Interdisciplinary Teamwork and Collaboration -...

CHAPTER 7

Interdisciplinary Teamwork and CollaborationAn Essential Element of a Positive Practice Environment

Patricia Reid Ponte, Anne H. Gross, Yolanda J. Milliman-Richard, and Kara Lacey

ABSTRACTInterdisciplinary collaboration is critical to excellence in patient care delivery. There is a growing consensus that the basic education for all clinical profession-als should include the knowledge, skills, and attitudes required to effectively participate in interdisciplinary teams, and that health care organizations should continue this education in the practice setting. The authors examine the large and growing evidence base regarding interdisciplinary collaboration and team-work and explore the relationship between interdisciplinary collaboration and patient, workforce, and organizational outcomes. Antecedents and attributes of the construct are presented, as well as structures, models, and programs that are being implemented by health care organizations and academic settings to facili-tate and advance interdisciplinary collaboration in clinical practice.

Over the past decade, nursing and other clinical professions have embraced the principles of interdisciplinary collaboration. Within health care organizations,

© 2011 Springer Publishing CompanyDOI: 10.1891/0739-6686.28.159

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160 ANNUAL REVIEW OF NURSING RESEARCH

interdisciplinary collaboration is critical to patient care as well as strategic plan-ning and quality and safety initiatives. Within both service and academe, there is a growing consensus that the basic education for all clinical professionals should include the knowledge, skills, and attitudes required to effectively participate in interdisciplinary teams, and that health care organizations should continue this education in the practice setting. And within the research community, there is a growing focus on advancing interdisciplinary research with the understanding that this approach yields stronger idea generation, methods, and study outcomes (Woods & Magyary, 2010).

Interdisciplinary collaboration is also a central feature of many programs and initiatives advanced by professional associations. The American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program; the Malcolm Baldrige National Quality Award; the American Association of Critical-Care Nurses Beacon Award; the American Organization of Nurse Executives Principles of a Healthful Practice Environment; the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS Program; and the Institute for Healthcare Improvement/Robert Wood Johnson Transforming Care at the Bedside initiative are just some of the programs promoting standards and frameworks that advance practice and organizational cultures steeped in inclusion, shared decision making, equity, and teamwork.

Underlying this push for greater interdisciplinary collaboration is the pre-mise that safety, quality, and effi ciency in patient care delivery is bolstered by structures and processes that equalize the status of clinicians on the care team, and that promote interdisciplinary collaboration and teamwork while reducing or eliminating traditional hierarchical systems and cultures. This premise is sup-ported by research on positive practice environments conducted by Aiken and colleagues (2002, 2009), Drenkard (2010), Havens (2001), McClure, Poulin, Sovie, and Wandelt (2002), and Kalisch (2010). Additionally, the application of crew resource management (CRM) concepts in the aviation industry resulted in important understanding about human behavior, risk mitigation, safety and human factors that contribute to error. This knowledge was transferred into the health care industry following the tragic deaths of patients from a chemotherapy overdose in 1995 (Clarke & Aiken, 2003; Connor et al., 2007; Conway et al., 2007). The premise is further endorsed by a series of reports from the Institute of Medicine (IOM, 1999, 2001, 2004) that identify interdisciplinary collaboration as a key element of a culture of safety and quality improvement efforts.

In this article, the authors examine the large and growing evidence base regarding interdisciplinary collaboration and teamwork. In addition to explor-ing the relationship between interdisciplinary collaboration and patient, work-force, and organizational outcomes, it examines antecedents and attributes of


Interdisciplinary Teamwork and Collaboration 161

the construct, as well as structures, models, and programs that are being imple-mented by health care organizations and academic settings to facilitate and advance interdisciplinary collaboration in clinical practice.

LITERATURE REVIEW METHODSSeveral terms are used in the current literature to address similar concepts related to collaboration across disciplines. These include: interdisciplinary, multi disciplinary, transdisciplinary, and interprofessional. Each term was closely examined in preparation for this literature review.

Tress, Gunther, and Fry (2006) and Cronin (2008) provide defi nitions for these concepts within the context of the research process. They defi ne disci-plinary studies as those that take place within the bounds of a single currently recognized academic discipline, while multidisciplinary studies involve several different academic disciplines researching one theme or problem but with multi-ple disciplinary goals. In multidisciplinary studies, participants exchange knowl-edge, but do not aim to cross subject boundaries to create new knowledge and theory. The research process progresses as parallel disciplinary efforts without integration but usually with the aim to compare results. Interdisciplinary studies involve connections being made across disciplinary boundaries; several unrelated academic disciplines are involved in a way that forces them to cross subject boundaries to create new knowledge and theory and solve a common research goal. Transdisciplinary studies integrate academic researchers from unrelated dis-ciplines, and nonacademic participants such as land managers and the public, to research a common goal and create new knowledge and theory. Transdisciplinary research involves a range of approaches that may result in the breaking down of disciplinary boundaries and the introduction of nondisciplinary knowledge from external stakeholders. Klein (2007) notes that because of these diverse perspec-tives transdisciplinary research has the potential to create new knowledge frame-works and an overarching synthesis, which may in turn lead to a “transcendent” process of knowledge production.

