Applying organizational science to health care: a framework for collaborative practice.

Despite decades of interest in interprofessional education (IPE) as a means to promote more “efficient, effective, comprehensive, and personalized” health care,1–3 few IPE programs have demonstrated sustained benefits for trainees or patients.4 In Canada5 and the United States,6 expert panels have defined interprofessional competencies to support overarching goals for educating health professions trainees (that is, learners at any stage of professional education in health care including continuing professional development). Yet even as these competencies specify desired outcomes for IPE, how best to achieve these goals within the educational and clinical systems of team-based health care remains unclear. A team’s success on a given task depends upon at least four conditions: The task must be suitable for teamwork, the team must include the right group of people to perform the task, the team members must combine their resources effectively to complete the task, and the organization must provide a supportive context for the team.7,8 Meeting these conditions in health care settings is a challenge as the nature of care delivery is complex.9–12 Health care is delivered in dynamic environments where providers care for many patients, each of whom may be served by several teams with different members. Further, each team’s approach to interprofessional collaboration may vary according to contextual factors (e.g., patient acuity, team composition, resource availability).13 Health care professionals—whether team leaders or team members—must adjust their approaches based on contextual factors to meet the needs of patients and communities.14 Leaders, in particular, influence teams’ effectiveness by facilitating action and making sure the resources necessary for optimal performance are available.15 Team members, however, may have conflicting perceptions of leadership structures and responsibilities,16 decreasing the team’s effectiveness. Recognizing that health care teams have varied structures and engage in diverse processes, educators should strive to develop curricula that help trainees gain a deeper understanding of collaborative work.2 To aid in the construction of educational programs with targeted IPE objectives, we sought to identify theoretical bases that support competencies for collaborative practice. We turned to the literature of organizational science, specifically the field of industrial and organizational psychology. In this field, psychologists study the behavior of people at work. [They] derive principles of individual, group, and organization behavior through research. They develop scientific knowledge and apply it to the solution of problems in work settings. The applications are science- and research-based … integrating science and practice so that activities in one domain inform activities in the other domain.17 In this article, we present select concepts to create a foundation for understanding teams, leadership, and collaboration in health care. The four concepts described--team process, leadership and followership, locus and formality of leadership, and dynamic delegation--apply to teams across health care settings. Health care workers at all stages of training who learn about these concepts will gain a deeper understanding of collaborative work and become better equipped to participate in and lead teams. We also propose knowledge, attitudinal, and behavioral competencies related to each concept that we believe should inform the efforts of educators, practitioners, and clinical and administrative leaders as they strive to improve collaborative practice and patient care.