Challenges Faced by Social Workers as Members of Interprofessional Collaborative Health Care Teams, Health & Social Work, May 2016
The trend toward greater inclusion of interprofessional collaborative health care teams is increasing. Collaborative models bring together various health care providers— physicians, nurses, social workers, psychologists, pharmacists, dietitians, and others— to provide team-based care. Critical factors, such as communication, can improve or deter success in the collaborative setting, and social work has the historical experience in team-based care that allows it to bring a unique perspective to the health care setting.
In the journal Health & Social Work,Wayne Ambrose-Miller, PhD, and Rachelle Ashcroft, PhD, published a study of social worker’s experiences in interprofessional collaboration. The study was conducted as a “focus group” made up of 11 attendees at a joint conference of the Canadian Association of Social Workers and the Canadian Association for Social Work Education in 2014. From the data gathered from the discussion, six main themes emerged: 1) collaborative culture, 2) self-identity, 3) role clarification, 4) decision making, 5) power dynamics, and 6) communication.
The group participants emphasized that a culture of collaboration is important for the success of collaborative teams, and leadership and nurturance help foster that culture.
Collaboration starts with an awareness of one’s own individual contributions as a social worker. Participants indicated that social workers have to proactively carve out their role within health settings in a way that is self-directed. Social work’s role fluidity was identified as an asset because it helps fill in service gaps and address clinical complexity. Participants indicated that social worker’s role as client advocate can create tension between the worker and the rest of the collaborative team.
Role clarification and having an awareness of one’s interprofessional colleagues were described as important to collaboration. Awareness of others was described in three ways: (1) interprofessional educational opportunities, (2) educating colleagues, and (3) the influence of colocation. Participants emphasized the importance of various professions learning from each other and valued some of the opportunities for collaborative learning provided at the university level. However, participants indicated that opportunities that exist for formal interprofessional learning are sparse.
Educating colleagues occurred in various formal and informal manners. Participants emphasized the importance of educating through demonstrating. Participants also described how educating colleagues could also occur at the broader macro level. For example, one participant recommended that social work’s professional bodies engage with medical professional bodies so as to help dynamics that occur within clinical collaborative settings. Colocation (i.e., working together in the same physical space) with other interprofessional colleagues was considered important for social work. Participants indicated that colocation was an important means for physicians and nurses to learn about social work in daily encounters.
Decision-making processes were identified as important for collaboration. Ultimately, participants advocated for a collaborative method of decision making. Decision-making processes were identified as a barrier when differences emerged across professions as to the decision-making process and outcomes that participants experienced.
Participants spent a great deal of time talking about the importance of communication in collaboration. Effective communication was described as necessary for interprofessional collaboration, whereby poor communication was considered a barrier to collaboration. Participants spoke about various forms of communication that were an asset to collaboration. For example, communicating through one’s action was one way that the various team members could learn about one another’s roles. Participants described documenting in client charts as a vehicle to demonstrate one’s own contributions to the collaborative. However, several participants described the use of electronic medical records (EMR) for charting as problematic for collaborative communication. Participants described that other team members did not read social work–specific chart entries in the EMR and felt that the EMR itself eroded the potential for reciprocal communication.
Power inequities and dynamics emerged in the data as a barrier to collaboration. Power inequities affected social work’s voice and contributions. Participants mentioned that physicians often assume greater power in the collaborative team environment, and will talk over social workers and other team members. Power inequities were considered particularly problematic for collaborative care when acted out through the actions and behaviors of colleagues. Because of existing power inequities, participants believed that social work had to be even more diligent with demonstrating worth to the collaborative team.
Social workers in this study have found collaborative care to involve both challenges and rewards. Challenges arise when social workers take part in interprofessional teams without a clear understanding of their role and the roles of their interprofessional colleagues. Social workers have also identified how power differentials have been exposed when opportunities arise for team decision making. There remains a need for clarity in the roles of social workers on interprofessional teams while still maintaining a sense of flexibility to look at team-specific needs. Social workers who have a strong sense of what social work can provide to the team have the ability to communicate that vision in the work that they do. To maintain the profession’s integrity and traditional values such as advocacy for one’s client, however, it is necessary to have a firm grasp on the unique perspective that social workers often brought to the team.