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
CPAT……………………………… Collaborative Practical Assessment Tool

G.C ………………………………...Gregorian calendar

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

MDT…………………………… …Multidisciplinary Team

OCAI………………………………Organizational Culture Assessment Instrument.

SPSS……………………………….Statistical Package for Social Sciences

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

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

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

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

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

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

V
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

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

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

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

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

VII
VIII
SUMMARY
Background: Multidisciplinary teamwork is crucial for providing comprehensive
patient care in healthcare systems, including mental health care settings in Ethiopia.
However, challenges such as disciplinary barriers, organizational hurdles, and limited
integration of mental health services hinder effective collaboration among healthcare
professionals. Addressing these challenges is essential to optimize collaboration and
improve healthcare outcomes in Ethiopian healthcare settings.

Objective: The objective of this research study is to investigate the challenges

impacting multidisciplinary team (MDT) collaboration at St. Amanuel Mental
Specialized Hospital 2023 G.C

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 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
 1. INTRODUCTION

1.1 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 (2). 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(3)

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(4).

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

1
professionals in mental health settings, such as strong unprofessional cultures and
conflict over leadership, further contribute to the limited adoption of IPE. in (5)

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. (6)

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. (7)

Studying the challenges of multidisciplinary or interprofessional team collaboration in

St. Amanuel Mental Specialized Hospital is expected to reveal valuable insights. The

2
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
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.

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.(8)

1.2.1 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 (9)
 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

3
 review seeks to provide a comprehensive understanding of the challenges
faced by MDTs in different settings and identify common themes and patterns.

 1.2.2 Challenges of Multidisciplinary Team Collaboration

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 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.(10)
 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.(11)

4
  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.(12)

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.
(13)
 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.(14)

5
 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.(15)
 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 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. (16)
 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.
6
 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.(17)

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-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. (18)
 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,
7
 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.
(19)
 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 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.(20)
 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
8
 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.(21)
 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.(22)
 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.(23)

9
1.2.2 Empirical Review of Challenges of Multidisciplinary Team Collaboration
 According to (24) 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 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 (17)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
10
 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,
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.

 1.2.3 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

11
 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.
 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
12
 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.

13
1.4 Conceptual Framework for Challenges of Multidisciplinary Team
Collaboration

Communication
Barrier
Active listening
Information Sharing
Feedback Mechanism

Multidiscip
linary
Team
Collaborati
Team Factors on Organizationa
l Factors
Roles and
Responsiblility Leadership
Trust abd Respect Resource
Decision Making Allocation
Conflict Resolution Policies
IPE

Figure 1: Conceptual Framework for Challenges of Multidisciplinary Team

Collaboration

14
1.3 Justification 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
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.

2. OBJECTIVE OF THE STUDY

2.1 General objective

 To explore and understand the challenges faced in multidisciplinary team

collaboration within St. Amanuel Mental Specialized Hospital in 2023 G.C

2.2 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,

15
 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.

16
3.METHODS AND MATERALS

3.1 Study Design and Study Period

The study will employ a mixed-methods descriptive crossectional 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. The study will be conducted from December 15 2023-January 15 2023 G.C

3.2 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.

3.3 Population

3.3.1 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 ICCMH professionals
who are involved in the multidisciplinary team as well as administrative personnel
who are present during the study period.

3.3.2 Source Population

Healthcare professionals working at St. Amanuel Mental Specialized Hospital in
Addis Ababa, Ethiopia.

17
3.4 Eligibility Criteria

3.4.1 Inclusion Criteria

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

3.4.2 Exclusion Criteria

 Trainees as well as Students will be excluded from the study.

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 Study Variables

3.6.1 Dependent Variable

 Multidisciplinary Team Collaboration Effectiveness

3.6.2 Independent Variable

 Organizational Factors
 Team Factors
 Communication Barrier

18
  Demographic data (Age, sex, Marital status, Religion, Job, Educational status)

3.7 Operational definitions

3.8 Data Collection and Instruments

3.8.1 Instruments Used

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
settings to assess and analyze the organizational culture, supporting efforts to
enhance the quality of care, patient experience, and overall organizational
performance.(25)
 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.(26)
 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.(27)

19
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.

3.8.2 Data Collection Procedure

Data collection was carried out by trained professionals employed at Amanuel Mental
Specialized Hospital. The professionals utilized a structured questionnaire, which was
prepared in English. Additionally, relevant information from patient profiles was
documented. The data collection process involved various steps, including
questionnaire distribution and collection. Prior to data collection, the questionnaire
underwent rigorous assessments to ensure its understandability, reliability, and
validity. Informed consent was obtained from the selected participants, and data
collection commenced. After completion, a thorough review was conducted to
identify any constraints or unanswered questions in the questionnaire. Once data
completeness was ensured, the collected data were ready for entry and subsequent
analysis.

3.9 Data Quality Control

To ensure data quality in the upcoming study several measures will be implemented
Special attention will be given to ensuring that healthcare professionals clearly
understand the instructions for answering the questionnaire. They will be explicitly
instructed not to provide their names or identification on the questionnaire to
encourage open and honest responses. The filled questionnaires will be collected in
the same session to minimize the possibility of missing or incomplete data. This
approach will ensure that the data collection process is efficient and comprehensive.
A pre-test will be conducted to determine the time needed to complete one
questionnaire and to assess the understandability of the questionnaire among the study
participants. The data collected during the pre-test will not be included in the final
analysis, but it will help identify any issues or areas of improvement in the
questionnaire. Prior to and during data processing, the information collected will be
checked for completeness. This step aims to ensure that all necessary data fields are

20
properly collected and recorded, minimizing the chances of missing or incomplete
data.

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
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.

3.11 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,

21
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
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.

22
CHAPTER FOUR- WORK PLAN
Table 1: Work plan of the study

No
Tasks Duration Activities
.
Study Design and Define research objectives, develop
1 5
Planning research questions, and plan study design.
Review relevant literature, identify
2 Literature Review 7 knowledge gaps, and develop theoretical
framework.
Ethics Approval and Prepare and submit ethics application,
3 10
Permissions obtain necessary approvals.
Sampling and Participant Define sampling strategy, recruit and screen
4 5
Recruitment participants.
Conduct interviews, surveys, or
5 Data Collection 15
observations as 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
9 Review and Editing 3
clarity and coherence.
Submission and Submit research report to relevant
10 5
Dissemination stakeholders or conferences, share findings.

Total 65

23
CHAPTER FIVE- BUDGET BREAKDOWN

Table 2: Budget Breakdown

Estimated Cost
No. Category
( ETB)

Principal Investigator 20,000

1 Personnel
Research Assistant 10,000

Participant
Participant Recruitment 2,000
Recruitment
2
and
Participant Compensation
Compensation

Printing and copying costs 4,000

Stationery and office supplies 2,000

Research
Data storage and backup 1,000
3 Material and
supplies Audiovisual equipment 2,000
Participant tracking and
500
identification
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

24
 Total 78,500

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ANNEX 1
Informed Consent

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.

28
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: _______________________

ANNEX 2ENGLISH VERSION OF THE QUESTIONNAIRE

Instructions: Circle the alternatives you have chosen umber given parallel to the
answer you chose

29
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
5. Doctorate (MD)

30
 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.

31
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.

32
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

33
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

34
 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.

35
 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.

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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.

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S

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