Informational role self-efficacy: a validation in interprofessional collaboration contexts involving healthcare service and project teams

The expanding rate of new knowledge in technical fields fosters the need for greater specialization and the development of subfields [1]. This phenomenon is echoed in healthcare [2] where healthcare professionals perform complex knowledge-intensive tasks [3]. The more healthcare professionals must train to integrate knowledge vertically and grasp the complexity of their specific profession, discipline or field—digging deeper as they specialize—the more challenging it is for them to integrate knowledge horizontally to collaborate interprofessionally. Hood [4] describes this problem in terms of a “double reflexivity”; a “double hermeneutic”. Unfortunately, in healthcare “members of each profession know very little of the practices, expertise, responsibilities, skills, values and theoretical perspectives of professionals in other disciplines” [5] in spite of the fact that communicating about expertise fosters trust [6]. Information about one’s training background, expertise and knowledge is in itself a type of knowledge referred to as informational characteristics: the “underlying attributes of individuals (e.g., work experience and education) which, although not immediately detectable, are important in the completion of the task” [7].

One key in helping healthcare professionals to better share informational characteristics and work collaboratively is to examine the core beliefs anchoring their actions. Many studies have shown that if a person believes he/she can perform a specific task well, he/she usually does [8] because the belief is accompanied by additional efforts and persistence when facing difficulties [9]. Such beliefs are called self-efficacy. Self-efficacy is an individual-level construct defined as beliefs in one’s capabilities to succeed at something specific [9, 10]. Meta-analyses on the topic show moderate to high corrected correlations in various work settings [11‐13]. A specific example in healthcare shows a positive relationship between increases in social service workers’ creative self-efficacy and increases in creative problem-solving and innovation [14].

Despite the central role of knowledge integration in interprofessional collaboration there are—to our knowledge—no instruments that measure the underlying beliefs of individuals in sharing their expertise. Achieving this through the development of a robust, specific, short, and one-dimensional measure is therefore the goal of the present study.

When a new measure is introduced, a stringent verification of its utility is to test for incremental validity; that is, to ask whether the measure adds to the prediction of a criterion above what can be predicted by existing phenomena and measures [15]. Four such criteria are crucial in predicting individual behaviors of teamwork and collaboration: goal similarity, interdependence, coordination, and trust.

A team is a collection of individuals united by a common goal and task interdependence [16, 17]. “Shared goals are what make collaboration ‘collaborative.’ Without at least one shared goal or endpoint, there would be no reason for two or more entities to work together at all” [18]. Team effectiveness hinges on dynamic and adaptive management of interdependencies [19]. Clarifying interdependences between team mates with different roles, and explicitly ironing out work processes through task-oriented coordination lead to team effectiveness [20]. Trust is another construct a new measure should add value to. Trust is crucial in high autonomy teams engaged in ambiguous, unstructured and novel situations [21]. An emergent state resulting from social interactions over time [22], trust derives from behaviour reliability (i.e., calculus-based trust) or from shared values and ideas (i.e., identification-based trust) [23]. Crucially, trust is also about people understanding each other—understanding without which individuals “will have trouble benefiting from the expertise of others” [24]. Attributions of trustworthiness (or lack thereof) can be based on a mix of previously held beliefs about another group (e.g., a professional group) and further thought processes prompted by new information about that group [25]. In healthcare settings particularly, trust is based on individuals manifesting competence including how competence is communicated [26]. Consequently, we posit that:

Informational role self-efficacy will demonstrate incremental validity over perceptions of goal similarity, interdependence, coordination, and intra-team trust, in predicting proactive team behaviors.

Two studies are needed to test this hypothesis, the first to develop the instrument and provide solid psychometric properties, and the second to cross-validate the instrument’s properties with a new sample and test for incremental validity.

We see at least two streams for future direction in research: team type and power heterarchy. First, because ongoing service delivery and project work are different forms of work [43] healthcare professionals involved in one may not play the same roles when involved in the other [44]. In healthcare service work, individuals acquire professional expertise early on in their training and this is an important factor in the formation of professional boundaries. Because interprofessional collaboration is seen as a determinant of high quality patient care [45], one’s ability to share expertise across expertise-based knowledge silos is very important. However, because project work primarily centres on organisational issues (i.e., “fixing” the system) rather than directly focussed on patient care (i.e., “fixing” the patient), healthcare expertise is still necessary when working on a project but less so than when providing healthcare to patients. Accordingly, we expect that the impact of informational role self-efficacy will be stronger in regular ongoing healthcare service work compared to project work.

Second, power heterarchy within teams is “a relational system in which the relative power among team members shifts over time as the resources of specific team members become more relevant (and the resources of other members become less relevant) because of changes in the situation or task” [46]. Power dynamics among physicians and nurses is a well-documented inhibitor of interprofessional collaboration in ongoing healthcare service work [5]. Since information is a resource and a form of power [47], we suggest future studies should test whether minimal interprofessional collaboration occurs because of nurses’ thwarted informational role self-efficacy. If so, building capacity beliefs in nurses should improve their collaborative behaviors.

Organizations can shape employees’ sense of efficacy towards desired performance outcomes [14]. Organizations can also engage in team-level activities. Discussing the five behaviors of our scale in a team-building exercise is pertinent for two reasons. First, the five behaviors relate to roles and communication, which is significant in light of a recent meta-analysis showing that team-building has an important effect on individuals’ role clarification and communication [48]. Second, team members tend not to share what is unique to each other and prefer discussing what is common to the team [49]. Consequently, it is important to make a conscious effort to stimulate team discussions on the informational roles of individual team members because, by definition, these roles will vary according to differences in individual expertise. These two reasons concur to suggest that a group discussion followed by an action plan aiming at increasing the quantity and quality of the five behaviors of our scale are likely to have a positive impact on how individuals collaborate.

This study has three limitations, each with implications for future research. First, the validity evidence is limited to a single method. Although measures are separated in time by 18 weeks on average, there is nevertheless a possible method effect [35]. Future studies should measure dependent variables with a variety of methods (e.g., questionnaires, observations, interviews). Second, our sample size for Study 2 is small which hinders generalizability. Third, informational role self-efficacy is an individual-level construct and our studies were not designed to draw conclusions at the team level. While we were careful to interpret results in terms of individual perceptions of team phenomena [50] and used instruments designed to assess individual behavior manifestation and/or perceptions pertinent to the team context [40], a worthy area of future research would be to integrate our measure in multi-level designs [51]. One such study could measure the relationship between (individual-level) informational role self-efficacy and task performance as a function of collective efficacy (group level). Collective efficacy is a shared belief that the team is able to perform effectively [52‐54]. It is logical to hypothesize that the relationship between informational role self-efficacy and task performance will be stronger in teams that rate high in collective efficacy compared to teams with low collective efficacy. Despite these limitations, we demonstrated that informational role self-efficacy is a measurable single-factor individual-level construct and is a correlate and predictor of important phenomena necessary in today and tomorrow’s diversified and dynamic work environment.