Discussion
The AITCS score, a self-assessment score of IPC, was associated with age, profession (nurse/non-nurse), relationships with neighbouring facilities and job satisfaction. Our findings suggest that younger professionals or nurses may be ideal members to lead community hospitals in increasing opportunities for IPC among clinics, welfare facilities, and secondary or tertiary hospitals, and to enhance self-efficacy-associated job satisfaction. Given that evidence on the effectiveness of community hospitals is relatively scarce, these findings may be useful for systematic changes in community hospitals, which can play the role of community hub to provide health and social services based on a more locally integrated health and care system.
Younger age was associated with higher total AITCS score. This is inconsistent with previous reports which suggest that it is typically difficult for novice professionals to play the role that other professionals envision of them within their own profession and to understand the contextual roles of other professions.29 30 IPC requires that mutual professionals learn expected roles with, from and about each other through prolonged interprofessional communication across many years. Based on their prerequisite education, it is likely that young healthcare professionals may regard superficial sharing of information as IPC,31 32 suggesting that younger healthcare professionals may tend to think that they conduct better IPC than older healthcare professionals. Younger professionals who are motivated to collaborate more within and across organisations may play a critical role in IPC.
Nurses also play a critical role in IPC33 and should therefore be more autonomous in IPC.34 Additionally, nurses can lead other professionals in effective IPC and create a culture that encourages the values and role models of collaborative practice within a team context.35 These characteristics of nurses may affect the self-assessment score of IPC.
Relationships with neighbouring facilities reflect interorganisational relationships. To enhance the effectiveness of interorganisational relationships, communication should be formal and informal within and across organisations.34 Additionally, because the degree of organisational relationships is linked to levels of collaboration, effective relationships across organisations should be active, regular, reciprocal, open and comfortable for communication among members.36 Such open and flexible communication styles within or across organisations may promote effective horizontal and vertical IPC. Horizontal integration refers to peer-based and cross-sectoral collaboration to improve overall health, while vertical integration refers to that which transcends organisational boundaries and connects community-based generalists with largely hospital-site specialists.10 Both types of collaboration can interact with each other and break down the walls of multiprofessionals and multiorganisations.
Other studies have shown that job satisfaction is associated with interprofessional perspective,37 team climate,38 and organisational culture and teamwork.39 40 While a number of previous studies have demonstrated that organisational culture is important for IPC,41 42 we found that relationships with neighbouring facilities were more strongly associated with IPC than the hospital to which participants belonged in multiple regression analysis. Moreover, job satisfaction was independently associated with IPC even after accounting for confounding factors. That healthcare professionals in community hospitals may regard IPC as their role may explain the association of the self-assessment score of IPC with job satisfaction.41
This study has several limitations. First, confounding factors of AITCS were defined as participants’ characteristics, namely age, gender, healthcare profession and hospital to which they belonged, and potential associated factors were relationships with neighbouring facilities, job burden and job satisfaction. It is likely that there were other confounding factors given that IPC is used as a dimension of organisational culture,43 leadership is a dimension of teamwork, and climate is highly associated with culture.39 However, this study showed that factors associated with the organisational culture of different hospitals were not independently associated with IPC in multiple regression analysis. Second, this study focused on only separating nurse and non-nurses (other) as profession categories. A larger sample is more representative of the population and needed to analyse detail factors (more professional categories, and the size of clinics and hospitals, and so on). Third, the findings may not be generalisable to all community-based hospitals. However, comparison of the low response rate with that in other studies in healthcare27 suggests that these findings may be useful for developing an interprofessional education system in community hospitals. Given that evidence on the effectiveness of community hospitals is relatively scarce, a strength of our study is that our findings may be useful for systematic changes in community hospitals to enhance the integration of service delivery and benefit to the community. In particular, Japan has a unique work culture comprising a hierarchical and relationship-dependent climate within organisations, and workers are expected to be hard working. Given that this cultural background may differ among countries, it is important to compare factors associated with IPC in other cultures.