Interprofesional collaboration occurs in a team context [1] and is “a type of professional work which involves different health and social care professions who regularly come together to solve problems or provide services” [2]. “Person-centered care is a philosophy of care built around the needs of the individual and contingent upon knowing the unique individual through an interpersonal relationship.” [3]. Some consider interprofessional collaboration as inherently patient-centred [4]. Understanding what contributes to patient-centred care is key. Furthermore, the combination of interprofessional collaboration in teams and patient-centered care is a necessary amalgamation when it comes to delivering complex mental health care and services. Indeed, biopsychosocial roots of mental health disorders impact multiple aspects of the lives of patients [5]. A plurality of views from the part of health care professionals is essential for providing all-inclusive, rounded services and care that meet patient’s complex needs [6, 7].
Interprofessional collaboration in multidisciplinary teams is effective in mental health settings; it improves patient health status and treatment compliance, reduces suicides and clinical errors, boosts professionals’ satisfaction and motivation, lowers admission rates and shortens stays [8–11]. But in spite of this, multidisciplinary teams must surmount challenges such as barriers caused by different professional cultures [12], divergent values [13], and lack of recognition of each others’ roles [14]. Patient-centered care is intricate to manage [15] as teams must take into account more factors in delivering services and care. Collaborative relationships in mental health care teams are difficult to implement, require time, work and supportive structures [16] as well as addressing barriers due to power differences, time constraints, medical dominance, communication challenges and lack of resources [17–19]. In general people agree: multidisciplinary teams work better for complex patients’ needs but they are challenging to manage for team members. We wish to address some of these challenges by investigating the central role played by collaboration.
The objective of this study is to examine the impact of potential predictors of patient-centered care perceptions in multidisciplinary mental health teams. The complexity of multidisciplinary teams calls for a multilevel approach where some predictors are at the individual level while others are at the team level. Indeed, we will examine the role played by two important individual-level attitudes: belief in the benefits of interprofessional collaboration and informational role self-efficacy. In addition, we will examine how collaboration (i.e., at the team level) potentially impacts these predictors. Also, we will examine the role collaboration plays in linking team work role behaviors to team-level patient-centered care perceptions.
Individual- and team-level perspective
Team interactions in general and collaboration in particular are team processes, that is, they are “acts that convert inputs to outcomes through cognitive, verbal, and behavioral activities directed toward organizing taskwork to achieve collective goals” [20]. Specifically, collaboration is “the interplay of situation-appropriate uses of four interrelated processes: teamwork communication, synchronicity, explicit coordination, and implicit coordination.” [21]. Communication involves effective information exchange, synchronicity involves working on time and in time, explicit coordination involves overt exchanges on role and task assignments and finally, implicit coordination involves, anticipation of others’ needs without resorting to explicit coordination. Processes and the interactions they foster, act as a social context impacting team members’ behaviors and attitudes [22, 23].
As such, collaboration might impact two key yet understudied attitudes. First, not all healthcare workers may be absolutely convinced or totally enthusiastic of the benefits of interprofessional collaboration given some of the challenges in multidisciplinary teams. Yet belief in the benefits of interprofessional collaboration predict job satisfaction, knowledge exchange and trust [24]. Also belief in the benefits of interprofessional collaboration should also be associated with patient-centered care perceptions, especially if collaboration is high. Second, interprofessional collaboration cannot be effective if team members are not able to share pertinent information [4] such as their expertise. Informational role self-efficacy is an individual’s beliefs in his/her capability to communicate his/her expertise so that it impacts others’ performance [25]. Interestingly, professionals “know very little of the practices, expertise, responsibilities, skills, values and theoretical perspectives of professionals in other disciplines” [26]. It is therefore key to believe one can communicate his/her own expertise to others on the team and of course engage in corresponding behaviors. Consequently, we will test the following hypothesis (see Fig. 1):
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The relationship between (a) belief in the benefits of interprofessional collaboration and patient-centered perception and the relationship between (b) informational role self-efficacy and patient-centered perception that both occur at the individual level will be moderated by Collaboration (at the team level) such that both relationships will be more positive and stronger.
Team-level perspective
Teams must adapt to face the complexities and challenges of the work they are required to accomplish [27]. As such, “adaptation lies at the heart of team effectiveness” [28]. Challenges are numerous. For example, decision-making in multidisciplinary teams is significantly more difficult than when there is less diversity around the table [29]. Two intertwined sets of task-related behaviors are important for a team to adapt: adaptivity and proactivity. Team member adaptivity is the extent to which team members deal with, answer, and/or support changes that affect team roles while team member proactivity has to do with how individuals engage “in self-starting, future-directed behavior to change a team’s situation or the way the team works” [30]. Logically team member adaptivity and proactivity should lead to positive outcomes and in the case of multidisciplinary mental health teams it should impact their ability to deliver patient-centered care.
Teamwork implies task, role and resource interdependence [31] and collaboration (as defined above) is how interdependence is enacted. Maynard at al. [27] theorize that action processes mediate the relationship between task-based work and outcomes. In our context this translates into a process such as collaboration being the conduit between adaptivity and proactivity on the one hand and patient-centered care perceptions on the other hand. Consequently, we will test the following hypothesis (see Fig. 1):
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The relationship between team adaptive and proactive behaviors and team-level patient-centered care perceptions will be mediated by collaboration.