EXPLORING THE CHALLENGES AFFECTING

MULTIDISCIPLINARY TEAM COLLABORATION AT ST.

AMANUEL MENTAL SPECIALIZED HOSPITAL

RESEARCH PROPOSAL TO BE SUBMITTED TO ST. AMANUEL

MENTAL SPECIALIZED HOSPITAL RESEARCH
DEPARTEMENT

INVESTIGATORS

KEDIRE SEID YIMER

KALKIDAN DAWIT MEDFERU

SEIFESLASSIE WENDWOSEN AWULACHEW (PI)

OCTOBER, 2023 G.C

ADDIS BABA, ETHIOPIA

1
2
 EXPLORING THE CHALLENGES AFFECTING MULTIDISCIPLINARY
TEAM COLLABORATION AT ST. AMANUEL MENTAL SPECIALIZED
HOSPITAL 2023 G.C

INVESTIGATORS

SEIFESLASSIE WENDWOSEN AWULACHEW

KEDIRE SEID YIMER

KALKIDAN DAWIT MEDFERU

RESEARCH PROPOSAL TO BE SUBMITTED TO ST. AMANUEL MENTAL

SPECIALIZED HOSPITAL RESEARCH DEPARTEMENT

OCTOBER 2023

ADDIS ABABA, ETHIOPIA

I
DECLARATION
We the researchers declare,

This research proposal titled, "Exploring the Challenges affecting Multidisciplinary

Team Collaboration in St. Amanuel Mental Specialized Mental Health Hospital," is in
adherence to ethical guidelines and principles of research integrity. Necessary
approvals and permissions will be sought from the appropriate institutional review
board or ethics committee. The purpose of this study is to investigate the challenges
faced in multidisciplinary team collaboration within a specialized mental health
hospital. Data collection will involve qualitative and/or quantitative methods,
ensuring informed consent, voluntary participation, and confidentiality. The findings
of this research will contribute to existing knowledge by identifying barriers to
effective collaboration and may inform strategies and interventions to enhance
interdisciplinary teamwork and improve patient outcomes in similar settings. Any
funding or support received will be acknowledged, and conflicts of interest will be
declared. Proper citation and acknowledgment will be provided for all sources used in
this study.

II
APPROVAL SHEET
This research study entitled "Challenges Affecting Multidisciplinary Team
Collaboration at St. Amanuel Mental Specialized Hospital" has been proposed by
Seifeslassie Wendwosen, Kedire seid and Kalkidan Dawit in currently working at St.
Amanuel Mental Specialized Hospital. This study aims to investigate and address the
challenges that impact multidisciplinary team collaboration within our healthcare
setting.

The research proposal and methodology have been reviewed and evaluated by the
undersigned, who hereby grants approval for the commencement of the research
study.

Approval Committee Signature

III
ACKNOWLEDGMENT
We would like to express our sincere appreciation to the individuals and organizations
that have supported us during the preparation of this research proposal. Although this
proposal has not been approved yet, we would like to acknowledge the potential
contributions and support we anticipate receiving. We extend our gratitude to the St.
Amanuel Mental Specialized Hospital, whose potential financial support would
greatly facilitate the execution of this study. We would also like to thank the
administration and staff of the specialized mental health hospital for their anticipated
cooperation and willingness to participate in this research. Furthermore, we anticipate
the involvement of participants in this study and express our gratitude for their
potential contribution in providing insights and perspectives crucial to the success of
this research. Finally, we would like to acknowledge our advisors, mentors, and
colleagues for their anticipated guidance, feedback, and valuable input throughout the
research proposal development process.

IV
ACRONYM/ABBREVIATION
MDT……………………………………………Multidisciplinary Team

IPE………………………………………………Interprofessional Education

WHO……………………………………………World Health Organization

SPSS……………………………………………Statistical Package for Social

Sciences

G.C ……………………………………………… Gregorian calendar

USA…………………………………………….United States of America

TDF………………………………………………Theoretical Domain Framework

TDI………………………………………………Team Developmental Intervention

OCAI……………………………………………Organizational Culture Assessment

Instrument.

CPAT………………………………………….Collaborative Practical Assessment

Tool

V
Table of Contents
DECLARATION...........................................................................................................II

APPROVAL SHEET...................................................................................................III

ACKNOWLEDGMENT..............................................................................................IV

ACRONYM/ABBREVIATION...................................................................................V

LIST OF FIGURES...................................................................................................VIII

SUMMARY.................................................................................................................IX

CHAPTER ONE – INTRODUCTION..........................................................................1

1.1 Background..........................................................................................................1

1.2 Statement of the Problem.....................................................................................3

1.3 Research Questions..............................................................................................5

1.4 Objectives.............................................................................................................6

1.4.1 General objective...........................................................................................6

1.4.2 Specific Objective.........................................................................................6

1.5 Significance of the Study.....................................................................................6

1.6 Scope of the study................................................................................................7

CHAPTER TWO- LITERATURE REVIEW................................................................8

2.1 Introduction..........................................................................................................8

2.2 Challenges of Multidisciplinary Team Collaboration..........................................9

2.2.1 Communication Barriers...............................................................................9

2.2.2 Organizational Factors................................................................................10

2.2.3 Team Factors...............................................................................................12

2.3 Empirical Review of Challenges of Multidisciplinary Team Collaboration......15

2.4 Summary of the Literature Review....................................................................17

2.5Conceptual Framework for Challenges of Multidisciplinary Team Collaboration

..................................................................................................................................19

CHAPTER THREE- METHODS AND MATERALS................................................20

VI
 3.1 Study Area..........................................................................................................20

3.2 Study Population................................................................................................20

3.3 Study Design......................................................................................................20

3.4 Inclusion and Exclusion Criteria........................................................................20

3.4.1 Inclusion Criteria.........................................................................................20

3.4.2 Exclusion Criteria........................................................................................21

3.5 Sampling Technique and Sample Size...............................................................21

3.6 Data Collection Methods....................................................................................21

3.7 Variables of the study.........................................................................................22

3.7.1 Dependent Variable.....................................................................................22

3.7.2 Independent Variable..................................................................................22

3.8 Data Analysis Method........................................................................................23

3.9 Study Period.......................................................................................................23

3.10 Ethical Considerations......................................................................................23

CHAPTER FOUR- WORK PLAN..............................................................................25

CHAPTER FIVE- BUDGET BREAKDOWN............................................................26

REFERENCE...............................................................................................................27

ANNEX 1.....................................................................................................................31

ANNEX 2ENGLISH VERSION OF THE QUESTIONNAIRE.................................32

LIST OF FIGURES

VII
Figure 1: Conceptual Framework for Challenges of Multidisciplinary Team
Collaboration.................................................................................................................................29

VIII
SUMMARY
Objective: The objective of this research study is to investigate the challenges
impacting multidisciplinary team (MDT) collaboration at St. Amanuel Mental
Specialized Hospital. The study aims to explore the perspectives and experiences of
health professionals, including psychiatrists, general practitioners, psychologists,
pharmacists, nurses, and administrative personnel, who are involved in MDT
collaboration.

