Recommendations for an Interprofessional Team

Recommendations for an Interprofessional Team

Interprofessional Teams –       Interdisciplinary collaboration is essential in creating effective health care services and improving patient outcomes.  Good communication, leadership, cooperation, mutual respect, and shared responsibility are significant components of interdisciplinary teamwork.  The purpose of the interdisciplinary team is to form a comprehensive plan of care involving all professionals currently caring for a patient in one setting (Menefee, 2014)

Team Charter Recommendations

Team Ground Rules

            Forming ground rules for how the interprofessional team will work together is a vital step before starting any collaborative venture.  Creating ground rules sets an important foundation for how the team will work together in order to achieve its goals and is a reminder of the values the team aims to maintain.  All team members should be involved during the creation of the team’s ground rules (Evidence-Based Decision Making (EBDM), n.d.).

            Methods for establishing ground rules and expectations are:

1. ask each team member to write down what expectations are of one another,
2. going around the group, ask each member to share one item on his or her list (list items on a flip chart),
3. combine and refine the suggestions,
4. discuss whether the suggested rules are comprehensive (are any missing),
5. all team member must agree to abide by selected ground rules,
6. document ground rules so a written record is available, and
7. occasionally review the ground rules to be sure they still pertain to the team goals.

In addition to setting the ground rules, the team must also decide the appropriate consequences when a member does not follow an agreed up rule (EBDM, n.d.).

            Team collaboration in patient care is used in managing different opinions and suggestions among interprofessional disciplines.  Although all member of the team have the goal of collaboration, establishing an atmosphere that supports mutual respect and shared decision-making is a challenging task.  Instituting a formal set of ground rules will help facilitate collaboration among team members by launching a path for constructive behavior (Rebori, 2000).  Patients now have an increasing number of chronic illnesses that require the care and input of several interdisciplinary departments ranging from the physician to the social worker.  In order to improve outcomes for patients and reduce the number of errors, all members responsible for any part in care must be able to successfully collaborate.  This applies to any situation involving two or more staff members responsible for the care of a patient, ground rules need to be established in order to create common goals, how to achieve them, and maintain respect among all team members.  Ground rules set those standards for everyone that are a part of the health care team to follow when discussing patient care amongst the group (Hepp, Suter, Jackson, et al., 2015). Recommendations for an Interprofessional Team

Conflict Resolution Strategies

Communication among the health care team is important, whether it is verbal, written, nonverbal responses, or electronic (Boykins, 2014).  Conflict and breakdown in communication within interdisciplinary teams has been an issue for the past 30 years.  The arising number of specialties in health care such as social work, speech and occupational therapy, case managers, psychologists, etc., deficits in communication between all departments is increasing.  Addressing these barriers is vital to improving patient care and employee relationships.  The top identified barriers interfering with effective communication among interdisciplinary team members are team conflict and conflict resolution (Brown, Lewis, Ellis, et al., 2011). 

            Communication barriers among healthcare professionals needs to be accessed and ways of improving the current process developed.  All professionals on the healthcare team have to be willing and capable of understanding the different styles of communication used by other team members.  All interdisciplinary team members are responsible for communicating clearly and efficiently with patients, families, and other healthcare professionals during transition of care; and use information technologies during transition of care as (Boykins, 2014).    

Team strategies for conflict resolution should include a confidence in the managers of the organization to facilitate communication and resolve conflicts.  One study suggests engaging all members of interdisciplinary teams to participate in developing conflict resolution policies and procedures and implementing them throughout the organization to assist with improving communication among the health care team (Brown, et al., 2011). Recommendations for an Interprofessional Team

 The study also found that open and direct communication, a willingness to seek out solutions, and showing respect to other members of the health care team could help break down the barriers of resolving conflict.  Being open, honest and sincere toward the person the conflict is with can produce open communication and improve problem-solving skills.  Another step toward improving communication and conflict resolution among the team is the ability to assume responsibility for contributing to the conflict and being able to admit fault by apologizing.  Humility and respecting the opinion of other parties involved in the conflict facilitated resolution and was associated with the ability to listen to all parties, which created better communication and bettering patient outcomes  (Brown, et al., 2011).

