Journal of Interprofessional Education & Practice 15 (2019) 24–29

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Journal of Interprofessional Education & Practice

journal homepage: www.elsevier.com/locate/jiep

Healthcare professionals’ perceptions regarding interprofessional T

collaborative practice in Indonesia
Rezki Yeti Yusraa,c, Ardi Findyartinib,c,∗, Diantha Soemantrib,c
a
Graduate of Master Program in Medical Education, Department of Medical Education, Faculty of Medicine Universitas Indonesia, Indonesia
b
Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Indonesia
c
Center of Medical Education, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Indonesia

A R T I C LE I N FO A B S T R A C T

Keywords: Background: Effective interprofessional collaborative practice can strengthen and optimise healthcare. Objective
CPAT assessment of collaborative practice using a valid instrument is important in a healthcare setting for assessing the
Interprofessional collaboration in Indonesia effectiveness of a team's interprofessional collaborative practice. One of the instruments that can be used for this
Barriers purpose is the Collaborative Practice Assessment Tool (CPAT). This study aims to evaluate the interprofessional
collaborative practice of healthcare practitioners in Indonesia using CPAT.
Method: This was a cross sectional study conducted from March to June 2017. The CPAT questionnaire was
validated and the subscales were identified through factor analysis. The Cronbach alpha of the Indonesian
version of the CPAT questionnaire, with a total of 53 questions, was very good (0.916).
Result: The study involved 304 respondents drawn from the medical and healthcare personnel at Cipto
Mangunkusumo Hospital. This study used the Indonesian version of CPAT that has been validated in the
Indonesian context. The Indonesian version of CPAT consists of eight components: 1) relationships among team
members, 2) barriers to team collaboration, 3) team relationships within the community, 4) team coordination
and organisation, 5) decision making and conflict management, 6) leadership, 7) missions, goals and objectives
and 8) patient involvement, responsibility and autonomy. There were no significant differences in the total score
for perceived collaborative practice according to age, gender, professional background or length of work ex-
perience in the profession. However, there was a significant difference in the team barrier component based on
the profession, age and length of work experience in the profession. The significant difference in the team barrier
component was evident in the professional groups of doctors and nurses (p = 0.008). Moreover, the result
showed that age group may contribute to the different perceptions of the team barriers: between 20-30 years and
31–40 years (p = 0,026), between 20 and 30 years and > 50 years (p = 0,000), and between 31 and 40 years
and > 50 years (p = 0.001). Finally, there was a significant difference in the team barrier component based on
the length of work experience: between those who had been working for 1–5 years with 5–10 years (p = 0.016)
and those who had worked for > 10 years (p = 0.006).
Conclusion: This study showed that nurses perceived more barriers in practicing interprofessional collaborative
care than other professionals. Staff in the younger age group with a shorter length of work experience perceived
more obstacles than older people with longer lengths of work experience. Further research is needed to explore
factors that may support or hinder interprofessional collaborative practice in Indonesia.

1. Introduction
Health services are currently facing the challenges of medical and
healthcare provider shortages and their uneven distribution (World
Health Organisation (WHO), 2010). In addition, health problems are
becoming increasingly complex, resulting in the need for an adequate
healthcare system. One possible solution for this problem is colla-
boration between health workers. Based on research in the last 50
years, effective collaborative interprofessional care has been shown to
strengthen the health care system, optimizing and improving the
quality of health services.16 Collaboration occurs when healthcare
providers work cooperatively with their colleagues from other

∗
Corresponding author. Department of Medical Education & Medical Education Centre, Indonesia Medical Education and Research Institute, Faculty of Medicine,
Universitas Indonesia, Indonesia.
E-mail address: ardi.findyartini@ui.ac.id (A. Findyartini).

