649942

book-review2016

ILRXXX10.1177/0019793916649942Book reviewsBook reviews

BOOK REVIEWs

Creating the Health Care Team of the Future: The Toronto Model for Interprofessional Education and
Practice. By Sioban Nelson, Maria Tassone, and Brian D. Hodges. Ithaca, NY: Cornell University Press/ILR Press, 2014. 176 pp. ISBN 0801453007, $82.50 (Cloth); ISBN 978-0801479410,
$29.95 (Paperback).
DOI: 10.1177/0019793916649942
The fundamental premise of this book is simple and virtually inarguable: to create highfunctioning teams, it is helpful to start with how participants are trained. In the case of health
care, this training has traditionally occurred in professional silos with little attempt to integrate either the content or the process of training. Little wonder that our efforts to create
high-functioning health care teams have been fraught with challenge. The real value of this
book is as a highly practical guide for those individuals and organizations who are committed
to making interprofessional education a reality.
When health systems are advised to develop new structures such as select and train for
teamwork, the response is often: Sure, wed love to, but thats more easily said than done.
When new doctors, nurses, therapists, and other health professionals are exposed to interprofessional education while they are first forming their professional identities, health systems can more easily find appropriate individuals and provide additional training as needed
to work effectively together. The inputs to our health systems produced by our educational
institutions are then better aligned with the operational needs of our health systems.
But this too is more easily said than done. The same silos that interprofessional education
is intended to overcome in health care delivery systems can make interprofessional education
hard to produce in the professional education system. I know this through direct experience in our MBA program. We have excellent individual courses taught by professors who
are expert in their fields, but cross-course integration is still at an early stage. Even though
these students are getting the same professional degree, an MBA, there are still challenges to
bridge across the thought-worlds of accounting and leadership and operations management
and marketing and finance and human resource management and strategic management.
Our faculty is moving in the right direction with integrative learning as a goal of the program,
but our students still do much of the integration on their own with relatively little support
from us as professors. These silos in the MBA programand in MBA programs around the
worldmimic and reinforce the silos in our organizations, as we might expect given the
bureaucratic model both have inherited.
Even more challenging, then, is interprofessional education among health care professionals who attend different schools and graduate with different degrees after taking courses
from an entirely different set of faculty who report to different deans. Interprofessional education in this context requires agreement across schools, coordination between distinct academic schedules, and the allocation of time for interprofessional content that threatens to
displace existing course content.
Responding to this challenge, Creating the Health Care Team of the Future is a practical handbook written to share insights and lessons from one of the pioneers in this effortthe University of Toronto. Leaders from this university have partnered together to share what they have
learned about creating a culture of interprofessional education as well as concrete structures
to support it. One powerful structure is a gathering of newly matriculated students from
across 11 professions in a single room. The authors write:
The Year 1 introductory session on teamwork has a special feel to it. Convocation
Hall at U of T seats over 1200 people. It is an iconic building for the university,
which adds to the significance of this event for the freshman class. It will be
ILR Review, 69(4), August 2016, pp. 10171022
The Author(s) 2016
Journal website: ilr.sagepub.com
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where they convocate in two, three or four years. A lighthearted mood pervades
the event. Students fill the dark stadium in designated seating, placed away from
their classmates in teams that represent the multiple professional programs.
When the session begins, the facilitator with a head mic and lots of attitude, calls
out for all the different programs, and the students cheer from across the interprofessional clusters, identifying themselves as each program is named. It feels
more like a sporting than an academic event. Everyone is having fun and are
there to learn about their own new profession and those it intersects with. (p. 55)
This excerpt is telling. First, it demonstrates that the authors are able to articulate not
only the interprofessional structures in place at U of T but also the spirit in which they are
enacted. Second, this excerpt reveals a structure that is highly attentive to social identity
formation, held at the very start of the student experience, in a way that simultaneously
evokes three levels of identitythe University of Toronto entering class as a whole, ones
own professional identity, and ones interprofessional team identity. In this one formative
structure, these three intersecting social identities are upheld, symbolizing the potential for
professionals to hold multiple identities in high esteem and undercutting the inevitability of
professional silos and hierarchies.
This one formative structure is not sufficient, of course; the authors show how other conflicts have to be addressed to create not only a curriculum but an underlying culture among
the faculty. This culture, the so-called hidden curriculum that can easily undermine the
formal curriculum, is perhaps ideally characterized by relationships of shared goals, shared
knowledge, and mutual respect that support timely, accurate, and problem-solving communication across areas of expertise. These elements are the basic dynamics of relational coordination, dynamics that seem to be as relevant for those who educate health care professionals
as they are for those who deliver care to patients.
In addition to professional educators, leaders of health care systems themselves can learn
from this book as they work to transform their structures and cultures to support teamwork
around patients at the point of care, ideally reinforcing what new hires are learning in welldesigned interprofessional educational programs, rather than starting from scratch.
Jody Hoffer Gittell
The Heller School for Social Policy and Management
Brandeis University
Selling Our Souls: The Commodification of Hospital Care in the United States. By Adam D. Reich.
Princeton, NJ: Princeton University Press, 2014. 248 pp. ISBN 978-0-6911-60405, $39.50
(Cloth).
DOI: 10.1177/0019793916649941
A social worker trying to help diabetic, homeless, and other patients in need; a chaplain
trying to avoid burnout while giving emotional support; and a palliative care physician and
his team trying to change the prevailing physician culture around dyingin Selling Our Souls:
The Commodification of Hospital Care in the United States, Adam Reich unfolds the narratives
of people like these who work in hospitals trying to realize their aims of giving appropriate
care in the midst of intensifying market pressures. Drawing on 121 interviews, observations,
descriptive statistics, and archival data, Reich compares three not-for-profit health care organizations in a mid-sized town in California: a former public hospital, a Catholic hospital, and
an integrated health management organization. He does not seek to provide a causal explanation of varying hospital care practices but rather to explore the different dimensions of
its variation (p. 16). The three organizations vary on business strategy, management control
strategies, patient and payer mix, and financial performance. In his institutionalist analysis of
this complex variation, Reich provides a differentiated theoretical conceptualization of the
relationship between morals and markets. He also provides rich narrative accounts and data
on organizational dynamics as well as an intriguing set of patterns.
Reichs main focus is on the institutional legacies that shape how the people working in his
cases reconcile the contradictions between their non-economic values and market pressures.

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