Table 3.

Impacts of interprofessional team interventions and policies on communication, relationships, roles and satisfaction of PHC providers by jurisdictions

	Alberta	Ontario	Quebec	USA	Australia
Communication	Variable: in some PCNs, communication improved. In others, lack of role clarity resulted in difficult and/or miscommunication	Improved informal communication within and between practices. But variability in form: some never held meetings; others met regularly, actively, organized mentoring and actively reflected on processes of collaboration	Improved communication between providers within practices	Variable improvement. In some practices, communication was fostered especially between front and back office. In others, minimal impact due to conflict and power relationships	Improved communication between GP and nursing staff. However, some practices rarely had staff meetings or separate clinical and administrative meetings. Poor communication with external AHP and psychologists
Professional roles	Variable acceptance of roles related to knowledge and trust in each other’s competence. In some practices, doctors took on new roles (eg, more complex conditions)	Broadening of nurse responsibilities as well as the new role of NP. However, many (AHP and NP) felt they were not working to their scope of practice. Challenged work practices and professionals ideas of their roles. Family practitioners working in the same way they had been prior to the new model	Some tension regarding new roles. A clear division of labor was required but not achieved. Shared professional responsibility was regarded as being limited by the power of the medical profession and professional associations	Staff took on new roles and responsibilities as long as it did not encroach on the physician’s autonomy and role. Positive where there was openness about working and learning involving both medical and nonmedical staff together	Development of new roles for nurses and allied health despite uncertainty by doctors about their competencies and capacity
Relationships	Improved respect. However, assumption that network relationships occur naturally not requiring formal partnership. Behavior within meetings was a strong determinant of participation, collaborative decision making, respectful interactions	Further developed partnerships between PHC and community programs. Confusion about roles created some tension in some practices. Some friction with doctors over role of NP. Some resistance to change especially within established practices	Formal interorganizational relationships improved over time. Personal trust was limited by poor understanding of other roles. Shared professional responsibility opposed by the medical profession and professional associations	Improved relationships and shared decision making within practice in less hierarchical open decision making. Some conflict when power and authority of doctors or practice manager was challenged. Territoriality in team interventions was seen as the FP’s turf	Improved between practice and allied health services. But constrained by lack of knowledge of services. Some conflict over role of doctors and nurses. Doctors retained control over referral
Work satisfaction	Improved satisfaction and retention of nonphysician staff in less hierarchical teams	Generally improved. However, some frustration that expectations were not met. Many nursing and allied health confronted a clash between their expectations of interprofessional care and their experiences. Physicians felt their workload had not decreased	Improved work satisfaction of providers in FMGs	Those able to implement intervention really loved it and felt energized. Others were frustrated with the lack of progress	Improved satisfaction with shared workload and improved patient outcomes. Some GP and AHP dissatisfaction with referral processes, limited exchange of information, bad working relationships

Abbreviations: PHC, primary health care; PCN, primary care network; GP, general practitioner; AHP, allied health professional; NP, nurse practitioner; FP, family physician; FMG, Family Medicine Group.