https://doi.org/10.1016/j.xjep.2019.01.005
Received 5 September 2018; Received in revised form 6 January 2019; Accepted 10 January 2019
2405-4526/ © 2019 Elsevier Inc. All rights reserved.
R.Y. Yusra et al.
professions and with patients and their families.5 The willingness of
each profession to work with others in interprofessional teams is im-
portant. Every healthcare profession needs to focus on collaborative
competencies in order to implement collaborative practice, which
consists of teamwork, communication and team responsibility for
healthcare services.36
The effectiveness of interprofessional team collaboration in a
healthcare programme can be objectively assessed using valid instru-
ments.24 Many instruments have been developed to assess healthcare
interprofessional collaborative practice including: Collaborative Prac-
tice Assessment Tool (CPAT),31 Assessment of Interprofessional Team
Collaboration Scale (AITCS),24 Interdisciplinary Team Process and
Performance Survey (ITPPS),34 Perception of Interprofessional Colla-
boration Model Questionnaire (PINCOM-Q),23 Interprofessional Edu-
cation Collaborative (IPEC) Assessment Tool,11 Attitude Toward Health
Care Teams Scale (ATHCT)9 and TeamSTEPPS Teamwork Attitudes
Questionnaire (T-TAC) Manual.1
Several factors need to be considered when selecting an instrument
including its appropriateness to the research context, strong validity,
and applicability.30 The CPAT instrument was developed to assess le-
vels of collaboration and is able to identify strengths and weaknesses in
collaborative practice. It may therefore provide opportunities for fo-
cused training interventions for team members. AITCS measures col-
laboration in interprofessional teams and patient involvement in col-
laborative practice. In addition, the ATHCT focuses on assessing the
attitude of interprofessional team members, while PINCOM-Q was de-
veloped to assess perceptions and behaviour among healthcare profes-
sionals. The ITPPS instrument aims to assess team performance in long-
term nursing care, and PACT focuses on assessing communication and
cooperation. The IPEC instrument was developed to assess student
collaborative practice and T-TAC was designed to assess the attitude of
interprofessional teams.
Given that the purpose of the present study is to assess inter-
professional collaborative practice, either of two instruments (CPAT or
AITCS) could be used. CPAT was selected for several reasons. Firstly,
CPAT consisted of 56 items across eight components while AITCS
consisted of 37 statements across three components. Therefore, while
both instruments represent components which are relevant to inter-
professional collaborative practice, CPAT is more comprehensive than
AITCS. Secondly, previous studies show that, although both instru-
ments have very good internal consistency (CPAT: 0.67–0.89, AITCS
0.98),31 the internal consistency of AITCS may be too high and may
introduce possible redundancy.10 Thirdly, CPAT has been translated
into other languages such as French, Taiwanese and Japanese; hence, it
is more widely used and has been validated in different contexts. In
several studies, the high number of respondents in different countries
who completed the CPAT (Japan (n = 200), America (n = 100),35 and
Canada (n = 514)25) indicated its high response rate and applicability
in different contexts and cultures. In addition, the CPAT factor analysis
results showed eigenvalues of 1–4 for all components and Normed Fit
Index (NFI) and Comparative Fit Index (CFI) values of > 0.90. These
results suggested that the instrument is suitable for CFA analysis
(Schroder C et al., 2011). It can therefore be concluded that CPAT is
valid, reliable and appropriate for use in this present study.
To the best of our knowledge, there are very few studies relating to
the assessment of the collaborative practice of health worker teams in
Indonesia. The Indonesian collaborative practice models are similar to
traditional or hierarchical collaborative practice models14.32; The tra-
ditional collaborative practice model emphasizes two-way commu-
