Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, Canada.
J Interprof Care. 2020 Jul-Aug;34(4):528-536. doi: 10.1080/13561820.2020.1714563. Epub 2020 Feb 16.
Collaboration has achieved widespread acceptance as an indispensable element of healthcare delivery in recent decades, despite modest evidence for its impact on healthcare outcomes. Attempts to understand this seeming paradox have been based mostly in functionalist or conflict-theoretical approaches. Currently lacking, however, is an articulation of how collaborative ideals are embedded in broadly shared beliefs about what healthcare is and how it operates. In this article, we examine how language used in the CanMEDS competency framework and in two guides for Family Health Teams construct idealized versions of rational, autonomous physicians and primary care organizations, respectively. Informed by phenomenological sociology and neo-institutional theory, we characterize these documents as elements of formal structure, the putative "blueprints" for healthcare planning and activity. Drawing on this analysis, we argue that these documents and "collaborative" formal structures in general, not only function as tools to make healthcare more collaborative, but also create an appearance of "real" collaboration, independently of the realities of practice. We argue that they thus instill confidence that the current healthcare system functions according to deep-seated societal values of justice and progress. We conclude by emphasizing the potentially distorting influence of this on efforts to understand and improve healthcare.
尽管合作对医疗保健结果的影响证据有限，但近几十年来，合作已被广泛认为是医疗保健服务不可或缺的组成部分。试图理解这一明显的悖论的尝试主要基于功能主义或冲突理论方法。然而，目前缺乏的是如何在广泛共享的关于医疗保健是什么以及它如何运作的信念中嵌入协作理想的表述。在本文中，我们研究了 CanMEDS 能力框架中的语言以及两个家庭健康团队指南如何分别构建理性、自主医生和初级保健组织的理想化版本。受现象社会学和新制度理论的启发，我们将这些文件描述为正式结构的要素，即医疗保健规划和活动的所谓“蓝图”。借鉴这一分析，我们认为这些文件和一般的“协作”正式结构不仅是使医疗保健更具协作性的工具，而且独立于实践的现实，营造出“真正”协作的表象。我们认为，它们因此注入了信心，即当前的医疗保健系统符合正义和进步的深层次社会价值观。最后，我们强调了这对理解和改善医疗保健的努力的潜在扭曲影响。