The concept of interprofessional collaboration is explored by Clarke (2006) in the context of the educational process. Interprofessional collaboration occurs when students from various professions learn from and about each other to improve collaboration and the quality of care. The students’ interactions are char-acterized by integration and modifi cation refl ecting participants’ understanding of the core principles and concepts of each contributing discipline and familiar-ity with the basic language and mindsets of the various disciplines.

Within the clinical context, interdisciplinary collaboration has been defi ned as “a group of discipline-specifi c clinicians who relate on a routine



basis to each other for the purpose of patient- and family-centered care delivery within a particular practice, unit, or program. These clinicians are typically: nurses, physicians, social workers, pharmacists, psychologists, chap-lains, nutritionists, physical therapists, and occupational therapists. Given its link to clinical practice, the authors chose the construct “interdisciplinary” as the operational defi nition for this review; however, because interdisciplinary, multi disciplinary, transdisciplinary, and interprofessional are sometimes used interchangeably in the literature, all of these terms were used to identify eligi-ble articles for review.

INCLUSION CRITERIAThe literature review focused on articles published in the past decade (2000–2010). Consistent with the authors’ practice setting and experience and the overall aim of this paper, the articles selected for inclusion focused on one of the following three areas: (1) training and development necessary to assure that clinicians have the required knowledge, skills, and attitudes to provide inter-disciplinary care and work as a team to deliver care; (2) health care organiza-tional initiatives to advance interdisciplinary care and teamwork in the delivery of care; (3) research studies that demonstrated or attempted to demonstrate the relationship between effective interdisciplinary care and teamwork and patient, workforce, or organizational outcomes.

SEARCH STRATEGIES AND CRITIQUE METHODSSearches of the CINAHL and PubMed databases using EBSCO were conducted using the following keywords: interdisciplinary, multidisciplinary, trans-disci-plinary, inter-professional, collaboration, teamwork, teaming, team training, outcomes, practice, and care. Each article was reviewed, summarized, and cat-egorized according to: year of publication, the country of origin, the title of the paper and fi rst author, the purpose of the paper and in the case of research studies and improvement projects, the purpose, population, design, methods/ instruments utilized and major themes/fi ndings. A more limited search of the Medline database was also conducted to identify additional papers describing organizational structures and initiatives to advance interdisciplinary care and teamwork in the care delivery setting.

The authors assessed the quality of 68 papers using a rating system adapted from Cesario, Morin, and Santa-Donato (2002). Most of the papers were descrip-tive, describing programs of education or professional development, a quality improvement project, or a qualitative study that used interventions such as



team training to improve team effectiveness. Outcome and process measures believed to be related to effective interdisciplinary teamwork and collaboration were usually used to assess the intervention’s success. The authors ranked the papers using the following criteria: from 0 = minimal new information or evidence; 2 = supports or adds to current evidence or practice; 3 = innovative or new approaches to assuring competency by clinicians in effective teamwork or collaboration, or b) interventions resulted in positive patient outcomes (i.e., decreased length of stay, decreased hospital readmission rates, improved medication adherence, quality of life, symptom management); positive workforce outcomes (reduced turnover of staff, improved staff satisfaction, or perceptions of improved team-work); or positive organizational outcomes (such as reduced medication errors, improved safety culture, decrease in missed nursing care, and decreased cost).

TRAINING AND DEVELOPMENT IN THE ACADEMIC AND SERVICE SETTINGS

Physicians, nurses, pharmacists, and other clinicians have historically worked in teams to care for patients and families, yet academic programs and health-care organizations have only recently begun providing education and training to assure effective and effi cient teamwork. The current literature offers numer-ous examples of approaches to teaching interdisciplinary teamwork for the purposes of increasing overall team satisfaction, effi ciency, and quality of care. The recent increase in educational programming is likely related to recommen-dations made by the IOM in its 2003 report (IOM, 2003), Health Professions Education: A Bridge to Quality. In the report, the IOM identifi ed the ability to work in effective interdisciplinary teams when caring for patients and families as a core competency for clinicians. The report’s recommendations are based on the IOM’s assessment of competencies needed by clinicians practicing in the current health care system environment to assure patient safety and clinical quality in the care they deliver.

One of the studies addressing teaching strategies in the academic setting was conducted by Hobgood, Sherwood, Frush, Hollar, and Maynard (2010) and involved a randomized controlled trial (N = 438). In the study, the researchers assessed changes in knowledge, skill, and attitude associated with four different pedagogical methods for delivering teamwork training adapted from the AHRQ TeamSTEPPS Patient Safety Program: didactic (control), audience response didactic, role play, and human patient simulation. Participants included 203 senior nursing students and 235 fourth year medical students. Each student was randomly assigned into one of the teaching methods and all students completed pre- and posttest surveys. All four cohorts demonstrated an increase in attitude



and knowledge of teamwork; however, no single technique emerged as superior and none of the groups achieved a change in skill level. The study had several limitations in the area of design and measurement. Participants’ content knowl-edge at pretesting was higher than anticipated and a tool for measuring specifi c team behaviors within the context of the TeamSTEPPS tool was not available. Additionally, the intervention’s longitudinal effect on content retention by par-ticipants was not measured.