nication but perceives physicians to be the leaders and decision ma-
kers.33 According to Fatalina et al., health workers’ understanding of
collaborative practice is limited due to lack of access to information on
interprofessional collaboration.14
This study aims to evaluate the interprofessional collaborative
practice of healthcare practitioners, based on the perceptions of med-
ical and healthcare personnel at a national referral center hospital in
25
Journal of Interprofessional Education & Practice 15 (2019) 24–29
Indonesia.
2. Methods
2.1. Research design
This cross-sectional study uses a previously validated CPAT ques-
tionnaire. The questionnaire was validated using exploratory factor
analysis (EFA) following language adaptation and a pilot test. The data
underwent factor analysis using SPSS 20.0 to identify the number of
subscales while testing the validity and reliability of the questionnaire.
2.2. Data collection
The original questionnaire was translated into the Indonesian lan-
guage and then translated back to the original language by a certified
translator to check the quality and accuracy of the language and the
concept conformity. The translated CPAT was then subjected to a pilot
test. Thirty-one respondents rated each item according to its clarity and
comprehensibility. Following the pilot study, the anonymous CPAT was
administered to 400 respondents consisting of doctors, nurses, mid-
wives, pharmacists, nutritionists, physiotherapists, health analysts,
public health experts, radiographers, and other healthcare professionals
who were selected using a cluster-sampling method. An EFA was then
applied to the data.
The EFA showed sample adequacy of MSA 0.728–0.965, KMO 0.923
and Bartletts's Test of Sphericity 0.000. Eight components were ex-
tracted using the principal component analysis method and three items
that showed low extraction communalities (< 0.5) were excluded: Q17:
‘Procedures are in place to identify who will take the lead role in co-
ordinating patient/client care’, Q28: ‘Team members negotiate the role
they want to take in developing and implementing the patient/client
care plan’, and Q31: ‘Physicians usually ask other team members for
opinions about patient/client care’ (Schroder C et al., 2011). The low
value of extraction communalities suggests that these items might have
different construct from other items.10 The correlation coefficient score
for 53 questions was > 0.3 with a significance level of 5%.10 Extraction
using the principal component analysis method and oblimin rotations
resulted in eight components with a Cronbach's α value of 0.916. This
showed that the Indonesian CPAT met the criteria of construct validity
and reliability for each component and the whole questionnaire.
The Indonesian version of the Collaborative Practice Assessment
Tool (CPAT) consists of 8 components; namely, 1) relationships among
team members (9 statements, α = 0.906); 2) barriers to team colla-
boration (5 statements, α = 0.614); 3) team relationship with the
community (4 statements, α = 0.918); 4) team coordination and or-
ganisation (14 statements, α = 0.927); 5) decision-making and conflict
management (2 statements, α = 0.700); 6) leadership (5 statements,
α = 0.773); 7) missions, goals and objectives (9 statements,
α = 0.875); and 8) patient involvement, responsibility and autonomy
(5 statements, α = 0.772).
2.3. Data analysis
The scores of the Indonesian CPAT were calculated using the uni-
variate and bivariate analysis methods in the SPSS 20.0 software.
Univariate analysis was conducted to identify the characteristics of
respondents, while bivariate analysis was used to compare the values of
CPAT among the respondent groups. Respondents were grouped ac-
cording to age, profession and duration of work experience (determined
by a Kruskal-Wallis test) and also sex (using a Mann-Whitney test).
2.4. Ethical considerations
The questionnaires were completed anonymously and all data was
kept confidential by the authors. The study was approved by the
R.Y. Yusra et al. Journal of Interprofessional Education & Practice 15 (2019) 24–29