Methodology: The research study will utilize a mixed-method approach, combining

quantitative data collection through a census survey and qualitative data collection
through in-depth interviews and focus group discussions. The census survey will be
administered to all health professionals at St. Amanuel Mental Specialized Hospital
with knowledge and experience in MDT collaboration, while the qualitative
component will involve purposive sampling of participants for in-depth interviews
and focus group discussions. Budget Breakdown: The study will manage to use data
collectors, research assistants as well several

Expected Outcomes: The study expects to identify and analyze the challenges faced
by the MDT collaboration at St. Amanuel Mental Specialized Hospital. The findings
will provide valuable insights into the factors hindering effective collaboration and
help in developing strategies for improvement. The research outcomes will not only
be beneficial for the hospital itself but will also serve as a foundation for other
healthcare institutions facing similar challenges. The research study is allocated a
budget of 78,500 ETB, which will cover expenses related to research materials, data
collection tools, data analysis software, participant incentives, and administrative
support.

Budget Breakdown: The research study is allocated a budget of 78,500 ETB, which
will cover expenses related to research materials, data collection tools, data analysis
software, participant incentives, and administrative support.

Key words: Multidisciplinary team collaboration, challenges, mental healthcare,

mixed-method study, census survey, qualitative research

IX
X
CHAPTER ONE – INTRODUCTION
The introduction section of a research paper provides an overview and context for the
study. It aims to engage the reader, present the research problem or question, and
provide a rationale for the study. The introduction outlines the purpose, objectives,
and significance of the research, as well as any relevant background information and
previous studies that inform the current investigation. (Helwig et al., n.d.)

1.1 Background

The provision of high-quality patient care in modern healthcare systems depends

more and more on successful multidisciplinary teamwork. Teams of healthcare
experts from several disciplines, including doctors, nurses, pharmacists, social
workers, and allied health professionals, collaborate to provide complete and all-
encompassing patient care. (Smith et al., 2019; Johnson et al., 2020).
Multidisciplinary team collaboration in mental health care settings is becoming
increasingly important, especially in low- and middle-income nations like Ethiopia.
Multidisciplinary teams, made up of experts from a variety of fields such psychiatry,
psychology, nursing, social work, and occupational therapy, are essential to delivering
complete, person-centered care for people with mental health conditions. (World
Health Organization, 2020; Luitel et al., 2018).

Collaboration across multidisciplinary teams has the ability to boost patient

satisfaction and results while maximizing resource use. Effective collaboration within
multidisciplinary teams, however, continues to be a significant difficulty in healthcare
settings, resulting in subpar patient care and ineffective healthcare delivery. Designing
strategies and treatments to improve cooperation and patient outcomes requires an
understanding of the difficulties posed by diverse team collaboration. (Mitchell et al.,
2018; Xie et al., 2019)

The presence of disciplinary and professional barriers is one of the main obstacles to
interdisciplinary team collaboration. Healthcare practitioners frequently receive
training from inside their own specialties, which produces a variety of viewpoints,
terminologies, and methods for providing patient care. These disciplinary boundaries
can hinder effective communication, coordination, and mutual understanding among

1
team members, leading to fragmented care and potential errors in decision-making.
(Lee et al., 2021; Anderson et al., 2022).

The healthcare system itself can also help or hamper the collaboration of
interdisciplinary teams depending on its organizational structures, rules, and
workflows. Effective collaboration can be significantly hampered by poor
interprofessional education and training opportunities, ineffective care coordination
procedures, and inadequate communication routes. For the purpose of encouraging a
collaborative culture and improving the performance of interdisciplinary teams, these
systemic hurdles must be addressed. (Barr et al., 2018; Reeves et al., 2020)

The limited integration of mental health services within the broader healthcare system
is another challenge in Ethiopia. Mental health care often remains isolated from
primary care and other medical specialties, leading to a lack of coordination and
continuity of care . This fragmentation can impede multidisciplinary team
collaboration and result in suboptimal outcomes for individuals with mental health
conditions.( Alem et al., 2020; Kebede et al., 2019)

In conclusion, multidisciplinary team collaboration is essential for delivering quality

healthcare in Ethiopia. However, challenges such as the scarcity of healthcare
professionals, communication breakdowns, cultural dynamics, fragmented care, and
limited interprofessional education need to be addressed to optimize collaboration and
enhance healthcare outcomes in Ethiopian healthcare settings.

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1.2 Statement of the Problem

Multidisciplinary or interprofessional team collaboration is recognized as a critical

component of effective healthcare delivery. Bringing together professionals from
different disciplines, these teams aim to leverage diverse expertise and perspectives to
provide comprehensive and coordinated care to patients. However, despite its
importance there are obstacles and difficulties that hinder smooth collaboration and
coordination among team members (Kaini, 2017). Like Organizational culture the
absence of Interprofessional education and training, Hierarchy and power dynamics,
and Communication barriers hinder the successful implementation of
multidisciplinary or interprofessional team collaboration in healthcare settings.

Collaborative work among different professionals is crucial for delivering the desired
outcomes such as accurate diagnosis, effective treatment planning, seamless care
transitions, and improved patient satisfaction. The Norwegian health system
conducted a research to explore the challenges from the perspectives of both
healthcare providers and patients and arrived in a conclusion that the lack of
collaboration had negative consequences, including fragmented services for mental
health service users, inadequate rehabilitation services, and prolonged institutional
stays for older patients(Steihaug et al., 2016)

Organizational openness to trialing new innovations and a learning culture were

highly associated with implementation success conversely; an absence of a learning
culture can act as a major hindrance to successful implementation. Organizational
cultures comprised of staff who have too much autonomy (i.e., physicians
experiencing a high level of autonomy when making decisions about how to treat
patients) , are resistant to trial new innovations, or are unclear about organizational
values and beliefs can be barriers to successful implementation(Li et al., 2018).

16 studies identified systematic review of IPE programs for postgraduate mental

health staff revealed the lack of rigorous studies of the effects of IPE in mental health
education. This suggests a lack of implementation and evaluation of IPE interventions
in mental health. The challenges of ensuring collaboration among healthcare
professionals in mental health settings, such as strong unprofessional cultures and
conflict over leadership, further contribute to the limited adoption of IPE. in (Pauzé &
Reeves, 2010)

3
Power dynamics and trust among health professionals are observed, with
professionals using their power to protect their autonomy, power imbalances between
private and public sector providers, and attempts to reduce dependency on others to
maintain power. These power dynamics influence the strategic choices made by
health professionals regarding collaboration, impacting patient experiences. Trust is
identified as a crucial element in collaboration, developed through factors such as role
perceptions, demonstrated competence, and effective communication. However,
despite government policies promoting shared decision-making, its implementation
remains limited. The complexity of interprofessional relationships, particularly in the
delivery of primary and community-based health services across organizational
boundaries, adds challenges. The changing roles and boundaries generate uncertainty
and vulnerability, affecting trust levels and leading to mistrust. Ultimately, these
power dynamics and levels of trust directly influence patient experiences, highlighting
the importance of addressing power imbalances and fostering trust to improve
collaboration and enhance patient care. (McDonald et al., 2012)

Study that was conducted by also showed that Communication barrier can arise by
using complex medical terminologies and jargon. Healthcare professionals, including
nurses, often use specialized terminology that may not be easily understood by all
team members. This can create confusion and misinterpretation of information,
leading to errors or conflicts arising from misunderstandings. Effective
communication requires clear and concise language that is easily understood by all
members of the team. And also time constraints and high workload in the acute care
setting can also contribute to communication barriers. Nurses and other healthcare
professionals often face time pressures, requiring them to convey information quickly
and efficiently. This can result in incomplete or unclear communication, leading to
gaps in understanding and potential conflicts. Additionally, the fast-paced nature of
the acute care setting may limit opportunities for team members to engage in thorough
discussions or seek clarification, further exacerbating communication barriers. (Head
et al., 2019)

Studying the challenges of multidisciplinary or interprofessional team collaboration in

St. Amanuel Mental Specialized Hospital is expected to reveal valuable insights. The
research aims to uncover the organizational culture factors that hinder successful
collaboration, such as resistance to change or the absence of a learning culture. It will
4
also investigate communication barriers, including the use of complex medical
terminologies and time constraints, which can impede effective teamwork.
Additionally, the study will explore power dynamics among healthcare professionals
and their influence on collaboration, trust, and shared decision-making. Furthermore,
the role of interprofessional education in improving collaboration and patient
outcomes will be examined. Overall, this research will provide a comprehensive
understanding of the challenges faced by the hospital and offer valuable
recommendations for enhancing multidisciplinary collaboration, communication, and
patient care.

