INTERDISCIPLINARY RELATIONSHIPS

Professionals, paraprofessionals, and volunteers from disciplines other than social work are part of the environments our clients live in, and because social workers focus on the interaction between people and their environments, we must work effectively with people from other disciplines if we are to effectively serve our clients.  Learning to work effectively with other disciplines can be a challenge.  Each discipline has its own set of assumptions, values, and priorities, and these differences can easily lead to uncoordinated services, or, even worse, to resources being spent on interdisciplinary conflict.

There are many different models of interdisciplinary relationships.  Competition and conflict are two examples that are easy to conceptualize.  The model most consonant with social work values is collaboration.  Collaboration may be defined as working together.  It connotes that collaborators share power and that they each contribute special knowledge or skills.  Smith (1985) highlights the distinction by using the terms multidisciplinary and interdisciplinary, the former to refer to many disciplines working in the same setting and the latter to refer to members of those disciplines working together as a team.  Although this distinction is not standard in the literature, it is a useful distinction.

When individuals from various professions work together day to day in one setting, they often think of themselves as forming an interdisciplinary team, and yet interdisciplinary teams may function in other ways.  For example, a group of individuals from various disciplines may meet periodically or episodically to review critical incidents.  They are an interdisciplinary team even though they do not work together every day.  Similarly, an ethics committee typically consists of individuals from various disciplines and may even include members external to the organization to assure representation of diverse views.  This too is an interdisciplinary team.

And social workers frequently form both brief and ongoing interdisciplinary relationships that do not constitute team practice but that are nevertheless necessary for effective service.  Relationships with police officers, probation officers, attorneys, and judges are interdisciplinary in nature.  Similarly, relationships with teachers, school administrators, and playground supervisors may be necessary for effective practice.  To practice effectively, social workers must be prepared to work with all of the individuals in the client’s environment.  The focus of this brief review is on relationships with allied health professionals, not because those relationships are most important, but because those have been examined most in the professional literature.

Social work knowledge is influenced by and in turn influences other disciplines.  Cheung (1990) reviewed interdisciplinary contributions in professional journals from 1981 to 1985.  The top five disciplines cited in social work journals were social work, family studies, psychiatry, sociology, and education.  If clinical psychology, psychology, developmental psychology, educational psychology, social psychology, and applied psychology had been counted together, they would have placed second after social work as the source of citations.  The same article showed that social work was cited most in social work, education, family studies, clinical psychology, and psychiatry.  These finding demonstrate strong interdisciplinary relationships in professional knowledge, and suggest not only considerable overlap in knowledge but also the potential for significant ideas from one discipline to influence another.

Abramson and Mizrahi (1996) examined the characteristics physicians and social workers identified as important in collaborative relationships.  Those rated most important by social workers were, respect for collaborator, similar perspectives, positive quality of communication, social worker role well understood by physician, and amount of communication was positive.  Those items rated as most important by physicians were: the social worker was capable, positive quality of communication, respect for the physician, similar perspectives, and the social worker kept the physician informed.

Abramson and Mizrahi reported that the most common negative variables for social workers were: dissimilar perspectives, poor quality of communication, physician’s negative style, lack of respect for the social worker, and negative personal traits of the physician.  They reported the most frequent negative variables for physicians were: dissimilar perspectives, amount of communication was inadequate, social worker’s feedback was not timely, social worker did not keep the physician informed, and poor quality of communication.

A synthesis of those finding suggests that relationship variables are more important to social workers and that amount, timeliness, and content of communication are more important to physicians.

According to Sullivan (1998), the medical literature on collaboration is extensive.  It appears to be most extensive for relationships between physicians and nurses.  She cites five attributes as contributing most to an effective partnership: respecting each other, communication, working together, partnership relationship, and trusting each other.  She also reports on similar terms and related concepts that illuminate the idea of collaboration: joint practice, shared governance, coalition, cooperation, collegial, working together, teamwork, interdependence, and professionalism.