Table 1 data distribution was abnormal. Tables 3 and 4 show that there were no
Demographic distribution of the respondents (n = 304). statistically significant differences in the overall score based on age,
Variable Total (n) Percentage (%) profession, or length of work experience in the profession. However,
there were significant differences in the scores relating to the ‘barriers
Sex in team collaboration’ component and the ‘team relationships with the
- Male 88 28,9
community’ component according to age, profession, and length of
- Female 216 71,1
Age group
work experience in the profession.
- 20–30 years old 115 37,8 Table 3 shows that there were significant differences relating to the
- 31–40 years old 108 35,5 ‘barriers in team collaboration’ component based on the Kruskal Wallis
- 41–50 years old 61 20,1 test. A post hoc analysis using the Mann-Whitney test revealed that
- > 50 years old 20 6,6
there were significant differences between the age categories of 20–30
Profession
- Nurse 158 52,0 years old and 31–40 years old (p = 0,026), the categories of 20–30
- Doctor 94 30,9 years old and > 50 years old (p = 0,000), and the categories of 31–40
- Pharmacist 10 3,3 years old and > 50 years old (p = 0.001). Regarding the ‘team re-
- Radiographer 10 3,3
lationships with the community’ component, the respondents showed a
- Public health expert 8 2,6
- Health analyst 6 2,0
significant difference between the age category of 20–30 years old and
- Physiotherapist 5 1,6 the age category of 31–40 years old (p = 0.017), and also between the
- Midwife 4 1,3 categories of 20–30 years old and > 50 years old (p = 0.016). For the
- Nutritionists 4 1,3 sex category, no significant differences between the scores were found
- Other profession 5 1,6
(p > 0.05).
Length of work in profession
- 1–5 years 102 33,6 Table 4 shows that there was a significant difference in the ‘barriers
- 5–10 years 96 31,6 in team collaboration’ component, but only between the groups of
- > 10 years 106 34,9 doctors and nurses (p = 0.008). Nurses had lower scores, indicating
Collaboration team that they perceived more barriers when practicing interprofessional
- Emergency 8 2,6
- General surgery 11 3,6
collaborative care than the doctors. In terms of the length of work ex-
- Integrated Service Center 228 75 perience category there were also significant differences in the ‘barriers
- Paliative 13 4,3 in team collaboration components’ score, specifically between the col-
- Transplantation 6 2,0 laborating team that had worked for 1–5 years and the one that had
- Geriatric 10 3,3
worked for 5–10 years (p = 0.016) and between the team that had
- Difficult Case 16 5,3
- Code Blue 2 0,7 worked for 1–5 years and the one that had worked for > 10 years
- ICU 8 2,6 (p = 0.006). Meanwhile, there was no difference (p > 0.05) between
- Delivery room 1 0,3 respondents who had worked for 5–10 years and those who had worked
- Burn unit 1 0,3 for > 10 years. In all groups, the respondents who had worked for 1–5
Current position in team
- Team leader 7 2,3
years had a lower score, indicating that respondents with a short length
- Team member 297 97,7 of work experience faced more barriers when practicing collaborative
Work unit care than those who had worked for longer periods.
- In-patient unit 7 2,3
- Integrated Service Unit HIV 7 2,3
4. Discussion
- Geriatric 3 1,0
- Integrated private service unit 188 61,8
- Integrated Heart Center 83 27,3 Studies regarding collaborative practice in Indonesia are still very
- Intergrated Outpatient Unit 4 1,3 limited and information on collaborative practice has not been widely
- Emergency Department 5 1,6 disseminated. This is consistent with Fatalina et al.’s statement that
- Intergrated Surgical Service Unit 6 2,0
- Burn Unit 1 0,3
healthcare professionals' understanding of collaborative practice is
limited because of a lack of access to information on interprofessional
collaboration.14 This study shows that collaborative practice models
Research Ethics Committee at the Faculty of Medicine Universitas were similar to hierarchical or traditional models, based on the finding
Indonesia (Number: 150/UN2.F1/ETIK/2017). that 77.9% of respondents agreed that the final decisions concerning
patient care were in the hands of doctors. This finding confirms those of
studies which highlighted that the collaborative practice model in In-
3. Results donesia is similar to traditional or hierarchical collaborative practice
models14.32; The desired model in interprofessional collaborative
Three hundred and four medical and healthcare personnel com- practice is a complementary model in which no single profession is
pleted the CPAT with a response rate of 76%. The median age of re- more dominant than other professions. The complementary model is a
spondents was 34 years (minimum 20, maximum 64). The research was collaborative model in which the various professions share power and
conducted in the Integrated Private Service Unit, the Integrated HIV perspectives and have complementary roles and responsibilities with
Service Unit and the Integrated Heart Service Unit of Cipto regard to patient care.17
Mangunkusumo Hospital, which is a national referral hospital in an The number of studies that have assessed interprofessional colla-
urban setting. All respondents had experience of collaborative practice borative practice by using the CPAT instrument are very limited.31
in their respective units. The first two units employ the collaboration of Nevertheless, the results of this study are in line with studies that as-
different healthcare professionals in an outpatient setting, whereas the sessed collaborative practices using other instruments, such as the
latter unit is a more integrated inpatient setting equipped with an op- Jefferson Scale Instrument of Attitudes toward Physician-Nurse Colla-
erating room. The distribution of respondents can be seen in Table 1. boration (JSAPNC)4.17; Both the JSAPNC and the CPAT questionnaires
The distribution of CPAT scores based on its components can be measure perceptions regarding collaboration. JSAPNC measures per-
seen in Table 2, while Tables 3 and 4 provide the scores based on the ceptions and attitudes concerning collaboration between doctors and
respondent groups. nurses, while CPAT measures perceptions of collaboration between
Median value and non-parametric analysis were used because the multiple teams of healthcare professionals.18 In the current study, the