1.3 Research Questions

1. What are the primary challenges encountered by multidisciplinary teams in St.

Amanuel Mental Specialized Hospital when it comes to collaboration and
teamwork?
2. How do different professional roles, such as psychiatrists, psychologists,
social workers, and nurses, contribute to the challenges faced in
multidisciplinary team collaboration within St. Amanuel Mental Specialized
Hospital?
3. What are the barriers to effective communication and information sharing
among mental health professionals in multidisciplinary teams, and how do
they impact collaboration?
4. How do power dynamics, hierarchical structures, and professional boundaries
influence collaboration and decision-making processes within
multidisciplinary mental health teams?
5. How do external factors, such as limited resources, time constraints, and
organizational policies, impact multidisciplinary team collaboration in St.
Amanuel Mental Health Hospital?

5
1.4 Objectives

1.4.1 General objective

 To explore and understand the challenges faced in multidisciplinary team
collaboration within St. Amanuel Mental Specialized Hospital in 2023 G.C

1.4.2 Specific Objective

 To identify the specific challenges encountered by multidisciplinary teams in
St. Amanuel Mental Specialized Hospital regarding collaboration and
teamwork.
 To examine the impact of different professional roles, such as psychiatrists,
psychologists, nurses, social workers, and other mental health professionals,
on multidisciplinary team collaboration within St. Amanuel Mental
Specialized Hospital.
 To explore the barriers to effective communication and information sharing
among mental health professionals in St. Amanuel Mental Specialized
Hospital and their influence on collaboration.
 To analyze the influence of power dynamics, hierarchical structures, and
professional boundaries within St. Amanuel Mental Specialized Hospital
 To investigate the organizational factors, such as limited resources, lack of
interdepartmental coordination, and conflicting priorities, that contribute to
challenges in multidisciplinary team collaboration in St. Amanuel Mental
Specialized Hospital.

1.5 Significance of the Study

While the importance of collaboration and the need for multidisciplinary teams are
acknowledged, there is limited exploration of the specific barriers and challenges
faced by professionals in working collaboratively. By conducting this research study,
it can contribute to filling this gap in empirical evidence by providing a deeper
understanding of the challenges specific to multidisciplinary team collaboration in a
mental health hospital setting. Furthermore mental health hospitals often have distinct
characteristics and challenges compared to other healthcare settings. By focusing
specifically on multidisciplinary team collaboration within a mental health hospital,
this research study can shed light on the unique challenges faced by professionals in
this context. This knowledge can inform the development of targeted interventions
6
and strategies to enhance collaboration and address the specific needs of mental health
patients Specifically in St. Amanuel mental Specialized Hospital. In summary,
conducting this research study on the challenges of multidisciplinary team
collaboration in St. Amanuel Mental Specialized Hospital is significant because it
addresses a gap in empirical evidence, examines the impact on client outcomes,
considers the unique context of mental health hospitals, and has practical implications
for improving collaboration and patient care in mental health settings.

1.6 Scope of the study

This research is to investigate and address the challenges that impact multidisciplinary
team (MDT) collaboration at St. Amanuel Mental Specialized Hospital. This research
will utilize a mixed-method study design, combining quantitative data collection
through a census survey and qualitative data collection through in-depth interviews
and focus group discussions. The census survey will be distributed to all health
professionals at St. Amanuel Mental Specialized Hospital who possess knowledge
and experience in MDT collaboration. This study aims to comprehensively explore
the barriers and facilitators of effective MDT collaboration among various health
professionals, including psychiatrists, general practitioners, psychologists,
pharmacists, nurses, and administrative personnel. This study holds significant
implications for the improvement of patient care and outcomes in the context of
mental health care. By addressing the challenges surrounding MDT collaboration, we
aim to create a more cohesive and efficient healthcare environment, ultimately leading
to enhanced treatment outcomes and patient satisfaction. Moreover, the findings of
this research will have broader implications for the healthcare community, serving as
a valuable resource for other hospitals and institutions seeking to optimize
multidisciplinary teamwork and collaboration.

7
CHAPTER TWO- LITERATURE REVIEW
A literature review is a comprehensive and critical analysis of existing scholarly
literature and research on a specific topic or research question. It involves
systematically identifying, evaluating, and synthesizing relevant sources to provide an
overview, summary, and evaluation of the current knowledge and understanding of
the topic.(Danson & Arshed, 2015)

2.1 Introduction

In contemporary healthcare systems, the provision of high-quality patient care

requires the collaboration and coordination of diverse healthcare professionals within
multidisciplinary teams (MDTs) (Mitchell, 2011). MDTs, consisting of professionals
from different disciplines, such as physicians, nurses, pharmacists, social workers,
and allied health professionals, have become the norm in complex healthcare settings
due to their potential to improve patient outcomes, enhance care coordination, and
optimize resource utilization (Reeves et al., 2017)

This literature review aims to explore the challenges faced by MDTs in healthcare
settings, focusing on the factors that impact collaboration and hinder the achievement
of desired outcomes. this review will examine the literature on the challenges related
to communication barriers, role ambiguity, power dynamics, divergent goals, and
interprofessional conflicts within MDTs. By examining the evidence from various
healthcare contexts, this review seeks to provide a comprehensive understanding of
the challenges faced by MDTs in different settings and identify common themes and
patterns.

