BHL

Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=ijic20

Journal of Interprofessional Care

ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: https://www.tandfonline.com/loi/ijic20

Professional identity in interprofessional teams: findings from a scoping review

Stephanie Best & Sharon Williams

To cite this article: Stephanie Best & Sharon Williams (2019) Professional identity in interprofessional teams: findings from a scoping review, Journal of Interprofessional Care, 33:2, 170-181, DOI: 10.1080/13561820.2018.1536040

To link to this article: https://doi.org/10.1080/13561820.2018.1536040

Published online: 18 Oct 2018.

Submit your article to this journal

Article views: 5702

View related articles

View Crossmark data

Citing articles: 30 View citing articles

ORIGINAL ARTICLE

Professional identity in interprofessional teams: findings from a scoping review Stephanie Best a,b and Sharon Williams b

aAustralian Institute of Health Innovation, Macquarie University, Sydney, Australia; bSwansea University, Swansea, UK

ABSTRACT Integrated care has been identified as being fundamental to health and social care reforms. How this interprofessional working impacts on professional identity is unclear. There is a lack of reviews synthe- sising this growing body of literature. It is therefore timely to conduct a scoping study of the literature which explores the intersection between interprofessional care and professional identity. The aim of this study is to identify the factors that impact on professional identity when working in interprofessional teams. A scoping review was conducted; Business Source Complete (EBSCO); CINAHL; Proquest; Medline; Scopus; and Cochrane Reviews (January 1980 to July 2018) were systematically searched for studies focusing on professional identity and interprofessional teams. Inclusion and exclusion criteria were identified and applied, data were charted, and a synthesis of the narrative was conducted. Sixteen papers are identified as central to this scoping review. Analysis of the papers highlights three key areas of interest: the creation of professional identity; challenges and barriers to professional identity; and implications for leadership and management. The significance of this review is considered along with an agenda for future research. Expanding the research to include more empirical studies to consider areas such as the value of interprofessional education programmes and to include the voice of those professionals no longer working or choosing not to work in an interprofessional care setting should also feature within future research.

ARTICLE HISTORY Received 30 November 2017 Revised 19 August 2018 Accepted 9 October 2018

KEYWORDS Professional identity; interprofessional team; health and social care; scoping review

Integrated care has been identified as essential to delivering the reforms required in health and social care (Goodwin et al., 2012; Lê et al., 2016). There is a large body of literature on the topic of integrated care (see, for example, Lewis, Rosen, Goodwin, & Dixon, 2010; Ramsey, Fulop, & Edwards, 2009) with varying definitions though there are no universally accepted description and many sub-genres (Goodwin, 2016) encompassing terms such as multidisciplinary teamwork and interprofessional collaboration. The focus of this review is professional identity in the context of interprofessional team- work. Here, teams include a range of health and/or social care professionals who work closely together as a mutually depen- dent group in order to provide complex care for a community (Reeves, Lewin, Espin, & Zwarenstein, 2010). Still, the provi- sion of care through interprofessional teams has been an ambi- tion in health and social care for many years and is a priority across the UK (Ham, Heenan, Longley, & Steel, 2013). The relevance of delivering care through integrated services is found in each of the UK home nations: Scotland (Scottish Government, 2011); Northern Ireland (DoH, Northern Ireland, 2011) England (NHS England, 2014); and in Wales (Welsh Government, 2011). In addition, the demand for inte- grated care extends internationally (see, for example, Goodwin, 2015). Shifting the mechanisms and ethos for the provision of care through interprofessional teams has not been without its challenges (Dickinson, 2014), and a key component for a suc- cessful change in health care is noted as professional identity (Gheradi, 2012; Morgan & Ogbonna, 2008).

Professional identity encompasses one’s professional self- perception. Ibarra (1999, p. 764/5) employs Schein’s (1978) definition of professional identity, '. . . the relatively stable and enduring constellation of attributes, beliefs, values, motives, and experiences in terms of which people define themselves in a professional role'.This definition points to multiple influ- ences on professional identity which, although can develop over one’s professional life, tends to remain largely unchanged once formed. Ibarra (1999) also notes that professional iden- tity is more malleable at the early stages of a professional’s career.

Much is known about the drivers that construct profes- sional identity such as gender and profession (Adams, Hean, Sturgis, & Clark, 2006). It is also recognised that professional identity is further customised by working experience (Pratt & Corley, 2012), which centres on two areas: One, activity, i.e. role identity, with different professions’ individual knowledge and skill sets only doing what they can do, thereby unique in the eyes of colleagues and patients (Caza & Creary, 2016). Two, the feeling of distinctiveness. Van Maanen and Barley (1984) explored the concept of work identities and how peo- ple develop and retain a ''sense of uniqueness' (p. 295). They recognised work or professional social identity is constructed as an individual identifies as belonging to a profession with other individuals who engage in the same approach to a form of work—for example, physiotherapists, dieticians, etc.. This is of interest but does not explain why professional identity matters.

CONTACT Stephanie Best [email protected] Australian Institute for Healthcare Improvement, Macquarie University, 75 Talavera Road, NSW 2109, Australia Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ijic.

JOURNAL OF INTERPROFESSIONAL CARE 2019, VOL. 33, NO. 2, 170–181 https://doi.org/10.1080/13561820.2018.1536040

© 2018 Taylor & Francis

Siebert and Siebert (2005) argue an individual’s professional identity (both role and work identity) is of importance as it determines work attitudes and behaviours. This may be of per- sonal significance to an individual in how they define themselves and their place in the world of work and society. Crucially, the construction of one’s identity is highly relevant for those provid- ing care as it offers “a shared/collective representation of who one is and how one should behave” (Hogg & Abrams, 1988, p. 3). Deciding how services are delivered is ultimately dependent on practitioners’ behaviour that in turn establishes the quality of care received.

The focus of research on professional identity within health and social care is largely centred on single profes- sions and in education (e.g. Hood et al., 2014; Lindeman, 2009). Little however is known about professional identi- ties within the evolving world of integrated working (Mitchell & Boyle, 2015). We recognise there are two extant bodies of literature for professional identity and integration. Uniquely, this scoping review focuses on the intersection between these two areas of the literature with a particular focus on professional identity and interprofes- sional teams.

It is important and timely for this scoping review to be undertaken due to the growing expectation of what integra- tion can deliver to meet the increasing demands on health and social care. Exploring these two bodies of literature in isola- tion risks overlooking the contextual influences of service delivery within interprofessional teams and how this might impact on professional identity. The aim of this review is therefore

● To identify the factors that help us to understand the impact of working as part of an interprofessional team on professional identity.

● To provide an agenda for future research by identifying the emerging themes in the literature and considering how these might be expanded to meet the needs of contemporary health and social care.