Simulation technology, which is now commonly used as a teaching and learning strategy in the nursing and medical professions, has also been used to develop collaboration skills among nursing and medical students. In a study con-ducted by Reese, Jeffries, and Engum (2010), 15 third-year medical students and 13 senior nursing students at a mid-western university in the United States were paired together in a simulation lab. The students were assigned to jointly assess and care for a patient who was deteriorating as a result of postoperative compli-cations for a 20-minute period. Each student completed postsimulation surveys that used the Simulation Design Scale (Jeffries, 2007). High scores (mean 4.4 out of 5) were obtained for student perceptions that working well with another health care professional helped them provide higher quality care to the patient. Limitations of the study included sample size and design. Because there was no follow-up measurement of physician and nurse collaboration in real patient situa-tions, the researchers were unable to evaluate whether the simulation intervention improved teamwork at the bedside. Hallin, Kiessling, Waldner, and Henriksson (2009) studied the effect of clinical teamwork training on perceived interprofes-sional competence. The study involved 616 undergraduate students enrolled in nursing, medicine, physiotherapy, and occupational therapy programs in Sweden between 2002 and 2005. Each of the students participated in an interprofes-sional training course on a patient care unit and completed pre and post train-ing course surveys, measuring perceived interprofessional competence (response rate = 96%). The environment where the learning occurred was also assessed. Results indicated that all groups perceived an increase in their level of knowledge about each others’ work (p = .000), and believed the training had contributed to their understanding of the importance of teamwork and communication in patient care (p = .000). The study’s authors also concluded that the clinical unit where care was provided was an effective learning environment and conducive to increasing collaboration and professional competence in teamwork. However, measurement of interdisciplinary collaboration post intervention was not part of the study.

Dumont, Briere, Morin, Houle, and Iloko-Fundi (2010) studied faculty perceptions of inter-professional collaboration training, conducting an inter-vention among faculty in the school of Health Sciences at Laval University in



Quebec. The aim of the study was to increase faculty knowledge of interpro-fessional collaboration training and enhance their point of view regarding its benefi ts. Pre- and posttest results indicated an increase in faculty point of view following the intervention.

In the clinical setting, examples of adapting teamwork training methods from other industries to the health care environment are also beginning to emerge, with a focus on reducing medical error through improved communication, col-laboration, and role clarifi cation. Mann, Marcus, and Sachs (2006) successfully adapted concepts of CRM team training in the inpatient obstetrics environment. Neily and colleagues (2010) also successfully adapted CRM concepts in a team training initiative across 74 facilities in the Department of Veterans Affairs and reported an overall 18% decrease in surgical mortality rates after the interven-tion. Dodds et al. (2010) incorporated principles of interdisciplinary practice into their leadership curriculum for maternal and child health practitioners at the University of North Carolina, Chapel Hill, promoting increased competence and commitment to interdisciplinary practice among fellows who complete the program. Goldsmith, Wittenberg-Lyles, Rodriguez, and Sanchez-Reilly (2010) reported fi ndings from a qualitative study of six interdisciplinary clinician team members in the geriatric and palliative care setting. One conclusion of this study was that using refl ective narratives as a pedagogical tool can be a rich and benefi cial means for helping team members understand one another’s experiences and perceptions of teamwork. Of note were the divergent views within various disciplines about the effectiveness of teamwork and effectiveness within their group. These divergent views were also noted by Hansson, Arvemo, Marklund, Gedda, and Mattsson (2009) in their study of district nurses and general medical doctors providing primary care in Sweden. Mills, Neily, and Dunn (2008) also uncovered divergent views of level of collaboration and teamwork across disci-plines when they administered the Medical Team Training (MTT) questionnaire to the members of a surgical team. The researchers noted that using the MTT questionnaire can help focus team training sessions on areas of need.

These and other studies highlight the benefi ts of interprofessional edu-cation and the importance of interprofessional learning for improved collabo-ration, communication, and teamwork. At the same time, it is worth noting an observation offered by Henderson, O’Keefe, and Alexander (2010), who cite the benefi ts of interprofessional education while cautioning that over-emphasizing it or over-attributing its successes should be done with reservation until clearer outcomes are available.

To provide the reader with ease of access to examples of current curricula and training methods found in the literature, Table 7.1 follows.


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ORGANIZATIONAL MODELS AND STRUCTURES THAT ADVANCE INTERDISCIPLINARY

COLLABORATION AND TEAMWORKThere is increasing reference in the literature to the role of interdisciplinary leader-ship in shaping an environment of transparency, collaboration, and equal part-nering and accountability in the oversight of clinical services. Reid Ponte, Gross, Winer, Connaughton, and Hassinger (2007) describe the role of a triad model of leadership (physician, nurse, and administrator) in supporting effective team collaboration, decision making, priority setting, patient safety, and patient- and family-centered care. Richardson and Storr (2010) focused on the role of leader-ship, interdisciplinary working, advocacy, empowerment, and collaboration in assuring patient safety, and identifi ed gaps in the level of infl uence, leadership, and empowerment held by nurses and the potential for improving this inequity.

