By Michele Chaban, MSW, RSW, PhD, University of Toronto, University of Wales, Wilfrid Laurier University
as published in "The Newsletter of the Rapid Response Radiotherapy Program of Toronto Sunnybrook Regional Cancer Centre" August 2006
...The world teaches us that cultures collide. Cultures in health science are no different. Inter-professional thinkers such as Ivy Oandeson, Chair of Inter-Professional Studies at U of T, suggests that health science is a culture and each profession is its own distinct culture. The disciplines bring their diverse ways to all our processes in the hopes of enhancing outcomes in patient care, education, research, etc. Conflicts within teams or between professional cultures are often based on competing values, beliefs and practices. The conflict can escalate for many reasons, but de-escalation takes place through dialogue and time. It is my experience that this can build and fortify a team. Not dealing with the conflict, or having one culture determine processes and outcomes encourages cultures in conflict. Patients, families and professional caregivers suffer for these value based battles.
If you consider inter-professional teams as cultures, ask yourself: does your team exhibit cultural competence between and amongst the disciplines? Is there a democracy of disciplines or a dominant profession? If so, does this dominant culture use its position to facilitate the other disciplines or determine them? What will you do to maintain the mosaic of care?
How we retain Canadian values in Canada’s health care system is more complex than having a food fair at lunch. Honouring diversity means the once hierarchical models of practice must flatten and function as inter-professional teams equitably. The once-separatist silos of the professions will hopefully build bridges between and amongst themselves while not losing the inherent integrity of each professional culture, while allowing patients and families access to all disciplines. To have equity and access, the team must educate each other and those they serve. This means a body of knowledge must be created, conveyed and be available on a continuum for those who need it.
How can this be done? Firstly, viewing ourselves as distinct cultures changes the phenomenology of how to view and interact with inter-professionalism. It bears more responsibility for all of us, especially the dominant culture(s). Secondly, consultation and collaboration are skill sets we acquire, but are seldom taught. It is assumed we know how to exercise this specialized form of communication. Learning how to consult and collaborate within an inter-professional team is one step towards enhancing team function, dealing with inter-professional diversity, honouring difference and, most importantly, mediating inter-professional cultures. Being true to Canadian values in our health care system means finding a way to honour our differences and build the mosaic, rather than allowing ourselves to become a melting pot, i.e., we all do bio-psycho-social-spiritual care or act as silos in solitude.
In a system dedicated to productivity, high-performance outcomes, we may have to find ways for the spirit in the machine of health care to manifest itself. We and they are human – we are more than our functioning. It is only if we exercise our humanness, both at the bedside and with each other, that we will keep the system person-centred and able to tolerate, if not celebrate, each other’s diverse ways. Then, truly, we will be ensuring the integrity of Canadian culture in our health care system.
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