2.2 Challenges of Multidisciplinary Team Collaboration

2.2.1 Communication Barriers

A study conducted in USA California the authors emphasize the need for greater
collaboration between professions, taking into account the unique knowledge and
expertise of professionals in each field and the impact on client outcomes. The
importance of shared values and ethics among professionals, as well as a respect for
the unique expertise each discipline brings to the table. It calls for a better
understanding of other professions and their contributions to treatment, and suggests
that students and trainees in these fields should recognize the value of

8
multidisciplinary teams and the expertise available within them. According to the
study absence of the capacity to actively listen, to engage in dialogue, and to reflect
another person’s point of view may derail an interdisciplinary collaborative effort.
While the article briefly mentions the need for greater collaboration and the impact of
differing scopes of practice and training, it does not extensively explore the barriers or
challenges that professionals face in working collaboratively and but it does not delve
into the empirical evidence demonstrating the impact of such collaboration on client
outcomes.(LaFrance et al., 2019)

A study conducted in University of Ottawa Canada in 2005 on the impact of

professional culture on effective collaboration stated the fact that each healthcare
profession has its own unique culture, including values, beliefs, different
communication and language, role and hierarchy, Cognitive learning and training.
These professional cultures create challenges for effective interprofessional
collaboration. The study emphasizes the need for understanding and addressing the
cultural barriers that hinder effective interprofessional teamwork. Insight into the
factors contributing to professional cultures can guide the development of innovative
educational approaches to improve interprofessional collaborative practice.
Unfortunately the study fails to explicitly examine the empirical evidence of the
impact the professional culture on multidisciplinary team collaboration.(Hall, 2005)

A prospective observational study that was conducted in children’s hospital in

Philadelphia nd the University of Pittsburgh Medical Center allowed for the
systematic examination of communication patterns, teamwork, and collaboration
within the interprofessional team setting. The study finds that physicians dominate the
speaking time during team meetings, while non-physicians have limited opportunities
to contribute. This communication imbalance can hinder effective teamwork and
collaboration within the team. The study found that physicians spoke for an average
of 83.9% of each meeting's duration (with a standard deviation of 7.5%), while non-
physicians (presumably other members of the interprofessional team) averaged 9.9%
of the meeting's duration (with a standard deviation of 5.2%). These findings indicate
a significant difference in speaking time between physicians and non-physicians,
suggesting an imbalance in participation and communication patterns within the team.
(Walter et al., 2019)

9
2.2.2 Organizational Factors
A collaborative study conducted by universities in USA in 2011 established the
importance of interprofessional education (IPE) in healthcare .The study stated that
one of the major challenges of effective interprofessional collaboration is lack of
adequate training and education which eventually negatively impacts the quality of
care being provided. As a result the study highlights that IPE allows for the sharing of
skills and knowledge between different healthcare professions. It promotes a better
understanding, shared values, and respect for the roles of other healthcare
professionals. By engaging in IPE, students gain insights into the perspectives and
expertise of other professions, fostering a collaborative and team-based approach to
healthcare.(Bridges et al., 2011)

A systematic review was performed to assess the effectiveness of IPE interventions

compared to profession-specific education interventions or no education intervention.
These outcomes established the potential benefits of IPE interventions in improving
professional practice and healthcare outcomes. Like Improved Communication and
Collaboration, Enhanced Patient-Centered Care, as well as Enhanced Knowledge
Exchange.(Reeves et al., 2013)

A systematic review was conducted by a collaborative team from institutions in the

United Kingdom and Canada on the effects of interprofessional education (IPE) on
multidisciplinary team collaboration The review emphasizes the importance of
understanding the organizational context in which IPE initiatives are implemented.
Factors such as the culture, structure, and resources of the organization can
significantly impact the success of IPE. Therefore, it is necessary to align IPE efforts
with the goals and priorities of the organization. Furthermore the study suggests
exploring the effectiveness of interprofessional team-based learning by bringing
together learners from different professions to work on shared tasks or case scenarios,
fostering collaboration, communication, and problem-solving skills. Team-based
learning can simulate real-world healthcare settings and enhance the readiness of
learners for interprofessional practice.(Reeves et al., 2016)

A qualitative study of repertory grid questions followed by clarification questions that

was conducted in Australia in 2005 among a total of 39 strategic informants and 202
healthcare practitioners participated in the study explored the Healthy Teams Model

10
as a dynamic model that can be used in conjunction with a Reflective Analysis and
Team Building Guide to help healthcare practitioners critically evaluate and enhance
their team functioning. Furthermore the study acknowledges the challenges and
obstacles to effective teamwork, such as separate lines of control, diverse objectives,
professional barriers, and conflicts between individuals and the organization. It
emphasizes the need for suitable organizational structures, rewards systems, and
workforce development opportunities to support effective teamwork. However the
study focuses on identifying the characteristics of effective teams but provides limited
insight into the underlying team dynamics and processes that contribute to those
characteristics. (Mickan & Rodger, 2005)

A concurrent mixed research method design that was conducted in the northwest
region of Ethiopia. Specifically, teaching and referral hospitals on 2022, among 279
nurses and 87 physicians revealed that unsatisfactory organizational support, poor
professional support, and poor interpersonal support were independently associated
with ineffective collaboration among nurses and physicians. a significant number of
the respondents (43.4%) reported ineffective collaboration during their professional
activities. Participants reported that ineffective communication between nurses and
physicians hindered collaboration. Furthermore the qualitative data indicated
instances where both nurses and physicians did not fulfill their professional
responsibilities, which impeded collaboration. This could include neglecting to
consult with each other, not sharing important patient information, or not involving
the appropriate healthcare professional in decision-making. The qualitative findings
identified unsatisfactory organizational support as a significant barrier to
collaboration. This could involve inadequate resources, lack of clear policies and
guidelines, or insufficient support from management or administration. However the
study fails to Includes broader range of healthcare professional’s policy makers and
incorporating patient perspectives which could have provided valuable insights into
the collaborative dynamics and outcomes of healthcare delivery.(Degu et al., 2023)

2.2.3 Team Factors

A collaborative study was conducted in the USA by using a mixed method approach
by combining both quantitative and qualitative approach. The study managed to find
out common challenges faced by healthcare teams and strategies for overcoming
them. Among the challenges were accountability, conflict management, decision-
11
making, reflecting on Progress, coaching. The study proposed a comprehensive
framework for team effectiveness that can be applied to different types of healthcare
teams. The framework consists of multiple levels that build upon each other to
contribute to the development of ideal team states. Strategies and guidance for
managing each of the identified challenges were provided based on the researcher’s
collective experience with Team Development Interventions (TDIs). However the
study does not explicitly discuss the influence of cultural, organizational and
contextual factors on teamwork in healthcare. (Zajac et al., 2021)

A qualitative study using the Theoretical Domain Framework (TDF) was conducted
in Canada in 2021, with a total of 66 OR healthcare professionals participated,
including registered nurses, practical nurses, anesthesiologists, surgeons, and
perfusionists. The study managed to figure out enablers of effective teamwork like
people management, shared definition of teamwork, communication strategies,
positive emotions, familiarity with team members, and alignment of teamwork with
professional roles. On the other hand, barriers to teamwork included others'
personalities, gender dynamics, hierarchies, resource issues, lack of knowledge of best
teamwork practices, negative emotions, conflicting norms and perceptions across
professions, unfamiliarity with team members, and challenges related to on-call and
night shifts. The study demonstrates the application of the Theoretical Domains
Framework in understanding the determinants of interprofessional behavior and
informs the development of evidence-based interventions to improve teamwork.
However while qualitative research provides rich insights and in-depth understanding
of the experiences and perspectives of healthcare professionals, quantitative research
can offer additional information on the prevalence and impact of the identified
barriers and enablers. The study lacks a quantitative research approach that could
complement the qualitative data. (Etherington et al., 2021)

A qualitative study with grounded theory analysis that was conducted in Sabah
Malaysia identified several barriers that hindered collaboration in the mental health
system. These barriers included Lack of autonomy: Limited decision-making
authority or independence for individuals or systems involved in the mental health
system. Lack of relatedness, a lack of trust, understanding, or caring about each other
among stakeholders.. Lack of motivation: A lack of willingness or motivation to
engage in collaborative efforts. Lack of resources: Inadequate availability of
12
competence, time, physical resources, and opportunities necessary for collaboration.
The study insists the need for a conceptual framework that specifically addresses
collaboration in psychiatry, particularly in non-Western and lower- and middle-
income countries. Furthermore the study acknowledges patient-centered approach
which can lead to increased patient and care satisfaction, improved treatment
adherence, and better overall mental health outcomes.(Shoesmith et al., 2020)

