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The purpose of this paper is to report on the findings of the first stage of a project seeking to evaluate and overcome inter-professional barriers between health and social care staff within a single, co-located, integrated community team. The project seeks to answer the following questions: first, Do inter-professional barriers to integrated working exist between health and social care staff at the interface of care delivery? Second, If inter-professional barriers exist, can joint health and social care assessments help to overcome them? The paper develops the current evidence base through findings from a staff questionnaire and the initial findings of a pilot study of joint health and social care assessments aimed at overcoming inter-professional barriers to integration.

The first stage of the project involved running an anonymous, online questionnaire with health and social care staff within a single, co-located community adult health and social care team. The questionnaire aimed to explore staffs’ perceptions of inter-professional collaboration when assessing the health and care needs of service users with a high degree of complexity of need. The second element of the study presents the initial findings of a small pilot of joint health and social care assessments. A second staff survey was used in order to provide a “before and after” comparative analysis and to demonstrate the effect of joint assessments on staffs’ perceptions of inter-professional collaboration at the interface of care delivery.

Health and social care staff value joint working as a means of improving quality of care. However, they also felt that inter-professional collaboration did not occur routinely due to organisational limitations. Staff members who participated in the pilot of joint assessments believed that this collaborative approach improved their understanding of other professional roles, was an effective means of enabling others to understand their own roles and helped to better identify the health and care needs of the most complex service users on their caseloads. Initial findings suggest that joint assessments may be a practical means of overcoming inter-professional barriers related to a lack of communication and lack of understanding of job roles.

The questionnaires highlighted the need for integration strategies that are aimed at facilitating collaborative working between staff of different professions, in order to achieve the aims of integration, such as a reduction in duplication of work and hand-offs between services.

To date, few studies have explored either staff perceptions of collaborative working or the effectiveness of joint assessments as a means of overcoming inter-professional barriers. This paper adds new data to an important area of integration that legislators and researchers increasingly agree requires more focus. Although the findings are limited due to the small scale of the initial pilot, they provide interesting and original data that will provide insight into future workforce integration strategies.

The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives.

This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions.

This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking.

Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts.

The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these “grass-root” initiatives engender and how they are consolidated.

The purpose of this study was to explore inter-professional clinicians’ perspectives on resident leadership in the context of inter-professional teams and to identify a definition for leadership in the clinical context. In 2015, CanMEDS changed the title of one of the core competencies from manager to leader. The shift in language was perceived by some as returning to traditional hierarchical and physician-dominant structures. The resulting uncertainty has resulted in a call to action to not only determine what physician leadership is but to also determine how to teach and assess it.

Focus groups and follow-up individual interviews were conducted with 23 inter-professional clinicians from three pediatric clinical service teams at a large, Canadian tertiary-level rehabilitation hospital. Qualitative thematic analysis was used to inductively analyze the data.

Data analysis resulted in one overarching theme: leadership is collaborative – and three related subthemes: leadership is shared; leadership is summative; and conceptualizations of leadership are shifting.

Not all members of the three inter-professional teams were able to attend the focus group sessions because of scheduling conflicts. Participation of additional clinicians could have, therefore, affected the results of this study. The study was conducted locally at a single rehabilitation hospital, among Canadian pediatric clinicians, which highlights the need to explore conceptualization of leadership across different contexts.

There is an evident need to prepare physicians to be leaders in both their daily clinical and academic practices. Therefore, more concerted efforts are required to develop leadership skills among residents. The authors postulate that continued integration of various inter-professional disciplines during the early phases of training is essential to foster collaborative leadership and trust.

The results of this study suggest that inter-professional clinicians view clinical leadership as collaborative and fluid and determined by the fit between tasks and team member expertise. Mentorship is important for increasing the ability of resident physicians to develop collaborative leadership roles within teams. The authors propose a collaborative definition of clinical leadership based on the results of this study: a shared responsibility that involves facilitation of dialog; the integration of perspectives and expertise; and collaborative planning for the purpose of exceptional patient care.