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R.Y. Yusra et al. Journal of Interprofessional Education & Practice 15 (2019) 24–29

Table 2
Scores of CPAT questionnaire.
Component Number of questions Score CPAT Score Median (Min-Max)

Min Max

Relationships among members 9 0 45 36 (25,45)

Barriers in team collaboration 5 0 25 14 (2,24)
Team relationships with the community 4 0 20 16 (0,20)
Team coordination and organisation 14 0 70 56 (43,70)
Decision making and conflict management 2 0 10 4 (2,10)*
Leadership 5 0 25 20 (11,25)
Mission, goals and objectives 9 0 45 37 (30,45)
Patient involvement, responsibility and autonomy. 5 0 25 20 (5,20)
Total 53 0 265 205,5 (154,248)

* Precaution on the analysis of the component is warranted since it was only consisted of two items.10

majority of respondents were doctors and nurses; hence, the research
that used the JSAPNC instrument is still relevant as a comparison.
Sayed's study in 2011, which used the JSAPNC, showed that there is
a relationship between age and length of work experience in respect of
collaborative values. In line with Sayed's research, Elsous et al., who
also used the JSAPNC, showed that there is a relationship between age
and length of work experience in respect of the collaborative values of
doctors and nurses in Palestine.12 The study by Martiningsih also con-
firms that age affects the attitude of nurses and doctors regarding col-
laborative practice.20 The results of such studies indicate that older
respondents show higher collaboration scores than younger ones. Re-
spondents who had been working for many years had stronger colla-
borative attitudes than the recently employed respondents. However,
Mongo found that there were no effects of age and length of work ex-
perience on collaboration values.22
This study demonstrated the differences in perceived barriers to
team collaboration between groups with different ages and lengths of
work experience. Greater age or a longer length of work experience
produced higher scores relating to the barriers to team collaboration.
The higher the barrier component score in the team, the fewer barriers
are experienced. A person's maturity and interaction pattern with
others changes with age.7 Greater age and longer experience of working
in a profession afford more face-to-face interaction and more oppor-
tunity to share experience. Macdonald and Kartz suggested that in-
creasing interaction with nurses will increase doctors' knowledge of the
nursing profession.19 Sayed's research also showed a similar result: that
increased experience improved the nurse and physician collaboration
scores.29
The self-confidence of health workers, which increases with age,
will affect interpersonal and interprofessional interactions in health
care collaboration.26 Teams with longer lengths of work experience
have more opportunities to collaborate and are more concerned with
task elaboration and interpersonal relationships within the team.2
Longer work experience in a collaborative team also improves the ne-
gotiating skills that are necessary for conducting patient-centred
healthcare collaboration.28 The influence of age and duration of work
experience on healthcare interprofessional collaboration may depend
on the context of health services in which the collaboration takes place,
since collaboration also needs to take into account the healthcare or-
ganisational system and culture.28
This study also showed different perceptions regarding the ‘barriers
to team collaboration’ component based on the different professions,
especially between doctors and nurses. The nurses perceived more
barriers when practicing collaborative practice than the doctors. This
may be a result of the existing hierarchical structure and socio-cultural
factors. Hojat et al. in America, Israel, Italy and Mexico carried out a
socio-cultural comparison of nurses' and doctors' attitudes to colla-
boration.17 The results of this study indicate that there is a difference in
the attitude to collaboration between doctors and nurses. Doctors and
nurses from countries which employ a complementary model (e.g.
America and Israel) may have more positive attitudes to physician-
nurse collaboration than those from countries with a hierarchical model
of collaboration (e.g. Italy and Mexico).17 In organisations with a
hierarchical culture, the tendency of a profession to be more autono-
mous and to have difficulties in collaborating tends to be higher,
whereas the opposite occurs in organisations with complementary
cultures.28 Thus, promoting a complementary collaborative model
might be necessary for improving attitudes towards collaborative
practice.
The barriers to collaborative practice experienced by nurses might
also be caused by other professions’ lack of knowledge regarding the
role of nurses.3 Moreover, the lack of support from professional orga-
nisations for their contribution to improving quality of care leads to
poor collaboration between nurses and doctors.29 Erickson and Clifford

