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Promoting An Interprofessional Teamwork Culture

I recently attended the White Coat Ceremony for the Class of 2014 of the Texas Tech University Health Sciences Center (TTUHSC) Paul L. Foster School of Medicine in El Paso, Texas. I was impressed by this Ceremony that is dedicated to fostering humanism in medicine. The objective of the Ceremony is to clarify for students that the responsibility of physicians is to take care of patients and care about patients. This objective resonated with me, as a nursing professional, as it very likely would with all healthcare professionals. I was acutely aware that humanism is only one of the many threads that run through all healthcare professions. These common threads lay the foundation for the promotion of a much-needed interdisciplinary or interprofessional teamwork (IT) culture in healthcare.

An IT culture is critical because it can potentially prevent some of the 7,000 deaths that occur annually due to preventable hospital errors that have been associated with a need for improved interprofessional collaboration.1 TTUHSC has responded to this need through its Quality Enhancement Plan: Interprofessional Teamwork Initiative 2009, which offers priceless information that can be used by healthcare professionals to promote an IT culture. The overarching, long-term vision of the TTUHSC IT initiative is to establish an institutional culture that is committed to the values of interprofessional education and care, including collaboration, communication, and coordination. The IT initiative builds upon the collaborative foundation established by existing TTUHSC centers and institutes and lays the groundwork for an IT culture through a new institute, the Institute for Interprofessional Scholarship in Practice, Innovation, Research, and Education. The purpose of the IT initiative is to prepare graduates to be leaders in the dynamic healthcare environment by promoting the knowledge, skills, behaviors, and attitudes required to provide high quality, safe, individualized care for patients as members of interprofessional teams. This purpose clearly supports the institutional mission and continues the TTUHSC tradition of providing leadership in health professions education and patient care. The TTUHSC IT initiative is based on published literature on interprofessional collaboration and teamwork.

IT in healthcare is: 1) an amalgamation of the interactions among team members to provide quality, individualized care for patients, 2) the cornerstone of teamwork, and 3) founded on active and ongoing partnerships. These partnerships are often between people from diverse professions and backgrounds, who work together to solve problems and provide healthcare service.2 IT is the collaborative interaction among interprofessional team members to provide quality, individualized care for patients. IT is organized by expanding human motivation from individual goals that are pursued competitively, to focus on common goals that are pursued cooperatively. Individuals form a team through two central actions of work, thinking and doing. The two central actions of work, thinking and doing require team members to collaborate and communicate by using a shared language to solve complex problems3,4 Furthermore, team members must be cognizant of the overall objectives of the team, rather than just being responsible for individual tasks. This will allow them to function effectively as practitioners in complex healthcare environments.

The current complex healthcare environment requires practitioners to assimilate evidence-based scientific knowledge and sophisticated psychomotor skills while participating as team members. As members of the healthcare team, individuals are expected to promote safe, quality patient care through IT, communication, and coordination. IT is one of the core competencies needed for healthcare practitioners to be effective in the twenty-first century. The significance and importance of IT is also indicated by reports from several other organizations interested in healthcare research, practice, and education.6

Researchers have established that IT is critical for safe, quality healthcare and that teams make fewer mistakes than individuals, especially when the members of the team are aware of the different responsibilities of each team member.6 The Joint Commission on Accreditation of Healthcare Organizations recently reported that almost 70 percent of patient adverse events are associated with the lack of collaboration and communication among practitioners.6 Furthermore, the National Patient Safety Education Framework has reported that safe, quality patient care can only occur when healthcare practitioners know their role in an organization and understand the importance of working with other members of an interprofessional team.6 There is evidence that this can best be achieved by education of healthcare profession students in an IT culture.

