The dynamic interplay between professional identity, threat and context within interprofessional health care teams

Abstract

Research Doctorate - Doctor of Philosophy (PhD)Interprofessional practice has garnered widespread attention in the literature, yet current evidence does not elucidate the key mechanisms and contextual factors that determine its outcomes. This thesis by publication, arranged in the form of an overview, four core publications and two ancillary papers, addresses the question of how professional identity, identity threat and context interact to impact on interprofessional working. Professional identity underpins much of what occurs in interprofessional health care teams. Threats to valued professional identities can activate faultlines within teams and trigger tensions, conflict and underperformance, if not adequately managed. These threats can take the form of differential treatment of professional subgroups; divergent values and norms; and assimilation or devaluing of other professions. As the perception of threat is context dependent, this research focuses on rural settings where professional boundaries can be less distinct. This study was part of a larger project investigating the enablers of, and barriers to, effective interprofessional practice in an Australian rural health care context. Health practitioners representing various settings, functions, locations and professional backgrounds were interviewed to gather data on the contexts, mechanisms and outcomes of interprofessional practice. Independent content and thematic analyses were integrated to present the findings. The findings show that many rural clinicians were motivated to engage in interprofessional practice, and in doing so embraced flexible approaches and role overlap as a means to manage workforce pressures and overcome professional isolation. In contrast, interprofessional working was stymied by some practitioners who observed strict role boundaries and traditional hierarchies and who were reluctant to consider input from other health disciplines. However, workload sharing and role flexibility is limited in its application and cannot overcome continued skill deficits in rural health services. Moreover, extended role overlap or any hint of genericism is likely to provoke professional identity threat as individual professions need to maintain their distinctiveness and claims to unique expertise. Leadership strategies are required to balance a shared team identity with the salient professional identities characteristic of health care contexts. This is one of the first studies to examine the interplay between professional identity, professional identity threat and context, with particular reference to interprofessional practice in rural settings. By employing a sociological lens to examine the mechanisms and contexts of interprofessional practice, it advances our knowledge of the nature of collaboration between the professions and how interprofessional activities translate in the workplace