Considering clinical protocols and guidelines: what lessons for IPE?

Abstract

Background: Interprofessional collaboration is enhanced if professionals work across discursive boundaries. While interprofessional education interventions may encourage this the practice environment may militate against the implementation of understandings developed in educational settings. Summary of work: Interviews with doctors and nurses highlighted differences between each professions’ views of clinical protocols and guidelines. This prompted us to conduct a critical discourse analysis of a number of clinical guidelines and the systems which guide their development and approval. Summary of results: Our analysis shows a range of discourses at work within clinical protocols régimes. Development and approval systems are dominated by collectivist discourses emphasising communication and collaboration within rigid bureaucratic systems. The protocols exemplify a neo-liberal discourse where people who are the objects of care are positioned as clients or consumers amenable to standardised aliquots of diagnosis and care, the level of which can be justified on the basis of scoring systems and claims related to a ‘scientific’ evidence base. The régimes also suggests (perhaps falsely) flattened hierarchical structures, a democratising discourse where all professional voices are equal in the provision of care. Discussion: A nursing identity relies on experience, holistic views of patients and collective approaches to practice. The medical identity is based on craft-based development of expertise associated with generating distinctive and sometime idiosyncratic responses to a patient’s needs. Each comes to protocols with different ‘agenda’. Conclusions: The collectivist discourse of protocol development does not seem to carry through to their utilisation. Protocols appear to act as objects that reinforce discursive boundaries between the groups. Take-home messages: Educators need to consider the effect of protocols on practice and account for this in the design of educational interventions. Understanding the discursive roll of protocols might help educators design more robust IPE programmes.