Collaboration between service professionals during the delivery of health care: Evidence from a multiple-case study in US hospitals

We investigate service delivery in one specific type of professional service firms (PSF), namely hospitals. A distinctive operational feature of this setting is that the delivery of health care services requires continuous collaboration between two professional workforces: physicians and nurses. We conducted a multiple-case study at five acute care U.S. hospitals, which involved 49 semi-structured interviews, to uncover the organizational mechanisms that facilitate effective collaboration between physicians and nurses. Our analyses suggest that they experience distinct challenges that prevented collaboration during health care delivery. Specifically, physicians typically favored evidence-based standards of care which can sometimes undermine patient interactions. We refer to this preference as a disease-focus challenge. We also found that nurses were often hesitant to speak-up during their interactions with the physicians, which constitute a hierarchical challenge. Commonly prescribed mechanisms, such as multi-disciplinary rounding, were not effective in overcoming these challenges. Our analyses revealed new forms of collaboration between different levels of the physician and nursing entities, which we denote as "nursing-led cross-level collaboration" and "physician-led cross-level collaboration". Our study suggests that nursing-led cross-level collaboration helped mitigate the disease-focus challenge experienced by physicians while physician-led cross-level collaboration helped mitigate the hierarchical challenge experienced by nurses. It also offers preliminary insights on how PSF in general can develop and sustain such collaboration. Taken together, our findings offer new insights on the micro-foundations of work performed by PSF. (C) 2016 Elsevier B.V. All rights reserved.