The IOM has identified IT as an educational imperative, noting that graduates from health professions programs are not prepared to work effectively in interprofessional teams as new healthcare practitioners.1 A segregated approach to healthcare professional education is no longer appropriate in the current complex, technological health system. In 1993, the Pew Health Professions Commission recommended that curricula throughout the health sciences be revised to promote interprofessional teamwork.6 Unfortunately, many healthcare profession educators have not responded to this recommendation. This is evidenced by the reality that, even though most of the healthcare that is delivered today is done by teams of practitioners, training often remains focused on individual responsibilities. Members of healthcare teams rarely receive IT training, leaving practitioners inadequately prepared to enter complex health care settings.6 There is one promising development that counters this persistent challenge. Recently, multiple accrediting agencies for educational programs in the healthcare professions have written standards focusing on graduate competency to function as members of an interprofessional team.

The Accreditation Council for Graduate Medical Education has identified teamwork and leadership as one of its general competencies.6 Additionally, professional organizations have developed position statements supportive of IT education. For example, the American Association of Colleges of Nursing has identified the need for interdisciplinary education based on mutual understanding and trust.6 In a 2000 joint meeting between the Council on Graduate Medical Education and the National Advisory Council on Nurse Education and Practice, attendees recommended interdisciplinary education and practice as the main approach to promoting patient safety. Furthermore, the inclusion of IT instruction is supported by The American Society of Health-System Pharmacists and the American Physical Therapy Association.6 Unfortunately, in spite of these published standards, many challenges exist in relation to the development and application of IT educational activities.

The integration of IT educational activities into healthcare professions academic centers can be a daunting task for multiple reasons. Perceived and actual curricular challenges to the implementation of IT education activities include the following: differences in philosophy very narrow discipline-specific mission statements, inadequate knowledge of other disciplines, and value conflicts. There are also many academic organization challenges to the promotion of an IT culture to include: organizational structures, scheduling, student mix, financial reimbursement, the absence of uniform academic calendars, clinical placement issues, administrative support, faculty inflexibility, and varying geographic locations.6 However, focusing on the many impressive benefits of IT educational activities can prompt educators to overcome the aforementioned challenges and promote an IT culture.

Current healthcare environment and regulatory agencies indicate that there are many benefits of IT educational experiences that promote an IT culture for healthcare professions students and recipients of their care.7 The student benefits include: an increased appreciation of the role of other disciplines, improved attitudes toward IT, and increased learning. Faculty have identified visible and profound changes resulting from IT educational activities to include a cultural change reflecting collaboration and resilience and breaking down of traditional boundaries.6 The benefits of an IT culture for healthcare recipients include: 1) improved quality of patient care, 2) improved resource utilization and patient satisfaction, 3) decreased cost, and 4) decreased morbidity and mortality. These benefits are certainly worth the effort for all healthcare professionals to renew a firm commitment to promote a culture of IT.

References

  1. Kohn, L.T. , Corrigan, J. M. & Donaldson, M. S. (2000). "To Err is Human: building a Safer health System", ed. Committee on quality of Health Care in America, Institute of Medicine, National Academy of Science, Washington, DC.
  2. Bearbien, J. M., & Baker, D. P. (2008). The use of simulation for training teamwork skills in health care: How low can you go? Quality and Safety in Health Care, 13 (Suppl 1), i51-i56.
  3. Drinka, T. J. K., & Clark, P. G. (2000). Healthcare teamwork.interdisciplinary practice and teaching. Westport, CT: Greenwood Publishing Group, Inc.
  4. Gibson, C. B., & Zellmer-Bruhn, M. E. (2001). Metaphors and meaning: An intercultural analysis of teamwork. Administrative Science Quarterly, 46, 274-303.
  5. Daily, B. F., & Bishop, J. W. (2003).TQM workforce factors and employee involvement: the pivotal role of teamwork. Journal of Managerial Issues, 15(4), 393-412.
  6. Texas Tech University Health Sciences Center (TTUHSC). (2009). Quality Enhancement Plan: Interprofessional Teamwork Initiative 2009,Accessed July 12, 2010 at: http://www.ttuhsc.edu/qep/documents/ttuhsc.pdf
  7. Allen, D. D., Penn, M. A., & Nora, L. M. (2006). Interdisciplinary healthcare education: Fact of fiction? American Journal of Pharmaceutical Education, 70 (2), 1-2.

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