Leadership Issues

In health care, leaders are seen as a crucial part in influencing clinical team practice, patient safety and quality care.  Empowering effective interprofessional teamwork in a clinical practice is a challenging and complex task.  Team leader are expected to have the skills and knowledge to assist members from different professions learn how to integrate each person’s attitude, wisdom, and professional and regulatory obligations into team practice (Chatalalsign & Reeves, 2014). Recommendations for an Interprofessional Team

Strong leadership provides a vision and practical means required for employing innovative ideas among team members.  A lack of clear leadership is negatively associated with team support for innovation, commitment, and willing to participate.  The team leader sets the tone or culture of the team by engaging and motivating all members.  Ensuring that communication is free flowing and that all members feel supported and able to participate is the main job of the team leader.  Without a leader, a safe environment for constructive disagreement and conflict resolution is unreachable (Sims, Hewitt, & Harris, 2015).

Hierarchy within healthcare causes a conflict between team members in regards to leadership.  Often times, team members expect physicians to be the team leader and expressed a frustration when a physician was not the leader.  In some cases, physicians did not want the leadership role or using the status of being at the top of the hierarchy chain to encourage participation of other members (Sims, et al., 2015).

The team must collaboratively identify a leader in order to establish a clear direction and vision for the team, and is able to listen and provide support and supervision to all members.  Lacking a clear leader can cause power battles among team members.  This is counterproductive to patient care, creating poor communication and attitudes, decreased participation, and frustration among members.  Patient may wind up with longer hospital stays and a decline in overall health outcomes (Sims, et al., 2015).

Communication and Collaboration Strategies Recommendations for an Interprofessional Team

Best Practices for Team Collaboration

The Institute of Medicine has listed the concept of effective interdisciplinary collaboration as one of its 10 rules for improving health care.  Unfortunately, there is limited evidence for an unfailing development to create and sustain an environment that advances interdisciplinary teamwork and collaboration (Bender, Connely, & Brown, 2013).  The team’s goal is to enhance collaboration and to build a culture of patient safety.  Teamwork influences the efficiency of patient safety, care, and clinical outcomes has been identified as a strategy for improving this process by decreasing adverse events and increasing safety.  Applying evidence based strategy to the group, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), will help to guide members to implement better communication and collaboration (Thomas & Galla, 2013).

To improve the culture of collaboration, participation from all team members is required in order to work together as an efficiently with the goal of attaining desired patient care and averting harm.  TeamSTEPPS tackles leading causes of medical errors, increases safety, quality, and productivity in health care.  It is supported by more than 20 years of research and has been tested in several hospitals across the country (Thomas & Galla, 2013). Recommendations for an Interprofessional Team

In order to have positive implementation, the organization must align its goals with the team’s objectives and safety aims.  TeamSTEPPS provides an infrastructure that includes executive level administration as well as interdisciplinary staff to participate in patient collaboration.  Each member of the team will contribute knowledge and information with the creditability, expertise, and motivation to create improved patient care (Thomas & Galla, 2013).

Some of the successful communication tools and strategies that have been developed by other hospitals using TeamSTEPPS are:

• STEP – tool for monitoring circumstances in the delivery of care.  Status of the patient; team members; environment; progress towards goal.
• SBAR – structure for all team members to effectively communicate with each other.  (Situation, Background, Assessment, Recommendation).
• Huddle – problem solving; impromptu planning to re-establish situation responsiveness and supporting plans already in place while assessing the need to modify the plan.
• Check back – employing closed-loop communication to make sure the information communicated by the sender is comprehended by the receiver as intended (Thomas & Galla, 2013)

