An Examination of the Authority of Health Professionals in the Climate of Inter-Professional Practice and Patient/Family Engagement

This paper investigates the authority of various health professional groups in the climate of inter-professional practice and patient/family engagement. The health care system in Canada and around the world is implementing inter-professional practice and encouraging patient/family engagement to provide safer and more coordinated care. However, the effect of the two initiatives on the practice of health professionals and the experiences of patients/families is not well examined. This paper intends to understand:1) the status of professional authority in health care delivery through the lens of patient/family engagement; and 2) how authority varies among different health professional groups through the lens of inter-professional practice.

Data for this research were collected through individual interviews with 29 health professionals who come from a wide range of professions, 7 health profession learners, 11 patients and 6 families on medicine and pediatrics at a tertiary care teaching hospital. Data were analyzed using thematic coding, informed by grounded theory to reveal gaps in perspectives and experiences.

Several mechanisms were adopted on both wards to engage various health professional groups and patients/families in health care delivery, inter-professional rounds being the biggest initiative. However, I argue that professional authority exists among health professional groups with medicine leading the rounds and asking for input from other professions, while patients/families are not yet integrated members of the health care team. The research reveals workload, resources, and practice variation as some of the significant factors. There are shared perspectives on patient/family engagement and inter-professional practice among health professionals and between health professionals and patients/ families. However, I propose that there are gaps between perspectives and experiences (both the working experiences for health professionals and the hospital experiences for patients/families). Training that integrates patient engagement and inter-professional practice for current and future health professionals is essential to providing patient- and family-centered health care.