The identification of a research question is the first step for a scoping review. Unlike systematic reviews, the intention is for the question to be broad to direct the development of the search approach. This article contributes to the discussion by exploring the following research question:

“What are the existing themes in the field of professional identity in interprofessional teams in health and social care?”

Methodology

Research design

The use of scoping studies to synthesize research evidence is becoming increasingly popular (Pham et al., 2014). There are numerous definitions and purposes for scoping studies out- lined by Levac, Colquhoun, and O’Brien (2010). Our review of the literature was undertaken to examine the extent, range, and nature of research activity (Arksey & O’Malley, 2005; Levac et al., 2010) within the area of research connecting professional identity and interprofessional teams.

A scoping review provides a rigorous and transparent method for mapping areas of research (Pham et al., 2014), and can be used as a stand-alone project or as, in this case, a preliminary step to a systematic review (Arksey & O’Malley, 2005). For this review, it is of particular use given the link between professional identity and interprofessional teams has not yet been extensively reviewed (Mays et al., 2001). A scoping review can be used to determine the extent, range, and nature of research activity in a topic area and identify gaps in the existing literature (Arksey & O’Malley, 2005; Levac et al., 2010). While the scoping review approach has been added to over the years (Levac et al., 2010; Pham et al., 2014), the underlying stages identified by Arksey and O’Malley (2005) remain. These are identifying the research question, identifying relevant studies, study selection, charting the data, collating, summarising, and reporting the results, and finally an optional consultation. Having consulted previous scoping studies (Mossabir, Morris, Kennedy, Blickem, & Rogers 2015; Reeves et al., 2011), this article follows these steps.

Data collection: search strategy

A comprehensive search was undertaken of the following the databases: CINAHL; Proquest; Medline; Scopus; Business Source Complete (EBSCO); and Cochrane Reviews. The key- words and Boolean search operators are as follows: “profes- sional identity” AND team* AND health were employed (January 1980 to July 2018). The search term “team*” was deliberately left broad to ensure we did not limit the potential paper returns. Similarly, the term ‘health’ was used so as not to limit the different professions included in the study. In total, 482 papers were found with the following returns from each database: CINAHL, 87; Medline, 128; Proquest, 40; Scopus, 211; EBSCO, 16; and Cochrane Reviews, 0.

Selecting the appropriate studies requires the development of inclusion and exclusion criteria based on the research question. Papers can then be removed from the scoping review if they do not fulfil the criteria. Table 1 lists the criteria developed and used for this scoping study.

Figure 1 outlines a four-stage process of identifying appro- priate papers and the results from each stage. From the 482 papers, returned duplicates were removed and the titles were reviewed using the inclusion and exclusion criteria in Table 1. This narrowed the search to 64 papers. On reviewing the abstracts from the 64 papers, 22 articles met the criteria in Table 1. Twenty-nine full-text papers were assessed against the inclusion and exclusion criteria based on the full-text document. Thirteen papers were discarded as were not rele- vant to interprofessional practice (e.g. focused only on stu- dents/education or one profession—medics, nurses, or paramedics). Sixteen papers, therefore, remained to be ana- lysed for this scoping review.

Data analysis

First, the 16 papers are ‘charted’ (Arksey & O’Malley, 2005) before they are discussed. Table 2 extracts the context and process-oriented information from each article. In line with the scoping literature process (Arksey & O’Malley, 2005),

JOURNAL OF INTERPROFESSIONAL CARE 171

papers were not excluded on the grounds of quality or approach however, the methodological details are included in Table 2. Both authors participated in the reviewing and sifting process. Where there was uncertainty whether to include a paper, the article was reviewed by both authors and discussed before including/excluding.

Ehrich, Freeman, Richards, Robinson, and Shepperd (2002, p. 28) note that the aim of a scoping study is to ‘map a wide range of literature and to envisage where gaps and innovative approaches may lie’. Our scoping exercise revealed five meth- odological approaches: reviews (n = 3), conceptual (n = 2), quantitative (n = 4), qualitative (n = 6), and mixed methods (n = 1). For the literature review papers, only one offered a systematic approach to paper selection. The 16 papers selected for review were all peer-reviewed articles which had been published between 1997 and 2015. Ten papers were published since 2010, five between 2000 and 2009, and one was pub- lished in 1997. The countries of origin for the papers were Canada, Australia, UK, and Norway, while the literature reviews and opinion pieces did not limit their geographical focus.

Findings

Qualitative content analysis

The final stage of a review is the collation and analysis of the papers. Levac et al. (2010) call for qualitative content analysis followed by thematic analysis, which should be reported in relation to the research question. Initial content analysis is undertaken which in this scoping review revealed three areas of interest prior to the thematic analysis being undertaken. This initial review of the 16 papers also showed studies were undertaken in different international contexts and designed for diverse purposes. The underlying background of the majority of papers was of change—in particular highlighting changes in population needs and the subsequent drivers for service delivery redesign. Consequently, interprofessional working has become prominent within academic discussion.

The research question calls for the identification of research themes and categories (Carnwell & Daly, 2001) within the intersection of professional identity and integration. Three

key themes identified from the content analysis of the papers were as follows: (i) the creation of professional identity, (ii) challenges and barriers to professional identity, and (iii) impli- cations for leadership and management. Sub-themes of voice, power, and culture were also present. Each of the 16 papers is discussed within the three key areas of interest.

Creation of professional identity: how people construct their professional identity The development of professional identity is considered at the individual and group level. Clark (2014) discusses the narra- tive or storytelling in interprofessional practice and education. The notion of creating one’s own professional identity is explored at three places: self, relationship with patients, and relationship with the others in the team. Clark (2014) finds the narrative approach allows insight into the complexity of the multiple layers of professionals and recognises the need for a variety of voices (rather than uniprofessional) in creating professional identity. This concept of voice draws on Clark’s (1997) earlier work that focuses on values in healthcare pro- fessional socialisation (here Clark refers to socialisation as ‘the acquisition of the knowledge, skills, values, roles and attitudes associated with the practice of a particular profession’ p 442). This article is limited to medicine, nursing, and social work. Socialisation is argued to be conceptualised as the develop- ment of a distinctive viewpoint with different healthcare pro- fessionals having unique perspectives that combine at the point of making complex clinical decisions. Interestingly, Clark (1997) goes on to draw on Kiger’s (1993) analogy of professional identity as a ‘carapace’—in one respect, not one whole but conjoined or as a protective armour to buffer the more traumatic elements of clinical practice. Counter to the shield of the carapace, the focus of Mitchell, Parker, and Giles’ (2012) paper is open-mindedness. Sinkula, Baker and Noordewier’s (1997) definition of open-mindedness is employed as a willingness to question one’s own position and find evidence against one’s beliefs or perspectives. The researchers used survey questionnaires and conclude that open-mindedness offers a backdrop to enable discussion across professions. However, this has little impact where health professionals strongly identify with their own profes- sion. In contrast, where health professionals are aware of the different professional roles, open-mindedness can help facil- itate healthy debate.

