The game-play in primary care collaboration: “It feels like I am defending my position, and you are defending yours.”

Background: Allied health professionals possess the expertise to improve primary healthcare for frail older adults but do not structurally engage in interprofessional collaboration. Game theoretical concepts may help characterize and explain collaboration and decision-making in the Dutch primary healthcare setting to offer professionals a better perspective for action than the current barriers and facilitators known. Goal: To explore game characteristics between allied health and other primary healthcare professionals and to explain which collaboration aspects contribute to certain game-play and outcomes. Participants: Primary healthcare professionals (general practitioners, practice- and community nurses) and allied healthcare professionals (dieticians, physiotherapists, occupational therapists). Methods: We conducted 25 semi-structured interviews with healthcare professionals, either in-person or online. We asked about their experiences with collaboration between allied health- and other primary healthcare professionals. We used inductive thematic analysis to identify barriers and enablers of collaboration. We used an existing codebook to identify context elements, actor-strategies, game outcomes, and possible implications. We coded three types of games: The Principal-Agent game (P-A), i.e., the principal has more power and the agent more information resulting in power-information asymmetries; The Battle of the Sexes (BS), i.e. healthcare professionals share a common goal but have conflicting preferences and often show go-alone behavior; and the Volunteers Dilemma (VD), i.e., not acting is beneficial, but can lead to worst-case scenarios for both patients and professionals. Results: In each interview, we found multiple games and identified variations of each game. These variations led to clusters of games representing generic patterns and individual collaboration situations. Examples include a P-A-game that involves a general practitioner who chooses to reject the physiotherapist’s advice, damaging their working relationship; a BS-game in which a community nurse does not reconcile with an occupational therapist on care aid use, which confuses older adults; a VD-game where community nurses are hesitant to involve a dietician, which frustrates the dietician and can lead to preventable weight loss. Discussion: In this study, we characterize game theoretical concepts between allied health- and other healthcare professionals in a primary healthcare setting. All three games appeared in different forms, showing a variety of implications for collaboration or older adults. Furthermore, the form of a game relates to specific collaboration elements that help to explain or prevent certain game-play. These findings support designing behavioral interventions. Changing how healthcare professionals play games could benefit primary care collaboration with allied health- and other primary healthcare professionals. As a result, quality of care could be improved by better utilization of allied health expertise. Next steps: These games can raise awareness of game-playing during collaboration in multidisciplinary training sessions. Additionally, they could provide starting points to change behavioral patterns and improve collaboration between allied health- and other primary healthcare professionals. Further research is needed to test whether interventions on behavior can support changing primary healthcare.