Pluralistic dialogue : a grounded theory of interdisciplinary practice : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, New Zealand
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Date
1999
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Massey University
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Abstract
This grounded theory study explains how health professionals work in interdisciplinary teams in health services where the call for new collaborations is intensifying. Forty-four participants from four teams in two major acute-care hospitals participated in the study. In total there were eighty hours of interviewing and eighty hours of participant observation. All data were constantly compared and analysed using Glaser's emergent approach to grounded theory. Underpinning the study are the premises of symbolic interactionism that are assumed to shape the focus of this study, team interactions, and collective action within an acute care setting. It is argued that interdisciplinary team members express a concern for meeting service needs, and continually resolve that concern through the process of pluralistic dialogue. This is a means for discussing differences, that supports team members who are thinking through and constructing new ways of working together. It emerges as various health professionals integrate multiple perspectives, which contribute to the clinical and organisational management of the client service. Pluralistic dialogue has two complementary phases. These are rethinking professional responsibilities and reframing team responsibilities. Rethinking and refraining are theoretical processes that are underpinned by team learning, and, by new ways of managing changing service structures. Therefore, it is suggested that, in an interdisciplinary team, health professionals must break stereotypical images in order to meet service needs in a context where teams are constantly grappling with different mind-sets. Team members continually resolve their concern for meeting service needs by negotiating service provision. As a result, the health professionals are free to engage in the dialogic culture. The process of pluralistic dialogue has the potential to challenge, to empower, to transform; or it can perpetuate mediocrity. The decision to dialogue mindfully with others is essentially individual. Any variation in an individual's commitment is covered by disciplinary associates but seldom challenged by colleagues from a different professional group. A person may choose a non-involved response at any time, although someone must fulfil functional responsibilities in the team. Any variation in an individual's commitment is covered by disciplinary associates but seldom challenged by colleagues from a different professional group. This study also highlighted several significant categories impacting on effective interdisciplinary practice. Competency, alternative world views, information exchange, accountability, personality differences, and leadership, all affected team processes and pluralistic dialogue. But, it was quite clear from the data that, interdisciplinary team members can, and do form synergistic relationships that benefit both clients and colleagues. Team success is dependent on the individual's courage to challenge the self and the humility to cooperate in collective learning experiences. This substantive theory presents just a glimpse of the practical life of interprofessional people working in two busy city hospitals. The teams studied were unusual in that they each offered specialist care to a select group of clients. Perhaps they were unique and are non-representative of the average person who is a health professional today. So many of the health professionals were highly educated, well-respected specialist practitioners who stand out for their individual investment and dedication to improving the client's pathway through acute care. The study participants' patterns of behaviour would suggest that, when interdisciplinary practice is well established, an attitude of cooperative inquiry pervades joint actions and interactions that focus on meeting service needs
Description
Irregular pagination: missing p.108
Keywords
Health professionals, Health care teams, Team interaction, Health care services