SHORT R EPORT S

The ‘‘elephant in the room’’: using emotion management to uncoverhidden discourses in interprofessional collaboration and teamwork

Corinne B. Hart

Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada M5B 2K3

INTRODUCTION

Over the last decade, there has been increasing recognitionof therole that effective interprofessional collaboration and teamworkhas in supporting the provision of client-centered care. This hasled to an increased emphasis on education that encourages thedevelopment of the necessary skills for interprofessional teampractice. In Canada, much effort has gone into creating anational framework that identifies the foundational competencydomains that underpin interprofessional practice and care(CIHC, 2010). Yet, both research and anecdotal experiencesuggest that even with ongoing comprehensive team develop-ment and competency-based education, unresolved tensionsinfluence interprofessional team dynamics.

To date, there has been only minimal research into thetensions experienced by interprofessional teams. Whatresearch does exist suggests that historical power relation-ships and strategies of professional closure (e.g., Friedson,1970; Witz, 1992) underlie relationships and interactionsacross interprofessional teams and that these factors are notmitigated through teaching interprofessional competencies.Even the goal of client-centered care does not necessarilymoderate the strength of the ‘‘professional project’’ (Baker,Egan-Lee, Martimianakis & Reeves, 2010).

Despite the very real impact of the professional project onteam function, explicating power dynamics can be challen-ging, as the idea of professional hierarchy is fundamentally atodds with assumptions of interprofessional collaboration.Indeed, the notions of shared leadership and the softening ofprofessional silos that underpin interprofessional teamworkare in tension with the protectionism that is at the heart of theprofessional project. Yet, anecdotal evidence strongly sug-gests that power and status relationships are ‘‘the elephant inthe interprofessional room’’; clearly present, but rarelyacknowledged. Without making explicit the way in whichreal and perceived professional power and status are enacted,

however, the development of effective strategies for strength-ening interprofessional team function remains at a surfacelevel.

Emotion management, a concept introduced by Hochs-child (1983) in her broader discussion of emotion work mayoffer a window into discourses around power and statuswithin the interprofessional team. Defined by this author as‘‘the way in which people manage and display theiremotional reactions and responses in the context of work’’,emotion management can include outwardly displayedbehaviors such as smiling, nodding, or deferring as well asthe internal processes associated with suppressing anegative reaction or ‘‘biting one’s tongue.’’ More broadly,emotion management can also involve the sublimation offeelings by telling oneself that team function trumps theindividual.

There is some evidence that emotion managementstrategies are more prevalent when there is a perceivedpower imbalance. Both the literature on low status work(e.g., Lively & Powel, 2009) and anecdotal reports byinterprofessional team members support the notion thatpeople are more likely to engage in emotion managementwhen they feel that they have only limited power. Researchalso suggests that by presenting as facilitative, or a ‘‘teamplayer,’’ emotion management can be a deliberate strategyfor enhancing a lower status member’s professionalstanding and thus protecting his or her power within theteam (Baker et al., 2010).

Within the literature, emotion management has gen-erally been seen as a product of emotional labor (Hochs-child, 1983). It can be argued that it could alternately beconsidered a methodology for examining power and status.Specifically, using emotion management as a lens throughwhich to explore participation on an interprofessional teammay provide valuable insight into how power and status areenacted in interprofessional settings.

Received 2010; revised 2011; accepted 2011.

Correspondence: Dr Corinne B. Hart, PhD, Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario,Canada M5B 2K3. E-mail: c4hart@ryerson.ca

Journal of Interprofessional Care, 2011, 25: 373–374� 2011 Informa UK, Ltd.ISSN 1356-1820 print/1469-9567 onlineDOI: 10.3109/13561820.2011.578224

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This report briefly outlines plans to undertake anexploratory study to investigate the connections betweenprofessional role and status and the way in whichinterprofessional team members manage and display theiremotions.

METHODS

This study will use emotionmanagement as amethodologicallens. Semistructured, open-ended interviews will be con-ducted with 12–15 members of an interprofessional team onan in-patient unit in a large mental health facility in Canada.The interviews will focus on four broad areas: perceptions ofworking in an interprofessional team, perceptions of teamprocess, perceived role within the team, and perceived use ofemotion management to facilitate team function. Interviewprobes will encourage participants to think specifically abouthow their professional designation shapes their participationon the team. Ensuring representation of the mix ofprofessionals (and their professional positioning) on theteam is intended to increase the likelihood that the data willcapture underlying issues of power and status.

A modified grounded theory analysis will be used todevelop a narrative accounting of the primary themes thatemerge through this exploratory, descriptive study. It isanticipated that by asking about perceived interrelation-ships between professional role, role and participation onthe team and emotion management, underlying issues ofpower and status will be brought to the fore. In addition toproviding substantive data on the impact of perceivedpower and status on interprofessional team participation,this study is intended to guide the development of furtherresearch into emotion management as a lens for elucidatingpower and status within interprofessional teams.

DISCUSSION

Identifying and addressing the elephant in the room hasimplications for both interprofessional education andpractice. Acknowledging underlying power dynamics canallow for a critical analysis of ‘‘what is really going on’’ wheneducational strategies that teach role clarification, commu-nication, and conflict management do not resolve teamtensions. It can also provide a foundation from which to

move the development of effective strategies for interpro-fessional teamwork from what is primarily a skill-based(competency) approach to one that incorporates therealities of historical (and often seemingly immutable)power relationships.

Notions of power and status challenge the assumptionsof interprofessional collaboration. Finding ways to exposepower dynamics and make them explicit is important, if weare to go beyond paying lip service to the idea ofinterprofessional teamwork. This exploratory study willdemonstrate whether emotion management can provide amethodological lens through which to identify issues ofpower and status and as such, to begin the muchneeded discussion about the elephant in the interprofes-sional room.

ACKNOWLEDGEMENTS

The author thanks the staff and leadership of the dualdiagnosis program at the Centre for Addictions and MentalHealth for supporting this project and Hemant Gohil for hiscontribution to ongoing work on emotion management.

Declaration of interestThe author reports no conflict of interest. The author aloneis responsible for the content and writing of the paper.

REFERENCES

Baker, L., Egan-Lee, E., Martimianakis, T., & Reeves, S. (2010).Relationships of power: Implications for interprofessional educa-tion. Journal of Interprofessional Care, 25(2), 98–104.

Canadian Interprofessional Health Collaborative (CIHC). (2010). Anational interprofessional competency framework. Retrieved fromhttp://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf.

Friedson, E. (1970). Profession of Medicine: A Study of the Sociology ofApplied Knowledge. New York: Dodd, Mead & Co.

Hochschild, A. R. (1983). The Managed Heart: Commercialization ofHuman Feeling. Berkeley: University of California Press.

Lively, K. J., & Powel, B. (2009). Emotional expression at work and athome: Domain, status, or individual characteristics? SocialPsychology Quarterly, 69(1), 17–38.

Witz, A. (1992). Professions and Patriarchy. London: Routledge.

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