2.2.2 A multi-dimensional approach

15

Reflection on process refers to collaborators’ open discussion and feedback on the collaborative process, with the aim to strengthen the effectiveness of collaborative relationships. Some studies identified successful service integration as incorporating a commitment to self-evaluation.

Mertz at al. (2011) described three main dimensions of the forms of collaborative practice in US dental practice and identified a range that exists within these dimensions:

1. Organizational structure. This dimension considers: (i) Professional participants, who may be independent practitioners in separate organizations or be employed by the same organization; (ii) Setting, which refers to the legal and organizational structure present to monitor the collaborative agreement between providers. Collaborative practices may incorporate one or more individual practices or exist within a single organization. In some cases, providers may be required by law to practice in certain settings; (iii) System ownership, which may exist within a public or private organization or between two independently owned organizations; (iv) Referral networks, which can be informal, formal or exclusive within an organizational structure. Referral is a critical component of the collaborative practice and personcentered care, as when patients’ needs exceed the competence of a given provider and they need to be referred to the next level of care; (v) Professional relations, where trust, respect and shared goals are critical for the success of the collaborative practice.

2. Legal and institutional requirements may include: (i) Formal collaborative agreements, which may or may not exist. However, such agreements are often required by law or by the organization where collaborative practice takes place; (ii) Protocols for clinical care delivery, which may or may not be included in collaborative practice agreements. Some protocols may be tailored to individual practices or may be more generic legal templates; (iii) Supervision, which typically falls under three main categories: direct, indirect, and general. Direct supervision requires the physical presence of the supervising clinician, while indirect supervision allows the person performing the activity to be independent, provided that the supervising provider is on-site. General supervision can be conducted remotely; (iv) Education. Some providers may be exposed to inter-professional education in their pre-service training, while others may be introduced to the concept after they are employed by the organization; (v) Licensing and certification. In the United States, state licensing is required, which defines the eligibility, education, training and testing requirements. Certification is a separate activity offered by the private sector and may be required by some states to meet the licensing requirements.

3. Operational and financial structure. This dimension includes: (i) Caseloads. If the providers are employed by the same organization, the provider with more advanced competence will take more difficult cases. If the providers are independent, an appropriate referral should be administered based on the patient’s needs;