CHIC Scale

Although numerous initiatives to measure, evaluate, and improve health care have been developed, organizations may not adequately understand how staff perceptions influence their organization^1,2,3,4. Those with a low capacity for collaborative leadership cannot fully utilize the resources and talents available. Growing evidence of adverse events and patient dissatisfaction with provider-patient communication shows that provider education, assimilation, practice, and reflection are required⁵. As the Interprofessional Education and Collaboration (IPEC) movement gained momentum to address these concerns, researchers started studying dynamics between established healthcare disciplines⁶. Ironically, many of the resulting tools are specific to individual healthcare professions rather than addressing the common platform of interprofessional collaboration. This new instrument bypasses the context constraint by directly examining the applied value of collaboration.

Competency and Attitude Instruments

In practice, an over-reliance on leadership competency frameworks is questionable and flawed⁷. However, many organizations continue to invest in leadership competency models or behavioral frameworks⁸. The limitation of assessing collaboration skills as an outcome is the lack of a suitable measure of collaboration that is not dependent on context⁹. While many of the existing collaboration tools focus on attitudes or competencies, they fail to meaningfully encapsulate the interdependent elements that facilitate effective practice of interprofessional collaboration. Research suggests that people's ability to perceive their strengths or emotional intelligence does not strongly correlate to observable behavior⁸. Consequently, it was necessary to develop an instrument that measured the capacity and frequency of interdependent behaviors observed in healthcare teams.

Argument for Capacity Measures

Behavior can be analyzed in objective terms, while attitudes, competency, and other inventories cannot. An individual may have a high competency for a given task, but if other factors inhibit the application of that potential then the demonstration of that competency is diminished. For example, one study found that 36% of an organization's performance is linked directly to its capacity to collaborate¹⁰. In the same way that social determinants of health influence individual health outcomes so too are people affected by many factors that influence their capacity to collaborate with others. Likewise, simply having a strong desire or knowledge to be healthy or collaborate is not enough to affect the desired outcome. Researchers and healthcare practitioners must look beyond the intent or ability to practice interprofessional collaboration to reveal the quality of collaboration being practiced. For this reason, the CHIC avoided opinion or agreement scales and was developed using a frequency scale of observed and experienced behavior on a 7-point Likert scale (Never, Rarely, Seldom, Sometimes, Often, Usually, Always).

Role of Collaborative Leadership

The distinction between abilities (functions and personal inventories) and capabilities (capacity) is critical because it directly connects an individual's behavior to their participation in collaborative leadership. Determining the capacity for collaboration in a healthcare setting is not a new idea, but it has been significantly underdeveloped for many years. Doherty¹¹ (1995) offered a five-step framework to empirically value clinical collaborations through a qualitative approach. In their framework, each level indicates a greater degree of collaboration and capacity for collaboration as a whole¹¹. However, this framework did not include a validated instrument to measure the various levels of interprofessional collaboration or indicate which individuals have sufficient capacity to collaborate on the same level as their interprofessional peers.

Individual Practice

To keep pace with the rapid medical advances in the last several decades, today's healthcare environment necessitates effective collaboration between diverse, interprofessional healthcare providers. Unfortunately, in many organizations, the importance of interpersonal dynamics is frequently minimized or dismissed as irrelevant⁸. Such organizations are not entirely aware of the multi-dimensional nature of leadership. Understanding the interplay between different leadership types provides a foundation for exploring how engaging in interprofessional collaboration influences the relationship quality between clinical staff.

Patient Outcome Satisfaction

Eighty-two percent of healthcare organizations are concerned with patient experience as a top priority indicator of quality patient outcomes, and they are executing interventions designed to create and sustain a caring culture^12,13. There is a powerful alignment with positive patient experience and reduced complications, resource utilization, burnout, and reduced turnover rates^14,15. Additionally, errors are reportedly reduced when patient satisfaction and engagement scores are higher due to improved communication and higher staff satisfaction¹⁶.

Provider Satisfaction

Provider satisfaction, which is considered by many to be the fourth of the Institute of Healthcare Improvement (IHI) aims, is directly linked to patient satisfaction and the quality of care provided. Perceptions of caring are essential for everyone in healthcare regardless of the frequency of employee encounters¹². Research demonstrates that enhanced team functioning results in a better provider climate and higher staff and patient satisfaction^17,18.

Effects of Absent Collaboration

The essential elements of healthcare delivery are often insulated. The literature assumes that providers can complete jobs sequentially and alone; this creates cultural barriers that affect care¹⁹. It has been noted that poor working relationships and siloed efforts exacerbate negative patient outcomes²⁰.