The purpose of this paper is to investigate how three communication interventions commonly used during discharge planning and care transitions enable inter-professional knowledge sharing and learning as a foundation for more integrated working. These interventions include information communication systems, dedicated discharge planning roles and group-based planning activities.

A two-year ethnographic study was carried out across two regional health and care systems in the English National Health Service, focussing on the discharge of stroke and hip fracture patients. Data collection involved in-depth observations and 213 semi-structured interviews.

Information systems (e.g. e-records) represent a relatively stable conduit for routine and standardised forms of syntactic information exchange that can “bridge” time–space knowledge boundaries. Specialist discharge roles (e.g. discharge coordinators) support personalised and dynamic forms of “semantic” knowledge sharing that can “broker” epistemic and cultural boundaries. Group-based activities (e.g. team meetings) provide a basis for more direct “pragmatic” knowledge translation that can support inter-professional “bonding” at the cultural and organisational level, but where inclusion factors complicate exchange.

The study offers analysis of how professional boundaries complicate discharge planning and care transition, and the potential for different communication interventions to support knowledge sharing and learning.

The paper builds upon existing research on inter-professional collaboration and patient safety by focussing on the problems of communication and coordination in the context of discharge planning and care transitions. It suggests that care systems should look to develop multiple complementary approaches to inter-professional communication that offer opportunities for dynamic knowledge sharing and learning.

Managing violence is an important clinical and managerial responsibility within contemporary mental health practice and there have been considerable developments across the country to pave the way for a more ‘standardised’ approach to conflict resolution. Many trusts employ someone to lead on ‘conflict resolution’ but the precise nature of the lead role and the responsibility attached to it vary greatly between organisations. Similarly, some trusts have sophisticated systems for delivering and monitoring conflict training and updates, whereas others do not. The project described here sought to clarify how training for conflict resolution is organised within a sample of mental health trusts in England. Data was generated by questionnaire and telephone interview with trust leads, and the audit findings were then analysed and used to inform an inter‐professional training pilot in one local trust. It is now expected that frontline staff will enter into conflict resolution training as defined by the NHS Security Management Service (2004) and be trained in accordance with a national syllabus of training standards. Audited opinion suggests that the training co‐ordinator role is associated with improved governance in relation to conflict‐resolution training. Arguably, if national benchmarks and standards are to be met in relation to conflict resolution, trusts need to invest in training infrastructure and at least consider the merits of funding a dedicated co‐ordinator role and inter‐professional training.

In this chapter, the authors will discuss the global learning partnership (GLP), which is an innovative and evidence-informed model of experiential learning for health professional students. The model is based on partnerships between universities to promote the UN Sustainable Development Goals (SDGs) agenda.

The GLP is a placement opportunity for an inter-professional cohort of visiting and local students and academics, designed as an action-orientated, community engagement learning experience focused on addressing community health and well-being needs (Goal 3). Consistent with the SDGs, strong partnerships (Goal 17) are essential to lasting impact.

The aim of developing the GLP was to design, implement, and trial a new model of global placement that was sustainable, capacity building, and a genuine learning opportunity for local and international health science students, driven by the agenda to increase learning about and action on the SDGs. This model was designed to harness the strengths of existing educational frameworks recognized for the beneficial learning opportunities they provide; inter-professional learning; learning from and with communities with SDG needs; and with a three-week immersion component for building cultural competency.

In addition to focusing on the SDG agenda, the GLP is unique in drawing on the knowledge and skills of local students and academics in educating the visiting students to work in geopolitically and socioculturally complex community setting building, as visitors learn from both local students and the local community about best practice.

This chapter will provide discussion of the theoretical framework underpinning the model design and draw on the student and academic experience. Practice details are also provided to allow educators in other organizations to replicate the partnership model.

Employee loyalty is generally a very positive trait. However, when loyal employees are confronted with dysfunctionality in the workplace the impact on their well-being can be significant. The purpose of this paper is to assess the interaction of employee loyalty and employee experience of inter-professional dysfunction in a hospital setting to predict employee job tension.

The paper is based on the analysis of a cross-sectional attitudinal survey of employees within a hospital setting in Australia. The authors use OLS regression and an SPSS macro (by Hayes, 2013) to assess the regions of significance of the interaction effects.

