Encouraging interprofessional collaboration: The effects of clinical protocols.

Abstract

AIMS AND OBJECTIVES:To consider the characteristics of protocol documents themselves as a factor influencing the nature of care delivery and their potential to facilitate greater interprofessional collaboration. BACKGROUND:Healthcare guidelines and clinical protocols provide important guidance and direction to health professionals in their delivery of care. By detailing requirements and actions to be taken in specified circumstances or contexts, these documents may facilitate a broadening of the pool of people able to deliver care. DESIGN:Critical reading of four clinical protocols representing the range of protocol types in use was carried out to consider the extent to which the documentation of guidelines and protocols and the documents themselves might be considered as vehicles for increased collaboration in health care. METHODS:A "close reading" rubric was developed directing the researcher to look for evidence in each protocol of the following: authorship, person or group responsible for the protocol's development; stated document purpose; target readers, either stated or implied; the particular subjects, the document names and the objects created by them such as care pathways; the use of specific terminology and imagery, the documents' form and structure; and evidence of intertextuality referring to other documents, for example legislation or policy statements. Tabulation of the coding analysis is presented. RESULTS:Nurses were the only professional group named in the documents as assignees or subjects. "Patients" and "care" are the objects created, and the scientific-biomedical discourse with its associated procedural language was dominant. CONCLUSIONS:Many protocols have been developed to standardise practice and increase the effectiveness of teamwork. They may, however, constrain collaboration in healthcare settings because they diminish a nursing "voice" and create the expectation that nurses alone work across the spectrum of protocols. RELEVANCE TO CLINICAL PRACTICE:An unintended consequence of the global use of clinical protocols and guidelines to support safe and efficient healthcare delivery may be to reduce interprofessional collaboration.