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.

通过重视各学科的专业知识，可实现以患者为中心的整体照护，因为决策将基于专业专长而非既定层级体系。尽管医疗行业历来以层级化权力结构运行（即部分群体拥有更大话语权），但此类权力动态机制却鲜有被探讨。本综述针对这一研究空白，对评估多学科团队（multidisciplinary team, MDT）权力动态的现有量化测量工具进行系统性梳理与评价。通过筛选出心理测量学性能优良的测量工具，变革推动者能够揭示指导实践中权力结构的集体思维过程，并制定相应策略以缓解权力失衡问题。研究团队检索了多个学术数据库，纳入以英文发表的、针对急诊/住院环境下多学科团队权力动态的量化测量工具相关研究。结果采用叙述性综合法进行整合分析。总计检索得到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评估工具（如跨专业协作量表（Interprofessional Collaboration Scale））。但研究结果同时证实当前证据基础仍存在多处不足：1）需对现有测量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研究样本；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，将有助于开发未来用于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。