Thesis Format
Integrated Article
Degree
Doctor of Philosophy
Program
Health and Rehabilitation Sciences
Supervisor
Cristancho, Sayra
2nd Supervisor
Watling, Chris
3rd Supervisor
Lingard, Lorelei
Abstract
Contemporary interprofessional (IP) medical teams are characterized by their complexity and dynamism, transcending medical specialities and sub-specialities. These teams grapple with competing care challenges and knowledge demands in pursuit of delivering high-quality and safe patient care. To navigate these intricacies effectively, team members must maximize their scopes of practice while collaboratively providing and receiving assistance when necessary. However, the understanding of how individuals within these teams navigate the complexities of help provision and receipt remains limited in the medical education literature.
The concept of ‘help’ in medicine is intricate. In a culture that has traditionally valued independence and autonomy, asking for help can be perceived as face threatening. When help is sought, it is often entrenched in hierarchical structures and influenced by power dynamics. Recognizing these tensions is not sufficient to mitigate their impact, potentially leading to lasting consequences for team cohesion and, ultimately, patient outcomes.
This dissertation uses the tenets of grounded theory to explore how helping behaviours, both the provision and the receipt of help, become enacted in IP teams. First, a scoping review of the literature was undertaken to explore how other professions understand and enact helping behaviours within their own settings and circumstances. From there, the helping concept was then investigated in an authentic surgical team as well as an IP simulation setting. Findings of the research suggest that the process of seeking help is socially mediated and context specific and is experienced similarly across a variety of professions. In some instances, helping engagement unfolds in a straightforward and succinct manner but at other times, may involve covert approaches to avoid perceived indignity. Simulation adds an additional layer of complexity to the helping engagement process. Simulation has been proposed as a safe space in the education literature where IP team members can work together safely, while addressing the complex interplay among individuals of varying professions as scenarios unfold. However, during simulation participants aligned their practice more in keeping with a mechanism of assessment rather than its intended learning and development objectives. As a result, helping behaviours were overtly avoided with a view instead to demonstrating personal skills and capabilities in a performative way.
This research highlights a disconnection between the recognized significance of helping engagement in team-based professions and its actual implementation within IP teams. While helping behaviours are commonplace in other professions, with various motivations for engagement, it is viewed as an integral part of professional practice. In contrast, in medicine, helping engagement is often a complex and challenging endeavour, both in clinical practice and in contexts designed for learning and development.
Summary for Lay Audience
In contemporary medical teams, collaboration across different specialties is crucial for delivering high quality patient care. However, the dynamics of how team members seek and provide help within these complex settings is not well understood in the health professions education literature.
In medicine, where independence and autonomy are traditionally valued, asking for help can be seen as threatening to one’s professional identity. The act of seeking help is influenced by hierarchical structures and power dynamics, and the consequences of not addressing these tensions can impact team cohesion and patient care outcomes.
This dissertation which uses grounded theory, explores how helping behaviours, both seeking and providing help, are enacted in IP health care teams. Three studies framed this work. First, a scoping review was conducted to understand how helping behaviours unfold in other professions including health care. Findings from the review suggest that helping is socially mediated, context-driven and often unfolds in a transactional way. The review also helped to highlight the unique dynamics in health care, where the presence of a patient introduces a triadic relationship in the helping process, which can influence the seeking and receipt of help.
The scoping review was followed by a study which explored the complex nature of helping within an IP surgical team. Findings from this study emphasized the influence of individual characteristics, work context, and power dynamics on how help is sought and provided. Lastly, a study examining the helping behaviours of IP teams participating in simulation revealed that simulation was a challenging environment in which to capture v helping behaviours, as participants often wanted to demonstrate independence and competence even in scenarios that were beyond their current scope and capabilities.
Overall, the research within this thesis highlights a disconnection between the recognized importance of helping in team-based professions and its actual implementation in IP medical teams. While helping is commonplace in other professions, it remains a complex and challenging aspect of medical practice, both in clinical settings and educational contexts. Understanding and addressing these challenges are crucial for improving teamwork and ultimately enhancing patient care.
Recommended Citation
Kennedy, Erin K., "Helping Engagement in Interprofessional Health Care Teams: A Constructivist Exploration" (2024). Electronic Thesis and Dissertation Repository. 9983.
https://ir.lib.uwo.ca/etd/9983