Payne (2006) looks at identity politics and argues that the way identity is constructed is changing. Historically, roles have been attributed to people because of the role they played with established power dynamics; roles were well understood. This aligns with the International Health Professionals in Neiterman and Bourgeault’s (2015) paper who strongly iden- tified themselves with their role. Payne (2006) argues with the advent of the multiprofessional teams and suggests roles now need to be negotiated due to boundaries being more complex and the different skills and resources required both within the team and beyond. Payne (2006) suggests Communities of Practice are fundamental as they help construct the identities of fellow professionals and develop a shared history.

A sub-theme within the construction of professional iden- tity is power. Payne (2006) suggests the previously stable power

Table 1. Inclusion and exclusion criteria. Source: Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Inclusion criteria Studies were included if they: (1) Were written in English (2) Published between 1980 and July 2018 (3) Were focused on registered health and or social care staff (HCPC, NMC etc) (4) Were focused on teams working in health and/or social care (5) Included multi-professional teams (6) Published in peer-reviewed journals

Exclusion criteria Studies were excluded if they: (1) Were focused on one professional group (2) Were focused on education in isolation. Papers were included if they

included education as an aspect of the study (3) Were focused on professional identity for students (4) Were not related to health or social care (5) Were conference papers or dissertations. (6) Published in grey literature

172 S. BEST AND S. WILLIAMS

dynamics between professionals are shifting alongside the growth of multiprofessional teams. Lingard, Reznick, DeVito, and Espin (2002) studied the development of ‘other’ profes- sional identities in the operating room. They found that the construction of ‘others’ was commonly quite negative espe- cially in relation to their values andmotivations. This is counter to how the ‘other’ profession views itself. The interpretation is dependent on whether they view motivation to be driven by a concern for the patient or a desire for power. They note where training is uniprofessional the practitioner can have ‘narrow or distorted understandings of one another’s roles, skills and cul- tures’ (Lingard et al., 2002 p. 733). MacDonald, Jayasuriya, and Harris (2012) investigation into power dynamics also centred on trust and how professionals collaborate in the management of type two diabetes. Working across professions is reported to potentially lead to uncertainty and risk and so influences how different professions collaborate. Here trust is paramount to enabling collaboration. They conclude that interprofessional relationships dominate the success or otherwise of policy at the local level. One key finding is the use of power to retain autonomy (felt as a key part of some professions’ identity), including the use of passive resistance by some professions.

In creating a professional identity, the above studies acknowledge it is a social activity (from practice or educa- tion). The development of a ‘strong’ professional identity is

not noted to be undesirable but more significant due to the need to recognise the professional identity of others and negotiate ones’ own professional identity while constructing that of other professions. Trust is identified as a vital compo- nent when negotiating professional identity during a period of change. In summary, this section notes how the use of power can be found to have a negative effect in building the per- ceived professional identity of others. Other challenges for professional identity in interprofessional teams are explored in the next section.

Challenges: interprofessional teams—threat to professional identity? The challenges to professional identity present in several ways. The policy context is explored by Pate, Fischbacher, and Mackinnon (2010 p. 203) who identify that change produces a fear of perceived dilution of professional identity with a need to ‘defend their turf’. Pate et al. (2010) note the fight for professional identity is not new, with the concept of professional identity being long-standing and highly valued by health professionals. As a result, there are associated ‘in’ groups and ‘out’ groups. The article refers to many studies on the challenges to professional identity which commonly dis- cuss the challenges without identifying solutions. Here Pate et al. (2010) offer a potential solution from the conflict

Records identified through

database searching

(n = 482)

S c r e

e n

in g

In

c lu

d e

d

E li

g ib

il it

y

Id e

n t if

ic a

t io

n

Records after duplicates removed

(n = 383)

Records screened

(n = 71)

Records excluded

(n = 42)

Full-text articles assessed

for eligibility

(n = 29)

Full-text articles excluded,

with reasons

(n = 13

4x Student focus

2x Education focus

3x Focus not teamworking

(social network analysis,

emotional labour)

4x narrow professional

focus (only medicine and

nursing or only medicine))

Studies included in

qualitative synthesis

(n =16)

Figure 1. Process for scoping study and numbers of paper identified (Adapted from Moher, Liberati, Tetzlaff, & Altman, 2009).

JOURNAL OF INTERPROFESSIONAL CARE 173

Table 2. Summary of papers meeting inclusion criteria.

Paper title Year Author(s) Stated aim of

paper Professions identified

Methodological approach Data collection Key Findings Country

1. When do interprofessional teams succeed? Investigating the moderating roles of team and professional identity in interprofessional effectiveness.

2011 Mitchell, R., Parker, V., & Giles, M.

To explore the moderating role of team identity and professional identity threat in interprofessional team performance

Three to five different professions (detail not given)

Quantitative Survey data from 47 interprofessional teams in a tertiary referral hospital

Threat to professional identity impacts on performance

Australia

2. Interprofessional practice and professional identity threat

2013 Mcneil, K. A; Mitchell, R.J, & Parker, V.

To use Chrobot- Mason et al.’s (2009) typology to explore the triggers of professional identity conflicts, to understand why faultlines appear in interprofessional teams and why professional identities become salient and impair team functioning

Doctors, nurses, social workers, allied health professions, physicians assistants

Review of literature and summary of workplace studies

Not specified Professional identity ‘faultlines’ appear with different treatment of groups

Not demarcated

3. Open dialogues in social networks: Professional identity and transdisciplinary collaboration

2010 Holmesland, A., Seikkula, J., Nilsen, O., Hopfenbeck, M., & Arnkil, T

To explore the challenges connected to the transformation and emergence of professional identity in transdisciplinary integrated care

Healthcare professionals and social and educational professionals

Qualitative Three interviews conducted with two focus groups: 1. healthcare professionals; 2. professionals from the social and educational sectors.

Collaboration dependent on professionals’ mutual reliance

Norway

4. Narrative in interprofessional education and practice: Implications for professional identity, provider-patient communication, and teamwork

2014 Clark, P. To look at narrative approaches in research and practice; self- narrative, co- creation with the patient, co- constructed with members of healthcare team

Health- and social care professionals

Review of literature

Databases Cinahl, PubMed, PsychlNFo and Sociological Abstracts Behavioral and Social Sciences searched with keywords. No timeframes used. Number of papers sourced not provided

Positives of integrated working builds confidence in professional identity

Not demarcated

5. Professional identity in multi- disciplinary teams: The Staff Speak

2008 Workman,A. & Pickard, J.

To reflect on the experience of an integrated multidisciplinary team over 3 years.

