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Lecture 6

Lecture 6 - Interdisciplinary Teams in Ontario - Sue Haydt's Guest Lecture.docx

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Soc & Social Anthropology
SOSA 2503
Emma Whelan

Oct. 3, 2013- Guest Lecturer 11/8/2013 7:14:00 AM Interdisciplinary Teams in Ontario – Susan Haydt, dissertation project for PhD Today’s Goals: - Outline findings about teams from four health professions - Re-visit concepts in system of health professions (emphasis on medical profession) Why I did this study - Personal curiosity: from research in Ottawa integrating pharmacist into primary care teams, lot of tension - Literature gap:  Elephant in the room, no one looking at teams from critical perspective, assumed teams were good and beneficial  Jury really still out to see if teams effective for patient outcomes  Teams – politically charged topic, healthcare doesn’t want to say anything negative about teams, sociology gives neutral perspective  Literature focuses on making teams work, macro and micro level  Wanted to look at what happens if we look beyond assumption of team greatness.  What do we learn when we take frequencies away from sound recording How I did my study - Ontario as the case - Theoretical framework  Situational Analysis (Clarke, 2005) - Set parameters  Focus on state and leadership of four health professions (medicine, nurse practitioners, dietetics, and chiropractic)  Physicians had potentially the most to lose, NPs could only work in teams, dieticians were a popular choice to have in teams, chiropractic (primary care integration and bad past relationship with medicine) - Data  Textual analysis (min. 383 documents) – legislative document, political debate etc.  Key informant interviews (15) – policy experts, people who had set up teams in Ontario Representative of Health Coalition - Analysis  Focus on what each group said, claims about what teamwork was and assumptions The Situation: Teams in Ontario Long history (+40yrs) of primary care teams  Bottom-up initiatives (Community) o Sault Group Health Centre (1962) o Community Health Centres (1970s) - Top-down initiatives (Provincial governments)  E.g., Health Service Organizations and Community Health Centre Pilot (starting in1982), all forms of government have tried to implement teams, save $$, maximize service  Talk of financial crisis intensifies (1990s): more dramatic shift to cost containment pressure, fed cutbacks, cutbacks to provinces, flavored gov’t’s talk and action towards teams. Liberal Government (2004) 3 main initiatives: 1. ―Our Model‖: Family Health Teams: docs share resources work with other professionals on site. Docs outnumber other professionals  200 FHTs implemented  $600 million invested 2. Community Health Centres: more even mix of healthcare professions, ratio more even  Added 21 full CHCs and 28 satellites  $139 million invested 3. Nurse Practitioner-led Clinics: at least 1 physician on site as a consultant  25 NPLCs implemented  $38 million invested Team Model Teams weighted toward doc dominated models. Family Health Team (FHT)  Physicians make majority of clinical decisions and the other professionals assist the physician (more traditional division of labour)  Physicians are in charge of care, delegate works to other  Tend to be physician-governed boards, followed by mixed gov’t, small portion community only  Tend to serve mainstream populations Community Health Centre (CHC)  Clinical decision making split more evenly between the professionals  More egalitarian structure, non-physicians engage in clinical decision making, patients may not even see a physician  Always community-governed boards  Tend to serve access-challenged populations (poor, elderly, First Nations, GLBT) Nurse Practitioner-led Clinic (NPLC)  Nurse Practitioners make majority of clinical decisions and consult with physicians when needed; other professionals provide support  More egalitarian relationship between NPs and physicians  Always a mixed governance board (nurse practitioners and community members)  Tend to serve geographically isolated populations with no physician services Findings – Physicians - Maintenance Strategies: maintain traditional division of labour - Preferred team model = FHT (to the exclusion of others) Maintenance Strategies –Emphasize the physician-patient relationship vis-à-vis teams  Teams as a possible disruption to that relationship and a disruption to good quality care  Patients still want the physician in charge of their care –Emphasize an evolutionary—not revolutionary—change to teams  Moving too fast or pushing too hard will result in physicians refusing to work in teams, attempt to set pace and tone of switch –Outlining the role to be played by them and by other health professionals  Physicians as best/logical choice of team leader  Other health professions would best serve as helpers to the physician rather than substitutes - Stated preference for the FHT model  especially vs. the NPLC model Other Health Care Professions: - Attempting to expand scope of practise eg. NPs seeking ability to prescribe meds. - Docs try to prevent by arguing allowing other profs to diagnose and prescribe would interfere with interdisciplianary teams functioning. - Enhancing scope of practise focuses independence rather than interdependence and collaboration. - Use teamwork to maintain their own leadership in teams and to stay comfort
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