Interprofessional collaboration among health professionals in cleft lip and palate treatment and care in the public health sector of South Africa

(2021) 19:25 Hlongwa and Rispel Hum Resour Health https://doi.org/10.1186/s12960-021-00566-3 Open Access RESEARCH Interprofessional collaboration among health professionals in cleft lip and palate treatment and care in the public health sector of South Africa Phumzile Hlongwa1,2* and Laetitia C. Rispel3 Abstract Background: Collaboration among different categories of health professionals is essential for quality patient care, especially for individuals with cleft lip and palate (CLP). This study examined interprofessional collaboration (IPC) among health professionals in all CLP specialised centres in South Africa’s public health sector. Methods: During 2017, a survey was conducted among health professionals at all the specialised CLP centres in South Africa’s public health sector. Following informed consent, each member of the CLP team completed a selfadministered questionnaire on IPC, using the Interprofessional Competency Framework Self-Assessment Tool. The IPC questionnaire consists of seven domains with 51 items: care expertise (8 items); shared power (4 items); collaborative leadership (10 items); shared decision-making (2 items); optimising professional role and scope (10 items); effective group function (9 items); and competent communication (8 items). STATA®13 was used to analyse the data. Descriptive analysis of participants and overall mean scores were computed for each domain and analysed using ANOVA. All statistical tests were conducted at 5% significance level. Results: We obtained an 87% response rate, and 52 participants completed the questionnaire. The majority of participants were female 52% (n = 27); with a mean age of 41.9 years (range 22–72). Plastic surgeons accounted for 38.5% of all study participants, followed by speech therapists (23.1%), and professional nurses (9.6%). The lowest mean score of 2.55 was obtained for effective group function (SD + -0.50), and the highest mean score of 2.92 for care expertise (SD + -0.37). Explanatory factor analysis showed that gender did not influence IPC, but category of health professional predicted scores on the five categories of shared power (p = 0.01), collaborative leadership (p = 0.04), optimising professional role and scope (p = 0.03), effective group function (p = 0.01) and effective communication (p = 0.04). Conclusion: The seven IPC categories could be used as a guide to develop specific strategies to enhance IPC among CLP teams. Institutional support and leadership combined with patient-centred, continuing professional development in multi-disciplinary meetings will also enrich IPC. Keywords: Interprofessional collaboration, Cleft lip and palate, Multi-disciplinary, Health professional, South Africa *Correspondence: 1 School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Full list of author information is available at the end of the article Introduction The global discourse on interprofessional collaboration (IPC) or the ability of health professionals to collaborate or work together as a team has intensified [1–7]. IPC is defined as: “multiple health workers from different © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Hlongwa and Rispel Hum Resour Health (2021) 19:25 professional backgrounds working together with patients, families, caregivers, and communities to deliver the highest quality of care” [5]: p. 13. The envisaged benefits of IPC include identifying and drawing on the strengths of each member of the health professional team and using those strengths to prevent and manage complex diseases, provide quality of care, and improve both patient and health worker outcomes [5, 6]. This is because IPC improves communication and teamwork and promotes coordination across the continuum of health care [5, 6]. IPC also facilitates egalitarian relationships among health professionals [8], and assists with the amelioration of health workforce shortages [5]. Some scholars suggest that the lack of or sub-optimal IPC among members of health-care teams contributes to poor health-care quality [9]. Research on IPC indicates that patient outcomes and quality of care are enhanced and costs are reduced when health-care team members work together towards shared patient-centred goals [9–16]. IPC has been reported to benefit patients with non-communicable diseases and mental disorders [9]. A study that evaluated the effect of pharmacist participation in medical rounds in an intensive care unit demonstrated a two-thirds reduction in preventable adverse drug events due to prescribing errors [17]. A systematic review of 36 randomised controlled trials involving IPC demonstrated that the risk of hospital readmission was reduced by 19%, while emergency department visits among older adults was reduced by 31% [18]. A study found that patients treated by IPC teams were more satisfied with the care they received [19]. Another study in an acute care setting found that IPC resulted in a decrease in readmissions and an overall decrease in catheter-associated urinary tract infections over time [3]. IPC has also been found to benefit health professionals in primary health-care settings [20], while studies on IPC in palliative care and geriatric care demonstrated mutual benefits for patients and members of the healthcare team [19, 21]. A number of competency frameworks have been developed to assess IPC among health professionals in different settings [22–27]. These frameworks evaluate various attributes of IPC such as communication, care coordination, decision-making, power imbalances, role expectations, teamwork, shared responsibility, and organisational culture. The frameworks differ in the number of domains and/or assessment items, the study setting, development methodology, and measurement scales [22–27]. These competency frameworks have been criticised for limiting innovation and interfering with interprofessional practice [28 (...truncated)