Included nurses, social workers, and housing support officers

Qualitative Experience of an integrated multidisciplinary team over 3 years and two case studies

Initial anxieties about dilution of professional identity have not been realised in practice in part due to: they were over-stated; good planning; benefits of integrated working are so evident to staff

UK

6. Forming professional identities on the healthcare team: Discursive constructions of the ‘other’ in the operating room.

2002 Lingard, L., Reznick, R., DeVito, I., & Espin, S.

To explore team members’ interpretations of team communication in the operating theatre

Surgeons, nurses, anaesthetists, trainees

Qualitative 52 team members divided into 14 focus groups

Impact of other people’s views on developing one’s professional identity tendency (especially for novices) to simplify and distort others’ roles and motivations This has implication for the formation of novices’ professional identity formation

Canada

(Continued )

174 S. BEST AND S. WILLIAMS

Table 2. (Continued).

Paper title Year Author(s) Stated aim of

paper Professions identified

Methodological approach Data collection Key Findings Country

7. Restructuring Tthe multi- professional organization: Professional identity and adjustment to change in a public hospital.

2007 Callan, V., Gallois, C., Mayhew, M., Grice, T., Tluchowska, M., & Boyce, R.

To focus on employees’ multiple group memberships and their acceptance of organisational change

Nurses, administration, medical and ‘other health professional’

Quantitative Organisation (large public hospital) wide survey (n = 1558) with returns (n = 779)

Multiple identities; Protective role of identity with professional depts. during change that threatened group status. Needs care with management

Australia

8. Blurred roles and permeable boundaries: The experience of multidisciplinary working in community mental health

2000 Brown, B., Crawford, P., & Darongkamas, J.

To interrogate the implication of the teamwork approach for professional identities and occupational boundaries for those working in community mental health

Community mental health nurses, occupational therapists, clinical psychologists, psychiatrists, mental health support workers

Qualitative Investigation of three interdisciplinary mental health teams— interviews (n = 29) across three teams

Generalisation: Interprofessional working encourages development of professional boundaries

UK (rural England)

9. Values in healthcare professional socialization: Implications for geriatric education in interdisciplinary teamwork

1997 Clark, P. G. To explore the process of acquiring a professional identity

Social workers, physicians, and nurses

Conceptual Framework developed to discuss literature

Socialisation as a means to acquire professional identity

Not demarcated

10. Identity politics in multi- professional teams: Palliative care social work

2006 Payne, M. To examine professional identity in social work and then developments in thinking about multi-professional teamwork

Palliative care practitioners including social workers and nurses

Conceptual Not specified Not about maintaining traditional professional identities but developing a professional identity within that team

Centres on learning for the UK

11. Health improvement: Countervailing pillars of partnership and profession

2010 Pate, J. Fischbacher, M. & Mackinnon. J

To assess the extent to which employees identify with their professions and whether professional identity poses a significant barrier to multi- disciplinary interorganisational partnerships

Managers, nurses, doctors, social workers

Mixed methods Mixed methodology approach. Survey with 31% response rate. 26 interviews

Strong professional identity hinders partnership. Authors offer solutions

Scotland, UK

12. The influence of power dynamics and trust on multi- disciplinary collaboration: A qualitative case study of type 2 diabetes mellitus.

2012 McDonald, J, Rohan, J. & Fort Harris, M.

To explore the influence of power dynamics and trust on collaboration between health professionals involved in the management of diabetes and their impact on patient experiences

A ‘diverse’ range of professions including GPs, pharmacists, physiotherapists, community nurses, dieticians, optometrists, podiatrists, and other community support workers

Qualitative Semi-structured interviews with 45 health service providers from 19 organisations and eight patients

Three themes: use of power to protect autonomy, power dynamics between private- and publicsector providers, and reducing dependency on other health professionals to maintain power. Role boundaries between and within professional groups and services are changing. The uncertainty and vulnerability associated with these changes has affected the level of trust and mistrust.

Australia

(Continued )

JOURNAL OF INTERPROFESSIONAL CARE 175

resolution and negotiation literature: decategorisation (down- playing the significance of the profession), re-categorisation, or dual identity. The first two are not considered in a positive light, while dual identity is perceived to have greater possibi- lities, involving recognition of the identity of the professional and the team.

Mitchell has three papers in this scoping review. In this article, Mitchell, Parker, and Giles (2011), note the challenge of diversity, with a focus on the impact on team effectiveness. Their quantitative study used survey data from 47 teams and identified the negative effects of diversity. Here an increase in the diversity of a team formed a threat to professional identity and impacted on performance. Building on Chrobot-Mason, Ruderman, Weber, and Ernst’s (2009) work, McNeil, Mitchell, and Parker (2013) review the literature to draw out threats to professional identity. The authors identify five triggers of professional identity conflict: differential treatment, different values, assimilation, insulting or humiliating action, and sim- ple contact. The article explores how each of these triggers can act as a ‘professional identity faultline’ when working across

professions providing challenges to the development of inter- professional team working (implications for management and leadership will be considered later). These faultlines serve to divide professions. Nevertheless, the need for mutual reliance is drawn out in a qualitative study by Holmesland, Seikkula, Oystein, Hopfenbeck, and Arnkil (2010). Findings from focus groups demonstrate that in order for the team to function successfully, practitioners need insight int their own role and that of others. The traditions of specialisation, the difficulty in letting go of ones’ own role is found to be impacted by stereotypical anticipation of roles by those unfamiliar with the potential breadth of others’ work. Drawing on the concept of Community of Practice, in line with Payne (2006), they identify the need for familiarity with others and their knowl- edge to break down cultural barriers.

The role of culture is also identified by Neiterman and Bourgeault (2015). This article explores several areas, includ- ing professional identity, with overseas educated health pro- fessionals adapting to working in Canada. The health professionals forming the sample for this study are not strictly

Table 2. (Continued).

Paper title Year Author(s) Stated aim of

paper Professions identified

Methodological approach Data collection Key Findings Country

13. Open- mindedness in diverse team performance: Investigating a three-way interaction.

2012 Mitchell, R., Parker, V., & Giles, M.

To explore the role of open-minded interaction in professionally diverse teams.

Nurse, dietician, physiotherapist, social worker, medical practitioner, pharmacist, occupational therapist, speech pathologist, radiographer and psychologist

Quantitative Survey data from 218 members of 47 professionally diverse teams

Need for open mindedness—limited by strong professional identity. A focus on professional differences enhance value of team interaction

Australia

14. Professional integration as a process of professional resocialization: Internationally educated health professionals in Canada

2015 Neiterman, & Bourgeault.

To examine the integration process.