The authors find, as anticipated, significant direct effects for employee loyalty and inter-professional dysfunction on employee job stress. The authors further find significant interaction effects that suggest that highly loyal employees who experience inter-professional dysfunction also experience disproportionately high levels of job tension.

The main research implication of this research relates to the confirmation of the presence of an interaction effect between loyalty and inter-professional dysfunction in predicting employee job stress. Further, the zone of significance analysis (following Johnson and Neyman) suggests that this effect is evident at even low levels of inter-professional dysfunction.

Organisations should appreciate employee loyalty but should also be aware that loyal employees are more vulnerable to the negative consequences of organisational dysfunction than are employees with limited organisational loyalty.

The paper confirms the importance of managing organisational cooperation between groups in organisations as a precursor to positive employee outcomes.

This is the first paper to investigate this interaction and to apply Johnson-Neyman analysis to confirm the regions of significance for the interaction effects noted.

The purpose of this paper is to examine how knowledge exchange between academics and clinicians in Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) is influenced by their social position based on their symbolic and social capitals, that is, their personal professional status and connections to high-status professional peers, knowledge brokers, and unfamiliar professional peers.

Using an online survey, the author triangulates the cross-sectional measurement of the effects of academic and clinicians’ social position in the initial and later phases of CLAHRCs with the longitudinal measurement of these effects over a two-year period.

First, academics and clinicians with a higher personal professional status are more likely to develop joint networks and decision making both in the early and later phases of a CLAHRC. Second, academics and clinicians who are more connected to higher status occupational peers are more likely to develop joint networks in the early phase of a knowledge exchange partnership but are less likely to become engaged in joint networks over time. Third, involvement of knowledge brokers in the networks of academics and clinicians is likely to facilitate their inter-professional networking only in the later partnership phase.

Academics and clinicians’ capitals have a distinctive influence on knowledge exchange in the early and later phases of CLAHRCs and on a change in knowledge exchange over a two-year period.

Prior research on CLAHRCs has examined how knowledge exchange between academics and clinicians can be encouraged by the creation of shared governance mechanisms. The author advances this research by highlighting the role of their social position in facilitating knowledge exchange.

The potential of inter‐professional education and training in primary care is increasingly being recognised, especially in light of UK policy developments relating to clinical governance and primary care groups and trusts. Action to Support Practices Implementing Research Evidence (ASPIRE) was set up in North‐west England in 1997 to assist primary care teams in finding, appraising and applying evidence. Outlines some of the lessons learned and questions raised about the feasibility of such inter‐professional initiatives. It was necessary to gear the programme to meet the various expectations and needs of different professionals. Target setting by teams and the provision of protected time within a structured framework appeared to yield direct and indirect benefits to participants. However, there is a need for much more rigorous evaluation of multidisciplinary programmes with regard to their ability to overcome traditional hierarchies and barriers, their effectiveness in improving practice and their longer‐term costs and benefits.

Competency-based measure is increasingly evident as an effective approach to tailoring training and development for organisational change and development. With design stage widely reckoned as being decisive for construction waste minimisation, the purpose of this paper is to identify designers’ competencies for designing out waste.

Due to paucity of research into competency for construction waste mitigation, this study corroborates verbal protocol analyses (VPA) with phenomenological research.

Combining findings from the two methodological approaches, competencies for designing out waste are grouped into five categories, three of which are largely task related and two being contextual competencies. The study suggests that design task proficiency, low waste design skills and construction-related knowledge are indispensable task competencies, while behavioural competence and inter-professional collaborative abilities are requisite contextual competencies for designing out waste. In concurrence with task-contextual theory of job performance, personality variables and cognitive abilities are found to influence one another. This suggests that both task and contextual competencies are not only important, they are less mutually exclusive with respect to designing out waste.

This study implies that apart from commitment and dedication of designers to waste minimisation, design and firm practices are expected to be adapted to the industry’s standard.

Basis for training needs of design professionals as well as redeployment criterion are further elaborated in the paper. By enhancing competencies identified in this study, construction waste would not only be significantly designed out, adequate cost saving could be made as a result of waste reduction.