A literature review conducted at university of Montreal Canada on 2005 discusses the

importance of interprofessional collaboration in improving the effectiveness of health
services. The study aims to enhance the understanding of collaboration by exploring
conceptual frameworks and theoretical models. Furthermore the study also indicates
that the integration of patients into healthcare teams is an area that lacks serious
attention in the literature. The study concludes by emphasizing the need for
collaboration over competition in healthcare settings. Despite recognizing the
importance of patient involvement, the study highlights that the literature does not
provide a serious attempt to determine how patients could be integrated into the
healthcare team. The study highlights that there is still limited understanding of the
complexity of relationships between health professionals, particularly in terms of how
they are socialized within their disciplines and the services they offer.(D’Amour et al.,
2005)

A discursive paper study that was conducted in Anglophone Caribbean, Jamaica on

challenges of implementing a multidisciplinary team (MDT) in a tertiary hospital in
Jamaica. A retrospective audit was conducted during the study and they managed to
establish MDT having encountered challenges along the way. Among those
challenges Established clinicians had reservations and reluctance to participate in the
MDT process. Their opinions were not readily valued, and there was a divide between
them and the younger, more recently trained clinicians who supported the MDT
concept. The MDT approach was not routinely practiced in the Anglophone
Caribbean region. Established clinicians were skeptical about the need for change and
were resistant to participating in the MDT process. While the article discusses the
challenges faced in implementing the MDT approach, it does not delve into a detailed
assessment of the specific barriers and their impact. Further research could explore
the barriers encountered in different healthcare settings and regions, as well as the
strategies to overcome them effectively.(Cawich et al., 2014)
13
A socio-historical analysis conducted in Canada 2010, the authors mention drawing
upon historical documents to understand the emergence of health and social care
professions from crafts guilds. They also state that they utilize sociological theories to
analyze the nature of professional development for team leadership. This suggests that
the study involved examining historical records and applying sociological
perspectives to understand the socio-historical context and its implications for
interprofessional teamwork and leadership. Furthermore the study also stated that
boundary frictions, hierarchical imbalances, and power/status inequalities that affect
teamwork within interprofessional teams.(Reeves et al., 2010)

2.3 Empirical Review of Challenges of Multidisciplinary Team

Collaboration

According to (Spaulding et al., 2021) a systematic review that was conducted at

Baltimore, USA, included the search for relevant studies was performed in databases
such as PubMed, CINAHL, Embase, and ERIC, and that the studies included in the
review were published between 2007 and 2017.

Data from the selected studies were extracted using a standardized approach. The
study collected information on study characteristics, participant demographics,
intervention details, outcome measures, and results. A narrative synthesis approach
was used to summarize and analyze the findings of the included studies. The main
findings of the systematic review described in the document were

Attitudes and Perceptions: Out of the 19 studies included in the review, 17 (89%)
reported statistically significant improvements in attitudes toward other disciplines
and the value placed on a team-based approach for improving patient care. This
suggests that IPE had a positive impact on changing attitudes and perceptions among
healthcare students and professionals.

Collaborative Behavior: All seven studies that assessed changes in collaborative

behavior found statistically significant improvements. This indicates that IPE
contributed to positive changes in how healthcare students and professionals
collaborated with each other in a team-based setting.

Collaborative Skills Develsopment: Among the 12 studies that assessed the

development of collaborative skills, the results were mixed. Some studies reported
14
positive outcomes in terms of skill development, while others did not show significant
improvements. This suggests that the impact of IPE on collaborative skill
development may vary across different contexts and interventions. However, it is
important to note that the included studies varied in terms of settings, teaching
methods, assessment measures, and quality, which may have influenced the results.
Thus further research, particularly among healthcare professionals, and the
assessment of long-term impacts and patient-centered outcomes need to be done.

As per a study (Degu et al., 2023)that was conducted among nurses and physicians in
specialized public hospitals, the northwest, Ethiopia: mixed method multi-centered
cross-sectional study" presents a research study conducted in Ethiopia to investigate
inter-professional collaboration between nurses and physicians in specialized
hospitals. The study utilized both quantitative and qualitative methods to gather data
and analyze the factors affecting collaboration.

The quantitative data was collected through a structured questionnaire administered to

279 nurses and 87 physicians working in referral and teaching hospitals. The study
found that a significant number of respondents (43.4%) reported ineffective
collaboration during their professional activities. The multivariable analysis identified
unsatisfactory organizational support, poor professional support, and poor
interpersonal support as independent factors associated with ineffective collaboration.

In addition to the quantitative data, qualitative data were collected through focused
and semi-structured interviews with nine key informants. The thematic analysis of the
qualitative data revealed that poor communication, lack of professionalism, and
failure to adhere to professional duties were barriers to nurse-physician collaboration.

The study concludes that nurse-physician collaboration in the studied hospitals was
below the expected level, with a large proportion of participants experiencing
ineffective collaborations. The findings highlight the importance of improving
collaboration by enhancing organizational, professional, and interpersonal factors.
The qualitative findings support the quantitative results, emphasizing the need for
interventions to empower interprofessional collaboration.

The study's implications include the generation of evidence for evidence-based

collaborative practice and providing baseline information for policymakers,

15
healthcare organizations, and facility managers to plan and intervene in
interprofessional collaboration between nurses and physicians in clinical settings.
Overall, this document provides valuable insights into the state of inter-professional
collaboration between nurses and physicians in specialized hospitals in Ethiopia,
highlighting the factors influencing collaboration and suggesting strategies for
improvement.

2.4 Summary of the Literature Review

The literature review examined various challenges faced by multidisciplinary teams

(MDTs) in healthcare settings, with a focus on factors that hinder collaboration and
the achievement of desired outcomes. The review highlighted Communication
Barriers: Several studies emphasized the importance of effective communication
within MDTs. Barriers such as a lack of active listening, dialogue, and understanding
of other professions' contributions can derail collaborative efforts.

The review identified organizational factors that impact MDT collaboration. Lack of
adequate training and education was highlighted as a major challenge, negatively
affecting the quality of care provided. Interprofessional education (IPE) interventions
were found to be beneficial in improving professional practice, enhancing
communication, collaboration, and patient-centered care. The organizational context,
including culture, structure, and resources, significantly influenced the success of IPE
initiatives.

The review explored challenges related to teamwork within healthcare settings.

Common challenges included accountability, conflict management, decision-making,
and reflecting on progress. Overall, the literature review provides valuable insights
into the challenges faced by MDTs in healthcare settings. However, there are several
gaps that future research can address:

1. Empirical Evidence: Some studies mentioned the need for greater collaboration and
the impact of certain factors on collaboration, but they did not delve into the empirical
evidence demonstrating the actual impact on patient outcomes. Future research should
focus on gathering empirical data to support the identified challenges and their effects
on desired outcomes.

