Impact of Power Dynamics on Collaborative Practice: A Foucauldian-Informed Discourse Analysis

Abstract

Despite international initiatives to promote and encourage interprofessional collaboration in healthcare, research has identified barriers that hinder such practice in reality. Primary amongst these, are power relationships in multidisciplinary teams (MDT), which are described as hindering communication between professionals, and giving rise to stereotypical views, facilitating hierarchical relationships, limiting capacity for change, and impeding clinical decision-making.

To help understand why such practice exists, this research utilised Foucault’s approach to discourse analysis, to study the effects of power dynamics on clinical decision-making and collaborative practices, within an MDT team of a Neonatal Intensive Care Unit (NICU). Data were collected from semi-structured interviews and direct observations of three multidisciplinary team meetings and two ward rounds. The interviews were conducted to uncover the rich descriptions associated with power relationships. Topics discussed, included MDT staff's understanding of collaborative practice, real workplace examples of collaborative practice, bicultural practice and solitary or unilateral practice, examples of interactions which portrayed or supported the exertion of power, and examples of gatekeeping of power. Observations included, but were not limited to, commentary on roles, body language, interruptions, and contributions, which were recorded in the form of field notes.

Transcripts were analysed using Foucault’s understanding of power, knowledge, discourse, governmentality, and punishment. Four key discourses were identified to influence collaborative practice and power dynamics within the NICU MDT. These included the biomedical discourse, the culture of blame, the sanctity of life and collaborative practice. While all discourses were always in play, each rose to dominance in different situations. As each discourse came to the forefront of practice, it had a significant yet unique effect on staff behaviour, communication, power dynamics and collaboration. Although the biomedical discourse was a relatively dominant discourse, shaping the flow of power and the forms of communication that were favoured, collaborative practice was revealed to be a dynamic phenomenon, that was responsive to the changing situation in the NICU and to the various actors. Empowered with this understanding, MDT staff can better identify, engage in, and encourage collaborative decision-making to improve health care delivery.