Table 3
Distribution of CPAT scores based on respondents’ age and sex.
Component Age (years) Median (Min-Max) P Kruskal Sex Median (Min-Max) P Mann
Wallis Whitney
20–30 31–40 41–50 > 50 Male Female

Relationships among team members 36(25,45) 36(29,45) 37(34,45) 37(34,45) 0,397 36 (25,45) 36 (25,45) 0,654
Barriers in team collaboration 14(8,22) 15(9,23) 15(2,24) 17,5(9,23) 0,000 14 (8,24) 14 (2,23) 0,776
Team relationships with the community 16(0,20) 16(0,20) 16(0,20) 16(7,17) 0,021 16 (0,20) 16 (4,20) 0,739
Team coordination and organisation 56(43,70) 56(43,70) 56(51,70) 56(46,70) 0,225 56 (43,70) 56 (43,70) 0,761
Decision making and conflict 4(2,10) 4(2,10) 4(2,8) 4(2,8) 0,565 4 (2,9) 4 (2,10) 0,144
management *
Leadership 20(15,25) 20(12,25) 20(11,25) 20(14,25) 0,359 20 (12,25) 20 (11,25) 0,815
Missions, goals and objectives 37(30,45) 37(31,45) 38(32,45) 37,5(33,45) 0,630 37 (33,45) 37 (30,45) 0,924
Patient involvement, responsibility and 20(15,25) 20(5,25) 20(12,25) 20(12,25) 0,324 20 (5,25) 20 (12,25) 0,690
autonomy
Overall Score 204 (181,248) 204 (154,244) 210 (177,248) 210,5 (177,235) 0,401 205,5 205,5 0,852
(154,248) (172,248)

** Precaution on the analysis of the component is warranted since it was only consisted of two items.10

27
R.Y. Yusra et al. Journal of Interprofessional Education & Practice 15 (2019) 24–29

Table 4
Distribution of CPAT scores based on respondents’ profession and length of work.
Component Profession Median (Min-Max) P Kruskal Length of work (years) Median (Min-Max) P Kruskal
Wallis Wallis
Doctor Nurse Other 1–5 5–10 > 10
professions

