Interprofessional collaboration (IPC) is a complex social phenomenon defined by the relationships and interactions that occur between health practitioners from various professional backgrounds (World Health Organization 2010). 

When performed successfully, IPC contributes to positive patient outcomes, cost-effective healthcare and higher satisfaction levels for both patients and practitioners (Reeves et al 2017).

A recent research project investigated IPC in physiotherapy private practice facilities in northern Queensland.

The project consisted of two phases—an online survey of 49 physiotherapists followed by a qualitative approach involving individual semi-structured interviews with 28 physiotherapists and 64 hours of observation across 10 private practice facilities. 

Ethics approval was obtained from the James Cook University Human Research Ethics Committee (H7639/H7951).

Why was this research needed?

The small-scale monoprofessional clinic, employing only physiotherapists or relying on a sole practitioner model of care, has traditionally been the dominant service delivery model in physiotherapy private practice in Australia.

Many physiotherapists have thrived in these clinics; however, their opportunities for interaction with health practitioners from other professions may be limited. 

We are not suggesting that the monoprofessional model is outdated or less effective, but as the potential benefits of IPC are increasingly recognised and the proportion of physiotherapists entering private practice continues to climb, there was a pressing need to explore how combining the knowledge and skills of health practitioners from diverse professions can lead to more holistic and comprehensive care.

What did the research find?

We found that physiotherapy private practitioners valued IPC because of its potential to significantly enhance the quality of patient care:

‘I think it’s extremely important to have interprofessional collaboration in place for the client to address their needs comprehensively.’

Engaging in IPC also enabled many physiotherapists to establish stable referral bases with health professionals from various external organisations:

‘Interprofessional collaboration is really good for your business model. In private practice, you get… timely referrals and… more appropriate referrals.’

Many physiotherapists believed that working in an interprofessional manner was more professionally rewarding and personally satisfying when compared to practising in isolation from other professions:

‘It’s definitely more rewarding. It’s eye-opening. You find out about your other clinicians and other professions in a more intimate way and it’s actually quite rewarding in that aspect too. It’s definitely more interesting.’

However, our survey found that although 98 per cent of physiotherapists working in private practice considered IPC necessary to provide adequate person-centred care, they reported their interprofessional interactions to be infrequent and mostly limited to informal exchanges with health practitioners from a small number of professions.

Financial challenges, including physiotherapy private practitioners’ perceived need to compete for clientele, emerged as significant barriers to effective IPC. 

Many physiotherapists admitted that protecting their income was often a higher priority than IPC
and referring patients to health professionals working at other organisations was perceived to result in lost clientele:

‘It’s private practice; it’s a competition. If you don’t see people… and if patients want to go to someone else instead of you, then you’re not making money and you don’t have a job and you can’t employ other people. So, do we really want to involve… other professions?’

Time constraints and workload schedules also presented challenges for IPC. 

A perceived lack of time was reported as a major barrier to IPC by most physiotherapy private practitioners:

‘Interprofessional collaboration fluctuates depending primarily on how busy people are. The biggest barrier to interprofessional collaboration is definitely the lack of time needed to perform it.’

Some physiotherapists said that there was not enough time during work hours to take part in IPC and claimed that treating patients during this time was their highest priority, rather than participating in interprofessional work:

‘I think the most important thing about clinic time is treating people. Taking however many hours to… write an email… a letter, you’re taking that time away from treating patients and if you’ve got 50, 60 plus patients a week, there’s very little time for anything else.’

Additionally, physiotherapists who were physically separated from other health professions due to their geographical location reported barriers to IPC. 

Many physiotherapists emphasised that workforce shortages in regional and rural areas made it more challenging to collaborate effectively:

‘Working regionally, it’s very difficult not to be siloed… because Australia… has a very small number of health professionals in regional areas. So, it’s difficult to find somebody… to collaborate with in regional Australia.’

Did the research reveal any facilitating factors? 

Close physical proximity of multiple health practitioners was regarded by physiotherapists to be a key enabler of IPC. 

For example, physiotherapists employed in multi-professional clinics reported having more opportunities to interact with clinicians from other health professions than those working as sole traders or in monoprofessional private practices:

‘We’re lucky here because we see that interdisciplinary approach as a formality. It’s easy for us because we have so many different professions under the same roof. I guess it’s a lot trickier for smaller private practices that only employ physios.’