Other researchers have focused on identifying models that promote collab-oration and partnership at the level of the care team. In a descriptive study using exemplars from staff on several inpatient units at the Hospital of the University of Pennsylvania, Dietrich and colleagues (2010) identify shared governance and peer review as models that are helpful in promoting partnership and learning and improving quality of care. O’Leary et al. (2010) conducted a controlled trial to evaluate the impact of structured interdisciplinary rounds. In the study, usual communication methods were maintained on one unit (the control unit), while interdisciplinary rounds were implemented on another (the intervention unit).In post intervention surveys, staff on the intervention unit reported improvements in the quality of interdisciplinary communication and collaboration. Vogwill and Reeves (2008) observed multidisciplinary rounds on an inpatient unit in a large medical center in Canada and concluded that communication among interdis-ciplinary colleagues could be streamlined and enhanced with the use of struc-tured processes to facilitate the exchange of information. Lown and Manning (2010) examined the effects of Schwartz Center Rounds, an interdisciplinary forum where attendees discuss psychosocial and emotional aspects of patient care. Through retrospective surveys, they found that clinicians participating in Schwartz Center Rounds reported better teamwork and a heightened apprecia-tion of the roles and contributions of colleagues. The researchers also found that the more rounds individuals attended, the greater was the impact on teamwork.

While these articles offer some information about organizational structures and models that promote interdisciplinary collaboration, the literature review makes it clear that such models are in a nascent form industry-wide. Additional research is needed to identify other structures that advance interdisciplinary col-laboration, as well as tools capable of measuring important attributes, anteced-ents, and consequences.



INTERDISCIPLINARY TEAMWORK AND COLLABORATION AND PATIENT, WORKFORCE, AND

ORGANIZATIONAL OUTCOMESUnderstanding the costs, effectiveness, and impact of interdisciplinary collaboration and teamwork in the health care arena has been a topic of interest and research for at least three decades across multiple disciplines. In 2001, Schmitt reviewed past research efforts on the effectiveness of team care, summarizing methodological and conceptual challenges encountered by researchers, gaps in the available evidence, and directions for future research. The summary included 10 studies on the effec-tiveness of team care, conducted between 1950 and 1985, and described the study settings and outcomes relative to costs and patient morbidity and mortality. Eleven studies of geriatric team care interventions were also included, with descriptions of the settings, participant characteristics, and cost and mortality outcomes. With each study, Schmitt critiqued the methods, design, subject selection, measurement of collaboration, and outcome evaluation. Schmitt also provided a brief summary of selected studies reported in the literature between 1985 and 2000. The Schmitt review revealed slow progress between the 1950s and 1990s in advancing theoret-ical models of interdisciplinary teams, conducting rigorous research on the effi cacy of these models, and effectively measuring their outcomes. The limitations that were identifi ed related to the conceptualization and measurement of team collaboration. There was variable reporting of outcomes, possibly due to the diffi culty of consis-tently measuring the amount, type, and duration of team interventions. Although a body of knowledge on team effectiveness began to emerge by 2000, it focused largely on the inpatient, hospital-based setting, with much of the work being con-ducted in intensive care units. Randomized clinical trials were scarce, issues with measuring collaboration remained a problem, and outcome measurement was still an area for improvement. These methodological issues continue today.

More recently, Manser (2009) conducted a review of current teamwork research in areas of high risk medical care such as operating rooms, intensive care units, emergency departments, and trauma resuscitation teams. This review supported the relationship between effective teamwork and patient safety and recommended further study in the following areas: (1) investigations of interdis-ciplinary collaboration and teamwork factors that contribute to adverse events; (2) staff perceptions of teamwork within their teams; and (3) observational stud-ies of teamwork behaviors related to high clinical performance and outcomes.

Petri (2010) offers an overview of the meaning of interdisciplinary col-laboration in health care settings using Rodger’s Evolutionary View of Concept Analysis to identify attributes, antecedents, and consequences of interdisciplin-ary collaboration, and also calls for future research on the development of robust measures to evaluate it. Fennell, Prabhu Das, Clauser, Petrelli, and Salner (2010)



described the impact of various types of multidisciplinary care team structures on quality of treatment and care and proposed a conceptual model for effective multidisciplinary oncology care teams using Donabedian’s (2000) approach of structure, process, and outcome as a foundation for measuring the impact of multidisciplinary teams on patient outcomes.

Individual studies examining the effects of interdisciplinary collaboration on patient outcomes include one by O’Mahony, Mazur, Charney, Wang, and Fine (2007), which assessed the impact of interdisciplinary rounds and deter-mined that adjusted average length of stay decreased after rounds were intro-duced. Chung and Nguyen (2005) found that introducing an interdisciplinary team focused on pain management yielded improvements in patient satisfaction after only three months. Pratt and colleagues (2007) adapted the CRM concepts to team training in the obstetrics environment and reported a 23% reduction the incidence of adverse outcomes over four years as well as an improvement in the satisfaction of all team members.

Table 7.2 outlines literature that explores organizational models and train-ing approaches to interdisciplinary teamwork.

INSTRUMENTATIONInstruments designed to measure perception of teamwork by team members, measures of effective interdisciplinary collaboration by individuals (some proxy measures) and team member’s knowledge and skill in teamwork behavior are beginning to emerge in the health care literature. Many of the available instru-ments and the programs that have been designed to use them are adapted from the TeamSTEPPs program developed by the Department of Defense and the AHRQ and/or based on CRM principles developed and promulgated from the aviation industry. Table 7.3 outlines instruments that measure outcomes of effec-tive interdisciplinary collaboration and teamwork.

