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Storming the gates of interprofessional collaboration

Bethea, Dorothy Peterson EdD, MPA, OTR-L; Holland, Cecil A. Jr. EdD, PhD, RN; Reddick, Bobbie Kearns EdD, MPH, RN

Nursing Management (Springhouse): September 2014 - Volume 45 - Issue 9 - p 40–45
doi: 10.1097/01.NUMA.0000453272.11253.01
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This type of collaboration is the way of the future; are you aware of its benefits for leaders?

At Winston-Salem State University in Winston-Salem, N.C., Dorothy Peterson Bethea is a professor and chair for the graduate department of Occupational Therapy; Cecil A. Holland Jr. is an associate professor and assistant dean of Admissions, Student Affairs, and Program Effectiveness for the division of Nursing; and Bobbie Kearns Reddick is an associate professor for the division of Nursing.

The authors have disclosed that they have no financial relationships related to this article.

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Healthcare's complexities make it difficult to provide comprehensive solutions across all disciplines.1 Managers know that collaboration is a key element in handling intricate and ongoing issues and operations in any organization. Some have suggested that these growing complexities make it necessary for more interdependence among healthcare professionals. An interprofessional approach enables persons from different disciplines to share unique perspectives to achieve common goals.1 Thus, it's important to gain a better understanding of factors contributing to interprofessional collaboration.2

In recent years, interprofessional collaboration has garnered much attention in clinical arenas with interdisciplinary teams related to patient care.1,3,4 Consequently, it's important that factors contributing to successful interprofessional collaboration be understood as disciplines work together to achieve common goals. Literature suggests that stronger collaborative relationships across healthcare disciplines are associated with improved patient safety, quality of care, and outcomes.5,6

Nurse leaders need to be cognizant of the importance of interprofessional collaboration and its influence on leadership and regulations in healthcare. The American Association of Colleges of Nursing (AACN) created a vision to communicate the importance of shaping future changes to the ongoing development of the nursing profession and to the quality of outcomes in patient care. The vision emphasizes essential core competency domains for interprofessional collaborative practice. These domains include values/ethic for interprofessional practice, roles/responsibilities, interprofessional communication, and teams/teamwork.7 Integrating the knowledge of interprofessional collaboration and implementing the interprofessional collaborative practice competency domains, the nurse leader can create an environment where interprofessional collaboration is standard practice.

For example, with the emphasis on integrated healthcare fostering interprofessional collaboration in practice and leadership, nurses are promoted as full partners and team leaders with physicians and other health professionals. Nurse-led multidisciplinary teams must be strategically coordinated to carry out an individualized care plan that improves the patient's health status. Collaboration is expected when developing standards of care, and is promoted with outcomes-focused research. Nurse leaders must comprehend the scope of practice of other disciplines to facilitate effective communication in care team meetings, market services, and contribute to policy development. As policymakers promote the consolidation of care and reimbursement based on combining services, all healthcare providers must comprehend the ramifications to the related services or disciplines.

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Forging a team

The concept interprofessional collaborative practice described by the World Health Organization and adapted by the AACN is “when multiple health care workers from different backgrounds work together with patients, families, caregivers, and communities to deliver health care.”7 Both organizations support the development of collaborative practice and encourage collaborative patient-centered approaches.

In the 2010 Institute of Medicine and Robert Wood Johnson Foundation Future of Nursing report, it's suggested that there's a necessity to transform healthcare systems in which “interprofessional collaboration and coordination are the norm.”8 The Affordable Care Act established the Center for Medicare and Medicaid Innovation to test creative means for delivering care, such as bundling services delivered by several providers.8 This also promotes the need for collaboration. Nurse leaders can help create the culture that fosters and encourages collaboration between healthcare disciplines and assist in operationalizing collaborative strategies and modeling interprofessional collaboration through joint efforts in practice, research, education, and service.

Collaboration is defined as “conveying ideas by sharing, and implies collective action oriented toward a common goal, in a spirit of harmony and trust.”2 In healthcare, collaboration refers to individuals “working together, sharing responsibilities for solving problems and making decisions to carry out plans.”9 A systematic review of 70 articles describes collaboration as dynamic and includes sharing partnerships, interdependence, and power.2 Many researchers have described sharing as essential to collaboration, including shared values, data, decision making, planning, and intervention, along with sharing of each discipline's perspectives and healthcare philosophy. For example, sharing accurate patient information, medical records, test results, and care plans among healthcare professionals is fundamental to coordinated care.