            Another evidence-based strategy for interprofessional collaboration is the Menefee Model (MM) and is based on the acceptance that evidence-based plans of care without interdisciplinary team collaboration and patient engagement contribute to poor patient care.  The MM depends on care plans that are consistently used to create and maintain interventions based on the patients’ needs.  All team members use the Interdisciplinary Plan of Care (IPOC) during daily rounds.  On a daily basis, the nurse discusses what the patient’s goals are and then it is documented in the patient’s own words where it is then shared at interdisciplinary rounds without any clinical interpretation.  The patient and the family are the center of the interdisciplinary team when planning interventions and goals.  The team, lead by the nurse, meets on a daily basis to review and collaborate on the patient’s goals and necessary interventions.  Transition of care to home or another facility is discussed and agreed upon by the patient and all the team members in order to facilitate a smooth transition of care.  Mandatory attendance to the plan-of-care rounds is required by all disciplines involved in the care of the patient.  In the course of collaborative rounding, the total picture of the patient is seen which creates positive outcomes (Menefee, 2014).

Benefits and Limitations of Various Forms of Communication

            Traditionally, interprofessional communication has relied on numeric paging systems that created many problems.  This form of communication is limited with a one-way receiver of information and causes repeated interruptions that can contribute to frustration among clinicians and an increase in medical errors.  Communication inadequacies, which lead to loss of time for clinicians also increased length of stay for patients and cost hospitals up to 12 billion dollars per year (Wu, Lo, Rossos, et al., 2012). Recommendations for an Interprofessional Team

            Using information technology to create effective interprofessional communication has been proven to improve care.  Recommendations include the use of email, smartphones, texting, and the electronic medical record (EMR).  The evolution of technology is supposed to reduce the burden of synchronous communication and interruptions.  Research on the effectiveness of new means of communication is inadequate by an insufficiency of information regarding communication between health care providers.  To date, most of the research conducted has looked at communication between the patient and provider (Smith, Quan, Morra, et al, 2012). Recommendations for an Interprofessional Team

            The introduction of the smartphone in hospital units allows for nurses and other clinicians to communicate by telephone as well as email.  Research showed some communication between interprofessional team members had changed to email, but the majority of communication remained telephone calls or face-to-face.  The way in which communication technology was used also depended on the users level of comfort with the technology.  Another concern was the issue of maintained confidentiality and privacy.  Hospitals need to maintain secure Internet systems to prevent patient information from being stolen.  Email responses decreased the number of interruptive phone calls for non-emergent issues between nurses and doctors.  The downside was for clinicians to decide whether information was urgent or if it could wait.  Emails also lacked the nonverbal cues and created more misunderstandings than verbal communication.  Guidelines need to be established to determine the appropriate response type for different clinical situations that balances the needs of the nurse, the needs of the patient, and physician workload (Smith, et al., 2015).

            As technology has progressed, patients’ medical records and documentation of care has moved to electronic systems.  The EMR offers more efficient, standardized way of charting, and enables immediate inclusion of information into the patient chart.  EMRs offer a useful tool in promoting health and preventing disease.  Providers are prompted to order needed tests, procedures, or consults to monitor and improve patient outcomes.  Patient privacy is a concern with use of the EMR.  The ease of transmitting patient information electronically can be easily compromised if the organization does not implement safeguards to prevent this (Furst, Finto, Malouf-Todaro, et al., 2013). Recommendations for an Interprofessional Team

Conclusion

            As health care continues to evolve, quality and safety will always be a major goal of the organization.  Communication whether it is written, verbal, or electronic plays a major role in achieving theses goals.  The health care team members need to be able to successfully communicate and work together to make cooperative decisions that are patient centered and promote positive patient outcomes (Wagner, Liston, & Miller, 2011).  Diverse skills and knowledge among the team members increases opportunities for collaborative care and informal learning, which aid in advancing patient care.  Good communication skills also improve the team members ability to resolve conflicts, promotes trust and loyalty among each other, while providing a welcoming environment that encourages the sharing of ideas and interdisciplinary collaboration (Groves, 2014).

Recommendations for an Interprofessional Team