Patient-Centered Care and its Role in Healthcare

Collegiality is the corollary to the concept of a collegium which a group of individuals united by the collective commitment to a certain idea that imposes some obligations.  A study by Kangasniemi et al. (2017), highlighted the importance of collegiality in health care in order to provide safe patient-centric care and achieve patient satisfaction. Collegiality is significantly important in nursing because it provides an equal and reciprocal relationship between members of the same profession. From decade, hierarchical health professions such as physician often considered nurses as the assistance and majority of them do damage when attempting to build any cohesive team. Furthermore, Behavior of incivility, unkindness and belittle criticism significantly decreases the confidence of nurses which further leads to poor performance and question patient safety. Nurses are most trusted frontline health professionals that ensure patient safety and provide high standard care to the patient. Therefore, maintaining healthy collegiality between nurses and physicians boost confidence in nurses, enhance the interpersonal relationship, which in turn improve patient outcome. There are three significant attributes That contributed to maintaining healthy collegiality in-between health professionals, especially nurses and physicians. The first attribute is the relationship between nurses and physicians, which further enhances performance and improve coordination. The second attribute is shared authority, which built on trust and improves their practice. The third attribute is respect is an integrated part of health professionals and showing respect to each other improves interpersonal collaboration and provide safe and quality patient-centric care. This paper will illustrate the aim and interest of the study, concept and literature review, the definition of three attributes in following paragraphs.

The knee interested in the topic of collegiality developed because from decade the constant interprofessional conflict observed between nurses and physicians in every health professionals .often nurses  portrayed as just assistant, less scholarly by physicians  rather than a colleague who are capable of making effective clinical judgements. I become interested in the topic when I have encountered an incident in labor and delivery unit. I have witnessed of a situation where my fellow co-workers was feeling apprehensive to speak up, which resulted in loss of valuable nursing input for positive patient outcomes. Therefore, I become interested in conducting the analysis in order to understand the concept of collegiality and the attributes in for enhancing patient outcome health care setting.

Concept Definition and Literature Review

This sectionwilltake a closer look at the definitions of collegiality, appealing to the descriptions that are most suitable to nursing. Murray (2010), stated that  collegiality is seen as the process of “getting along with one another” (p.763). While the scholar admits that it is a complex idea, he notes that collegiality is intertwined with respect, unselfishness, and the absence of undue criticism. Löfgren, & Karlsson (2016), link this concept to “reciprocity” and cohesion (p.271).  Löfgren, & Karlsson (2016), Suggested that collegiality is associated with positive emotional domains, and highlighted that concept enables a control among colleagues with similar competences. Therefore, it is apparent that collegialityis the intrinsic component of the organizational process. For instance, Freedman (2012), described collegiality as a powerful device of organization that prevents professionals from making challenging clinical decisions.

The Need for Collegiality in Healthcare

Yet, it is apparent that the common usage of collegiality is too general, while the implementation of the concept in the field of nursing is much more specific. Padgett (2013), suggested  that collegiality is attributed to peer monitoring. In the clinical environment, reviewing and monitoring of others’ work contribute to the eradication of the potential gaps and errors in treatment that can lead to fatal consequences and adverse health outcomes. Another study by Ditmer (2010), noted that the lack of collegiality  contributed to the creation of unsatisfying and “uncivil work environment” that hinders the professional development (p.10). The rise of collegiality is associated with the eradication of violence and other manifestations of the unprofessional behaviors in the nursing environment (Kangasniemi et al., 2017).

