Understanding and strengthening collaboration in the workplace: How to work towards constructive conflicts

Current clinical workplaces require a variety of health care professionals to work together on solving patientcare or health care problems.¹ In the era of team-based patient care, collaborative practice with colleagues across clinical disciplines and health care professions requires additional skills and abilities.² However, we tend to take it for granted that many of our daily routines—including working together—do not require possessing fundamental understanding of definitions or core skills of collaboration. Such an approach may no longer be sustainable as we educate and prepare future clinical practitioners to work in complex health care settings and navigate changes in health care systems as well as population and societal health care needs.³

As educators and researchers, we should strive to foster awareness among health care professionals and clinical teachers on the importance of successful collaboration and, consequently, patient safety and quality improvement in patient care.^{4, 5} To ensure that our learners become effective collaborators, it is important for clinical teachers to understand what real collaboration entails and put deliberate strategies for daily collaborations in place.

This toolbox article provides theoretical principles and practical strategies for both clinical teachers and learners on the importance of and know-how for effective collaborative practice. We first define and elaborate on terminology often used when talking about collaboration. Then, we discuss key concepts, related to inherent challenges of collaboration in the workplace and the important role of constructive conflicts, hierarchy and psychological safety within an organisation. Lastly, to help clinical teachers improve learners' collaboration beyond their own discipline or profession, we provide approaches to integrate these concepts into day-to-day clinical teaching.

There are terms related to collaboration commonly used in the health care professions, but it is not certain that individuals involved have a shared mental model of their meaning. We define and expand upon commonly used terminology:

Health care professionals and learners face a variety of challenges to collaborative, interprofessional patient care in their practice; these can pertain to knowledge, skills and attitudes. Knowledge deficits relate to lack of awareness of the roles of professionals from other practice arenas. Skill deficits can be ineffective communication skills, integrating a variety of perspectives in addressing patient and family needs, and ability to anticipate and navigate conflicts. Examples of attitudinal challenges are continuing traditional hierarchies, fixed ideas about team leadership and lack of perceived psychological safety. These challenges often remain hidden under the surface. In this section, we focus on three key challenges: managing conflicts, hierarchy and psychological safety. The final part of this section outlines the role organisations can have in addressing these challenges.

Owing to the pressing need for effective collaborations in the health care workplace, it is important for clinical teachers and learners to be able to work on main ingredients of collaboration and participate in constructive conflicts. Therefore, the emphasis of teaching should be on both the awareness and creation of constructive conflicts, with a psychologically safe learning environment as its prerequisite. Clinical teachers could work from the three main approaches that are listed in Figure 1 and described in detail below. Besides raising awareness of learners in these three areas, clinical teachers and learners must demonstrate and model these behaviours as well.

Moreover, as a tool for constructive conflicts, we could build upon different team behaviours known from literature.^{9, 14} These behaviours could be translated to educational practice in a comprehensive way by integrating them to a ‘3D tool’: disclose, dialogue and discuss (see Figure 2). Clinical teachers could help their learners to move away from destructive conflicts and work towards constructive conflicts by using these ‘3Ds’, especially when various disciplines or professions take part. After all, it is important to let everyone feel engaged and be heard, use each other's expertise and not shy away from discussions but work towards real teamwork instead.^{12, 19} The scenario in Box 2 illustrates how disclosures can lead to further dialogue and discussions.

The need for various health care professionals to work collaboratively is critical to current clinical practice. Therefore, we need to ensure that we train effective collaborators in the workplace. Clinical teachers should understand what successful collaboration entails and how to put deliberate strategies in place for our learners to become successful collaborators across disciplines and professions. First, it is important to stress the acknowledgement of interdependence when striving for collaboration, as can be found in effective teamwork. Second, challenges such as hierarchies and lack of perceived psychological safety need to be combatted. By disclosing information, starting dialogues and even discussions on content, constructive conflicts and positive team outcomes can be reached. Finally, alignment at an organisational level, inviting and appreciating multiple perspectives can lead to creation of environments where successful collaboration takes place.

Stephanie N.E. Meeuwissen: Conceptualization; writing—original draft; visualization; writing—review and editing. Wim H. Gijselaers: Writing—review and editing; writing—original draft. Erik K. Alexander: Writing—original draft; writing—review and editing. Subha Ramani: Writing—review and editing; writing—original draft; conceptualization.

The authors have no conflicts of interest to declare.

The authors have no ethical statement to declare.