Advancing interprofessional theory: Deliberative democracy as a participatory research antidote to power differentials in aged care
Peter Nugus, Centre for Medical Education and Department of Family Medicine, Canada ; Geetha Ranmuthugala, School of Rural Medicine, Australia ; Joanne Travaglia, Health Services Management, Australia ; David Greenfield, Australian Institute of Health Services Management, Australia ; Josianne Lamothe, School of Criminology, Canada ; Anne Hogden, Australian Institute of Health Innovation, Australia ; Kendall Kolne, School of Communication Sciences and Disorders, Canada ; Jeffrey Braithwaite, Australian Institute of Health Innovation, Australia
Journal of Interprofessional Education & Practice Volume 15, Number 1, ISSN 2405-4526 Publisher: Elsevier Ltd
Interprofessional relations in health care have been examined through the frame of “clinical democracy”. Yet, traditional interpretations of democracy have assumed a zero-sum, competitive interpretation of power, leading to unelaborated invocations for health professionals to “collaborate” more or do “teamwork” better. The aim of this study was to understand the priorities that health professionals from different occupations have for individual patient care, and the opportunities they have to express those priorities, as a foundation for a more expansive democratic theory.The case setting was a mixed-method, pre-post, participatory research (PR) study examining the dynamics and levels of satisfaction of interprofessional information-sharing and decision-making on an acute aged care unit.Stage 1, pre-intervention, revealed that non-medical health professionals – nursing and, in particular, allied health professionals – lacked opportunities for input into decision-making for patient care. Following deliberative, public feedback of the findings to managers and health professionals, an intervention was negotiated to re-structure the weekly case conference and referral processes. Stage 2, the post-interventional findings showed an increase in perceptions of information-sharing, and participation in case conferences, as well as recognition of power differentials in interprofessional relations.In the public negotiation of increased prominence of particular roles and aligning role clarity with the needs of particular patients, the findings show that the notion of deliberative democracy characterizes the qualitative-cumulative, rather than merely quantitative-redistributive power among health professionals in different occupational roles. As a case of conscientization, deliberation engages practical interprofessional improvement simultaneously as educational empowerment.
Nugus, P., Ranmuthugala, G., Travaglia, J., Greenfield, D., Lamothe, J., Hogden, A., Kolne, K. & Braithwaite, J. (2019). Advancing interprofessional theory: Deliberative democracy as a participatory research antidote to power differentials in aged care. Journal of Interprofessional Education & Practice, 15(1), 100-111. Elsevier Ltd.