16
2. Patient Perspectives: The literature review primarily focused on the perspectives of
healthcare professionals and organizational factors. Future research should
incorporate the perspectives of patients to gain a more comprehensive understanding
of the collaborative dynamics and outcomes of healthcare delivery. Quantitative
Approaches: While qualitative research provided in-depth insights into the
experiences and perspectives of healthcare professionals, future research should
consider incorporating quantitative approaches to complement the qualitative data.
Quantitative studies can offer additional information on the prevalence and impact of
identified barriers and enablers. Cultural and Contextual Factors: The influence of
cultural, organizational, and contextual factors on teamwork within healthcare settings
was not extensively explored. Future research should examine how these factors
impact collaboration and identify strategies to address cultural barriers and promote
effective teamwork.

In conclusion, the literature review highlights the challenges faced by MDTs in

healthcare settings, particularly in terms of communication barriers, organizational
factors, and team dynamics. Future research should fill the gaps by providing
empirical evidence, incorporating patient perspectives, employing quantitative
approaches, and examining the influence of cultural and contextual factors on
collaboration. Addressing these gaps will contribute to the development of effective
strategies and interventions to enhance multidisciplinary team collaboration and
improve patient outcomes in healthcare settings.

17
2.5Conceptual Framework for Challenges of Multidisciplinary Team
Collaboration

Team
Factors
Roles and Communicatio
Responsiblility Multidiscipli n Barrier
Trust abd nary Team Active listening
Respect Information
Collaboratio Sharing
Decision
Making
n Feedback
Conflict Mechanism
Resolution

Organizati
onal
Factors
Leadership
Resource
Allocation
Policies
IPE

Figure 1: Conceptual Framework for Challenges of Multidisciplinary Team Collaboration

18
CHAPTER THREE- METHODS AND MATERALS

3.1 Study Area

St. Amanuel Mental Specialized Hospital is a renowned mental healthcare facility

situated in Addis Ababa, the capital city of Ethiopia. The hospital is dedicated to
providing specialized care and treatment for individuals with mental health
conditions. It serves as a referral center for mental health services and caters to a
diverse range of patients seeking comprehensive psychiatric care. Amanuel Hospital
provides both inpatient and outpatient care. Inpatient services are available for
individuals who require intensive treatment and monitoring, while outpatient services
cater to those who can receive treatment while living in the community. The hospital
has a multidisciplinary team of healthcare professionals dedicated to providing quality
care. This team may consist of psychiatrists, psychologists, psychiatric nurses, social
workers, occupational therapists, and other mental health specialists.

3.2 Study Population

Professionals from different disciplines who participate in the collaborative care

process at the hospital. You can consider including psychiatrists, psychologists,
psychiatric nurses, social workers, occupational therapists, and any other relevant
healthcare professionals involved in the multidisciplinary team as well as
administrative personnel who are present during the study period.

3.3 Study Design

The study will employ a mixed-methods study design; in order to capture the
complexity of the challenges and gain a more comprehensive understanding of the
topic, strengthening the validity and reliability of the research findings.

3.4 Inclusion and Exclusion Criteria

3.4.1 Inclusion Criteria

 Employees who have been involved in MDT collaboration for at least 6 month

3.4.2 Exclusion Criteria

 Part-Time professionals, trainees as well as Students will be excluded from
the study.

19
3.5 Sampling Technique and Sample Size

 Quantitative Study: In order to increase the generalizability of this study on

the challenges of multidisciplinary team collaboration at St. Amanuel Mental
Health Hospital, a census survey approach will be employed, targeting the
entire population of the hospital. The total population under investigation
consisted of 400 individuals actively involved in the multidisciplinary team
collaboration. By utilizing a census survey, every eligible individual within the
population will be included, ensuring comprehensive representation of the
multidisciplinary team at St. Amanuel Mental Health Hospital. This approach
will eliminate potential sampling bias and increase the external validity of the
study, allowing for accurate inferences and generalizability of the findings.
 Qualitative Study: A purposive sampling technique will be employed to
select participants for the qualitative data collection. The sample will include a
diverse range of healthcare professionals, such as psychiatrists, general
practitioners, psychologists, pharmacists, nurses, and administrative personnel,
who possess knowledge and experience in MDT collaboration. The sample
size will be determined based on data saturation, ensuring that a sufficient
amount of information is collected to address the research objectives.

3.6 Data Collection Methods

Quantitative Study: One of the data collection methods we will be utilizing in my

research is self-administered questionnaires. This method involves providing
participants with a structured questionnaire that they can complete on their own. By
using self-administered questionnaires, we aim to gather quantitative data efficiently
and systematically. In addition to self-administered questionnaires, we will also
conduct interviews as a data collection method in our research. Interviews provide an
opportunity for in-depth exploration and understanding of participants' experiences,
perspectives, and challenges related to the topic of multidisciplinary team
collaboration.

 OCAI-Organizational Culture will be assessed by OCAIWHICH stands for

Organizational Culture Assessment Instrument. It is a tool developed by
Cameron and Quinn (1999) to assess and analyze the organizational culture
within an organization. The OCAI can be adapted and applied in healthcare

20
 settings to assess and analyze the organizational culture, supporting efforts to
enhance the quality of care, patient experience, and overall organizational
performance.(Heritage et al., 2014)
 TeamSTEPPS (Team Strategies and Tools to Enhance Performance and
Patient Safety) is a teamwork system developed by the Agency for Healthcare
Research and Quality (AHRQ) in collaboration with the Department of
Defense. It is designed to improve communication, teamwork, and patient
safety within healthcare settings.(Grose & Burney, 2022)
 The CPAT- designed to evaluate the effectiveness of collaborative teamwork
within healthcare teams, such as interprofessional teams or multidisciplinary
teams. It assesses various dimensions of collaboration, including
communication, coordination, shared decision-making and mutual respect
among team members.(Quek et al., 2022)

Qualitative Study: In-depth Interviews: Individual, semi-structured interviews will

be conducted with selected participants. These interviews will allow for a
comprehensive exploration of participants' perspectives, experiences, and challenges
related to MDT collaboration. The interviews will be audio-recorded with
participants' consent and transcribed verbatim for further analysis.

3.7 Variables of the study

3.7.1 Dependent Variable

 Multidisciplinary Team Collaboration Effectiveness

3.7.2 Independent Variable

 Demographic data
 Organizational Factors
 Team Factors
 Communication Barrier

3.8 Data Analysis Method

 Quantitative Section-To analyze the data and examine the relationship between
the identified challenges and multidisciplinary team collaboration, regression
analysis will be performed. Multiple linear regressions will be used to assess the

21
 impact of independent variables (challenges) on the dependent variable (team
collaboration). The independent variables will include communication
breakdowns, role ambiguity, conflicts, and organizational factors. The dependent
variable, team collaboration, will be measured using a validated scale assessing
collaboration effectiveness.

The regression analysis will allow for the identification of significant predictors of
team collaboration challenges and provide insights into the relative influence of each
challenge. Additionally, it will allow for the quantification of the strength and
direction of the relationships between the independent and dependent variables. The
regression analysis will be conducted using statistical software such as SPSS version
26.

 Qualitative Section-Qualitative data will be collected via focused interviews or

semi-structured in-depth interviews and analyzed using ATLAS.ti version 7.0.7
software via narratives using the thematic analysis method.

