The pursuit of joint accreditation begins with process and documentation. It ultimately exposes the deeper challenge of aligning systems, structures and professional cultures.
This reality became clear to me through a recent participation in the BaFa BaFa simulation, which offered insight into how culture shapes interaction and collaboration. Deeply rooted professional cultures continue to shape how we learn, communicate and claim ownership of work and can pose an unintended barrier to true interprofessional collaboration.
Experiencing Culture through BaFa Bafa
BaFa BaFa is an experiential learning simulation designed to teach learners what it feels like to enter an unfamiliar culture. Participants are divided into two groups, each given a distinct set of rules, values, communication styles and expectations. These rules are not explained to outsiders. When participants from each group attempt to interact with each other, confusion, frustration and misunderstanding quickly emerge. Individuals from each group believe they are behaving logically and appropriately, while viewing those from the other group as difficult or uncooperative (Hall, 2005). The lesson is simple but uncomfortable. Conflict does not arise from bad intent. It arises from cultural differences and from the assumption that one way of operating is universal.
Healthcare as a Cultural System
Healthcare functions in much the same way. Healthcare was built on hierarchy, and our structures reflect that history (Shein, 2017). Reporting relationships, credentialing pathways and educational processes reinforce profession-specific ownership. When learning and practice remain organized by profession, the outcomes are predictable. A siloed structure produces siloed behavior (Hall, 2005). Interprofessional education is more than a change in language; however, adding interprofessional language to a fragmented system does not on its own, change the system itself (Institute of Medicine [IOM], 2015; Schein, 2017).
Culture as a Barrier to Collaboration
Culture further complicates the challenge. Each profession operates within its own social structure. Each has its own hierarchy, communication norms and expectations around authority and responsibility. Like distinct human cultures, these professional groups do not automatically understand one another. When we ask teams to collaborate without acknowledging these differences, we are skipping an essential step (Hall, 2005; Schein 2017).
This cultural barrier is not limited to education. It extends directly into clinical practice. While we often talk about team-based care, the reality is that most healthcare professionals are still trained, educated and deployed within professional silos. Though collaboration is expected, it is rarely taught or structurally supported outside of limited contexts (Institute of Medicine [IOM], 2015; Interprofessional Education Collaborative [IPEC], 2023).
Why Collaboration Works in Safety/Critical Environments
In the safety space, healthcare has embraced interprofessional collaboration with remarkable consistency (Reason, 2000; Institute of Medicine [IOM], 2015). Checklists, standardized procedures, time outs and shared accountability are accepted as nonnegotiable. Professional hierarchy yields to process because the risk of failure is too high. Variation is recognized as dangerous, and consistency is seen as protective. We understand in these moments that safety depends on teams, not individuals.
When Systems Fail, Individuals Compensate
James Reason describes multiple levels at which failure can occur within complex systems; his paradigm is commonly referred to as the Swiss cheese model. In healthcare, we use his work to understand safety events and adverse outcomes. When systems lack shared structures, we rely on individuals to interpret and navigate complexity on their own. This is where rule-based errors emerge (Reason, 2000).
Each profession brings its own cultural rulebook. How to escalate concerns. How to document care. How to prioritize tasks. How to communicate urgency. How ownership is defined. These rules are learned through professional socialization and thus reinforced over time (Hall, 2005). When professionals are expected to collaborate without shared structures, these differences create friction, confusion and missed opportunities. The burden of alignment is placed on individuals rather than the system.
Collaboration is far more successful when shared structures exist (Institute of Medicine [IOM], 2015). When expectations, processes and accountability are clear, teams can function reliably, regardless of professional background. This is exactly why interprofessional collaboration works best in safety critical environments where standardized processes remove ambiguity. Outside of those environments, collaboration often fails not because individuals are unwilling but because the system requires them to bridge cultural gaps on their own.
Interprofessional collaboration succeeds when systems are intentionally designed to support it (Interprofessional Education Collaborative [IPEC]). With the exception of safety, critical moments professional ownership and hierarchy quickly reassert themselves. Education, planning, care coordination and quality initiatives often revert to profession-specific approaches despite the same evidence supporting interprofessional collaboration.
Learning together does not automatically equate to interprofessional education. True interprofessional education requires intentional learning with, from and about one another. Without understanding why our colleagues practice, communicate and prioritize the way they do, collaboration remains superficial. The BaFa BaFa experience makes this visible almost immediately. When rules are assumed, unfamiliar behavior is misinterpreted and trust erodes quickly (Interprofessional Education Collaborative [IPEC], 2023).
