Interprofessional Working in

Hospitals: The Case of Nepal

Dr Bachchu Kailash Kaini

(PhD, MBA, PGDHM, BL, BEd, BCom, Certificate in Clinical Audit in Health & Social Care)

Context

• Changes in demographic structure and disease pattern

• Increased cost of care

• Concept of specialties and sub-specialties emerging

• Well informed patients and more choices

• Expansion of roles of health care professionals (HCPs)

• Changing health care environment requires new ways of working & collaborative practice

• IPC is a collaborative working in which HCPs

share common purpose of developing mutually

negotiated goals which are achieved through

agreeing a care plan, the management of it and

procedures (HFO, 2007; Hawley, 2007; Leathard, 2003; Payne, 2000; Pietroni, 1992; Colyer, 2012).

• Interprofessional working (IPW) to happen in

practice, HCPs:

– Pool their skill, knowledge and expertise

– Shared professional view points

– Make joint decision

– Learn from each other

Interprofessional Care (IPC)

• Collaboration, IPW and effective communication:

reduces the clinical incidence, misunderstanding

and errors, and enables HCPs be more readily

aligned to the departmental and organisational

vision (Verhorsek et al, 2010;. Mills et al, 2008; CHSRF, 2006; Joint Commission, 2005)

• More positive health care outcomes are

achieved by collaborating effectively between

HCPs (Byrnes et al, 2009; CHSRF, 2006; Nolte, 2005; EICP, 2005; Holland et al, 2005;

Pollard, 2005; Dow and Evans, 2005; McAlister et al, 2004; Leathard, 2003; Miller et al, 2001;

Biggs, 1997; Ritter, 1983)

• Other aspects of IPW researched and assessed

in the past

Literature Review

Power Perspectives of Theory of Professions

• Theory of Professions: division of labour

based on skills, knowledge and expertise

• Knowledge is a source of power and it has

great influence in determining professional

behaviour and dominance

• Medical dominance exists in health care

and professional dominance of medical

professionals comes from autonomy

(Freidson, 1970a; 1970b)

• To identify and analyse various factors that

support and hinder IPW in Nepalese hospitals

• To examine understanding and perceptions of

IPW among HCPs

• To assess perceptions of IPW on health care

delivery in Nepal

• To examine professional power perspectives of

theory of professions in relation to IPW

• To make recommendations for improving

interprofessional collaborative practices

Research Objectives

Research Methodology

• Qualitative research method, case study

• Purposive sampling

• Three hospitals in Kathmandu, 38 HCPs (40% nursing, 34% Medical and 26% AHPs)

• Use of semi structured interview schedule & analysis of documentary evidence

• Qualitative content analysis

• Interpretive thematic approach

• Open coding, categorisation, theme generation, establish relationships, interpretation & conclusion

Demographics

34%

37%

29%

Participants by Hospital Types

Public

Private

Voluntary

34%

40%

26%

Participants by Professional Groups

Medical

Nursing

AHPs

56%

44%

Participants by Gender

Male

Female

Main Findings

• IPW is widely understood, recognised

and valued by HCPs

• HCPs carry out different roles, values,

status and responsibilities

• Verbal means of communication is

used most of the time. Other common

forms: medical notes, team meetings

• Service users involvement in IPC is

valued

Main Findings

• Power differences in medical, nursing and

AHPs

• Dominance of medical professionals exists in

Nepalese hospitals

• Medical professionals lead IPC team

• HCPs perceived different levels of autonomy

• Boundaries between HCPs changing

• Cultural and gender differences in medical,

nursing and AHPs

Main Findings

• HCPs do not have significant contact with one

another during their formal or university

education

• HCPs learn IPC skills at work and they felt

competent

• IPW is not sufficiently motivated amongst

HCPs and adequate appreciation is lacking

• Concept of IPW and power perspectives of

theory of professions are equally applicable in

Nepalese context

Perceived Barriers to IPW

• Organisational: Lack of training and

education, no protocol for IPW, high

workload & no support from

management

• Professional: Professional dominance

and isolation, hierarchy & no

understanding of other professions

• Personal: Poor communication, ego,

negative attitude & no mutual respect

Recommendations for Improving IPW

• Training and education

• Policies and guidance

• Clinical leadership

• Organisational structures and

support

• Appropriate communication