The qualitative findings will be integrated with the quantitative results obtained from
the census survey to provide a comprehensive understanding of the challenges
affecting MDT collaboration. The convergence of data from both methods will allow
for a triangulation of findings, enhancing the overall validity and reliability of the
research outcomes.

3.9 Study Period

The study will be conducted on November 07 2023 to December 07 2023 G.C

3.10 Ethical Considerations

Prior to initiating the study, ethical approval will be obtained from the relevant
institutional review board or ethics committee at St. Amanuel Mental Specialized
Hospital. The research protocol, including the study design, data collection methods,
and participant confidentiality measures, will be reviewed to ensure adherence to
ethical guidelines and the protection of participants' rights.

Informed consent will be obtained from all participants involved in the study.
Participants were provided with detailed information about the research objectives,
procedures, potential risks, and benefits. They will be assured of their right to refuse

22
participation or withdraw from the study at any time without consequences. Written
consent will be obtained from participants, and their anonymity and confidentiality
were strictly maintained throughout the research process.

23
CHAPTER FOUR- WORK PLAN
Table 1: Work plan of the study

No. Tasks Duration Activities

Define research objectives, develop research

1 Study Design and Planning 5
questions, and plan study design.

Review relevant literature, identify knowledge

2 Literature Review 7
gaps, and develop theoretical framework.

Ethics Approval and Prepare and submit ethics application, obtain

3 10
Permissions necessary approvals.

Sampling and Participant Define sampling strategy, recruit and screen

4 5
Recruitment participants.

Conduct interviews, surveys, or observations as

5 Data Collection 15
per study design.
Data Analysis and Clean and analyze collected data, identify
6 10
Interpretation themes or patterns, and interpret findings.
Results Presentation and Summarize findings, prepare visual
7 5
Discussion representations, and discuss results.
Report Writing and Write research report, include methodology,
8 10
Finalization results, and conclusion.
Review and edit the research report for clarity
9 Review and Editing 3
and coherence.
Submission and Submit research report to relevant stakeholders
10 5
Dissemination or conferences, share findings.

Total 65

CHAPTER FIVE- BUDGET BREAKDOWN

24
Table 2: Budget Breakdown

No. Category Estimated Cost ( ETB)

Principal Investigator 20,000

1 Personnel
Research Assistant 10,000

Participant Participant Recruitment 2,000

2 Recruitment and
Compensation Participant Compensation

Printing and copying costs 4,000

Research Stationery and office supplies 2,000

3 Material and Data storage and backup 1,000

supplies
Audiovisual equipment 2,000

Participant tracking and identification 500

Surveys/questionnaire 4,000
4 Data Collection
Interviews/ Focus Group 8,000

Miscellaneous
5 Unforeseen Costs 10,000
Expenses

Contingency
6 Reserve Budget 15,000
Fund

Total 78,500

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ANNEX 1
Informed Consent

29
You are invited to participate in a research study examining the challenges of
multidisciplinary team collaboration at St. Amanuel Mental Specialized Hospital. The
purpose of this study is to gain a better understanding of the obstacles faced by
healthcare professionals when working together as a multidisciplinary team, and to
identify potential solutions to improve collaboration.

Participating in this research study does not involve any physical risks. However,
discussing potential challenges in multidisciplinary team collaboration may evoke
personal or professional discomfort. Should you experience any distress during the
interview, you have the right to decline answering any specific questions or withdraw
from the study at any time without penalty.

There are no direct benefits to you as a participant, but your involvement will
contribute to the advancement of knowledge in the field of multidisciplinary team
collaboration in a mental health setting. The findings from this study may help
identify areas for improvement and inform future interventions to enhance teamwork
and patient care outcomes.

Your confidentiality and privacy are of utmost importance in this study. All
information collected during this research will be kept strictly confidential and stored
securely. Your personal identifying information will be separated from the data
collected during the interview, ensuring that your responses remain anonymous. Only
the researcher and authorized personnel will have access to the data, and your
information will be used solely for the purpose of this study.

By signing this document, you confirm that you have read and understood the
information provided above, and that you voluntarily agree to participate in this
research study. You understand that you have the right to withdraw from the study at
any time without penalty and that your decision to participate or decline participation
will be respected.

Participant's Name: and Signature _______________________

Date: _______________________

Researcher's Name and Signature: _______________________

30
ANNEX 2ENGLISH VERSION OF THE QUESTIONNAIRE
Instructions: Circle the alternatives you have chosen umber given parallel to the
answer you chose

Section one Sociodemographic Information

No. Questionnaire Alternative

Q1 Sex 1.Male
2.Female
Q2 Age Age in years--------------
Q3 Marital status? 1.single
2.Married
3.divorced
4.widowed
Q4 Religion? 1.Orthodox
2.protestant
3.muslim
4.Catholic
5.others(specify)---------------
Q5 Ethnicity? 1.amhara
2.oromo
3.tigre
4.gurage
5.others(specify)-----------------
Q6 Job? 1.Psychiatrist
2. General Practitioner
3. MSc in ICCMH
4. Nurses
5.Pharmacist
6. Psychologist
7. Social Worker
8.others
Q7 Educational level? 1. Diploma
2. .BSc
3. MSc
4. PhD

31
 5. Doctorate (MD)

Section Two- Organizational Culture

The Organizational Culture Assessment Instrument (OCAI)

The OCAI consists of six questions. Each question has four alternatives. Divide 100
points among these four alternatives depending on the extent to which each alternative
is similar to your own organization. Give a higher number of points to the alternative
that is most similar to your organization. For example, in question one, if you think
alternative A is very similar to your organization, alternative B and C are somewhat
similar, and alternative D is hardly similar at all, you might give 55 points to A, 20
points to B and C, and five points to D. Just be sure your total equals 100 points for
each question.

Note, that the first pass through the six questions is labeled “Now”. This refers to the
culture, as it exists today. After you complete the “Now”, you will find the questions
repeated under a heading of “Preferred”. Your answers to these questions should be
based on how you would like the organization to look five years from now

1. Dominant Characteristics Now Preferred

A The organization is a very personal place. It is like an extended family.

People seem to share a lot of themselves.

B The organization is a very dynamic entrepreneurial place. People are

willing to stick their necks out and take risks.

C The organization is very results oriented. A major concern is with

getting the job done. People are very competitive and achievement
oriented.

D The organization is a very controlled and structured place. Formal

procedures generally govern what people do.
Total

2. Organizational Leadership Now Preferred

A The leadership in the organization is generally considered to exemplify

mentoring, facilitating, or nurturing.

B The leadership in the organization is generally considered to exemplify

entrepreneurship, innovating, or risk taking.

32
C The leadership in the organization is generally considered to exemplify a
no-nonsense, aggressive, results-oriented focus.

D The leadership in the organization is generally considered to exemplify

coordinating, organizing, or smooth-running efficiency.

Total

3. Management of Employees Now Preferred

A The management style in the organization is characterized by teamwork,

consensus, and participation.

B The management style in the organization is characterized by individual

risk-taking, innovation, freedom, and uniqueness.

C The management style in the organization is characterized by hard-

driving competitiveness, high demands, and achievement.

D
The management style in the organization is characterized by security of
employment, conformity, predictability, and stability in relationships.

Total

4. Organization Glue Now Preferred

A The glue that holds the organization together is loyalty and mutual trust.
Commitment to this organization runs high.

B The glue that holds the organization together is commitment to innovation

and development. There is an emphasis on being on the cutting edge.

