Trust

Trust is both an enabler and a result of a collaborative environment, so it was not surprising to see trust cited as an important ingredient in the IPC success stories. In a team environment one needs to know the different roles of the various team members and trust that the respective tasks are being done. One participant called it the ingredient that was either going to "make it or break it". A symptom of a non-trusting environment was noted by one participant when they recalled a time where one physiotherapist would complete a discharge assessment on one day and on the next morning another physiotherapist would feel compelled to do it again. It was interesting to also note that ownership was linked to trust in two very different ways. Ownership was seen as an impediment to IPC in the following example:

It would appear that ownership can play a dual role. The difference is that in a team environment there is a collective pride and sense of ownership towards shared goals (for example holistic care of the client), while in a non-trusting environment individual care givers tend to take personal and exclusive ownership over the specific elements of care for which they are responsible.

Other trust related comments were that in patient centred collaborative care, there has to not only be trust between the various care providers, but also between the care providers and the patient (who actually are part of the care team). This trusting relationship may need some nurturing with team care as a nurse from a family health team commented that:

The biggest [impediment] that comes to mind is just not knowing what other people's roles are so then it is very difficult to have that level of trust, that say in the case of an educational program, that things are going to be done right. I think that applies to patient care so you have to kind of let go a little bit, which is really difficult to do if you don't know what the other role is, so you feel you need to take ownership of it yourself because you don't have the confidence [that it will get done otherwise].

I think one of my most valued experiences in my clinical life was being on the acquired brain injury team which did start from scratch, where you had a hand in planning right from scratch and everybody started at the same time. It creates a sense of ownership and I think it creates a sense of trust.

…we have been challenged by patients not really wanting to see an allied health professional for their disease condition. I think there was a couple of ladies or patients who, when we called to book appointments, basically said they don't really need to see you; "I go see my doctor on a regular basis and he takes care of me". So that in itself is a bit of a challenge. I don't know how prevalent that is, but we still get some of those comments.