What Joint Accreditation Revealed
Our own pursuit of joint accreditation reinforced this reality. The challenge was not process. The criteria were clear. The standards were consistent. The infrastructure was achievable. What hindered progress was culture. Long-standing professional identities, ownership of processes and deeply ingrained ways of working proved far more difficult to align than any operational requirement (Schein, 2017). While accreditation marked an important milestone, it did not signal the end of the work. In many ways, it revealed how much work still remains.
Designing for Interprofessional Collaboration
Achieving true interprofessional continuing education and practice requires more than shared criteria. It requires a willingness to examine and change professional culture. That work is slower, more complex and far less comfortable than process redesign (Hall, 2005; Schein, 2017).
Residents continue to learn alone. Nurses continue to learn alone. Pharmacists continue to learn alone. And in many ways, they continue to practice alone except in moments where safety demands otherwise.
Perhaps the future of healthcare education and practice is not profession specific with occasional interprofessional collaboration. Perhaps collaboration should be the default rather than the exception. Only when learning and practice mirror the reality of team-based care will we reach the highest levels of patient care and outcomes.
Interprofessional collaboration is not achieved by placing multiple professions in the same room. It requires shared structures, shared standards and a willingness to relinquish individual ownership in service of collective impact.
If interprofessional collaboration is truly the future of healthcare, then we must be willing to imagine and design it differently than we have in the past. That future could begin with shared onboarding where new healthcare professionals learn together from the start. Early collaboration allows teams to develop a shared understanding of roles, responsibilities, and expectations before silos emerge and professional norms become fixed. Learning the language, values, and priorities of other professions early creates a foundation for trust that cannot be replicated later.
Interprofessional case conferences could become routine rather than exceptional. Models already exist in tumor boards, morbidity and mortality reviews, and safety huddles. Expanding these approaches beyond specialty driven cases into broader clinical and systems discussions would normalize shared decision making and collective accountability.
Joint clinical rotations offer another opportunity. When learners from different professions train side by side, they gain insight not only into what their colleagues do but why they do it. These experiences reduce assumptions and replace them with appreciation. They also mirror the reality of team-based care far more accurately than isolated training pathways.
Curriculum design itself could shift toward true co-creation. Interprofessional teams of educators, clinicians and learners could design curricula together, ensuring that education reflects the needs of patients, teams and systems rather than the preferences of individual professions. This approach moves us from parallel learning to shared purpose.
Changing culture is never easy. But healthcare has already demonstrated that when the stakes are high enough, collaboration becomes nonnegotiable. We have seen this in safety and risk management. We saw this in healthcare’s COVID-19 response. The question is whether we are willing to apply the same urgency and intentionality to education and everyday practice.
Interprofessional collaboration is not about diminishing professional identity. It is about strengthening it within the context of a team. When learning and practice are intentionally designed to reflect the reality of how care is actually delivered, everyone benefits. Most importantly, patients and the communities we serve do. This requires moving beyond intention and into design. Creating shared learning environments, structures and expectations that make collaboration the norm rather than the exception.
References
- Institute of Medicine National Academies
Interprofessional Education for Collaboration Learning How to Improve Health from Interprofessional Models Across the Continuum of Education to Practice
https://www.ncbi.nlm.nih.gov/books/NBK207106/
- Hall P
Interprofessional teamwork professional cultures as barriers
Social Science and Medicine
https://pubmed.ncbi.nlm.nih.gov/16096155/
- Schein E H
Organizational Culture and Leadership
https://www.wiley.com/en-us/Organizational+Culture+and+Leadership%2C+5th+Edition-p-9781119212041
- Interprofessional Education Collaborative
Core Competencies for Interprofessional Collaborative Practice
https://www.ipecollaborative.org/ipec-core-competencies
- Reason J
Human error models and Management
British Medical Journal
https://pmc.ncbi.nlm.nih.gov/articles/PMC1117770/
Disclosure: This article was developed with the assistance of generative AI tools. All outputs generated by the AI were critically reviewed, edited, and validated by the author to ensure accuracy, originality, and alignment with current evidence and professional standards. The author assumes full responsibility for the final content.
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Michelle Earl, CHCP, is the director of continuing medical Eeducation at Nuvance Health with more than 23 years of experience in accredited continuing education. She leads system-level CME operations and supports the development of educational activities for multiple health professions. Earl's professional interests include leading and developing teams, exploring the practical use of AI in continuing professional development and supporting those new to the CPD/CME profession. She is actively engaged in the continuing education community through mentorship, presentations and professional service, and values thoughtful, well-executed education that supports clinicians in practice.