Crossing Over: health Professional Practice with/in Non-Healthcare Contexts (March 2012)

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Title: Crossing Over: health Professional Practice with/in Non-Healthcare Contexts
Principal ApplicantTitle(s)Institutional AffiliationFunding AmountAnticipated CIHR Submission Date
Dr. Stella Ng Post-Doctoral Fellow Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry at University of Western Ontario $15,000 March 2012
Co-Applicant(s)Titles(s)Institutional Affiliation(s)
Dr. Catherine Schryer Professor and Chair Dept. of Professional Communication at Ryerson University
Dr. Lorelei Lingard Professor Dept. of Medicine, Schulich School of Medicine & Dentistry at University of Western Ontario


Description of Proposed Project for Submission to CIHR

Rationale and Background

Virtually all health professionals cross over to the non-healthcare context through verbal and written communication [1-5]. A common instance of such "crossing over" is the clinician recommendation to a school-based team of health and non-health professionals, where the recommendation may be implemented formally for the shared patient/client through an Individual Education Plan (IEP; the collaborative genre in which clinician recommendations are translated into educational programming). This scenario does not take place seamlessly because disparate discourses act as barriers to collaborative and co-ordinated cross-sector care [6]. The challenges presented by the practice of healthcare across contexts are exemplified by the current debate about Ontario's School Health Support Services (SHSS), which provides community-based health services for school-age children. Health services are also provided by and within public school systems. Both systems serve the same school-age population with separate streams of care. A recent review of SHSS commissioned by three of Ontario's ministries (Health and Long Term Care, Education, and Child and Youth Services) identified a pressing need for improved cross-sector service provision [7]. Similarly, the CIHR Institute of Health Services and Policy Research identified Access to Appropriate Care Across the Continuum as a priority research area, including mechanisms to coordinate and integrate care across the often fragmented facets of the broader healthcare system [8]. To this end, interprofessional and interagency care are recommended for best practices and improved patient outcomes [9, 10], but the impacts of this recommendation are not well understood in terms of: how professionals navigate the varying and disparate discourses and contexts inherent in interprofessional and interagency care, and how a health professional's competence in the non-healthcare team context impacts patient outcomes [10]. A systematic review of interprofessional care interventions identified a need for qualitative methods to provide insight into these problems [10]. In particular, we require robust theoretical explanations and models of the factors that facilitate and constrain effective crossing over. Our research questions are: 1. How do health professionals cross over to the non-healthcare context, including navigation of disparate discourses and genres? 2. How might crossing over be facilitated to improve health and non-health professional practice and collaboration and co-ordinated health services?

Methodology and Methods

Constructivist grounded theory will be used to develop a theoretical explanation of processes involved in crossing over. We will purposively sample health/non-health teams from three non-healthcare settings: government, industry, and public education. Data collection will include observation, intensive interviews, and document review. Constant comparative analysis will enable theorization of the processes of crossing over, with a focus on explication of professionals' use of tacit knowledge across contexts. Rhetorical genre studies will serve as a framework through which to examine genres of health professional practice with/in non-healthcare settings.

Impact on Ontario HHR

The challenges of health human resources include issues such as workforce shortages and effective deployment of professionals other than physicians and nurses [11, 12]; many health professionals practice with/in non-healthcare contexts and yet are ill-prepared to do so, resulting in inefficiencies. The gap in training and understanding related to challenge inherent in crossing over results in compromised health services and dissatisfied health professionals [6, 12]. This research will begin to fill this gap.