Internationally educated physicians, nurses, or midwives

Qualitative Interviews with 179 internationally educated health staff and 70 federal, provincial and regional stakeholders

Professional resocialization— internationally trained health professionals— some aspects of professional identity are modified and others persist

Canada

15. Silos and social identity: The social identity approach as a framework for understanding and overcoming divisions in healthcare

2012 Kreindler, S., Dowd, D., Star, N., & Gottschalk, T.

To explore the integrative potential of a single theory (social identity approach) focusing on group level dynamics

Included: Doctors, nurses, managers, healthcare assistants, allied health professions

Systematic literature review

348 reports. Literature sourced up to the end of 2010

The need to move forward by working with and through social identities

English- speaking countries US, UK, Australia, and Canada

16. Professional diversity, identity salience, and team innovation: The moderating role of open- mindedness norms

2015 Mitchell, R. & Boyle, B.

To investigate a mediating role for professional salience in the relationship between professional diversity and team innovation

Nurses, medical doctors, paramedical staff, biomedical scientists, welfare workers, dentists, dieticians, pharmacists, psychologists, occupational therapists, opticians, physiotherapists, podiatrists, and radiographers

Quantitative Two different surveys sent to 122 healthcare teams, 76 teams responded

Leaders need to understand how to support open communication within the team to develop interprofessional innovation

UK

176 S. BEST AND S. WILLIAMS

part of one interprofessional team, but there is a focus on resocialisation with an interesting perception of presumed inferiority of internationally educated health professions join- ing teams. The idea of a culture of professional hierarchy through professional identity is drawn out as a barrier to interprofessional working.

The first three papers discussed in this section centre on conflict whether from a lack of recognition for each profes- sion, diversity, or faultlines. The remaining papers discussed within the theme of challenges recognise the role organisa- tional and professional culture can play (for good or ill) in building or overcoming challenges to professional identity in teams. The need for leadership and management is intimated by some of the papers in the first two sections of the discus- sion and are drawn out further in the next section.

Implications for leadership and management The essential role of leadership for integrating services is recognised (Best, 2017), and the need to actively manage the integration of different professionals, not leaving it to chance, is noted in several papers. Workman and Pickard (2008) offer a reflection on 3 years of working within a multidisciplinary team. Interprofessional teams in their UK locality are reported not to be an add-on to mainstream services but rather being the mainstream. Their reflections suggest that some of the fears of integrated working were negated by two management strategies: (i) effective planning and (ii) reporting the benefits back to staff to ensure they retained confidence in the change. An interesting finding reported in this article is on how different professions will apply for different posts, with social care staff more likely to apply for management posts than health professionals.

Callan, Gallois, Mayhew, and Grice (2007) also argue for the need to actively manage teams though from a different perspective. This study explores the multiple identities of health professionals in the context of change. Although prac- titioners may be members of many different work groups, professional identity is the primary one. In line with Kiger’s (1993) carapace, Callan et al. (2007) find professional identity has a protective role, in particular during periods of uncer- tainty. Change is just such a situation and threatens group status. Change threatens professional distinctiveness, and attempts to ignore a threatened identity in favour of the identity required for the change will reinforce the old iden- tity—especially in lower status groups. Callan et al. (2007) note professional identity during the process of change needs active management and suggest endorsing both the previous identity and the new one required. This is in line with the concept of dual identity from Pate et al. (2010).

Mitchell and Boyle (2015) develop their ideas on open- mindedness outlined earlier by investigating the moderating role open-mindedness plays on several factors including pro- fessional diversity when innovating. In this later article, they start from the conundrum that interprofessional collaboration can be detrimental to innovation; however homogenous groups can stifle innovation. The findings of the survey-based study demonstrate that when open-mindedness is high, the indirect influence on professional diversity is constructive; in contrast, when open-mindedness is low the indirect impact on

professional diversity is less helpful. These findings suggest the positive role open-mindedness plays in professional identity in diverse healthcare teams. Nevertheless, the findings show high open-mindedness and diversity alone will not promote innova- tion. There is a need for all team members to be aware of (and think of) other team members. Mitchell and Boyle (2015) note implications for practice and identify that leaders need to understand how to support open communication within the team to develop interprofessional innovation.

Brown, Crawford, and Darongkamas (2000) identify argu- ments for and against blurring roles and boundaries between professions. They note one of the challenges as ‘creeping gen- ericism’ (p. 426) and stress the need to retain a professional voice. In this qualitative study in the mental health context, Brown et al. (2000) conclude that while some perceive profes- sional boundaries as a relic they are in fact alive and well. Kreindler, Dowd, Star, and Gottschalk (2012) undertook a ‘critical scoping review’ to explore silos and social identity. The article is structured through five key areas of social identity theory noted as social identity, social structure, identity con- tent, strength of identification, and context. Kreindler et al. (2012) note a regular theme from the literature as the impor- tance of identity mobilisation and/or change in context in seeing changes in service delivery. Without a shift in profes- sional identity, change is less likely to succeed. They identify the work of Chreim, Williams, and Hinings (2007) to reframe physicians' working practices to enable their professional iden- tities to be able to move with the required change. As noted earlier, the need to actively manage professional identity within interprofessional teams is key. Kreindler et al. (2012) conclude that there is a need to welcome the opportunities of working ‘with and through’ health professionals to overcome silo work- ing in favour of effective service delivery.

Discussion

As a result of this scoping review, we have identified three cross-cutting themes that are worthy of further discussion. These themes are the role of others, the social nature of professional identity, and identity mobilisation. Each of these will be considered in relation to the current interprofes- sional literature and the review’s aim of identifying implica- tions for future research.

The role of others is commonly identified within interpro- fessional teams in relation to knowledge sharing (Falk, Hult, Hammar, Hopwood, & Abrandt Dahlgren, 2017) or patient care (Lapierre, Gauvin-Lepage, and Lefebvre (2017). In addi- tion, several of the papers in this scoping review recognised the role of others as playing a significant role in developing professional identity amongst practitioners in interprofes- sional teams. This idea suggests that to progress our under- standing of professional identity in interprofessional teams, a focus on single professions will be of limited value. Future studies will benefit from engaging the wider health and social care professions team to ensure advances in knowledge sup- port interprofessional team working and in turn patient care.

Tying in with the concept of ‘others’, the theme of the social nature of creation of a professional identity is drawn out. Socialisation manifests as the process by which interaction

JOURNAL OF INTERPROFESSIONAL CARE 177

with others occurs and so facilitates (or otherwise) the devel- opment of professional identity. The place for socialisation is recognised with student cohorts (Byszewski, Gill, & Lochnan, 2015; Gould, Day, & Barton, 2017) but less so amongst post- qualifying staff groups. This leads to considering whether dif- ferent approaches and different career stages for facilitating socialisation lead to different professional identities being cre- ated. What are the factors around socialisation that impact on how the professional identity is formed? Is it who is involved (uni/multi-professional) what stage (in training, early career, later career) or location?

