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Making it real: the institutionalization of collaboration through formal structure
Daniel W Miller1, Elise Paradis1
1Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, Canada.
Journal of Interprofessional Care
|February 18, 2020
Summary
Healthcare collaboration is widely accepted, but its impact is unclear. Documents like the CanMEDS framework create an appearance of collaboration, potentially masking practice realities and hindering improvement efforts.
Area of Science:
- Sociology of Health
- Healthcare Management
- Organizational Theory
Background:
- Collaboration is a key ideal in modern healthcare, yet its tangible benefits remain debated.
- Existing research often uses functionalist or conflict-theoretical lenses to explain this paradox.
- A gap exists in understanding how collaborative ideals are integrated into healthcare's foundational beliefs and structures.
Purpose of the Study:
- To analyze how idealized versions of physicians and primary care organizations are constructed through language in key healthcare documents.
- To explore the role of formal structures, such as competency frameworks, in shaping perceptions of collaboration.
- To investigate how these structures create an appearance of collaboration irrespective of actual practice.
Main Methods:
- Phenomenological sociology and neo-institutional theory were employed.
- Analysis focused on the language within the CanMEDS competency framework and guides for Family Health Teams.
- Documents were examined as formal structures or 'blueprints' for healthcare.
Main Results:
- The CanMEDS framework and Family Health Team guides construct idealized images of rational, autonomous professionals and organizations.
- These documents function as formal structures that promote an appearance of collaboration.
- This appearance of collaboration is generated independently of the actual collaborative practices within healthcare settings.
Conclusions:
- Formal structures and documents can create a perception of "real" collaboration, potentially obscuring practice-based challenges.
- This manufactured appearance can foster confidence in the healthcare system by aligning it with societal values.
- The focus on idealized structures may distort efforts to genuinely understand and improve healthcare delivery and outcomes.
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