Physiotherapists who worked at clinics that were co-located with other health services also considered this arrangement to facilitate IPC. 

Co-location refers to health services that are situated in the same physical space, although they are not necessarily fully integrated with one another:

‘We’ve got professions like dietetics and psychology in our complex… so we invite them over and have lunch and we do in-services with them.’

The spatial layout of physiotherapy private practice facilities was seen to influence the ease and frequency of interprofessional communication. 

At several clinics, the use of informal shared spaces was seen to enhance IPC by promoting socialisation and building rapport among team members. 

The break room at one practice was a medium-sized space where many staff, including physiotherapists, would attend to complete non-clinical tasks such as typing notes:

‘I really like going there to do charts because it’s a… quiet space away from patients where I can… focus and get my work done without interruption. It’s also nice to have the opportunity to interact with colleagues in a more relaxed setting… where we can chat about cases, bounce ideas off each other and… take a break from the intensity of the clinical environment.’

What else can be done to support IPC in private practice?

To create a more conducive environment for IPC, physiotherapists highlighted the need for a multifaceted approach, addressing funding and compensation issues, enhancing digital communication systems and optimising interprofessional education and training.

Physiotherapy private practitioners providing services through the Medicare chronic disease management program argued that the scheme did not account for the coordination and collaboration efforts required to comprehensively address the complex healthcare needs of people with chronic conditions. 

Subsequently, these physiotherapists stressed the need to increase the Medicare rebate for people receiving physiotherapy within the chronic disease management program to better reflect the time needed to perform interprofessional tasks, such as writing letters and reports to referring medical practitioners:

‘Clinicians need to be compensated for the time they spend liaising with other health professionals. It’s as simple as that.’

Physiotherapists also called for improved shared communication tools and user-friendly digital platforms that allow for seamless information exchange among health practitioners regardless of workplace location. 

The potential of My Health Record to support IPC between health practitioners from various clinical settings was acknowledged but it had not met physiotherapists’ expectations:

‘It is beneficial… to have unrestricted access to… medical information. That can… help interprofessional practice, but there’s… too many ethical considerations with the My Health Record. I… have taken myself off it, so why would I use it with my clients?’

Physiotherapists encouraged the university sector to play a greater role in supporting IPC. Integrating more mental health content into entry-level physiotherapy curricula was proposed as a means of fostering understanding and facilitating collaboration between health practitioners from different professions in addressing patients’ physical and mental health conditions:

‘Our knowledge of mental health… as a profession… is poor, so I don’t think it’s any surprise that physiotherapists don’t interact with psychologists because we’re probably too embarrassed to look stupid in front of them… so that… definitely needs to be focused on more [at university].

'I think it will go a long way in improving collaboration between physiotherapists and psychologists… and… OTs [occupational therapists].’

What are the implications for practice?

This research highlights the complexities faced by physiotherapy private practitioners in implementing IPC in their clinical practice while laying the groundwork to inform policymaking that will advance patient care and optimise the integration of services in Australia’s healthcare system.

Recognising and acting on the recommendations arising from this project will help ensure that IPC is not merely
a conceptual ideal but a consistently practised reality in the Australian physiotherapy private practice setting.

>> Jack Seaton APAM is an adjunct lecturer and PhD candidate at James Cook University. He also serves on the APA Queensland Branch Council and National Rural Advisory Committee.

>>Dr Anne Jones APAM is an associate professor and the Head of Physiotherapy at James Cook University. Her research interests include cardiorespiratory physiotherapy, clinical education, rural service delivery models and simulation-based learning.

>> Dr Catherine Johnston is a senior lecturer and the Clinical Education Manager at the University of Newcastle. Her research interests include clinical education in physiotherapy and cardiopulmonary physiotherapy.

>>Dr Karen Francis is a professor and the Associate Head of Research and Graduate Studies at Charles Sturt University. She is internationally recognised for her contribution to the development of rural nursing as a specialist discipline.

References

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 6, CD000072. https://doi.org/10.1002/14651858.CD000072.pub3

World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. https://apps.who.int/iris/handle/10665/70185