Partnership working has assumed an important role within UK public services, but an awareness of the need for professions in medicine, health and social care to work together more effectively has been around for much longer. Interest in the idea that professional should “learn together to work together” – what has come to be called interprofessional education (IPE) – has grown dramatically in recent years. In considering the evidence base for IPE there are a number of parallels with the partnership field.
IPE has been perceived as one potential solution to several of the practical difficulties associated with partnership working. Health and social care partnerships bring together a range of different professions to work together around the needs of service users. However, professions often have different values and perspectives underpinning the delivery of care and informing the ways in which they view other professions.
IPE is seen as a way to overcome ignorance and prejudice between health and social care professionals on the proviso that, by learning together, professions will better understand each other and value what others bring to the practice of partnership, and this will ultimately improve the quality of care and outcomes for service users.
The converse of this is also suggested: not learning together is thought to impact negatively on services and service users.
High-profile inquiries have consistently cited poor inter-agency and interprofessional working as a contributing factor towards failure on behalf of particular service users and recommendations for IPE have been made as a result.
IPE is regarded as crucial within particular areas such as safeguarding children, community mental health services, older people’s services, services for disabled children and other such contexts where it is suggested that vulnerable people will only receive quality of care if services are delivered by professionals who understand each other’s roles and responsibilities.
Despite – or perhaps because of – the current interest in IPE, there are a number of prefixes (multi/inter/uni/trans), adjectives (professional/disciplinary) and nouns (education/training/learning/studies) which are married together in any number of ways to refer to a range of phenomena which fit broadly within this area. Each of these terms do have different meanings but there is a tendency to use them inconsistently.
We can think of IPE on a continuum stretching from isolation (each profession organising their own education) through to transprofessional education (where the aim is to go beyond professional boundaries). There are similarities to the partnership field, with relationships ranging from informal co-operation through to full merger – yet we still have a tendency to refer to all of these different forms simply as “partnerships”.
As IPE has become more prominent, the rationales behind this way of working have expanded to include:
● To “know about” the roles of other professional groups.
● To be able to “work with” other professionals, in teams where members have clearly defined roles.
● To be able to “substitute for” roles traditionally played by other professionals, when circumstances suggest that this would be more effective.
● To provide flexibility in career routes.
Again, there are stark parallels with partnerships. Arguably within the current policy context partnerships have been established to counter myriad issues but have not always had clarity over the precise outcomes which they are aiming to achieve for service users.
Aside from motivations, though, there is a further aspect to IPE which has tended to be even less explicitly considered: links to underlying theory. Many reports of IPE are light on theory. Yet some commentators argue that without being underpinned by theoretical coherence in terms of choice of models, IPE will not be regarded as a substantive, informed practice.
However, given that historically IPE has tended to be located in practice, it may not be entirely surprising that it is not pervaded with academic theories. Indeed, for this reason IPE practitioners may resist an attempt to over-theorise the field. But theory does have important implications.
Whichever educational theory underpins an IPE programme brings with it certain assumptions about learning processes, and particular aspects to be satisfied. We would argue that, without an explicit concept of underlying educational theory, this has the potential to reduce the effectiveness of individual IPE initiatives. Similarly, we might argue without being underpinned by coherent theory, social care and health partnerships risk being incoherent at best.
So, IPE initiatives may be conceived with different aims and objectives (just as health and social care partnerships often are), they may be underpinned by different educational theories and take a number of different forms (again, just like partnerships).
No single template
As such, there is no one template for IPE programmes and they will differ depending on a range of contextual factors. There is large volume of descriptive literature which chronicles the processes of IPE and sets out what seems to work well in particular circumstances, at least as far as what the participants think – and again, the partnership literature also has a strong evidence base in terms of processes.
However, both fields have been criticised for lacking rigorous evidence of effectiveness in terms of measurable outcomes (particularly for service users). Given that both partnerships and IPE have had such a wide range of potential benefits ascribed to them, any measure of effectiveness must relate to the purposes of the intervention. As such, it is difficult to tell whether IPE “works”, not just in terms of its impact on participants, but particularly in terms of whether it makes any difference to quality of care and improves outcomes for those who use services.
Both partnerships and IPE have to some degree been recognised as “a good thing” which intuitively seem like they will have a positive impact without necessarily having evidence which unequivocally demonstrates this. But this tendency can easily lead to thinking about IPE as an end in itself – rather than a means to an end.
Unless the IPE movement is seen to deliver outcomes which are clearly underpinned by empirical data and theoretical models then it runs the risk of losing legitimacy. However, there is surprisingly little robust evidence about the outcomes of professional education published in the specialist journals about social work, medical and nursing education.
Evidence of outcomes
Once again, there are plenty of accounts of educational practice and theory, but few studies of outcomes beyond the degree of satisfaction of those taking part. However, IPE generally has to fight for its place in the curriculum or in agency training plans. It is often seen as inconvenient, expensive and troublesome to organise.
It is not surprising therefore, that proponents of IPE are frequently asked to justify it – and to answer the question, does it work? We think this question of effectiveness is quite fair to ask – but it is not a simple one. Neither partnerships nor IPE are the panacea to resolving all the issues in their respective fields and both need to be treated in a more analytical and nuanced way than they have tended to be thus far.
Helen Dickinson and Jon Glasby, Health Services Management Centre, University of Birmingham, are the editors of the new Better Partnership Working series. Click here for further information.
● Working in Teams, the next in this series, will appear in the 14 August edition of Community Care
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● This article is based on material from John Carpenter and Helen Dickinson’s Interprofessional Education and Training, the third book in a new series focused on Better Partnership Working. Published by Policy Press in association with Community Care, the five books seek to provide a series of accessible “how to” guides. These books summarise current policy and research in a detailed but accessible manner, offering practical support to those working with other agencies and professions and provide some helpful frameworks with which to make sense of the complexity which partnership working entails.