“It is no longer enough for health workers to be professional. In the current global climate, health workers also need to be interprofessional.” World Health Organization 2010.
Andrea, an RN, looked forward to the weekly interprofessional team meeting on the 20-bed unit of her hospital-based skilled nursing facility. The group, made up of a geriatric physician, nurse practitioner, social worker, dietitian, registered nurse, speech-language pathologist, and physical and occupational activities therapists includes patients in the formulation and review of care plans. Because patients join the group to discuss their cases only, the members must adhere to a carefully timed agenda. This morning, they all arrive on time — as usual.
Andrea discusses the progress of the first patient, Ted, whose goals include ambulating 30 feet on the unit twice a day and performing activities of daily living (ADLs) with minimal assistance from one person. The team members have a stake in his success because they have all personally cared for him. They had planned to discharge Ted to a personal care facility, but today they discover that he has ambulated only three times during the past week — less than 20 feet each time — and he has been able to perform ADLs only with maximum aid from one to two caregivers. The social worker begins to question the feasibility of the discharge goal while the physical therapist voices surprise at the poor ambulation since Ted regularly walks 50 feet in the physical therapy department. But Ted offers his perspective that he’s too tired to ambulate after therapy and that the very busy nurses asked him to walk at the worst times. He also reveals that in a tired state he is not able to communicate effectively about his needs. He states that the nurses become impatient, doing things for him before he has a chance to do them for himself.
Rather than reacting defensively or personally, Andrea attacks the problem. As a nurse, she knows that Ted may feel frustrated, tired and not in control. She asks him, “When are the best times for walking on the unit? Which activities do you need more time for?” Ted gives surprisingly motivated answers, stressing his wishes to go to a personal care facility. In fact, his enthusiasm convinces the group. The physical, occupational, and speech language therapists agree that the goal is realistic; the social worker reverses his questioning of the goal, promising to continue with the original placement plan.
If the team members had not met, a satisfactory conclusion may not have been reached. If the nurse had reacted negatively, the patient’s wishes might have been subjugated to personal agendas. Without the skilled input of the team players, the outcome might have been very different. Although each professional brought a unique perspective to the meeting, they shared a set of team skills.
Research has shown that interprofessional teamwork, also referred to as interprofessional collaboration, proves to be more effective than care delivered through individual professional contributions. An interprofessional approach can be defined as coordinated care of patients by a collaborative team of professionals who come together to provide their expertise to the patient’s plan of care. Advocates also define this practice as enhanced collaboration, where each professional’s contribution is valued equally.1 The team approach to patient care has numerous advantages, which include better planning, more effective clinical services, services that are more responsive and patient focused, and reduced duplication and fragmentation of care.1 Additional benefits include higher satisfaction among stakeholders, enhanced patient outcomes and increased patient satisfaction with healthcare delivery.1
Healthcare professionals tend to be more satisfied in their roles when they engage in teamwork. This may be because learning occurs through the exposure of team members to the skills of others from different disciplines. There’s also higher work satisfaction relating to the social support embodied in the team. Stress levels of staff may be reduced, resulting in improved job satisfaction, higher motivation and better mental health. Some researchers have noted a higher level of empowerment among team members than in those of control groups. The healthcare organization ultimately benefits from satisfied employees, control of healthcare costs and reduced staff turnover and improved retention.2 (Level B), 3 (Level B), 4 (Level B)
Changes in healthcare funding (resulting in reductions in staff) and regulation (increased requirements for documentation) have led healthcare organizations to find ways to produce improved outcomes more efficiently. Additionally, consumers are more informed and involved in demanding improved outcomes. This highlights the need to have effective working groups for planning, evaluation and provision of care.5
Teams pervade all healthcare settings, especially nursing homes and hospital-based nursing facilities, where interprofessional care planning is mandated.6
The Joint Commission standards reinforce these practices by emphasizing interprofessional care planning in hospitals as well.7
The American Nurses Association cites collaboration among the patient, healthcare providers and the family for care plans and professional performance in its Standards of Clinical Nursing Practice
The Interprofessional Team
Multidisciplinary, interprofessional and transdisciplinary team designations, often used interchangeably, refer to different groups in healthcare that operate with varying degrees of interaction among team members regarding patient care responsibilities. A multidisciplinary team comprises members from a variety of disciplines, each providing separate, discipline-oriented input to solving a problem. An interprofessional team is composed of members from various practices who interact, communicate and share with team members information that’s contributed from their own disciplinary perspective. Generally they collaborate to solve problems that are too complex to be solved by one discipline.9,10 Transdisciplinary teamwork crosses disciplinary boundaries with a more holistic approach to problem solving to develop innovations and new paradigms.10
Aspects of successful teams can be expressed with the acronym TEAMWORK:
- Team — Good selection of mature and flexible team members coupled with coordination of efforts and conflict management
- Enthusiasm — Commitment of team members
- Accessibility — Accessibility of the team to each other geographically or via electronic support, resulting in cohesiveness and collaboration of members
- Motivation — Incentives and a feeling of contribution for team members
- Workplace — Organizational support
- Objectives — Direct confrontation of problems and sharing of a goal or vision
- Role — Role clarity with cooperation and consensus decision making
- Kinship —Good communication and personality fit
The use of these principles can help in developing teams that are innovative and
creative in reaching team goals.
Teamwork may mean different things to different disciplines. The World Health Organization
has defined a “healthcare team” as “a group who share common health goals and common objectives, determined by community needs, to the achievement of which each member contributes, in accordance with his or her competence and skill and in coordination with the functions of others.”11
Researchers conducted a study that applied two tests, the “test of necessity” and the “test of sufficiency,” to identify teamwork’s defining attributes. The attributes involve “concerted effort, interdependent collaboration, and shared decision making.” Certain events must be present before teamwork can occur. These events, or “antecedents,” include:4 (Level B),
- Involving two or more healthcare professionals whose backgrounds/skills are complementary
- Ensuring that team members share information and maintain open communication
- Making certain that the role of each professional on the team is well understood
- Ensuring there are common health goals
How effectively a team accomplishes its goals depends on how well the members are able to work together. Expertise and emotional intelligence
are key factors contributing to the effectiveness of the group. Expertise includes all areas such as clinical, technical, social and interactional. Emotional intelligence involves self-awareness, self-management, social awareness and social skills. Emotional intelligence is the basis for interprofessional working relationships. The members of an effective team are able to balance emotional expressiveness with emotional restraint. They maintain a client focus and work together to achieve outcomes. Diversity is essential in interprofessional teamwork. Differing expertise, complementary skills and differing perspectives are needed to address complex needs. Selecting a group of individuals who have the requisite skills and can work cohesively together can be a challenge. It cannot be assumed that professionals are always able to be objective in their working relationships.12 (Level B)
Key Factors For Group Effectiveness
In the context of the cultural diversity of the healthcare team
, managing a multicultural team may present a special challenge. The key is to recognize that conflict can arise within the team because of cultural differences and that intervention may be needed to keep the team on track. Communication difficulties can produce barriers to effective team functioning by interfering with sharing of information or creating conflict due to misunderstanding. Strategies for dealing with cultural conflicts within the team include:
- Open acknowledgment of the cultural differences
- Structuring work to engage everyone
- Setting ground rules for the group early in the process
- Removal of a team member if other strategies have failed
Best results are tied to conflict resolution at the team level, where members are able to think through challenges and come up with solutions of their own.13 (Level B)