Academic journal article The Qualitative Report

The Phenomenon of Collaboration: A Phenomenologic Study of Collaboration between Family Medicine and Obstetrics and Gynecology Departments at an Academic Medical Center

Academic journal article The Qualitative Report

The Phenomenon of Collaboration: A Phenomenologic Study of Collaboration between Family Medicine and Obstetrics and Gynecology Departments at an Academic Medical Center

Article excerpt

There is a growing recognition that complex health issues necessitate intersectoral collaboration among medical specialties and with others outside of medicine. Collaboration in health care is cited as essential by national professional organizations (American College of Physicians, 2006; Future of Family Medicine Project Leadership Committee, 2004; Institute of Medicine, 2001; Lefebvre, 2007) and is a necessary component of Community Oriented Primary Health Care (Gottlieb, 2009) and the Patient Centered Medical Home that is promoted as a key component of reform of the US health care system (Gottlieb; Nutting et al., 2009). Many benefits have been reported to emerge from collaboration, including improved information processing and patient outcomes and reduced health care costs (Dietrich et al., 2004; Institute of Medicine; Jackson et al., 2003; Speir, Rich, Crosby, Fonner, & Cardiac, 2009). Gray (1989), defined collaboration as "a process through which parties who see different aspects of a problem [or issue] can constructively explore their differences and search for solutions that go beyond their own limited vision of what is possible" (p. 5).

Despite the national calls to collaborate, many people remain reluctant to engage in collaborative relationships (Topping, Hueston, & MacGilvray, 2003). This is in part because collaboration is complex and does not have an accepted standard definition (Blount, 2003). A common or colloquial definition of collaboration emerges from its Latin roots Col (together) and Laborare (work), yet this differs little from common definitions of cooperation or coordination (Blount). Chrislip (2002), a leading researcher in the field of collaborative leadership, defined collaboration as "mutually beneficial relationships between two or more parties who work together toward common goals by sharing responsibility, authority, and accountability for achieving results" (italics added).

Hesitation to collaborate is understandable given this definition as shared authority and accountability complicate decision-making, require dedicated effort and resources to maintain, and can result in uncertainty and loss of control (Blount, 2003; Dietrich et al., 2004; Nutting et al., 2009). For Cooke-Lauder (2005), "collaboration is not a process but a noisy, complex, unwieldy and unpredictable situation where the competing interests of different parties are always present, and where the resulting tensions and ambiguities need constant attention" (Cooke-Lauder, p.37). The complexity of defining and studying collaboration has even led some to doubt the rationale and benefits of collaboration (Zwarenstein & Reeves, 2000). Blount defined degrees of collaborative care that include coordinated care, co-location of services, and integrated care. A variety of authors have sought to distinguish true collaboration such as that defined by Chrislip (2002) from strategies with greater and lesser degrees of integration. Table 1, adapted and expanded from (Cooke-Lauder; Frey, et al., 2004; Gajda, 2004), describes a spectrum of social action with a gradient reflecting the degree of alignment or integration of resources, goals, and decision making. It highlights where collaboration fits in a spectrum of human activity in which goals and resources may coexist without communication or coordination, may be aligned (coordinated), shared (collaboration), subsumed (coadunation), or set in competition, or in opposition (counteraction).

Academic Medical Centers (AMC) are organized along specialty lines into departments and divisions, with separate lines of authority and separate traditions of professional socialization. The specialty orientation of faculty meetings, quality assurance, finance, and other structural factors reinforce these divisions. Within each subunit (department, division, unit) there are individuals at a variety of skill acquisition levels, ranging from novice through proficient to expert. …

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