Burr, Collett, & Leung (2017), highlighted the value of collegiality and  suggested that the implementation of this concept prevents the concentration of power in one healthcare professional. Thus, it becomes clear that collegiality helps avoid subjectivity and biasness of treatment. Therefore, collegiality triggers the rise in the collective accountability and conscious adherence to professional duties, and these factors are directly associated with the quality of health outcomes of the patients. Stewart, Floyd, Thompson and Caldwell, (2015) stated that collegiality boosts the sense of solidarity. Lowe and Tori( 2017) , further elaborated that true meaning of this concept  is “a true collaboration between health practitioners” rather than working in “isolated silos” which in turn ensures that the focus of the treatment processes remains  on the patient. The researchers highlight the value of close proximity and mutual respect since these features contribute to the substantial increase in proficiency and competence among healthcare professionals.

Defining attributes are critical characteristics of a concept that appear repeatedly in the literature (Walker & Avant, 2005). In case of collegiality, its most common characteristics are relationship, shared authority, and respect. The first attribute to be discussed is relationship. This concept presupposes that the professionals do not act individually, rather aligning their efforts in the collaborative approach to their duties. Kangasniemi et al., (2017) suggested that relationship in health care setting   is defined as the value of professional ethics expressed in the “mutual and equal relationship” between healthcare professionals. It is based on such behavioral patterns and attitudinal aspects as support, recognition, and maintenance of equality. In nursing, it refers to the quality of communication between professionals (Löfgren& Karlsson, 2016). Borges, Moreira and Andrade, (2018), defined a relationship as the interaction between two individual who communicate and transfer values, energy from their role. A relationship is related to trust and shared purpose (Alleman & Haviland, 2017). According to Freedman (2009) relationship is the activity of seeking information and giving advice.  Vagharseyyedin (2016). Suggested that relationship is based on mutual trust, and being sensitive to each other.

Defining Collegiality and its Attributes

The second attribute of collegiality is shared authority. It is a basis for the appropriate distribution of power, duties, and responsibilities that are based on the competencies of the professionals. The definition of shared authority implies that it is related to joint decision-making that values the contribution of all members of the team. Being related to the appropriate allocation of power, shared authority is one of the most valuable features of collegiality (Thompson, 2010).Similarly, Freedman (2012) noted that shared authority is associated with decision making.  Sahlin&Zetterquist (2016) stated that shared authority requires integrity when taking measures that can give rise to conflict between peers. McInnes et al., (2015), described shared authority as the “collaboration between nurses and physician” that improves the practice and outcome.  Reviewing it within the framework of nursing, Kangasniemi et al. (2017) align this concept with the state of openness and confidence that serve as the foundation of “emphatic and dialogic communication” (p.3). Joseph-Williams, Elwyn and Edwards, A. (2014), defined shared authority as “equal involvement of both health professionals” in order make effective clinical judgment. Its major consequences are the empowerment of the healthcare professionals to intervene when their colleagues commit errors. Thus, shared authority marks the high level of organizational support and joint accountability in the clinical environment.

The last attribute of collegiality is respect. According to Devine & Chin (2018), respect is one of the baseline features of integrity and ethical behavior. The culture of respect presupposes that the professional’s value and support each other, manifesting dignity. Respect in collegiality has to be mutual, as the peers in the working environment should pay due regard to the unique contributions of all professionals (Alleman & Haviland, 2017). Collegiality also implies that respect has to be aligned with unselfishness (Murray, 2010). Jacobs (2016), described respect as the “acknowledgement of choice and values of individual” that create positive environment. Stuart (2014), suggested that respect in nursing professionals help means acknowledging personal thoughts, values and dignity of individual.  In nursing, respect is the foundation of nurse retention since it gives value to the experience of the professionals in quality care (Twigg & McCullough, 2014).

Conclusion

In summary, collegiality is one of the inherent features of the positive and effective environment in nursing. While this concept is generally applicable, it has a special value in healthcare since it is related not only to the beneficial collaboration of the team. In nursing, collegiality is crucial since it directly influences the patient outcomes. The major attributes of collegiality, namely relationship, shared authority, and respect, create the favorable agenda of the provision of healthcare services of high quality since the positive patterns of cooperation of the professionals contribute to the efficacy of patient care.

Literature Review on Collegiality in Healthcare

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