Finally,mobilisation of professional identity. Most of the studies within the selected papers were conducted within the context of change. These papers highlight the point that professional identity requires active engagement and management and cannot be ignored, particularly during periods of uncertainty. Innovating is recognised by several papers as a time of insecurity and stress the need for clear communication. This is not to say the papers suggest professional identity should remain frozen: Table 3 high- lights a recognition for the need for identities to be mobile. The call for a flexible workforce is commonplace today, with the challenges facing health and social care requiring different ways of thinking about how professionals work (Dubois & Singh, 2009). Harvey, Annandale, Loan-Clarke, Suhomlinova, and Teasdale (2014) explore mobilising the identities of middle and junior managers, including clinical managers, with a focus on their manager identity. They find a nuanced picture of the ‘reluctant manager’. Switching the emphasis of their study to clinician identity may provide interesting insights into mobilising clinician professional identity taking in queries such as has the notion of a single professional identity for life, created before graduating, now become outmoded and no longer fit for purpose?

Returning to the research question posed earlier in the article ‘What are the current themes in the field of professional identity in interprofessional teams in health and social care?’, we identified three key themes from the professional identity in interprofessional teams’ literature: challenges and barriers to professional identity, how people create their professional identity within an interprofessional team, and finally implica- tions for leaders and managers. In addition, we identified three less evident and cross-cutting themes that emerged from our analysis of the papers: the role of others, the social nature of professional identity, and identity mobilisation. All of these themes have formed the future research agenda we propose for professional identity in interprofessional teams. Before moving onto this agenda, it is important to recognise the strengths and limitations of our study.

One of the strengths of this review was exploring an understudied, though vital arena within professional iden- tity. This focus set much of the inclusion and exclusion criteria. In turn, this focus can be pointed to as a limitation. The exclusion of papers centred on students or uniprofes- sional studies led to the exclusion of many excellent papers on the topic of professional identity. These would form an interesting paper in their own right and may help respond to a different research agenda: to what extent are there differ- ence between professional groups in how they develop/main- tain their professional identities and respond to integrated care initiatives.

The multiple definitions within integrated care can cause confusion and added complexity within the field. Often papers failed to provide a clear definition, and therefore this means the papers shortlisted may not adopt the same view- point of what an interprofessional team consist of. Greater use of the terms as defined by Reeves et al. (2010) would be helpful to both the research community and professionals.

Another areas that would benefit from consideration, but not included in this study, are people who work in integrated teams but whose roles are not part of a formal profession. This may include support staff or nonregistered team mem- bers such as support staff (clinical and administrative) or managers. These groups were not included in this study in a bid to place some boundaries on an already large topic.

While scoping reviews facilitate reporting and transparency (Brien, Lorenzetti, Lewis, Kennedy, & Ghali, 2010), scoping stu- dies have been criticised as being limited in rigour with a potential for bias (Grant & Booth, 2009). In this article, this complaint is mitigated with a thorough description of the search process undertaken and the adoption of a well-recognised approach used to guide the design of the review process (Arksey & O’Malley, 2005). The analysis of the papers was conducted and cross-checked by both researchers and themes and categories identified as advocated by Carnwell and Daly (2001).

Concluding comments: future research agenda

The salient points arising from this scoping review (see Table 3) are centred on creating a professional identity, while working within an interprofessional team, and how this links with others and social interaction. The most pertinent context for developing and maintaining a professional identity from this review is change. The main implication for practitioners work- ing interprofessionally across health and social care settings is what the literature refers to as ‘identity mobilisation’.

Following this scoping review, an agenda for future research is proposed specifically for studies to focus on the intersection between professional identity and integration. There is a lack of primary research studies in this space, and further investigations in this area need to employ robust methodologies to strengthen the evidence base. Given the significance of the integration agenda in contemporary health and social care delivery, the following areas of research will help to shape future studies.

● The practitioner’s perception of the value of professional identity in interprofessional teams needs to be further explored.

● The voice of health and social care professionals who actively choose not to work in interprofessional teams would be interesting to hear. Very few studies have been able to include this viewpoint within their research.

● The level of integration across healthcare professional groups is narrow, and further research is needed to explore teams with a larger representation of professions and the inclusion on nonprofessionals.

● The role of education is noted in several papers, and a study focusing on those professionals who do have joint undergraduate training could be informative. Papers that

178 S. BEST AND S. WILLIAMS

are specifically focused on students and education were outside the remit of this review, but we noted many of these have been recently published. Interprofessional teaching and training is attracting more attention, and we recommend that professional identity needs to feature within this cross-disciplinary work.

● Some interprofessional teams are solely based on health, and further research explicitly exploring those working in health and social care would shed light on working across organisational boundaries and associated challenges to professional identity in interprofessional teams.

● The focus of this study has been the healthcare profes- sionals. Further study exploring approaches to mobilising professional identity and then the impact this has on service users’ perception of care would be of interest to many.

● Several papers mentioned team cohesion, and further investigation into the links between professional iden- tity, team performance and service delivery would be of interest.

● Should professional identity be found to be significant, then support and development mechanisms will need to be identified.

ORCID

Stephanie Best http://orcid.org/0000-0002-1107-8976 Sharon Williams http://orcid.org/0000-0001-5377-7401

References

Adams, K., Hean, S., Sturgis, P., & Clark, J. M. (2006). Investigating the factors influencing professional identity of first-year health and social care students. Learning in Health and Social Care, 5(2), 55–68. doi:10.1111/lhs.2006.5.issue-2

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodo- logical framework. International Journal of Social Research Methodology, 8(1), 19–32. doi:10.1080/1364557032000119616

Best, S. (2017). Facilitating integrated delivery of services across organi- sational boundaries: Essential enablers to integration. British Journal of Occupational Therapy, 71(2), 64–71.

Brien, S., Lorenzetti, D., Lewis, S., Kennedy, J., & Ghali, W. (2010). Overview of a formal scoping review on health system report cards. Implementation Science, 5, 2. doi:10.1186/1748-5908-5-2

Brown, B., Crawford, P., & Darongkamas, J. (2000). Blurred roles and permeable boundaries: The experience of multidisciplinary working in community mental health. Health & Social Care in the Community, 8 (6), 425–435. doi:10.1046/j.1365-2524.2000.00268.x

Byszewski, A., Gill, J. S., & Lochnan, H. (2015). Socialization to profes- sionalism in medical schools: A Canadian experience. BMC Medical Education, 15(1), 204. doi:10.1186/s12909-015-0486-z

Callan, V., Gallois, C., Mayhew, M., & Grice, T. (2007). Restructuring the multi-professional organization: Professional identity and adjustment to change in a public hospital. Journal of Health and Human Services Administration, 29(4), 448–477.

Carnwell, R., & Daly, W. (2001). Strategies for the construction of a critical review of the literature. Nurse Education in Practice, 1(2), 57– 63. doi:10.1054/nepr.2001.0008

Caza, B. B., & Creary, S. J. (2016). The construction of professional identity. In A. Wilkinson, D. Hislop, & C. Coupland (Eds.), Perspectives on contemporary professional work: Challenges and experiences (pp. 259–285). Cheltenham, UK: Edward Elgar Publishing.