Sullivan goes on to cite work by Blake and Mouton (1970) and Kilmann and Thomas (1977) that examined assertiveness and cooperation as elements of collaboration:

High assertiveness + high cooperation = collaboration
Moderate assertiveness + high cooperation = compromise
Low assertiveness + low cooperation = avoidance
High assertiveness + low cooperation = competition
Low assertiveness + high cooperation = accommodation

Sullivan expands the concept of collaboration to the workplace as a whole.  Citing Evans (1994), she lists characteristics of capacitating environments:

Empower workers
Stimulate creativity of workers
Promote teamwork and learning
Promote comfort with implementing change
Motivate staff to accept increased responsibility
Develop workers’ potential
Facilitate staff understanding of organizational goals
Leaders delegate responsibility appropriately
Enable workers to communicate openly and directly
Foster collaboration with peers

These ideas suggest that important information about collaboration may be found in management literature that focuses on organizational environments and their contributions to organizational effectiveness, and it makes sense that collaboration can occur most effectively in an environment that supports it.  Interdisciplinary teams can occur with a variety of relationships.  Creating interdisciplinary collaboration is a goal for social workers to strive for.

Smith (1985) identifies benefits of interdisciplinary team practice:  improved organizational effectiveness, improved service to clients, synergistic effects, learning from other disciplines, mutual support, and team maturation as it grows from interdisciplinary tension.  Schofield and Amodeo (1999) list the benefits of increased awareness of one’s own discipline, more respect and understanding of other disciplines, opportunity for cooperative research, and development of a cooperative mind-set.  They cite additional benefits of improved access to care, improved patient efficacy in self care, improved role satisfaction for practitioners, reduction in length-of-stay and premature admissions, increased use of team members to meet varied needs, relieved burden for team members, facilitated work with difficult patients, and improved objectivity.

Smith goes on to discuss the importance of role boundaries, role maintenance, role clarity, and role overlap.  Good social work practice suggests that these issues be openly discussed among team members.  Similarly, obstacles to effective team functioning should be identified and openly discussed.  Schofield and Amodeo identify problems in teams that may merit attention: differing status among team members, unequal benefits for participation, variability in the organization and administration of each discipline that contribute to tension, different levels of personal commitment, disparate jargon and technologies, physician dominance, role confusion and blurring, increased time demands, insecurity about the value of the team approach, shift in professional status among disciplines, and lack of administrative support.  They cite additional difficulties: competition for clients, disagreements over leadership and authority, lack of a common value base, frequent rotation of some disciplines, unclear definition of team leader’s role, inadequate patient care, ineffective and inefficient communication, and lack of consensus on the prognosis of some clients.

Schofield and Amodeo discuss their findings:

[T]he conceptualizations and descriptions of the teams were so poor that reliable conclusions could not be drawn. . . . We also discovered that practitioners and researchers have invested an enormous amount of time, energy, and resources exploring this issue.  However, the costs incurred seem to have exceeded the benefits, because the cost effectiveness and clinical effectiveness of these teams have not been studied or documented adequately.

These findings demonstrate the need for social workers to be cautious in their conclusions and to continue the research about the effectiveness of interdisciplinary teams.  Social workers cannot avoid interdisciplinary relationships.  The nature of those relationships and the value of those relationships can be a matter of conscious choice.  The University of Washington School of Medicine web site (2002) provides a good summary:

Ethically, every member of the . . . team has separate obligations . . . based on the provider’s profession, scope of practice and individual skills. . . . Different knowledge and experience in specific issues both ethically and legally imparts unequal responsibility and authority to those care providers with the most knowledge and experience to handle them.  But also because of differences in training and experience, each member of the team brings different strengths.  Team members need to work together in order to best utilize the expertise and insights of each member.

Bibliography

Abramson, J. & Mizrahi, T.  When social workers and physicians collaborate: Positive and negative interdisciplinary experiences.  Social Work 41(3), 270 – 282.

Cheung, K. (1990).  Interdisciplinary relationships between social work and other disciplines: A citation study.  Social work research and abstracts 26(3) 23 – 30.

Schofield, R. & Amodeo, M. (1999).  Interdisciplinary teams in healthcare and human service settings: Are they effective? Health and social work 24(3), 210 – 219.

Smith, N. (1985). Social work in team practice.  In P.J. Lecca and J.S. McNeil (Eds.), Interdisciplinary team practice: Issues and trends (pp. 97 – 123).  New York, NY: Praeger Publishers.

Sullivan, T. (1998).  Collaboration: A health care imperative.  New York, NY: McGraw-Hill.

University of Washington School of Medicine (n.d.) Interdisciplinary team issues.  Retrieved April 16, 2002 from http://eduserv.hscer.washington.edu/bioethics/topics/team.html