C The glue that holds the organization together is the emphasis on achievement
and goal accomplishment. Aggressiveness and winning are common themes.

D The glue that holds the organization together is formal rules and
policies. Maintaining a smooth-running organization is important.

Total

5. Strategic Emphases Now Preferred

A The organization emphasizes human development. High trust, openness, and
participation persist.

B The organization emphasizes acquiring new resources and creating new

challenges. Trying new things and prospecting for opportunities are valued.

33
C The organization emphasizes competitive actions and achievement. Hitting
stretch targets and winning in the marketplace are dominant.

D The organization emphasizes permanence and stability. Efficiency,

control and smooth operations are important.

Total

6. Criteria of Success Now Preferred

A The organization defines success on the basis of the development of human

resources, teamwork, employee commitment, and concern for people.

B The organization defines success on the basis of having the most unique
or newest products. It is a product leader and innovator.

C The organization defines success on the basis of winning in the

marketplace and outpacing the competition. Competitive market
leadership is key.

D The organization defines success on the basis of efficiency. Dependable

delivery, smooth scheduling and low-cost production are critical.

Total

Section Three- Communication and team Dynamics

Instructions: Please respond to the questions below by placing a check mark (√) in
the box that corresponds to your level of agreement from Strongly Disagree to
Strongly Agree

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

34
Team Structure
It is important to ask patients and their families for feedback
1.
regarding patient care.
2. Patients are a critical component of the care team.
This facility’s administration influences the success of direct
3.
care teams.
A team's mission is of greater value than the goals of
4.
individual team members.
Effective team members can anticipate the needs of other
5.
team members.
High-performing teams in health care share common
6. characteristics with high-performing teams in other
industries.
Leadership
It is important for leaders to share information with team
7.
members.
Leaders should create informal opportunities for team
8.
members to share information.
Effective leaders view honest mistakes as meaningful
9.
learning opportunities.
It is a leader's responsibility to model appropriate team
10.
behavior.
It is important for leaders to take time to discuss with their
11.
team members plans for each patient.
Team leaders should ensure that team members help each
12.
other out when necessary.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Situation Monitoring
Individuals can be taught how to scan the environment for
13.
important situational cues.
Monitoring patients provides an important contribution to
14.
effective team performance.
Even individuals who are not part of the direct care team
15. should be encouraged to scan for and report changes in
patient status.
It is important to monitor the emotional and physical status
16.
of other team members.
It is appropriate for one team member to offer assistance to
17.
another who may be too tired or stressed to perform a task.
Team members who monitor their emotional and physical
18.
status on the job are more effective.
Mutual Support

35
 To be effective, team members should understand the work
19.
of their fellow team members.
Asking for assistance from a team member is a sign that an
20.
individual does not know how to do his/her job effectively.
Providing assistance to team members is a sign that an
21.
individual does not have enough work to do.
Offering to help a fellow team member with his/her
22. individual work tasks is an effective tool for improving team
performance.
It is appropriate to continue to assert a patient safety concern
23.
until you are certain that it has been heard.
Personal conflicts between team members do not affect
24.
patient safety.

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Communication
Teams that do not communicate effectively significantly
25.
increase their risk of committing errors.
Poor communication is the most common cause of reported
26.
errors.
Adverse events may be reduced by maintaining an
27.
information exchange with patients and their families.
I prefer to work with team members who ask questions about
28.
information I provide.
It is important to have a standardized method for sharing
29.
information when handing off patients.
It is nearly impossible to train individuals how to be better
30.
communicators.

Section Four- Collaborative Practice Tool

Strongly Disagree

Somewhat Agree
Mostly Disagree

Strongly Agree
Mostly Agree

Mission , Meaningful Purpose, Goals

Somewhat

Agree nor
Disagree

Disagree
Neither

1. Our team mission embodies an interprofessional

collaborative approach to patient/client care.

36
 2. Our team’s primary purpose is to assist patients/clients in
achieving treatment goals.
3. Our team’s goals are clear, useful and appropriate to my
practice.
4. Our team’s mission and goals are supported by sufficient
resources (skills, funding, time, space).
5. All team members are committed to collaborative practice.
6. Members of our team have a good understanding of
patient/client care plans and treatment goals.
7. Patient/client care plans and treatment goals incorporate
best practice guidelines from multiple professions.
8. There is a real desire among team members to work
collaboratively.

General Relationships

9. Respect among team members improves with our ability to

work together.
10. Team members care about one another’s personal well
being.
11. Socializing together enhances team work effectiveness.
12. It is enjoyable to work with other team members.
13. Team members respect each other’s roles and expertise.
14. Working collaboratively keeps most team members
enthusiastic and interested in their job.
15. Team members trust each other’s work and contributions
related to patient/client care.
16. Our team’s level of respect for each other enhances our
ability to work together.
Strongly Disagree

Somewhat Agree
Mostly Disagree

Team Leadership

Strongly Agree
Mostly Agree
Somewhat

Agree nor
Disagree

Disagree
Neither

17. Procedures are in place to identify who will take the lead
role in coordinating patient/client care.
18. Team leadership ensures all professionals needing to
participate have a role on the team.
19. Team leadership assures that roles and responsibilities for
patient/client care are clearly defined.
20. Team leadership discourages professionals from taking the
initiative to support patient/client care goals.
21. Team leadership supports interprofessional development
opportunities.
22. Our team leader models, demonstrates and advocates for
patient/client-centered best practice.
23. Our team leader is out of touch with team members’
concerns and perceptions.
24. Our team leader encourages members to practice within
their full professional scope.
25. Our team has a process for peer review.

37
General Role Responsibilities, Autonomy

26. Team members acknowledge the aspects of care where

members of my profession have more skills and expertise.
27. Physicians assume the ultimate responsibility for team
decisions and outcomes.
28. Team members negotiate the role they want to take in
developing and implementing the patient/client care plan.
29. Team members are held accountable for their work.
30. It is clear who is responsible for aspects of the patient/client
care plan.
31. Physicians usually ask other team members for opinions
about patient/client care.
32. Team members feel comfortable advocating for the
patient/client.
33. Each team member shares accountability for team decisions
and outcomes.
34. Team members have the responsibility to communicate and
provide their expertise in an assertive manner.
35. Team members feel limited in the degree of autonomy in
patient/client care that they can assume.

Somewhat Agree
Mostly Disagree

Strongly Agree
Mostly Agree
Somewhat

Agree nor
Communication and Information Exchange

Disagree

Disagree
Strongly
Disagre

Neither
e

36. Patients/clients concerns are addressed effectively through

regular team meetings and discussion.
37. Our team has developed effective communication strategies
to share patient/client treatment goals and
outcomes of care.
38. Relevant information relating to changes in patient/client
status or care plan is reported to the appropriate team
member in a timely manner.
39. I trust the accuracy of information reported among team
members.
40. Our team meetings provide an open, comfortable, safe
place to discuss concerns.
41. The patient/client health record is used effectively by all
team members as a communicate 0on tool.

Community Linkages and Coordination of Care

42. Our team has established partnerships with community

organizations to support better patient/client outcomes.
43. Members of our team share information relating to
community resources.
44. Our team has a process to optimize the coordination of
patient/client care with community service agencies.
45. Patient/client appointments are coordinated so they can
see multiple providers in a single visit.

38
S

39