INVESTIGATING THE BARRIERS TO INTERPERSONAL COLLABORATION IN FEDERAL TERTIARY HOSPITALS IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the Study

Over the past few years, there has been an increase in the occurrence of complex and long-lasting health conditions, which has created a significant demand for a highly efficient healthcare team (Lavelle et al., 2018; Mulholland et al., 2018). Presently, there is a need to efficiently collaborate across hospitals, community settings, and allied health sciences. Inter professional collaboration (IPC) refers to a form of communication when two or more healthcare professionals exchange their expertise through discussion, with the aim of delivering optimal care to patients, their families, and healthcare organizations (Ansa 2020). Therefore, in the healthcare industry, Inter professional collaboration (IPC) is a cooperative alliance that bears the responsibility for ensuring the provision of high-quality care to patients based on their individual requirements 

According to Tvrdy (2020) interpersonal teamwork plays a crucial role in healthcare delivery, making a substantial contribution to the quality and safety of patient care. Efficient cooperation among healthcare experts, including doctors, nurses, chemists, and allied health workers, guarantees that patients receive holistic care that encompasses all facets of their health requirements. Nevertheless, the World Health Organization (WHO) acknowledges that IPC in education and practice is a distinctive approach to delivering healthcare, which can also alleviate the worldwide shortage of healthcare professionals. Fernandez (2020) argued that collaborative practice has a positive impact on the quality of care and the effectiveness of health systems. Health professionals conduct evaluation procedures and a limited number of therapy actions autonomously, but management goals, particularly long-term goals, are created collaboratively. Every member of the team engages in effective communication and collaborates harmoniously in response to the patient's requirements. IPC enhances patient satisfaction, reduces medical errors, and improves health outcomes and healthcare quality.. 

McGettigan & McKendree (2018) opined that to measure the success of collaboration, it is important to first study the attitudes of nursing students and the challenges they encounter in inter-professional collaboration (IPC). Lie (2020) maintained that the opinions of nursing students towards their own field and that of other healthcare professions can impact their desire to collaborate. It can impact their perception and behavior towards other healthcare providers. Nevertheless, the successful achievement of IPC relies on attitude-related characteristics such as the establishment of trust, the implementation of effective communication methods, the formulation of shared management objectives, the recognition of necessary power disparities in decision-making, and the establishment of health organizational structures that promote IPC. Furthermore, there are numerous obstacles in interprofessional collaboration (IPC) that have a significant impact on both the patient's healthcare and the reputation of the health organization (Chong et al., 2021). 

Throughout history, the Nigerian healthcare system has been shaped by colonial legacies that brought about a hierarchical and inflexible organizational framework. Frequently, doctors are positioned at the apex of this hierarchy, while nurses, chemists, and other healthcare professionals assume secondary positions. The outcome is an asymmetry of power that obstructs transparent communication and cooperative decision-making, as subordinate professionals may experience intimidation or a lack of recognition within multidisciplinary teams (Akinyemi & Odubiyi, 2020). Furthermore, this historical precedent has fostered a culture within healthcare institutions characterized by the concentration of authority in a select few individuals, rather than being distributed among team members. As a result, the potential for collaborative practice is undermined. However, the educational system in Nigeria has historically prioritized individual professional capabilities rather than inter professional education (IPE), which is crucial for developing collaborative skills among healthcare personnel.

 Traditionally, medical, nursing, and pharmacy institutions in Nigeria have provided education to their students separately, without much collaboration or interaction across the different specialities. This division persists in professional practice, as healthcare professionals may be deficient in the requisite expertise and proficiency to efficiently cooperate with peers from different fields. Studies have shown that the lack of Interprofessional Education (IPE) in healthcare education in Nigeria leads to inadequate collaboration and communication among healthcare professionals (Adedeji & Folarin, 2018). Given the importance of this function, this study aims to investigate the barriers to interpersonal collaboration in Federal tertiary hospitals in Nigeria.

Statement of the Problem

In recent times, interpersonal teamwork in hospitals is crucial for delivering top-notch healthcare, enhancing patient outcomes, and guaranteeing the effectiveness of healthcare services. Nevertheless, in Nigeria, numerous obstacles greatly impede the efficient cooperation among healthcare experts. The obstacles encompass hierarchical frameworks, professional divisions, cultural disparities, insufficient communication abilities, and systemic challenges such as substandard infrastructure and limited resources. The conventional hierarchy, which places doctors in a position of superiority over other healthcare professionals including nurses, chemists, and laboratory techs, establishes a power disparity that hinders open communication and collaboration (Adeyemo, 2020). This hierarchical culture cultivates an atmosphere in which input from non-physician personnel is not given enough importance, resulting in subpar decision-making and a deficiency of collective accountability in patient care. Akinyemi (2019) argues that the top-down approach not only hinders the input of other healthcare professionals but also maintains a culture of silence, where lower-ranked workers may be reluctant to express concerns or suggestions, even when patient safety is in jeopardy. 

