Interprofessional Collaborative Practice in Primary Health Care in Aotearoa/New Zealand: A Discourse Analysis

Abstract

Interprofessional collaborative practice (ICP) has been identified as key to good primary health care (PHC) for decades. The release of the 2001 PHC Strategy in Aotearoa/New Zealand confirmed the importance of ICP in this country. An overview of the literature of ICP indicated there are varied and contested views of ICP and how it affects the work in PHC. Many frameworks and models of collaborative practice state effective ICP depends upon health care professionals being able to critically reflect on their practice. Drawing on critical hermeneutics theory this study explores how professionals working in PHC understand ICP and how they see reflective practice contributing to that understanding. Semi-structured interviews were carried out with 20 participants working in varied PHC settings. Ten participants worked in one suburb of a small provincial town. The other ten participants were located in a different region. A sociology of knowledge approach to discourse analysis was used to analyse the texts from these interviews. This entailed carrying out a narrative analysis exploring the key objects, metaphors, plot, and values of the stories told in the interviews. This was complemented by an analysis of the place of ICP to consider influences of work environments. These two analyses informed a discourse analysis of the practices of ICP and reflective practice. The potential benefits of interprofessional collaborative practice in primary health care are currently not being realised in this country. The study found a wide variety of ICP involving varied practitioners occurs outside of the dominant organisational infrastructure of the general practice. Yet the general practice, mainly staffed by GPs and practice nurses, remains at the centre of funding and policy infrastructure. Practitioners outside of the general practice invest much time and energy in building and maintain ICP relationships with practitioners within general practices as well as within other parts of the health system so as to provide better coordinated care for their patients. Significant changes to policy, funding and health system organisation are required to challenge the dominance of the general practice and enable ICP to flourish.