A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings

By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.唯有尊重各学科的专业知识，方能实现以患者为中心的整体照护——此时决策将基于专业能力而非既定的层级结构。尽管医疗行业历来以层级化权力结构运行（即部分声音拥有更大话语权），但此类权力动态却极少被讨论。本综述针对这一问题，对评估多学科团队（multidisciplinary team, MDT）权力动态的现有量化测评工具进行批判性梳理与评价。通过识别心理测量学性能优良的测评工具，变革推动者可揭示指导临床实践中权力结构的集体思维过程，并制定策略以缓解权力失衡问题。本研究检索了多个学术数据库，纳入以英文发表的、针对急诊/住院医疗环境下多学科团队权力动态的量化测评工具相关研究。研究结果采用叙事综合法进行整合分析。最终共检索到6202条检索记录，其中62条符合纳入标准。本综述发现了若干颇具应用前景的权力动态测评工具（如跨专业协作量表（Interprofessional Collaboration Scale））。但研究结果同时证实当前证据体系存在诸多不足：1）需对现有测评工具开展进一步的心理测量学与实用性验证；2）需纳入更具代表性的多学科团队样本；3）需对尚未成熟的权力维度展开更多评估研究。填补上述研究空白，将有助于开发未来旨在缓解权力失衡的干预方案，并最终改善多学科团队内部的协作效能。