Chreim, S., Williams, B. E., & Hinings, C. R. (2007). Interlevel influences on the reconstruction of professional role identity. The Academy of Management Journal, 50(6), 1515–1539. doi:10.5465/amj.2007.28226248

Chrobot-Mason, D., Ruderman, M. N., Weber, T. J., & Ernst, C. (2009). The challenge of leading on unstable ground: Triggers that activate social identity faultlines. Human Relations, 62(11), 1763–1794. doi:10.1177/0018726709346376

Clark, P. G. (1997). Values in Health Care Professional Socialization: Implications for geriatric education in interdisciplinary teamwork. Gerontologist, 37(4), 441–451.

Clark, P. G. (2014). Narrative in interprofessional education and practice: Implications for professional identity, provider–Patient communica- tion and teamwork. Journal of Interprofessional Care, 28(1), 34–39. doi:10.3109/13561820.2013.853652

Department of Health (DoH) Northern Ireland. (2011). Transforming your care: A review of health and social care in Northern Ireland. Retrieved August 19, 2018, from August 19 http://www.northern trust.hscni.net/pdf/Transforming_Your_Care_Report.pdf

Dickinson, H. (2014). Making a reality of integration: Less science, more craft and graft. Journal of Integrated Care, 22(5/6), 189–196. doi:10.1108/JICA-08-2014-0033

Dubois, C. A., & Singh, D. (2009). From staff-mix to skill-mix and beyond: Towards a systemic approach to health workforce management. Human Resources for Health, 7(1), 87. doi:10.1186/1478-4491-7-74

Ehrich, K., Freeman, G., Richards, S., Robinson, I., & Shepperd, S. (2002). How to do a scoping exercise: Continuity of care. Research Policy and Planning, 20(1), 25–29.

Falk, L., Hult, H., Hammar, M., Hopwood, N., & Abrandt Dahlgren, M. (2017). Nursing assistants matters-An ethnographic study of knowl- edge sharing in interprofessional practice. Nursing Inquiry, 25(2), e12216. doi:10.1111/nin.12216

Table 3. Summary of findings.

Creation of professional identity Challenges Implications for leadership and management

Sub-theme Others Social Power Conflict Interdependence Culture Multiple roles Voice Identity mobilisation

1. Mitchell et al. (2011) * * 2. McNeil et al. (2013) * * * * * 3. Holmesland et al. (2010) * * * * * 4. Clark (2014) * * * 5. Workman and Pickard (2008) * * * 6. Lingard et al. (2002) * * * 7. Callan et al. (2007) * * 8. Brown et al. (2000) * * * * 9. Clark (1997) * * * 10. Payne (2006) * * * 11. Pate et al. (2010) * * * 12. MacDonald et al. (2012) * * * 13. Mitchell et al. (2012) * * 14. Neiterman and Bourgeault (2015) * * 15. Kreindler et al. (2012) * * * 16. Mitchell and Boyle (2015) *

JOURNAL OF INTERPROFESSIONAL CARE 179

Gherardi, S. (2012). Why do practices change and why do they persist? Models of explanations’. In P. Hager, A. Lee, & A. Reich (eds), Practice, learning and change. Practice-theory perspectives on profes- sional learning (pp. 217–231). Dordrecht, Netherlands: Springer.

Goodwin, N. (2015). How should integrated care address the challenge of people with complex health and social care needs? Emerging lessons from international case studies. International Journal of Integrated Care, 15(3), 1–2. doi:10.5334/ijic.2254

Goodwin, N. (2016). Understanding Integrated Care. International Journal of Integrated Care, 16(4), 1–4. doi:10.5334/ijic.2530

Goodwin, N., Smith, J., Davies, A., Perry, C., Rosen, R., Dixon, A., . . . Ham, H. (2012). A report to the Department of Health and the NHS Future Forum – Integrated care for patients and populations: Improving outcomes by working together. London, UK: The King’s Fund and Nuffield Trust.

Gould, K., Day, K. H., & Barton, A. T. (2017). Changing student attitudes through interaction: Findings from an interprofessional workshop. Journal of Interprofessional Care, 31(4), 540–542. doi:10.1080/ 13561820.2017.1287165

Grant, M., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26(2), 91–108. doi:10.1111/j.1471- 1842.2009.00848.x

Ham, C., Heenan, D., Longley, M., & Steel, D. R. (2013). Integrated care in Northern Ireland, Scotland and Wales: Lessons for England. The Kings Fund. Retrieved August 19, 2018, from August 19 https:// www.kingsfund.org.uk/sites/default/files/field/field_publication_file/ integrated-care-in-northern-ireland-scotland-and-wales-kingsfund- jul13.pdf

Harvey, J., Annandale, E., Loan-Clarke, J., Suhomlinova, O., & Teasdale, N. (2014). Mobilising identities: The shape and reality of middle and junior managers’ working lives – A qualitative study. Health Services and Delivery Research, 2(11), 1–154. doi:10.3310/hsdr02110

Hogg, M. A., & Abrams, D. (1988). Social identifications: A social psy- chology of intergroup relations and group processes. London, UK; New York, NY: Routledge.

Holmesland, A., Seikkula, J., Oystein, N., Hopfenbeck, M., & Arnkil, T. E. (2010). Open dialogues in social networks: Professional identity and transdisciplinary collaboration. International Journal of Integrated Care, 10(3). ISSN 1568-4156 doi:10.5334/ijic.564

Hood, K., Cant, R., Baulch, J., Gilbee, A., Leech, M., Anderson, A., & Davies, K. (2014). Prior experience of interprofessional learning enhances undergraduate nursing and healthcare students’ professional identity and attitudes to teamwork. Nurse Education in Practice, 14(2), 117–122. doi:10.1016/j.nepr.2013.07.013

Ibarra, H. (1999). Provisional selves: Experimenting with image and identity in professional adaptation. Administrative Science Quarterly, 44(4), 764–791. doi:10.2307/2667055

Kiger, A. M. (1993). Accord and discord in students’ images of nursing. Journal of Nursing Education, 32(7), 309–317.

