1. Interprofessional Working in Hospitals: The Case of Nepal
Bachchu Kailash Kaini
(Cert in Clinical Audit in H&SC – London, PG in Hospital & Health Mgmt – IIHMR, Jaipur; MBA, LLB, BEd – TU, Nepal)
PhD Research Student (Final Year, Part Time), University of Greenwich, London
Clinical Governance Manager, Queen Elizabeth Hospital, London
Councillor, Dartford Borough Council, Dartford, Kent, UK

2. Context Changes in demographic structure and disease pattern
Increased cost of care
Concept of specialties and sub-specialties emerging
Well informed patients and more choices
Expansion of roles of health care professionals (HCPs)
Changing health care environment requires new ways of working & collaborative practice

3. Interprofessional Care (IPC)
IPC is a collaborative working in which HCPs share common purpose of developing mutually negotiated goals which are achieved through agreeing a care plan, the management of it and procedures (HFO, 2007; Hawley, 2007; Leathard, 2003; Payne, 2000; Pietroni, 1992; Colyer, 2012).
Interprofessional working (IPW) to happen in practice, HCPs:
Pool their skill, knowledge and expertise
Shared professional view points
Make joint decision
Learn from each other

4. Literature Review
Collaboration, IPW and effective communication: reduces the clinical incidence, misunderstanding and errors, and enables HCPs be more readily aligned to the departmental and organisational vision (Verhorsek et al, 2010;. Mills et al, 2008; CHSRF, 2006; Joint Commission, 2005)
More positive health care outcomes are achieved by collaborating effectively between HCPs (Byrnes et al, 2009; CHSRF, 2006; Nolte, 2005; EICP, 2005; Holland et al, 2005; Pollard, 2005; Dow and Evans, 2005; McAlister et al, 2004; Leathard, 2003; Miller et al, 2001; Biggs, 1997; Ritter, 1983)
Other aspects of IPW researched and assessed in the past

5. Power Perspectives of Theory of Professions
Theory of Professions: division of labour based on skills, knowledge and expertise
Knowledge is a source of power and it has great influence in determining professional behaviour and dominance
Medical dominance exists in health care and professional dominance of medical professionals comes from autonomy
(Freidson, 1970a; 1970b)

6. Research Objectives
To identify and analyse various factors that support and hinder IPW in Nepalese hospitals
To examine understanding and perceptions of IPW among HCPs
To assess perceptions of IPW on health care delivery in Nepal
To examine professional power perspectives of theory of professions in relation to IPW
To make recommendations for improving interprofessional collaborative practices

7. Research Methodology Qualitative research method, case study
Purposive sampling
Three hospitals in Kathmandu, 38 HCPs (40% nursing, 34% Medical and 26% AHPs)
Use of semi structured interview schedule & analysis of documentary evidence
Qualitative content analysis
Interpretive thematic approach
Open coding, categorisation, theme generation, establish relationships, interpretation & conclusion

8. Demographics

9. Main Findings IPW is widely understood, recognised and valued by HCPs
HCPs carry out different roles, values, status and responsibilities
Verbal means of communication is used most of the time. Other common forms: medical notes, team meetings
Service users involvement in IPC is valued

10. Main Findings Power differences in medical, nursing and AHPs
Dominance of medical professionals exists in Nepalese hospitals
Medical professionals lead IPC team
HCPs perceived different levels of autonomy
Boundaries between HCPs changing
Cultural and gender differences in medical, nursing and AHPs

11. Main Findings
HCPs do not have significant contact with one another during their formal or university education
HCPs learn IPC skills at work and they felt competent
IPW is not sufficiently motivated amongst HCPs and adequate appreciation is lacking
Concept of IPW and power perspectives of theory of professions are equally applicable in Nepalese context

12. Perceived Barriers to IPW
Organisational: Lack of training and education, no protocol for IPW, high workload & no support from management
Professional: Professional dominance and isolation, hierarchy & no understanding of other professions
Personal: Poor communication, ego, negative attitude & no mutual respect

13. Recommendations for Improving IPW
Training and education
Policies and guidance
Clinical leadership
Organisational structures and support
Appropriate communication