Within numerous Nigerian hospitals, there exists a prevailing atmosphere of rivalry rather than collaboration among various healthcare cadres (Ogbonna & Adebayo, 2018). This rivalry is frequently intensified by factors like as discrepancies in remuneration, ambiguous job responsibilities, and a failure to acknowledge the efforts of all healthcare professionals. The resultant tension can give rise to breaks in communication, lack of trust, and a reluctance to collaborate towards shared objectives. These disagreements not only impede the smooth progress of work but also have a detrimental impact on the standard of patient care. According to a study conducted by Ezeani (2018), inter-professional disputes were identified as one of the primary reasons for job dissatisfaction among healthcare workers in Nigeria. This discontent subsequently impacted their inclination to participate in collaborative practices. In addition, insufficient training and a lack of ongoing professional development opportunities may hinder effective collaboration. A significant number of healthcare workers in Nigeria lack sufficient training in cooperation and communication skills, which are crucial for effective collaborative practice Chukwuma (2021) assert that the conventional educational system frequently prioritizes individual accomplishment over collaborative efforts, and this mentality is then transferred to the professional environment. Moreover, there is a dearth of well-organized inter-professional education initiatives that could foster comprehension and reverence amongst diverse healthcare disciplines (Olatunde, 2018). Lack of adequate training and limited exposure to collaborative techniques might hinder healthcare personnel' ability to function efficiently within a team, resulting in less than optimal patient outcomes. In addition, structural obstacles such as insufficient personnel, unfavourable working environment, and limited resources intensify the hindrances to interpersonal collaboration. Hence, it is in the light of these that the study seeks to investigate the barriers to interpersonal collaboration in Federal tertiary hospitals in Nigeria.

 1.3  Objectives of the Study

The main purpose of this study is to investigate the barriers to interpersonal collaboration in Federal tertiary hospitals in Nigeria. Specifically, the study will;

1.Assess the effectiveness of communication channels among different professional groups within Federal tertiary hospitals in Nigeria.

2.Evaluate the whether the adequacy of training and education programs promotes inter-professional collaboration in Federal tertiary hospitals in Nigeria.

3.Identify the barriers to inter-professional collaboration in Federal tertiary hospitals in Nigeria.

4.Proffer strategies for enhancing inter-professional collaboration in Federal tertiary hospitals in Nigeria.

1.4  Research Questions

The following questions have been prepared for the study:

How effective are the communication channels among different professional groups within Federal tertiary hospitals in Nigeria?

Does the adequacy of training and education programs promote inter-professional collaboration in Federal tertiary hospitals in Nigeria?

What are the barriers to inter-professional collaboration in Federal tertiary hospitals in Nigeria?

What strategies can be proposed to enhance inter-professional collaboration in Federal tertiary hospitals in Nigeria?

1.5 Research Hypotheses

H0: There are no significant barriers to interpersonal collaboration in federal tertiary hospitals in Nigeria.

Ha: There are significant barriers to interpersonal collaboration in federal tertiary hospitals in Nigeria.

1.6 Significance of the Study

Basically, the study will have a big impact on Nigerian healthcare management and policy. In the very end, the findings will contribute to enhancing the efficacy and efficiency of healthcare provision in these establishments, improving patient outcomes and fostering a more unified healthcare workers. The present research aims to enhance the theoretical comprehension of the obstacles that hinder efficient interpersonal collaboration in healthcare environments, with a specific focus on Federal tertiary hospitals in Nigeria. It will provide a thorough examination of the different obstacle structural, cultural, or educational that stand in the way of healthcare professionals working as a cohesive team. Nevertheless, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review.

1.7 Scope of the study   

The scope of this study is boarded on the barriers to interpersonal collaboration in Federal tertiary hospitals in Nigeria. Geographically, the study will be delimited to some selected Federal tertiary hospitals in Nigeria.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Interpersonal Collaboration: The extent and quality of interaction, communication, and cooperation among healthcare professionals to achieve shared patient care goals.

Perception: The beliefs, attitudes, and understanding that nursing students have regarding interpersonal collaboration.

Interprofessional education (IPE): refers to a teaching approach where students from different healthcare and related disciplines learn together during part of their professional training.

Nursing Students: Individuals enrolled in a nursing program and undergoing clinical training or practical experience.