Ethics, Interprofessionalism and Healthcare

Dr. Vicky Gunn

Learning and Teaching

Centre

• Why is interprofessionalism an ‘ethics’ issue? Where does it fit within an ethics framework?

• Is interprofessionalism a response to increasing complexity (in terms of specialization) and the consequential awareness that this has an impact on healthcare outcomes?

• Psycho-dynamics as a way of mediating complexity?

Why is interprofessionalism an ‘ethics’ issue? Where does it fit within

an ethics framework?

• Does ethics require us to reflect on what and how we give value to one form of experience/knowledge over another?

• Does ethics encourage us to reflect on practice when the evidence suggests the possibility of achieving better healthcare outcomes?

“a growing body of evidence suggests interprofessionalism offers greater benefits for patient care and safety than multiprofessionalism…”

(Bleakley, et al., 2006, p. 467)

“Interprofessional relationships continue to be characterized by conflict rather than co-operation..”

(Irvine, et al, 2002, p.199)

Is interprofessionalism a response to increasing complexity (in terms of specialization) and the

consequential awareness that this complexity has an impact

on healthcare outcomes?

Irvine et al’s Useful Framework (2002)

• Professional divisions• Authority and the division of labour• Subverting medical dominance• Professional organization• Different value systems (cf Irvine, et al, 2004)• Legal effects

“Rather than promoting more egalitarian and collaborative social formations, healthcare teams tend to reflect, reproduce and perpetuate the traditional divisions of labour, status systems and systems of authority.”

(Irvine, et al., 2002, p. 204)

Irvine et al continued

• Cultural barriers:

• ‘Intellectual baggage’

• Language (eg ‘in shock’)

• Intra-professional variation

• Identity

• Training

Psycho-dynamics as a way of understanding the complex relational

interprofessional issues

Let’s try this assumption:

“When we list apparent obstacles to interprofessionalism, we are just embodying inter-group emotionality and psychodynamics within a reason-based framework. The actual behaviours and attitudes expressed are far less reason-based”

Emotionality given a body through factors we use to explain and explore interprofessionalism

STRUCTURAL OBSTACLES

CULTURAL OBSTACLES

Optional inter-group responses to conflict (or, how

do groups respond to one another?)

Acknowledge dependence

Compete

Focus on changing the other groups’ values, practices, perceived behaviours

Silence, inaction, & ingroup resentment

Collaborate and compromise ‘multiprofessionally’

Perform toleration

Potential for conflict and error increases

Avoidance

Is IPE responding to a question of ‘how are professionals and interprofessionals created?

ie exploration of the socialization processes.

Bourdieu’s Habitus:

“the coercive power of covert educational practice to reproduce the dominant values and beliefs of professional fields…”