title: Contested innovation: the diffusion of interprofessionalism across a health system.
abstract: OBJECTIVE
  Interprofessionalism (IP) has emerged as a new movement in healthcare in response to workforce shortages, quality and safety issues and professional power dynamics. Stakeholders can push for IP (e.g. education providers to the health system) or pull (e.g. the health system to the education provider). Based on innovation theory, we hypothesized that there would be unequal forces within and across stakeholder domains which would work to facilitate or resist IP. The strongest pull pressures would be from the health system and services; push pressures for IP would come from government and higher education; with weaker push forces and levels of resistance, from protectionist professional bodies.
  
  
  METHODS
  
  
  
  METHODS
  /st> Our model was tested in a geographically bounded health jurisdiction. Information was gathered and analysed via individual (n= 99 participants) and group (n= 372 participants) interviews with stakeholders, and through document analysis.
  
  
  RESULTS
  /st> The health system and services exerted the strongest pull in demanding IP. The strongest push factor was individual champions in positions of power. Professional bodies balanced their support of IP competencies with their role as advocates for their individual professions. A weak push factor came from government support for health workforce reform.
  
  
  CONCLUSIONS
  /st> Our hypothesis was supported, as were our predictions that the strongest pull would be from the providers and the strongest push from government and higher education. Our original model should be extended to account for contextual factors such as large-scale workplace and professional reform, which worked both for and against, IP.
authors: School of Public Health and Community Medicine and Centre for Clinical Governance Research, Australian Institute for Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia. j.travaglia@unsw.edu.au
authors: Joanne F
authors: JF
authors: Travaglia
authors: Peter
authors: P
authors: Nugus
authors: David
authors: D
authors: Greenfield
authors: Johanna
authors: J
authors: Westbrook
authors: Jeffrey
authors: J
authors: Braithwaite
mesh_terms: D003299:Cooperative Behavior; D003695:Delivery of Health Care; D004059:Diffusion of Innovation; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008962:Models, Theoretical