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Top1. Introduction
In the healthcare field in many countries, systems approach to Interprofessional Team Collaboration (IPC) is booming. IPC system has been attributed to enhanced outcomes of health services, which suggests IPC is a key element for the safety and quality of every healthcare setting (Zwarenstein et al., 2009; Matsushita and Kijima, 2012; Franklin et al., 2015; Takhom et al. 2020). Also, systemic interpersonal and inter-professional collaboration can be regarded to play a vital role in knowledge co-creation in health services (Quang and Shirahada, 2016). Conversely, there is also criticism that there is insufficient evidence to draw clear conclusions on the effects of IPC interventions (Reeves, 2017). Nevertheless, health policy makers in many developed countries have frequently called for the use of IPC system to improve patient care (UK Department of Health, 1997; Health Canada, 2003; WHO, 2010; MHLW Japan, 2010; Institute of Medicine 2013).
In fact, there has been an effort in Japan to utilize IPC in health policy. In Japan, IPC is often referred to as “team medicine” – the term officially adopted and used by the Ministry of Health, Labor and Welfare. Team medicine has been introduced as a financial incentive in the national healthcare reimbursement system to address the lack of “good governance of evidence” pertaining to patient outcomes (Matsushita, 2018). Within the decision-making process, “good governance of evidence” is a concept that represents the use of rigorous, systematic and technically valid pieces of evidence that are representative of and accountable to the populations served (Parkhurst, 2016).
In order to identify policy implications that are rooted in good governance, it is necessary to first empirically define the actions which consist IPC. From this definition, it would be possible to assess IPC as a tangible and measurable organizational system. With such an empirical baseline, we would also be able to compare evidence including various outcomes and functions of IPC. This study, or the work described in this paper, was one part of a large-scale study that examined the correlational relationship between IPC and outcome indicators, including quality of health services and patient safety. The outcomes include, but not limited to, average length of stay, mortality rate, bed turnover rate, incident rate of pressure ulcer, and incident/accident rate of falling. In our definition, the functions of IPC include partnership, collaboration and coordination which will be explained and discussed later.
Before embarking on the main stages of the research, we found it necessary to test the AITCS (Assessment of Interprofessional Team Collaboration) and AITCS-II or the shortened version of AITCS as shown in Appendix in Japanese settings to ensure the cross-cultural competence of the project. While IPC has been measured effectively using AITCS-II in healthcare settings globally, it was not available for the Japanese healthcare context. In an attempt to assess the status quo of IPC in the targeted hospital, the AITCS and AITCS-II or the shortened version of AITCS were adopted in our study as shown in Appendix. Thus, the primary purpose of this paper is, from a viewpoint of systems thinking, to test the AITCS-II-J (the Japanese version of AITCS-II) in terms of reliability and validity in a Japanese institutionalized acute care systems. The empirical and rigor measurements of IPC system is critical to evolving current scientific knowledge about the evidence related to the diversified effects of IPC including patient safety, quality and more largely health outcomes.
Orchard et al. (2012) developed and published the AITCS in 2012. Then modifying it into a shorter version, the AITCS-II was developed by encompassing 23 five-point Likert items, from 1=never to 5=always. The AITCS-II indicated evidence of reliability and validity in its original version (2018). Hellman et al. developed a Swedish version of the AITCS in 2016, and Caruso et al. adapted and verified the Italian version of the AITCS-II in 2018. Consequently, we had chosen the AITCS-II among other counterpart scales to statistically test the scale.