DISCUSSIONResearch conducted in the last decade has broadened our understanding of inter-disciplinary collaboration, including how it can be promoted and advanced by educational and organizational structures and how it affects patient outcomes. However even with this progress, much additional work is needed.

In the area of education, formalized models and programs of training in the principles and practices of interdisciplinary team collaboration, including the Team STEPPS approach, unit-based interprofessional training programs, and simulation lab team training, are increasingly being incorporated into the cur-ricula of academic programs and offered by continuing education departments


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de

velo

ped

by th

e C

onso

rtiu

m c

reat

ed to

cu

ltiva

te in

terd

isci

plin

ary

MC

lead

ers.

The

UN

C-C

H

MC

H L

eade

rshi

p C

onso

rtiu

m

Des

crip

tive

Rep

ort

of a

n E

duca

tion

al

trai

ning

and

Im

prov

emen

t In

itia

tive

(N

= 1

50

trai

nees

).

Qua

ntit

ativ

e an

d qu

alit

ativ

e pr

oces

s ev

alua

tion

s

The

inte

rdis

cipl

inar

y le

ader

ship

cur

ricu

lum

de

velo

ped

by t

he C

onso

rtiu

m

has

allo

wed

fello

ws

to e

mer

ge

as c

ompe

tent

pra

ctit

ione

rs a

nd

lead

ers

who

are

com

mit

ted

to in

terd

isci

plin

ary

prac

tice

an

d th

roug

h co

ntin

uous

qu

alit

y im

prov

emen

t m

etho

ds

of e

valu

atio

n, t

he p

rogr

am

has

adap

ted

to m

eet

the

chan

ging

nee

ds o

f tra

inee

s w

ho

part

icip

ate

in t

he p

rogr

am.

Dum

ont

et a

l. (2

010)

Des

crib

e th

e pu

rpos

e,

impl

emen

tati

on, r

esul

ts,

and

eval

uati

on o

f a s

erie

s of

cou

rses

for

facu

lty

in in

terp

rofe

ssio

nal

colla

bora

tion

.

215

facu

lty

from

th

e Sc

hool

of

Hea

lth

Scie

nces

at

Lava

l Uni

vers

ity,

Q

uebe

c

Inte

rven

tion

stud

y us

ing

pre/

post

test

m

easu

rem

ent t

o de

scri

be th

e ef

fect

of

an

educ

atio

nal

inte

rven

tion

on

know

ledg

e an

d sk

ills

rega

rdin

g th

e be

nefi t

s of

inte

rpro

fess

iona

l co

llabo

ratio

n.

Inve

stig

ator

der

ived

cu

rric

ula

base

d on

inve

ntor

y of

ex

isti

ng c

ours

es

and

met

hodo

logi

es

of t

each

ing

team

wor

k

Post

inte

rven

tion

sur

veys

sh

owed

an

incr

ease

in p

oint

of

vie

w r

egar

ding

kno

wle

dge

and

bene

fi t o

f int

erpr

ofes

sion

al

colla

bora

tion

tra

inin

g. (Con

tinue

d)


172

TA

BL

E 7

.2O

rgan

izat

iona

l Mod

els

and

Trai

ning

App

roac

h (C

ontin

ued)

Aut

hor

Purp

ose

Popu

lati

onR

esea

rch

Des

ign

Inst

rum

ents

or

Met

hods

Find

ings

Gol

dsm

ith

et a

l. (2

010)

To e

xam

ine

the

natu

re a

nd

proc

ess

of in

terd

isci

plin

ary

team

wor

k in

ger

iatr

ic a

nd

palli

ativ

e ca

re s

etti

ngs.

Six

inte

rdis

cipl

i nar

y ca

re t

eam

mem

bers

pa

rtic

ipat

ing

in a

on

e ye

ar fe

llow

ship

in

Int

erdi

scip

linar

y te

amw

ork

(ID

T).

Qua

litat

ive

stud

y;

sem

istr

uctu

red,

ta

ped

inte

rvie

ws

wit

h ea

ch t

eam

m

embe

r ut

ilizi

ng

open

-end

ed

ques

tion

ing

to

prom

ote

refl e

ctiv

e na

rrat

ive.

The

func

tion

al r

efl e

ctiv

e na

rrat

ive

anal

ysis

rev

eale

d sp

ecifi

c th

emes

tha

t de

mon

stra

ted

dive

rgen

t ex

peri

ence

/per

cept

ion

amon

gst

team

mem

bers

in

thei

r co

ncep

tual

izat

ion

of

team

wor

k an

d ef

fect

iven

ess

and

desc

ribe

d th

e co

llabo

rati

ve n

atur

e of

tea

ms.

R

efl e

ctiv

e na

rrat

ives

are

a

usef

ul t

ool i

n te

am t

rain

ing.

Hal

lin e

t al

. (2

010)

To e

valu

ate

whe

ther

st

uden

ts p

erce

ived

th

at t

hey

had

achi

eved

in

terp

rofe

ssio

nal

com

pete

nce

afte

r pa

rtic

ipat

ing

in c

linic

al

team

wor

k tr

aini

ng.