Relationships among team members 36,5 (30,45) 36 (25,45) 38 (25,45) 0,115 36 (29,45) 36 (25,45) 37 (30,45) 0,118
Barriers in team collaboration 16 (9,24) 14 (2,22) 15 (9,22) 0,008 14 (8,21) 15 (9,23) 15 (2,24) 0,018
Team relationships with the community 16 (0,20) 16 (0,20) 16 (0,20) 0,208 16 (0,20) 16 (8,20) 16 (0,20) 0,044
Team coordination and organisation 56 (43,70) 56 (47,70) 56,5 (43,70) 0,187 56 (46,70) 56 (43,70) 56 (46,70) 0,264
Decision making and conflict 4 (2,8) 4 (2,10) 4 (2,9) 0,376 4 (2,8) 4 (2,10) 4 (2,10) 0,068
management *
Leadership 20 (11,25) 20 (15,25) 20 (15,25) 0,694 20 (17,25) 20 (11,25) 20 (14,25) 0,199
Missions, goals and objectives 37 (31,45) 36,5 (32,45) 39,5 (30,45) 0,099 37 (30,45) 36 (31,45) 38 (32,45) 0,119
Patient involvement, responsibility and 20 (12,25) 20 (5,25) 20 (14,25) 0,221 20 (15,25) 20 (12,25) 20 (5,25) 0,314
autonomy
Overall score 209 (169,248) 204 (154,248) 209 (181,241) 0,143 205 (182,248) 202,5 209 (154,248) 0,100
(169,244)

* * Precaution on the analysis of the component is warranted since it was only consisted of two items.10

proved that improved nurse training and organisational support lead to
more effective collaboration between nurses and doctors.13 Doctors
may not understand the actual role of nurses in providing patient
care.21 Doctors tend to believe that nurses are subordinate to doctors in
collaborative practice, while the nurses believe that collaboration and
consultation should only be used when absolutely necessary.8
Regarding the history of professional development, very few pro-
fessional groups have worked together as closely as doctors and nurses.
However, these two professions are considered to have a dynamic re-
lationship from a sociological perspective.27 Consequently, the assumed
hierarchical culture and sociological division between these professions
may hamper collaborative practice. This statement is in line with Sie-
gler's assertion that several factors may hinder collaborative practice,
including social, institutional, economic, clinical and interpersonal re-
lationship factors.33
The Indonesian CPAT can help collaborative teams to identify ob-
stacles in team collaboration and solve problems based on the team's
attitudes. For example, at an individual level, barriers can be identified
through the question: ‘Team members feel limited in the degree of
autonomy in patient/client care that they can assume’. If the team ex-
periences this, then the way to overcome it is to learn about other
professions. By learning about the roles of the various other healthcare
professions, each team member may come to understand the roles and
responsibilities of those professions. Thus, they will collaborate more
effectively, respect the skills and knowledge of others and employ
collaboration to overcome further obstacles15.6;
4.1. Research limitations
The present authors are aware of the limitations of this study.
Firstly, the respondents were the health workers in one national referral
hospital which was not necessarily representative of the entire popu-
lation of health workers and collaborative teams in Indonesia.
However, the variations of the health professions in the current context
provided rich insights. Secondly, even though this study used a well-
validated questionnaire, the reasons underlying respondent perceptions
could not be explored. Thus, further research is necessary in order to
explore the in-depth perceptions of the respondents regarding the
various factors that influence collaboration. In addition, wider-scale
research could be conducted in different hospitals to see whether cul-
tural and regional differences affect the validity of CPAT while ob-
taining a more comprehensive view of interprofessional collaboration
in different healthcare settings.
5. Concluding comments
There are barriers to collaborative practice in the hospital based on
age, professional background and length of work experience in the
profession. Younger healthcare professionals with a short duration of
work experience perceive more barriers than older health workers with
longer work experience, while nurses experience more barriers in
practicing collaborative practice than doctors. While Indonesian CPAT
can successfully be used to measure perceptions of collaborative prac-
tice, further research is required in order to explore the factors that
obstruct the practice of interprofessional collaboration in Indonesia,
such as social, cultural, and leadership factors.
Acknowledgment
The primary funder of the study is Rumah Sakit Universitas
Indonesia/Universitas Indonesia Teaching Hospital (contract no TA/
JR/UI-005).
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.xjep.2019.01.005.
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