I was talking recently to a health administrator about communication between different groups in the hospital system. He said,
“Interdepartmental communication has been historically very difficult. There were different incentives that made working together something people didn’t want to do. If your department didn’t make the numbers, you’re in trouble, you’re the one out of a job.”
I wrote earlier about some personal and interpersonal constraints on interprofessional communication. This administrator’s comments point to some of the structural issues that can get in the way of interprofessional communication.
Apples to apples
Most of my experience in interprofessional communication is in the education sector, and most of that in higher ed. Departments within the same academic unit can be quite different. These differences are perhaps made the more frustrating because there are so many assumed similarities. In my experience, it was almost worse when we all thought we had been comparing apples to apples, only to find out later we hadn’t been.
Some of this friction had to do with differences in our disciplines. Some of it had to do with institutional structures. So I’m going to talk briefly about both of them.
The interdisciplinary part
“The health sector” is hardly monolithic. Different departments have different knowledge and experience, and potentially different priorities.
So, in addition to all the tricky and knotty problems of collaboration, you are also dealing with the equally urgent and complex ‘problem’ of different disciplinary approaches to the issues you are there to address.
Let’s imagine that every professional encounter is a kind of cultural encounter.
Communicating across professional ‘cultures,’ I suggest, involves making visible much of what is usually taken for granted in our disciplines or specializations. Our own disciplinary approaches tend to become invisible to us, so I’m going to start there.
Let’s make this concrete with an example. Think back to your professional program—nursing school, medical school, pharmacy school, public health, veterinary school, you get what I mean.
In your professional program, you learned the specialized language of your discipline while you learned medical and scientific information. There were thousands of new terms, which you were expected to use with your peers.
But you learned more than how to speak the language.
The term academic socialization refers to the ways postsecondary students are brought into the culture of a discipline through their study, and specifically through discipline-specific language use. Mary Lea and Brian Street, in their explanation, add that:
“Students acquire the ways of talking, writing, thinking, and using literacy that typifies members of a disciplinary or subject area community.”
This new culture of a discipline was intimately tied to your learning, your thinking, your membership in a group, and more.
For instance, taking med school as an example, you learned:
- ways of talking about medicine–with your instructors, residents, attendings, and patients
- how to think (and act) scientifically–in your case studies and clerkships
- how to read about medicine–in your lectures and classes
- and how to research and write about medicine (check out this classic, crafty JAMA editorial on medical writing)
You were socialized into these ways of talking, thinking, reading, and writing. Now, your job depends on it. You are surrounded by people also socialized into it, and whose jobs also depend on it.
To get better at your own interprofessional communication and collaboration, I am asking you to think about your own professional learning. This includes what you might have come to take for granted in your professional communities… that can make things tricky when interacting with other communities.
Why it feels personal
Regardless of whether or not you identify with the dominant voices or approaches in your discipline, your professional program involved your learning to read, write and think in a discipline- or specialty-specific way.
For a long time.
And you’re still doing it. Every day.
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So if someone from another specialization, discipline, or department disagrees with your group’s way of doing things, it can feel…personal. Because in part, it is.
Methodologists have pointed out that the approach we have been educated and socialized into can become entwined with our identity.
That is, how we do what we do professionally becomes part of who we are.
We’re kind of attached to it!
As a result, we can get personally protective of our disciplinary status quo.
This can make for some tense moments in interprofessional communication, when you’re looking at, talking with, and working with people who have different positions and different disciplinary backgrounds.
More than just working together
So, noticing and being conscious of our disciplinary m.o. is important, but this alone is not enough. We have colleagues with different disciplinary approaches. And we need to work together.
In a 2017 article about how researchers can move past historical differences, methodologist Norman Denzin refers to earlier work on fostering dialogue among people who work from different paradigms. Some of these recommendations include:
- openness to critique
- decline in confrontational stances
- avoidance of simplistic representations of others’ paradigms
- more fruitful dialogue among competing paradigms.
Thinking like this can help us appreciate from others’ standpoints the complexity that may underlie differences in approach, as well as those apparently straightforward tasks (such as inventory, scheduling, data gathering, etc.) in an interprofessional context. The kinds of things that can slow down progress during interprofessional communication.
Collaboration can feel stressful in the best of times. But sometimes there are internal structures that can make it tougher, unintentionally, by leading away from true communication or collaboration.
From an organizational standpoint, we’re talking about structures, policies, or arrangements like schedules, incentives, productivity requirements, various metrics you’re using, and more (even curricula).
A word about policies
Today, you are providing care amidst a complex web of policies, in systems and organizations under performance pressure. In health systems, anchor institutions, and community organizations, multiple levels of policy constantly overlap and interact. Sometimes cohesively, but often not.
Wherever you work, your institution’s structures, systems, policies, and laws, are written and interpreted, and reinterpreted and enacted, by humans. I mention this as a reminder that policies are man-made. What’s more, the relative importance and meaning of various policies are determined largely by who’s in charge at the time.
Without getting sidetracked by the very real social, cultural, historical and political processes surrounding policy, I want to invite you to keep one thing in mind:
Interrogating, shaping, or talking back to policy is an option.
I’ll suggest that one way to do this is call into question the effect of existing structures, practices and policies. How do these arrangements challenge–or sustain–communication and collaboration?
Are structures working against goals?
Consider what is being done in your institution, if anything, to examine structures, and to identify what might be working against aims of knowledge-sharing, communication, and collaboration.
Like the administrator at the start was talking about, you don’t want priorities in one area to accidentally conflict with priorities in another. For instance, if you value collaboration in your interprofessional communication, you don’t want all your metrics to depend upon competitive behaviors.
Here are some questions that might spark ideas:
- What do your local policies foster or inhibit when it comes to interprofessional communication? What processes/people do they enable and constrain?
For example, where and when group meetings are held matters. Some times and locations will make participation easier for some group members than for others.
- What already existing institutional structures could support the kinds of communication you’re asked to do?
For example, are there already existing collaborations? Can you piggy-back meetings and hold one after the other?
Consider what mechanisms are in place, or needed, for ongoing collaboration and support of everyone involved. This kind of information can be helpful in making a case to your organization about better facilitating interprofessional communication. If you’d like more help, contact me.