616

stud

ents

fr

om fo

ur

unde

r gra

duat

e ed

ucat

iona

l pr

ogra

ms

(med

icin

e, n

ursi

ng,

phys

ioth

erap

y,

and

occu

pati

onal

th

erap

y) a

t a

univ

ersi

ty h

ospi

tal

in S

tock

holm

, Sw

eden

.

Qua

ntit

ativ

e st

udy

Stud

y ou

tcom

es

wer

e m

easu

red

by

resp

onse

s fr

om

stud

ent e

valu

atio

n qu

estio

nnai

res

follo

win

g th

e co

mpl

etio

n of

uni

t-ba

sed

inte

rpro

fess

iona

l tr

aini

ngs.

The

stu

dy

com

men

ced

in th

e au

tum

n te

rm 2

002

and

was

com

plet

ed in

the

spri

ng te

rm

Act

ive

pati

ent-

base

d le

arni

ng

by w

orki

ng t

oget

her

in a

rea

l un

it-b

ased

con

text

see

med

to

be

an e

ffect

ive

mea

ns t

o in

crea

se c

olla

bora

tion

and

pr

ofes

sion

al c

ompe

tenc

e.


173

(Con

tinue

d)

Hen

ders

on

et a

l. (2

010)

To e

xplo

re t

he v

alue

of

inte

rpro

fess

iona

l edu

cati

on

(IPE

) in

Aus

tral

ia, w

hich

ha

s be

en d

escr

ibed

as

a re

spon

se t

o w

ides

prea

d ca

lls fo

r im

prov

ed

com

mun

icat

ion

and

colla

bora

tion

bet

wee

n he

alth

car

e pr

ofes

sion

als.

Com

men

tary

Alt

houg

h th

ere

is m

uch

that

is

com

men

dabl

e in

IPE

, the

au

thor

s ca

utio

n th

at t

he

bene

fi ts

may

be

over

stat

ed

if to

o m

uch

is a

ttri

bute

d to

, or

exp

ecte

d of

, IPE

act

ivit

ies.

E

ngag

emen

t w

ith

clin

icia

ns

in t

he c

linic

al p

ract

ice

sett

ing

who

are

inst

rum

enta

l in

assi

stin

g st

uden

ts m

ake

sens

e of

the

ir k

now

ledg

e th

roug

h pr

acti

ce, i

s im

pera

tive

for

sust

aina

ble

outc

omes

.

Hob

good

et

al.

(201

0)To

tes

t st

uden

t ac

quis

itio

n of

kno

wle

dge,

ski

ll, a

nd

atti

tude

s in

eac

h of

four

pe

dago

gica

l met

hods

fo

r de

liver

ing

team

wor

k tr

aini

ng.

203

seni

or n

ursi

ng

stud

ents

and

235

fo

urth

yea

r m

edic

al s

tude

nts.

Ran

dom

ized

co

ntro

lled

tria

l ut

ilizi

ng o

ne o

f fou

r ed

ucat

ion

met

hods

: di

dact

ic (

cont

rol)

, au

dien

ce r

espo

nse

dida

ctic

, rol

e-pl

ay,

hum

an p

atie

nt

sim

ulat

ion,

to

teac

h te

amw

ork

trai

ning

to

nur

sing

and

m

edic

al s

tude

nts.

T

he m

etho

ds w

ere

eval

uate

d

All

four

coh

orts

dem

onst

rate

d im

prov

emen

t in

att

itud

e an

d kn

owle

dge.

How

ever

, no

edu

cati

onal

tec

hniq

ue

appe

ared

to

be s

uper

ior

nor

resu

lted

in a

cha

nge

in

team

wor

k sk

ill.


174

TA

BL

E 7

.2O

rgan

izat

iona

l Mod

els

and

Trai

ning

App

roac

h (C

ontin

ued)

Aut

hor

Purp

ose

Popu

lati

onR

esea

rch

Des

ign

Inst

rum

ents

or

Met

hods

Find

ings

usin

g a

seri

es o

f 4

surv

eys

(pre

/pos

t tr

aini

ng)

mea

suri

ng

atti

tude

s,

know

ledg

e, s

kills

an

d pe

rfor

man

ce.

Inte

rdis

cipl

inar

y Te

ams:

Mod

els/

Com

pone

nts

Die

tric

h et

al.

(201

0)To

des

crib

e th

e co

mpo

nent

s ne

cess

ary

to fo

rm s

ucce

ssfu

l pa

rtne

rshi

ps u

sing

the

H

ospi

tal o

f the

Uni

vers

ity

of P

enns

ylva

nia

Nur

sing

E

xcel

lenc

e Pr

ofes

sion

al

Prac

tice

(H

UP-

NE

PP)

mod

el, a

t H

UP.

Mul

tipl

e un

its

at U

nive

rsit

y of

Pe

nnsy

lvan

ia

Hos

pita

l (H

UP)

.