The term partnership refers to disciplines working cooperatively in a collegial-like relationship. “Each partner must be aware of and value the contributions of the other professionals.”2 Awareness of others' knowledge, skills, and perspective is valued. Interpersonal skills such as mutual respect, trust, and effective communication are necessary attributes for success. In the partnership, different disciplines are recognized as making unique and important, yet complementary, contributions to the process.7 Knowledge of key partners' scope of practice will help all involved comprehend each member's full parameter of skills and range of expertise—and his or her limitations.

Interdependence denotes that “the achievement of desired outcomes would not be possible if each discipline acted independently.”9 Collaboration requires that professionals be interdependent rather than act autonomously. The expertise of other disciplines is needed as complex healthcare problems emerge. When people come together as a team, synergy emerges, and individual contributions are maximized, helping to achieve desired outcomes. Interdependence leads to collective action and effective decision making.2,10 Today, many facilities operate using the concept of multidisciplinary and transdisciplinary teams where some cross-training may occur in some shared areas to better utilize manpower.

Power is perceived as shared among team members and is characterized by simultaneous empowerment of those participating in the collaboration. Power is based on knowledge and expertise rather than titles, and the team recognizes and utilizes that expertise, giving legitimacy to the process.2 The collaboration builds on this perspective, and team members work together on professional activities, flexibilities, and collective ownership of goals by pooling resources and knowledge to resolve common challenges. Evidence of shared power might be the degree to which team members have input into how the team carries out its purpose, and recognizing opportunities to assume leadership or essential roles on a project or an event based on individual skills level.

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Start to finish

Effective interprofessional collaboration hinges on developing an efficient and useful team. An effective interdisciplinary team is essential from the beginning of any collaborative process and throughout the partnership. Team development employs team-building strategies to facilitate communication and interactions among team members. Using a team development process, a group transitions to an effective team, which fortifies the partnership and interprofessional collaborative efforts.

The initial stage of team development begins with forming. This stage of development may be short lived; however, it's critical in the development of a meaningful partnership. Team members engage in discussions about the nature of the work to be performed. Many questions surface at this stage regarding the purpose of the team, and much sharing of information occurs. It's important to develop clear structure, expectations, roles, and outcomes to build trust among team members because trust is important in all interprofessional collaborations.11

As the relationship develops, partners become familiar with one another and begin discussing a shared vision and interdependence. This represents the “storming” stage of team development. It isn't uncommon for members to experience conflict and frustration at this stage of the partnership. It's important that team members reevaluate and/or redefine the tasks, goals, and roles of each member to move beyond the frustration and confusion so often seen during this stage.11

As the work of the team develops into productive actions, team members become more industrious in their work and outputs. Conscious efforts to resolve problems and achieve group harmony are evident at this juncture, known as the “norming” stage. Moreover, differences among members are appreciated, valued, and used to enhance the team's performance. At the “performing” stage, appreciation and excitement are experienced as the team realizes its shared vision, mission, and goals. A tremendous feeling of satisfaction and power is evident at this stage of team development. Often a celebration is in order.11

The “ending” stage of team development represents the termination of the team and its work. At some point in time, most teams will experience an end. The ending stage is as important as any other stage of the team development process. Many emotions and feelings may surface during this stage. Team members should acknowledge the ending or transition to validate the accomplishments, outputs, and outcomes of the interprofessional collaborative effort. Evaluation of the team's work and processes is crucial at this juncture.11 Although this process is important in the development of new teams for short-term projects, it has far reaching implications and success with teams engaged in long-term projects or where healthcare teams are the norm.

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Achievements and challenges

Although the literature points to the importance of interprofessional collaboration, even under the best of circumstances it presents challenges. Therefore, members of the team should expect to experience both achievements and challenges. A successful endeavor can occur with minimal obstacles if the team interactions address mutual needs and goals, if there's an established mechanism for sharing information, and if there's a commitment to solve or address common problems or issues.

