Module Components

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NURS 450 - RN to BSN Transition: Implications for Practice, Policy and the Profession

Module 11: Interprofessional Teams

Key Components of Highly Effective Interprofessional Teams

A team is the structure and teamwork is the function (Finkelman, 2019).  In healthcare organizations, the “work group” is referred to as a team rather than a group.  Interprofessional teams are composed of health care professionals and support staff who collectively have the expertise, knowledge and skills needed for a specific task or activity.  Team members have clear roles and responsibilities, a shared vision and purpose, and are collectively accountable for performance and outcomes.  One quality of these teams includes mutual responsibility for their own success as well as for the success of team members.  Interprofessional team-based care is the goal. What does this mean? “Interprofessional team-based care is care delivered by intentionally created, usually relatively small work groups in health care who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients (e.g., rapid response team, palliative care team, primary care team, and operating room team)” (Interprofessional Education Collaborative, 2016, p. 8) .

We know that healthcare professionals will work in teams no matter the setting, the type or organization, and the patient population. Effective teams however, will exhibit three critical competencies that aid them in achieving their goals: “communication, collaboration, and coordination” (Finkelman, 2019, p. 308). How do these reflect the IPEC competencies?

Communication is an integral part of the work within the health care delivery system.  It is a skill nurse’s need in daily interactions as they work with patients, families, co-workers, other health care providers, administrators and managers, support staff, community agencies, etc.  The major goal of communication is the exchange of information that assists in attaining patient, organizational and provider goals while controlling costs.  Nurses need to understand the communication process, and use it assertively to promote patient centered care and the work required to achieve identified outcomes.  Communication is the process of sharing information or a message between one or more individuals (Finkelman, 2019).

The Joint Commission (2007) stated, “Ineffective communication is the most cited category of root causes of sentinel events (p. 2). Likewise Tiwary et al. (2019) reviewed that poor communication by health care professionals may lead to life-threatening complications: missed diagnosis in women treated for rheumatoid arthritis and a delay in treatment in a man suffering with ileocecal tuberculosis. “Poor communication is a failing of the health system, not of patients” (Butler & Sheriff, 2021, p. 67).  “Communication failures are both an independent cause of preventable patient harm and a cross-cutting contributing factor underlying other harms. Transitions of care (i.e., between care areas or shift changes) in acute care, settings are leading opportunities for communication failures directly causing patient harm. They are high-risk interactions in which critical information about the patient’s status and plan of care can be miscommunicated, leading to delays in treatment or inappropriate therapies" Rosen et al., 2018, p. 3).

If interested, read the report by Butler and Sheriff, titled How Poor Communication Exacerbates Health Inequities – And What to do about it, on the following link https://www.brookings.edu/research/how-poor-communication-exacerbates-health-inequities-and-what-to-do-about-it/

Examples of effective communication among nurses may include:

1. Uses clear, concise written and verbal communication skills to care team, including use of computers, transcription and shift report. For example SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition (IHI, 2021)
2. Communication demonstrates teamwork, safe, accurate handoffs, attention to detail & competent computer skills.

Collaboration is a complex process that builds on communication.  Collaboration in health care settings is more than simply cooperation, negotiation and compromise. It involves working jointly with other professionals who share responsibility to improve a patient’s health status or to solve an organizational problem.  Collaboration is a process that recognizes the expertise of others within and outside the profession and referral to other providers as appropriate.  Collaboration focuses on solving a problem, involves direct interaction with two or more people (e.g., a patient and/or provider) working toward this goal.  Key concepts include partnership, interdependence, collective ownership and responsibility.  The health care team is an example of ideal collaboration.  In a true collaborative team, responsibility is shared and “turfs” are nonexistent. Collaboration allows and promotes autonomy, professionalism, self-confidence, and improved patient outcomes.  Benefits include improved client focused care, better educated clients, client involvement in decision-making, overall improved quality of care, emergence of collegial relationships, increased job satisfaction, and decreased nursing turnover.  Decision-making is a team effort; there is trust, respect, consideration of others’ opinions, and clinical expertise.  When health care professionals across disciplines observe and participate in patient care conferences, they enhance the development of teamwork and collaboration skills.  

Wei et al., (2019) state that “collaboration among healthcare professionals is essential in creating a synergy to provide efficient, safe, and high-quality patient care. Interprofessional collaborative practice (IPCP) has become a core measure in promoting healthcare practice” (p. 324).  A single hospital or ambulatory care visit may require collaboration among an interprofessional group of clinicians, administrative staff, patients, and their family members. Multiple visits often occur across different clinicians working in different organizations. Ineffective care coordination and the underlying suboptimal teamwork processes are issues that we must all address. “The coordination and delivery of safe, high-quality care demands reliable teamwork and collaboration within, as well as across, organizational, disciplinary, technical, and cultural boundaries” (Rosen et al., 2018, p. 1).

Examples of effective collaboration may include:

1. Before going home, the nurse reviews important information with the patient and their daughter, who is taking the patient home. Physical therapy (PT) and Occupational Therapy are involved, as the patient will need home PT and OT services. Nursing, PT, and OT develop a comprehensive patient care plan.
2. Upon admission to the skilled nursing facility (SNF), the nurse requests a physician’s order for an interdisciplinary care planning meeting for the new resident. The nurse shares this information with both the resident and their partner. The nurse, in lay language, explains that the interdisciplinary team of health care professionals will assess, coordinate, and manage the resident’s comprehensive health care, including his or her medical, psychological, social, and functional needs.

Coordination is the process of working to see that the pieces and activities fit together and flow as they should and coordinated care is the “deliberate organization of patient care activities with information sharing” (Finkelman, 2019, p. 326).  “Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care” (Agency for Healthcare Research and Quality [AHRQ], 2018). If interested, read more about coordinated care on the AHRQ web site at https://www.ahrq.gov/ncepcr/care/coordination.html

Effective coordination requires working across services that are complementary and perhaps across clinicians or settings to ensure quality care across patient conditions, services and settings over time (IOM, 2001). The purpose of care coordination is to establish and support a continuous healing relationship, enabled by an integrated clinical environment characterized by a proactive delivery of evidence based care and follow up (IOM 2003).  Coordination requires that the nurse understand patient needs and the resources that are available to meet these needs.  An awareness of the association of costs and services are part of coordinating patient care.  Coordination occurs to ensure that something happens such as the provision of services.

Examples of effective coordination may include:

1. Implementation of clinical pathways to decrease the 30-day readmission rates.
2. Implementation of the Patient-Centered Medical Home (PCMH) Model of Care within the current organizational structure.

Interprofessional communication and collaboration are terms used throughout the American Association of Colleges of Nursing The Essentials: Core Competencies for Professional Nursing Education (2021).  The Essentials documents guide the development of nursing education and curriculum for the 21st century (AACN, 2021).  For example, the Essentials set the expectations that, RNs must be able to articulate the nurse’s role within an interprofessional team in promoting safety and preventing errors and near misses (AACN, 2021, p. 54). So how would you do that?

The American Nurses Association (ANA) Scope and Standards of Nursing Practice (2021) identify the need for communication, collaboration and coordination. Using the ANA's general standards of practice, the nursing process and professional practice are the focus.  Standard 5- Implementation has the new sub-standards of Coordination of Activities; learning environment that promote a positive learning and practice environment; and consultation to influence the identified plans, enhance the abilities of others, and effect change.  Professional Performance Standard 11 Collaboration reflects the shift toward from interdisciplinary teams, which usually means across health related disciplines to interprofessional teams that may include participants from any profession.