Hos

pita

l-ba

sed

repo

rtin

g of

co

mpo

nent

s of

effe

ctiv

e pa

rtne

rshi

ps

thro

ugh

nurs

ing

exem

plar

s

Exe

mpl

ars

of

seve

ral u

nits

de

scri

bing

diff

eren

t ap

proa

ches

and

m

odel

s fr

om w

eak

part

ners

hips

in a

hi

erar

chic

al m

odel

to

tho

se t

hat

is

stro

nger

and

mor

e co

mpl

ex in

a

hier

arch

ical

mod

el.

Part

ners

hips

are

nec

essa

ry

for

com

mun

icat

ion

thro

ugh

the

disc

iplin

es, e

xcha

ngin

g of

id

eas,

and

pee

r re

view

pro

cess

to

mai

ntai

n qu

alit

y ou

tcom

es.

Aut

hori

tari

anis

m is

not

an

easy

co

ncep

t to

rel

ate,

esp

ecia

lly in

in

stit

utio

ns t

hat

have

follo

wed

a

pate

rnal

isti

c do

ctri

ne fo

r ye

ars,

but

it is

pos

sibl

e to

hav

e ef

fect

ive

part

ners

hips

and

alt

er

the

old

way

of d

oing

thi

ngs,

gi

ven

the

effo

rt, c

omm

itm

ent,

co

llabo

rati

on, c

omm

unic

atio

n,

trus

t an

d re

spec

t of

the

re

lati

onsh

ip o

f aut

hent

ic

lead

ers

wit

h th

eir

empl

oyee

s.


175

(Con

tinue

d)

Oliv

er,

Tatu

m, K

app,

&

Wal

lace

(2

010)

To e

xplo

re t

he

expe

rien

ces

of h

ospi

ce

med

ical

dir

ecto

rs

wit

hin

the

cont

ext

of

colla

bora

tion

.

17 h

ospi

ce

med

ical

dir

ecto

rs

who

wer

e pr

evio

usly

invo

lved

in

a la

rger

sur

vey

stud

y on

the

sam

e to

pic.

Qua

litat

ive,

de

scri

ptiv

e st

udy

Sem

istr

uctu

red

inte

rvie

ws

wit

h th

emat

ic a

naly

sis.

Med

ical

dir

ecto

rs in

the

ho

spic

e se

ttin

g re

port

ed

posi

tive

col

labo

rati

ve

expe

rien

ces.

Ass

isti

ng

med

ical

dir

ecto

rs t

o fi n

d ti

me

and

fi nan

cial

opp

ortu

niti

es

for

prof

essi

onal

dev

elop

men

t an

d su

ppor

t in

the

ir r

ole

was

fo

und

to b

e an

opp

ortu

nity

to

furt

her

impr

ove

colla

bora

tion

.

Petr

i (2

010)

To e

xplo

re t

he m

eani

ng

of in

terd

isci

plin

ary

colla

bora

tion

wit

hin

the

cont

ext

of h

ealt

h ca

re.

Lite

ratu

re r

evie

w

to c

lari

fy t

he

curr

ent

use

of

inte

rdis

cipl

inar

y co

llabo

rati

on in

he

alth

car

e.

Rod

gers

’ E

volu

tion

ary

Vie

w o

f Con

cept

A

naly

sis

to

iden

tify

att

ribu

tes,

an

tece

dent

s, a

nd

cons

eque

nces

of

inte

rdis

cipl

inar

y co

llabo

rati

on.

A c

ompr

ehen

sive

defi

nit

ion

of

inte

rdis

cipl

inar

y co

llabo

rati

on

wit

hin

the

cont

ext

of h

ealt

h ca

re is

pre

sent

ed a

s an

ou

tcom

e of

thi

s an

alys

is.

Furt

her

inqu

iry

shou

ld fo

cus

on t

he d

evel

opm

ent

of v

alid

m

easu

res

to a

ccur

atel

y ev

alua

te

this

sub

ject

.


176

TA

BL

E 7

.2O

rgan

izat

iona

l Mod

els

and

Trai

ning

App

roac

h (C

ontin

ued)

Aut

hor

Purp

ose

Popu

lati

onR

esea

rch

Des

ign

Inst

rum

ents

or

Met

hods

Find

ings

Inte

rdis

cipl

inar

y Te

ams:

Impa

ct/O

utco

mes

Cas

hman

, R

eidy

, Cod

y,

& L

emay

(2

004)

To r

epor

t th

e re

sult

s of

a

long

itud

inal

stu

dy o

f an

inte

rven

tion

to

enha

nce

inte

rdis

cipl

inar

y te

am

func

tion

ing

in a

pri

mar

y ca

re s

etti

ng.

Hea

lth

care

te

am m

embe

rs:

phys

icia

n, n

urse

pr

acti

tion

er,

phys

icia

n’s

assi

stan

t,

regi

ster

ed n

urse

, he

alth

ass

ista

nt

(N =

5)

at a

fe

dera

lly fu

nded

co

mm

unit

y he

alth

ce

nter

in N

ew

Eng

land

, USA

.

Inte

rven

tion

stu

dyT

he S

yste

m fo

r th

e M

ulti

ple

Leve

l O

bser

vati

on o

f G

roup

s (S

YMLO

G)

was

use

d to

eva

luat

e te

am m

embe

rs’

asse

ssm

ents

of

prog

ress

tow

ards

ex

pres

sing

val

ues

cons

iste

nt w

ith

an

effe

ctiv

e te

am.

