Paradoxes and limits of interprofessional collaboration: analysis of an Extended Family Health and Primary Care Center

Abstract This article analyzes the possibilities and limits of interprofessional collaboration in mental health care, considering the articulations between the teams of the Extended Family Health and Primary Care Center and the Family Health Strategy in a city in the state of Rio de Janeiro, Brazil. This is a qualitative research, based on the philosophical hermeneutic approach, which was based on a case study, using as methodological strategies participant observation, narrative focus groups, and semi-structured interviews. The results indicate the inseparability of structural, organizational, and intersubjective elements in interprofessional collaboration, with strong tensions regarding the organization of work processes in both their formal and intersubjective dimensions. It was identified that the sharing of some care goals, such as demedicalization, fostered the construction of partnerships among the teams. On the other hand, from the dialog with the references used, it was understood that rules constructed with the intention of inducing cooperation had a paradoxical effect, generating unimplicated participation on part of the workers. It is concluded that trust at work has proven to be a fundamental element for collaboration, which requires the configuration of an organizational environment capable of bringing together interests and dealing with conflicts.

摘要 本文以巴西里约热内卢州某城市的拓展型家庭健康与基层医疗中心（Extended Family Health and Primary Care Center）团队与家庭健康战略（Family Health Strategy）团队之间的协作关联为研究视角，剖析精神卫生保健领域跨专业协作的可能性与边界。本研究为基于哲学诠释学方法的质性研究，采用个案研究设计，研究方法策略涵盖参与式观察、叙事性焦点小组座谈与半结构化访谈。研究结果显示，跨专业协作中的结构性、组织性与主体间性要素密不可分；在工作流程的组织层面，无论是正式制度维度还是主体间互动维度，均存在较强张力。研究发现，部分照护目标的共享（如去医疗化）推动了各团队间伙伴关系的构建。另一方面，结合对所引用文献的对话式研读可知，旨在促进合作而制定的规则产生了悖论性效应，导致工作人员出现形式化参与、未真正投入协作的情况。研究最终得出结论：工作中的信任已被证实是跨专业协作的核心要素，这要求构建能够整合各方利益并有效应对冲突的组织环境。