Literature Review
Every good research project contains a strong review of the relevant literature. The foundation for the effort that produced the CHIC Scale was guided by established scholarship in the field of interdisciplinary leadership studies. Once a comprehensive review of instruments relevant to the practice of interprofessional collaboration was complete, over 200 instruments had been examined. A thematic analysis of these instruments provided a basis for selecting the appropriate leadership theory from which a new instrument would be forged.
Since many of these instruments were created to facilitate collective decision-making, leadership theories with flat hierarchies were prioritized. Chief among the leadership theories explored was the Collaborative Leadership Model as it most closely matched the roles of a diverse group of healthcare professionals providing patient-centered care.
Selecting a Leadership Theory Model
Selection of a suitable leadership model allowed for a grounded examination of the forces that relate to Interprofessional Collaboration in a healthcare environment. Reconciling this leadership model with the themes generated from the analysis of the related instruments from the peer-reviewed literature yielded several useful insights. One insight, in particular, guided the research toward incorporating the Capabilities Approach.
This insight documents that many of the tools being reviewed were either attitude or competency-based. While improving and maintaining certain competencies are important, mastery of these skills does not necessarily translate to high-quality collaboration or evidenced-based, patient-centered care. Likewise, understanding one's attitudes toward interprofessional collaboration and related activities is an important tool for self-reflection and professional growth. However, the tools regarding attitudes were not sufficient to explore the practice of interprofessional collaboration beyond motivation.
Taken together this understanding of the competencies and attitude instruments explain mastery and motivation of specific elements of interprofessional collaboration, but fails to explain how highly competent and motivated professionals still struggle with collaborating across disciplines to achieve high-quality standards of patient-centered care.
Capabilities Approach
In her book Creating Capabilities: The Human Development Approach Martha Nussbaum advocates that the ability to accomplish tasks is built upon the capability to use the functions that support that effort. Simply put one's execution of a task is directly linked to their capacity to use the resources in their personal inventory of abilities. The Capabilities Approach1 provides a starting point for the theoretical framework for the CHIC Scale. It supports the assertion that having a specific ability is not the same as being able to practically apply that ability. For example, having a high IQ does not guarantee a happy life, wealth, or a successful career.
The CHIC Scale builds on this idea that an individual's personal inventory of skills, competencies, and abilities can only be applied practically if that individual has the capacity to use them. While personal inventories do change over time, capacity is a much more dynamic condition.
However, the act of making a decision can also be affected by sleep, stress, overall mental health, and many other factors. The CHIC Scale is not an exhaustive list of questions, but it is a useful tool to evaluate the success of an individual's capacity to apply their personal inventories to collaborate well.
Social Exchange Theory
Social transactions provide the foundation for collaboration. In addition to the factors mentioned above an individual ability to successfully participate in collaborative leadership is affected by the quality of the interaction and the condition of the individual relationships of those participating in the collaboration. The Social Exchange Theory (SET) contributes that elements such as power distance and group dynamics play a role in how well individuals within a group will contribute their most competent suggestions or tap into the most beneficial aspects of their motivation to provide high-quality, patient-centered care.
Putting it Together
Using the thematic analysis from the in-depth literature review, the leadership model of Collaborative Leadership with the Capabilities Approach, and the Social Exchange Theory provide the guiding clarity of the construction of the CHIC Scale.
Footnote: 1Nussbaum, M. C. 1. (2011). Creating capabilities: the human development approach. Cambridge, Mass.: Belknap Press of Harvard University Press. https://doi.org/10.4159/harvard.9780674061200