives can undermine collaborative efforts (Lowe & Herranen, 1978; Sands, Stafford, & McClelland, 1990; Schindler, Berren, Hannah, & Belgel, 1981). Role competition, role confusion, and turf issues also cause interdisciplinary tensions because each discipline must sacrifice some degree of autonomy for collaborative problem solving to take place (Abramson & Rosenthal, 1995; Campbell-Heider & Pollack, 1987; Kulys & Davis, 1987; Lowe & Herranen, 1978; Watt, 1985). Role definition poses problems as well. A number of studies have identified discrepancies between the perceptions of social workers and those of physicians regarding functions assigned to social workers. In particular, counseling activities are more often seen as a prime social work responsibility by social workers than by physicians (Carrigan, 1978; Huntington, 1981; Koeske, Koeske, & Mallinger, 1993; Lister, 1980).
Conflict also can arise from variations in professional socialization processes (Mizrahi & Abramson, 1985; Sands, 1989). Members of each profession define their role and the goals of services to clients differently and impart distinct values and culture in training their recruits (Cowles & Lefcowitz, 1992; Huntington, 1981; Mizrahi, 1986; Roberts, 1989). Communication difficulties then arise and often are ascribed to interpersonal dynamics rather than recognized and addressed as interprofessional in nature (Abramson & Mizrahi, 1986).
Physician dominance of team and interprofessional decision making has remained a critical issue for other health professions (Abramson, 1989; Campbell-Heider & Pollock, 1987; Dingwall, 1982; Freidson, 1984; Sheppard, 1992; Watt, 1985). …