Interprofessional Collaboration in Integrative and Complementary Medicine

Health care systems around the world are reaching their limits, with demand far outstripping supply. Demographic change, increasing chronic diseases, and multimorbidity are compounded by limited resources and a global shortage of 4.3 million health care workers. ¹ As a main result, less and less time is available to care for each individual patient. And as the situation threatens to worsen, the World Health Organization (WHO) recommends interprofessional collaboration as part of a solution to alleviate it. ¹

According to the World Health Organization, collaborative health care involves professionals from various disciplines working together with patients, their families, and communities to provide high-quality care across different settings. This approach encompasses a wide range of activities, including both clinical tasks like diagnosis and treatment, as well as non-clinical functions such as health communication, surveillance, management, and environmental health initiatives. ¹

Interprofessional collaboration enables the use of the skills of professionals and other resources in the best possible way and according to need, resulting in more economical action. It also enables the care of complex conditions requiring many different skills to be provided, thus ensuring a higher quality of care. Consequently, a Cochrane review found that practice-based interprofessional collaboration interventions can improve both health care processes and health care outcomes. ² Interprofessional collaboration generally enables different perspectives to be taken, expertise to be pooled, and synergy effects to be exploited. The focus is always on the patient and their care.

According to a Swiss survey of various health professionals, the following are considered indispensable for characterizing interprofessional collaboration: joint decision-making, cooperation on an equal footing, joint role clarification, and the involvement of patients. At the same time, the actual reality of care stood in stark contrast to the perceived importance of interprofessional collaboration; interprofessionality was practiced significantly less than its perceived importance would suggest. ³

In order to gain a comprehensive understanding of the factors influencing the implementation of interprofessional collaboration in health care, the innovation management approach developed by Reinhardt, Hietschold, and Gurtner (2017) has been transferred to the context of interprofessional practice: ⁴

Individuals who do not yet work together in an interprofessional manner see barriers (e.g., pronounced hierarchies between individual professions), while individuals who already practice interprofessionality in their work context report various drivers that support its implementation and resolve conflicting goals (e.g., a corporate culture based on partnership). One possible trigger for the actual implementation of interprofessional collaboration could be, for example, reducing the emotional and cognitive distance between professions (that is, how close one feels to the other profession and how well one can empathize with it), which could be achieved through concrete measures such as joint team meetings.

Key dimensions of successful interprofessional collaboration are (i) clear goals (main goal: effective patient care), (ii) shared team identity, (iii) shared commitment, (iv) clear roles and responsibilities within the team, (v) interdependence between team members, and (vi) integration between work processes. Communication among team members is particularly important here. It is not without reason that poor communication is the main cause of patient safety incidents. ⁵

However, achieving successful interprofessional collaboration requires deliberate effort and attention to these key dimensions. This additional workload may partly explain why some health care professionals may be reluctant to collaborate with other professionals. As previously stated, without prior experience, individuals are more likely to focus on the barriers rather than drivers, ⁴ which can further discourage them from embracing interprofessionality. Importantly, patients are not passive recipients in this model. Interprofessional collaboration invites patients to become active participants in their care, contributing their preferences, lived experiences, and goals.

In the past, we, that is, the authors of this editorial, have mainly worked in single-profession working groups. This was very convenient, as members of the same profession naturally “speak the same language”; in other words, they have been socialized in the same worldview and trained in the same methods. Of course, this seemingly convenient arrangement comes at the price of a lack of different perspectives. In contrast to that, our current team comes from nine different professions (and speaks eight different native languages, by the way). It is not always easy to ensure that everyone is starting from the same premises, but these diverse professional perspectives and the resulting creativity more than compensate for this. Based on our experience, we can easily recognize the driving forces behind the implementation of interprofessional collaboration as well as its benefits.

What does all this have to do with integrative and complementary medicine? The Academic Consortium for Integrative Medicine and Health defines: “Integrative medicine and health reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, health care professionals, and disciplines to achieve optimal health and healing.” ⁶ This makes integrative medicine interprofessional by definition! Without comprehensive and precisely orchestrated collaboration between various health care professions on an equal footing, complex integrative therapy concepts would be inconceivable and certainly impossible to implement.

This means that integrative medicine can be seen as a pioneer in the necessary adaptation of health care to a changing reality. Even though multidisciplinary teams are already a reality in most areas of care, an outdated relic of medical history prevents their potential from being fully exploited: this is what sociologists call “medical dominance.” ⁶ Historically, despite all the proclamations of “partnership,” “collaboration,” and “shared leadership,” the medical system is a highly hierarchical system. Physicians have traditionally held the authoritative role in care and research. This means that physicians traditionally have sole decision-making power over the individual care of a patient; they determine not only how they themselves work, but also how other health care professions work. In addition, this dominance of a particular professional group naturally also preserves the dominance of its scientific worldview, in this case that of biomedicine. ⁷

Integrative medicine and health, insofar as it is meant seriously and is not just a marketing label, must break through this dominance. The biomedical worldview is complemented with a more holistic one held by complementary health professional groups. Diagnoses require the experience and traditions of all professional groups, and the integration of “all appropriate therapeutic and lifestyle approaches, health care professionals, and disciplines” ⁶ requires all professions involved to meet on an equal footing centered around the patient.

If integrative medicine is serious about its commitment to whole-person care, it must also commit to the structures that make this possible—above all, true interprofessional collaboration. Now is the time to move beyond symbolic partnerships and toward systemic change. Only then can we hope to meet the health challenges of the present—and the future.

Overall, medical systems and professions should collaborate rather than operating as fragments in isolation within the health care system. As with integrative medicine and health, it is important to emphasize that interprofessional collaboration is a means to an end, not an end in itself: the overarching goal is to improve the patient’s state of health.

(Also) through its inherent interprofessionality, integrative and complementary medicine can therefore contribute to initiating the urgently needed transformation of the health care system in order to overcome the problems and challenges of our time.

Stay healthy and stay curious.