Kreindler, S., Dowd, D., Star, D. N., & Gottschalk, T. (2012). Silos and social identity: The social identity approach as a framework for under- standing and overcoming divisions in health care. Milbank Quarterly, 90(2), 347–374. doi:10.1111/j.1468-0009.2012.00666.x

Lê, G., Morgan, R., Bestall, J., Featherstone, I., Veale, T., & Ensor, T. (2016). Can service integration work for universal health coverage? Evidence from around the globe. Health Policy, 120(4), 406–419. doi:10.1016/j.healthpol.2016.02.007

Lapierre, A., Gauvin-Lepage, J., & Lefebvre, H. (2017). La collaboration interprofessionnelle lors de la prise en charge d’un polytraumatisé aux urgences: Une revue de la littérature. Recherche en soins infirmiers, 129 (2), 73–88. doi:10.3917/rsi.129.0073

Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 69. doi:10.1186/1748-5908-5-69

Lewis, R. Q., Rosen, R., Goodwin, N., & Dixon, J. (2010). Where next for integrated care organisations in the English NHS. London, UK: The Nuffield Trust. Retrieved August 19, 2018, from August 19, https:// www.nuffieldtrust.org.uk/files/2017-01/where-next-integrated-care- english-nhs-web-final.pdf

Lindeman, M. A. (2009). Assessment staff in home and community care services: Issues of learning and professional identity in Australia. Health & Social Care in the Community, 17(4), 406–414. doi:10.1111/j.1365-2524.2008.00841.x

Lingard, L., Reznick, R., DeVito, I., & Espin, S. (2002). Forming profes- sional identities on the health care team: Discursive constructions of the ‘other’ in the operating room. Medical Education, 36(8), 728–734.

MacDonald, J., Jayasuriya, R., & Harris, M. (2012). The influence of power dynamics and trust on multidisciplinary collaboration: A qua- litative case study of type 2 diabetes mellitus. BMC Health Services Research, 12(1), 63. doi:10.1186/1472-6963-12-63

Mays, N., Roberts, E., & Popay, J. (2001). Synthesising research evidence. In N. Fulop, P. Allen, A. Clarke, & N. Black (Eds.), Studying the organisation and delivery of health services: Research methods. London, UK: Routledge

McNeil, K., Mitchell, R., & Parker, V. (2013). Interprofessional practice and professional identity threat. Health Sociology Review, 22(3), 291– 307. doi:10.5172/hesr.2013.22.3.291

Mitchell, R., & Boyle, B. (2015). Professional diversity, identity salience and team innovation: The moderating role of openmindedness norms. Journal of Organizational Behavior, 36(6), 873–894. doi:10.1002/job. v36.6

Mitchell, R. J., Parker, V., & Giles, M. (2011). When do interprofessional teams succeed? Investigating the moderating roles of team and pro- fessional identity in interprofessional effectiveness. Human Relations, 64(10), 1321–1343. doi:10.1177/0018726711416872

Mitchell, R. J., Parker, V., & Giles, M. (2012). Open-mindedness in diverse team performance: Investigating a three-way interaction. The International Journal of Human Resource Management, 23(17), 3652– 3672. doi:10.1080/09585192.2012.654807

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. & The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7). doi:10.1371/journal.pmed1000097

Morgan, P. I., & Ogbonna, E. (2008). Subcultural dynamics in transfor- mation: A multi-perspective study of healthcare professionals. Human Relations, 61(1), 39–65. doi:10.1177/0018726707085945

Mossabir, R., Morris, R., Kennedy, A., Blickem, C., & Rogers, A. (2015). A scoping review to understand the effectiveness of linking schemes from healthcare providers to community resources to improve the health and well-being of people with long-term con- ditions. Health & Social Care in the Community, 23(5), 467–484. doi:10.1111/hsc.12176

Neiterman, E., & Bourgeault, I. L. (2015). Professional integration as a process of professional resocialization: Internationally educated health professionals in Canada. Social Science & Medicine, 131(April), 74–81. doi:10.1016/j.socscimed.2015.02.043

NHS England (2014) Five year forward view. Retrieved August 19, 2018, from August 19 https://www.england.nhs.uk/five-year-forward-view/

Pate, J., Fischbacher, M., & Mackinnon, J. (2010). Health improvement: Countervailing pillars of partnership and profession. Journal of Health Organization and Management, 24(2), 200–217. doi:10.1108/ 14777261011047354

Payne, M. (2006). Identity politics in multiprofessional teams: Palliative care social work. Journal of Social Work, 6(2), 137–150. doi:10.1177/ 1468017306066741

Pham, M. T., Rajić, A., Greig, J. D., Sargeant, J. M., Papadopoulosa, A., & McEwen, A. A. (2014). A scoping review of scoping reviews: Advancing the approach and enhancing the consistency. Research Synthesis Methods, 5(4), 374–385. doi:10.1002/jrsm.1123

Pratt, M. G., & Corley, K. G. (2012). Organizational identities: On identity ambiguity, identity conflict and members’ reactions. In C. Bartel, S. L. Blader, & A. Wrzesniewski (Eds), On Identity and the Modern Organization (2nd ed., pp. 99–118). New York, NY: Psychology Press.

Ramsey, A., Fulop, N., & Edwards, N. (2009). The evidence base for vertical integration in health care. Journal of Integrated Care, 17(2), 3– 12. doi:10.1108/14769018200900009

Reeves, S., Goldman, J., Gilbert, J., Tepper, J., Silver, I., Suter, E., & Zwarenstein, M. (2011). A scoping review to improve conceptual

180 S. BEST AND S. WILLIAMS

clarity of interprofessional interventions. Journal of Interprofessional Care, 25(3), 167–174. doi:10.3109/13561820.2010.529960

Reeves, S., Lewin, S., Espin, S., & Zwarenstein, M. (2010). Interprofessional teamwork for health and social care. London, UK: Blackwell-Wiley.

Schein, E. H. (1978). Career dynamics: Matching individual and organi- zational needs. Reading, MA: Addison-Wesley.

Scottish Government (2011). Achieving sustainable quality in Scotland’s healthcare, A ‘20:20ʹ vision. Retrieved August 19, 2018, from August 19 https://www.gov.scot/Topics/Health/Policy/2020- Vision

Siebert, D. C., & Siebert, C. F. (2005). The caregiver role identity scale: A validation study. Research on Social Work Practice, 15(3), 204–212. doi:10.1177/1049731504272779

Sinkula, J. M., Baker, W. E., & Noordewier, T. (1997). A framework for market-based organizational learning: Linking values, knowledge and behavior. Journal of the Academy of Marketing and Science, 25, 305– 318. doi:10.1177/0092070397254003

Van Maanen, J., & Barley, S. R. (1984). Occupational communities: Culture and control in organizations. Research in Organizational Behavior, 6, 287–365.

Welsh Government (WG) (2011) Together for health a five year vision for the NHS in Wales. Retrieved August 19, 2018, from August 19 http:// www.wales.nhs.uk/sitesplus/documents/829/togetherforhealth.pdf

Workman, A., & Pickard, J. (2008). Professional identity in multi-disciplinary teams: The staff speak. Journal of Integrated Care, 16(3). 29–37. doi:10.1108/14769018200800023.*Papersincluded in the review

JOURNAL OF INTERPROFESSIONAL CARE 181