Advantages: There are many advantages to developing interprofessional collaboration. First and foremost, this allows members of the team to increase its knowledge of the roles, skills, competencies, and similarities and differences of team members and thus cultivate relationships that otherwise may not have developed. A second advantage is collective responsibility where all partners share their expertise and are responsible for providing the information, materials, financial resources, and/or manpower that are fundamental to the process. A third advantage is improved communication between professionals. Sharing of information and discussions contribute to better understanding of the language and nuances of the different professions, respect for the communication process, and improved outcomes. A fourth advantage is improvements in patient safety. By working together collaboratively, healthcare professionals create an environment ripe for improved patient safety and better quality of care. A final advantage is the collegial relationships established and maintained; these relationships are important as teams continue to collaborate on other issues important to all disciplines.

Challenges: Sometimes, the most difficult challenge is identifying professionals interested in participating on an interprofessional team. This is often due to lack of contact and working with other disciplines; race, gender, or class-based prejudice; or traditions/professional cultures, particularly medicine's history of hierarchy. A major challenge to interprofessional collaboration is often territoriality, in which the members of the group protect the scope and practice of their particular profession in regard to identity, autonomy, and accountability.12 However, this territoriality is often due to a lack of knowledge of other professions, a lack of contact and/or communication with other professions, and fear of losing control.13 Another critical challenge is the difficulty in developing clear goals and expectations for the collaboration. These result from a lack of clarity, challenge, commitment, feedback, and task complexity. An additional challenge is the necessity of a commitment of time to meet, discuss, and share in the group process.

Strategies for overcoming challenges: Although challenges exist in any interprofessional collaboration, learning about and understanding other members of the team from a professional perspective is a very important step in the process. To effectively function as a high-performing interprofessional team, it's critical that all members have a clear understanding of the interprofessional purpose, vision, and goals, as well as an understanding and appreciation of each member's contributions to the collaborative effort. As a leader, it's incumbent that you provide each member of the team an opportunity to share their discipline's perspective, thereby offering all members of the team a chance to learn more about each of the professions.

Moreover, in an interprofessional collaborative process, rotating leadership and responsibility ensures positive team interactions and commitment. Interprofessional teams operate more efficiently and effectively when ground rules are established. As a leader, providing structure to the meeting and reporting processes are crucial. Meeting times should be established to accommodate the team members' schedules. Ground rules specific to meeting times and length, as well as members' behavior, timely reporting processes, and so on are necessary in terms of creating an environment that supports the interprofessional collaborative process. By implementing these strategies, teams can create an atmosphere that promotes successful negotiations and collaborations.14

To effectively engage in interprofessional collaboration, the nurse leader must understand the effects of collaboration on patient outcomes and healthcare quality. These effects have been well documented in the literature.15-17 The nurse leader must also understand the impact that interprofessional collaboration has on job satisfaction and team cohesiveness. Healthcare organizations benefit from effective interprofessional collaboration in terms of more efficient work processes, more satisfied healthcare providers, reduced healthcare cost, and greater responsiveness of healthcare needs, which improves the quality of healthcare and healthcare outcomes.15,16,18,19

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Alignment for the future

Interprofessional collaboration has gained attention in healthcare organizations and educational enterprises across the nation. This is mostly attributed to the trends of patient-centered care, maximizing human resources, and accountability for quality cohesive care. Engaging in interprofessional collaborations requires attention to the development of effective partnerships and teams. Incumbent in team development are the concepts of sharing, partnership, interdependence, and power. All of these ideas are essential factors that contribute to successful interprofessional collaboration.

Advantages attributed to interprofessional collaboration include collective responsibility or appreciation for expertise of other team members, improved communication, cultivation and sustainable collegial relationships between partners, and formation of an effective healthcare team. Challenges include buy-in and belief in the process, territoriality related to scope of practice, agreement among disciplines on common goals, and the time commitment required to achieve success.

Having gained momentum, interprofessional collaboration is an important concept necessary to quality healthcare on many levels. Professional programs emphasize interprofessional education in their curriculum. In healthcare organizations, contribution of a well-organized team makes the most complex process surmountable. Disciplines committed to the collaborative process tend to have a holistic view of healthcare delivery by sharing knowledge and learning together without professional and defensive boundaries, which contributes to better team work, student experiences, and improved comprehensive healthcare outcomes.

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