The evolution from disciplinary to transdisciplinary (Adapted from Colón et al. (2008))
The interdisciplinary model acknowledges the overlap in knowledge of the different team members and facilitates horizontal communication at many points in the process of evaluating and treating a patient.
The transdisciplinary model of care takes collaboration to a higher level, incorporating ongoing cross-disciplinary education and regulated overlapping roles (Nandiwada and Dang-Vu 2010). This model also includes the patient/family members as part of the team (Ruddy and Rhee 2005). By institutionalising frequent communication and by regulating team members’ overlapping roles, this collaboration prevents fragmentation and duplication of services along disciplinary lines.
Transdisciplinary healthcare involves reaching into the spaces between the disciplines to create positive health outcomes through collaboration. This is likened to a multiplayer sports team where each has their own role and responsibilities, and implicit trust is required, together with practice, to get the best outcome. In this case, the outcome is improved health and quality of life for patients with multiple comorbidities and extenuating social circumstances.
Rather than having each specialty work only within its realm of expertise with communication limited to brief meetings or short notes in patient progress notes, transdisciplinary care seeks to be integrative. As described by King et al. (2009), transdisciplinary care seeks to share roles across discipline boundaries to encourage increased communication and collaboration within the team. Implementation of a shared care plan is the goal, with the patient at the centre of it.
The traditional barriers of hierarchy and protocol-based red tape are dispensed with and free exchange of communication is encouraged.
As highlighted by Andre Vyt, interprofessional teamwork exists when not only appropriate referrals are made but when there is a joint contribution in setting up care and treatment plans (Vyt 2008). In a transdisciplinary approach, the knowledge of each other’s working methods and competencies has reached such a high level and the shared care planning runs so smoothly that it is difficult for outsiders to identify immediately which team member has which profession. However transdisciplinary does not simply refer to a confusion of dissolution of professional identities; rather, it points out the intensity of shared goal setting, the commonality of a shared reference framework, and the swift interplay between the team members.
1.4.2 The Fundamentals of Transdisciplinary Care
Reilly (2001) put forth the following premises as fundamental in transdisciplinary care, and this is further illustrated by Tan and Tan (2013) (Fig. 1.2):
Role extension – Involves the need for constant improvement within one’s own specialty such that one has security in one’s own role and responsibility. This helps to resolve turf issues and boundaries.
Role enrichment – Seeks to increase one’s knowledge outside of one’s discipline and thus acquire the knowledge from other disciplines within the team. This is achieved by a commitment to collaborative work and excellent communication between team members.
Role expansion – Via intensive, ongoing interaction and learning between team members, role expansion is achieved whereby each member of the team begins to pick up the skills and knowledge of the other disciplines.
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