Wednesday, 22 November 2017

Commentary: Collaboration in Canadian Health Care

Ken Cabrera

This is in response to the article entitled: Intentional partnering: a grounded theory study on developing effective partnerships among nurse and physician managers as they co-lead in an evolving healthcare system by Clausen et al. (2017). As a graduate student pursuing my nurse practitioner degree, I found this study to be fascinating, meaningful and significant.

For years now, Quebec has been undergoing sweeping health care reforms aimed at integrating health care and social services at various structural levels to improve the overall quality and delivery of care (Vedel et al., 2011). The reorganization of primary care, the integration of primary and secondary care at the clinical level, and developing effective governance and change management have been identified as three of most important challenges facing Quebec health care. Moreover, the implementation of nurse practitioners at the primary care level has been identified by the Quebec government as a key initiative to strengthening the delivery and quality of primary care (Vedel et al., 2011). The ability of the nurse practitioner to provide cost-effective, high quality care as indicated by positive patient-outcomes is well-documented (Martin-Misener et al, 2015).

The article refers to today’s rapidly changing climate, the complexity of challenges and the daunting task of meeting these challenges while striving to maintain safety and quality of care. In response to these challenges, key factors have been identified to facilitate change and transform care delivery: collaborative healthcare management structures and leadership. As a result, several health care systems in Canada are instituting co-leadership and co-management models- the benefits of which have been documented (e.g. greater unity, co-responsibility, interdependence, mutual obligation, preservation of the individuality of the partner).

Clausen’s substantive theory of ‘intentional partnering’ could not be more relevant considering the current state of affairs. The recognition of the nurse practitioner as an indispensable resource and their ever-expanding presence at various levels of the health care system coincides with this shift towards collaborative management in health care delivery systems. To meet this end, the successful transformation of health care can only be achieved within a context that is firmly grounded in collaborative leadership. Understanding and embracing ‘Intentional partnering’ which involves moving through a three-cog system of ‘accepting mutual necessity’, ‘daring to risk (together)’ and constructing a shared responsibility is the key to unlocking the power of the nurse practitioner and physician co-leadership dyad.

The findings of this study clearly illuminate for us as physicians and nurses alike that we share a common goal, and despite our allegiance to our own professional agendas - we are better together. Not only can we meet our own professional objectives through respectful co-leading and collaboration, but as a united team, we can achieve immeasurably more resulting in benefits for everyone. I believe only by working collaboratively can we meet the challenges of the future. 

The knowledge generated from this study by Clausen et al. has extended our understanding of nurse-physician dyadic relationships to new depths. Furthermore, it has provided us with a theoretical framework out of which we have a systematic approach to foster inter-professional collaboration. I believe, this seminal study represents a monumental contribution to the nursing profession and nursing leadership with enormous implications for the future of all Canadians.

Ken Cabrera
Graduate student, Primary Care Nurse Practitioner Program
McGill University
Quebec, Canada


Clausen C., Lavoie-Tremblay M., Purden M., Lamothe L., Ezer H. Mcvey L. (2017) Intentional partnering: a grounded theory study on developing effective partnerships among nurse and physician managers as they co-lead in an evolving healthcare system. Journal of Advanced Nursing 73(9), 2156–2166

Martin-Misener, R., Harbman, P., Donald, F., Reid, K., Kilpatrick, K., Carter, N., Bryant-Lukosius, D., Kaasalainen, S., Marshall, D. A. & Charbonneau-Smith, R. 2015. Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review. BMJ open, 5, e007167.

Vedel, I., Monette, M., Beland, F., Monette, J. & Bergman, H. 2011. Ten years of integrated care: backwards and forwards. The case of the province of Qu├ębec, Canada. International journal of integrated care, 11.


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