Industries as diverse as health [1, 2], aviation , manufacturing , finance , education  and the military  have identified that collaborative learning and team-based practices are key drivers of performance improvement, safer organisations and systems renewal. Yet there is limited research which demonstrates convincing models of inter-professional learning (IPL) (also titled inter-professional education, IPE) and inter-professional practice (IPP) that successfully achieve these outcomes, particularly across whole health systems. This is a substantial issue requiring attention.
This project's broad goal is to use IPL as the basis for improving IPP, which in turn is thought to lead to enhanced safety and quality of care for patients, and morale and outcomes for patients, staff and students [8, 9], across an entire health system. This means the project stands at the intersection of three industries - tertiary education, professionally-based education, and the health system, and it spans both the public and private heath sectors. Specifically, the project will achieve its overarching goal through an Australian Research Council (ARC) funded action research project to strengthen IPL and IPP across the Australian Capital Territory (ACT) health and tertiary and professional education systems.
By action research we mean disseminating findings to participants and other stakeholders, encouraging bi-directional feedback and enabling reflection to stimulate productive change and improvement in a participatory environment. The scientific innovation we aim to realise is to enhance systems-wide teamwork and collaboration through the application and testing of a new model of IPL and IPP in order to bring about profound culture change in the way health professionals work together to deliver services. The project contributes the largest, most comprehensive effort to achieve this yet attempted. We define IPL as "a collaborative, interdisciplinary education and learning process designed to produce effective, multidisciplinary patient centred care"  and IPP is the enactment of competencies required to attain this . IPL involves educating clinical professional staff (doctors, nurses and midwives, and allied health practitioners) in multidisciplinary approaches with the aim of encouraging IPP - ie, greater levels of teamwork, collaboration, knowledge-sharing and problem-solving in health settings.
The significance of IPL and IPP
Why are IPL and IPP important; how will they contribute to improvements? Why is this project significant? Previous studies, reviews and commentaries have suggested that IPL can lead to collaborative IPP amongst clinicians and clinical groups [12, 13]. This, in turn, is believed to contribute to safer and higher quality services to patients, and improved morale for staff and students [14, 15]. The literature suggests that patient care (or, outside of health care, services to customers more generally) will be improved by stronger practitioner relationships, teamwork and inter-professional communication.
Summarising this claim, we have argued that "IPL is centrally concerned with improving the way people work together so that clinicians can grow professionally, learn from others, provide support to colleagues and improve the quality of care to patients" . The putative benefits of IPL and IPP have been well documented: enhanced communication and trust amongst clinical groups , collaborative skills , reductions in between-professional rivalries , and better professional relationships . IPL is held to build team approaches , and lead to more creative, integrated services . IPL is said to help students understand how to contribute effectively with other disciplines . Establishing common educational curricula across health professional groups will logically help create common philosophies, languages, perspectives and values  and enable skills transfers across the professional silos that prevail today .
However, there have been criticisms to balance these optimistic assessments. Progress to date has been slow and uneven. Some tertiary education providers have been uncomfortable about IPL. Existing professionally-based educational structures and practices facilitate specialisation, and maintain medical, nursing and allied health traditions and unique contributions, albeit at the expense of teamwork . Others have argued that IPL and IPP can be riven with unclear philosophies, replete with muddled thinking and multiple objectives , and they might often have more theoretical potential than actual importance . The sharpest criticism comes from those who argue that IPL and IPP advocates have failed to provide strong evidence for their claims. The data supporting the proposition that IPL influences IPP to create sustained systems change is weak and diffuse, and the evidence largely comprises non-transferable case study, survey and other limited data [29, 30]. There is no level 1, randomised study showing convincingly that IPL has worked; but neither is there strong level 1 evidence showing that it does not [31, 32]. Deeper, more extensive evaluation efforts are therefore required and action research demonstrations of IPL and IPP are needed. Ideally, we would study an entire health system in a project that involved multi-methods and multiple levels; it is time to do so.
The action research project we propose addresses this crucial problem. It is hard to overestimate its importance. Health is an exemplar industry requiring effective teamwork: whenever things go wrong in health care, reports , enquiries  and studies  show that a predetermining factor is that patient care is delivered in a fragmented, isolated way, with health-care professionals having failed to collaborate effectively. Safety is compromised and quality suffers in such circumstances . Internationally, the rate of adverse events - incidents which harm patients, caused by the health care system itself - is estimated to occur in 10% of all admissions . It is well established that in the order of 18,000 Australian patients die and 50,000 patients are disabled annually and major causes include poor communication and lack of teamwork as well as tribal, non-collaborative structures . IPL and IPP are thus argued to be crucial underlying determinants of safer acute care models and improved quality of services.
The case for the project
There is a growing understanding amongst policymakers, educators and clinicians that IPL's contribution, and the enactment of IPP, are important but as yet unrealised. For example, the Health Workforce Advisory Committee of the New Zealand Government has argued: "Health practitioners must learn to work in teams whose aim is to provide safe, high-quality, integrated and well-managed care that makes best use, in the widest sense, of all the resources a community has to commit to health .... To achieve this will require changes to the way health practitioners are trained and deployed, and to the way they work" . The Institute of Medicine (IOM) in the United States of America put it this way: "Clinical education simply has not kept pace with or been responsive enough to shifting patient demographics and desires, changing health system expectations, evolving practice requirements and staffing arrangements, new information, a focus on improving quality, or new technologies .... Once in practice, health professionals are asked to work in interdisciplinary teams, often to support those with chronic conditions, yet they are not educated together or trained in team-based skills" . Canada's Commission on the Future of Health Care agrees: "If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement" . The National Health Service (NHS) in the United Kingdom has expressed a confirming view: "All health professionals should expect their education and training to include common learning with other professions" .
Quite simply, however, regardless of the favourable admonitions, no one has put a research team in the field under the right conditions (with receptive research partners, a health and related education system with a strong readiness to engage and a motivated and skilled workforce) to do this work, despite the widespread international agreement about the imperative for systems-wide IPL and IPP. We conducted a literature review on IPL and IPP  in preparation for the partnership's work together in 2005 and to design this project. This has helped position ACT Health and the partners and has laid the platform for IPL and IPP across the Territory. We uncovered 37,812 references. We subjected these primary references to a content analysis using Leximancer, a software analysis tool to create a conceptual map of IPL and IPP. We conducted a secondary refining process and excluded non-substantial, atheoretical, non-empirical and less relevant articles. The usable literature set comprised 3,765 references which were reviewed by two independent researchers, sorted into categories and further synthesised. We found no previous study of the kind we are describing here, internationally or locally. In as rigorous a way as is possible therefore we will be advancing the knowledge base in this area.