Inte

ntio

nal t

eam

tra

inin

g an

d de

velo

pmen

t, c

oupl

ed

wit

h de

dica

ted

tim

e fo

r te

am m

eeti

ngs,

can

res

ult

in

team

mem

bers

’ exp

ress

ing

valu

es c

onsi

sten

t w

ith

high

func

tion

ing

team

s.

Team

mem

bers

’ obj

ecti

ve

asse

ssm

ents

, as

wel

l as

thei

r liv

ed e

xper

ienc

es, p

rovi

de

deta

iled

reaf

fi rm

atio

n th

at

to s

usta

in e

ffect

ive

team

fu

ncti

onin

g, o

rgan

izat

iona

l st

ruct

ures

and

rew

ard

syst

ems

mus

t su

ppor

t th

e te

am’s

visi

on a

nd g

oals

. M

etho

ds fo

r re

duci

ng

team

tur

nove

r ar

e ne

eded

to

ens

ure

grow

th a

nd

sust

aina

bilit

y.


177

(Con

tinue

d)

Fenn

ell e

t al

. (2

010)

Rev

iew

of v

ario

us t

ypes

of

mul

tidi

scip

linar

y ca

re

(MD

C)

team

s an

d th

eir

impa

ct o

n th

e qu

alit

y of

tr

eatm

ent

care

for

canc

er

pati

ents

. The

aut

hors

als

o ou

tlin

e a

conc

eptu

al m

odel

of

the

con

nect

ion

betw

een

team

con

text

, str

uctu

re,

proc

ess,

and

per

form

ance

an

d th

eir

subs

eque

nt

effe

cts

on c

ance

r tr

eatm

ent

care

pro

cess

es a

nd p

atie

nt

outc

omes

.

MD

C t

eam

s ca

ring

fo

r on

colo

gy

pati

ents

.

Targ

et o

f the

hea

lth

care

, org

aniz

atio

nal

beha

vior

and

m

anag

emen

t lit

erat

ure.

Des

pite

adv

ance

s in

res

earc

h on

MD

C in

onc

olog

y m

any

gaps

for

futu

re r

esea

rch

rem

ain;

in

wha

t situ

atio

ns d

o w

hich

st

ruct

ures

wor

k be

st; w

hat

char

acte

rist

ics

of p

hysi

cian

s an

d ot

her

team

mem

bers

ass

ure

optim

al te

am p

erfo

rman

ce;

wha

t ext

erna

l/reg

ulat

ory

infl u

ence

s pr

ohib

it or

enh

ance

th

e su

stai

nabi

lity

of M

DC

te

ams;

whi

ch ty

pe o

f MD

C le

ad

to b

est p

atie

nt q

ualit

y of

life

, ou

tcom

es, a

nd e

xper

ienc

e.

Woo

ds &

M

agya

ry

(201

0)

Des

crib

es t

he im

pera

tive

of

inte

rdis

cipl

inar

y co

llabo

rati

on in

tr

ansl

atio

nal r

esea

rch

wit

h sp

ecia

l em

phas

is o

n co

ntri

buti

ons

of n

urse

s in

th

ese

colla

bora

tion

s.

Opi

nion

pie

ce

base

d on

rev

iew

of

liter

atur

e

Han

sson

et

al.

(200

9)To

mea

sure

att

itud

es

tow

ard

colla

bora

tion

am

ong

Gen

eral

Pr

acti

tion

ers

(GP)

and

R

Ns

and

to in

vest

igat

e w

heth

er

A c

ohor

t of

600

G

Ps a

nd R

Ns

in

Vast

ra G

otal

and

regi

on o

f Sw

eden

Qua

ntit

ativ

e st

udy

The

Jef

fers

on S

cale

of

Att

itud

es t

owar

d Ph

ysic

ian

Nur

se

Col

labo

rati

on a

nd

the

Prof

essi

onal

RN

s w

ere

slig

htly

mor

e po

siti

ve a

bout

col

labo

rati

on

than

GPs

. A p

osit

ive

atti

tude

to

war

d co

llabo

rati

on d

id n

ot

seem

to

be a

par

t of

the

GP’

s


178

TA

BL

E 7

.2O

rgan

izat

iona

l Mod

els

and

Trai

ning

App

roac

h (C

ontin

ued)

Aut

hor

Purp

ose

Popu

lati

onR

esea

rch

Des

ign

Inst

rum

ents

or

Met

hods

Find

ings

ther

e is

a c

orre

lati

on

betw

een

a po

siti

ve a

ttit

ude

tow

ard

colla

bora

tion

and

hi

gh s

elf-

este

em in

the

pr

ofes

sion

al r

ole.

Self-

Des

crip

tion

Fo

rm (

PSD

F) w

ere

used

.

prof

essi

onal

rol

e to

the

sa

me

exte

nd a

s it

is fo

r R

Ns.

Pr

ofes

sion

al n

orm

s se

em

to h

ave

mor

e in

fl uen

ce o

n at

titu

des

than

do

gend

er

role

s. R

Ns

seem

mor

e co

nfi d

ent

in t

heir

pro

fess

ion

than

GPs

.

Kyd

ona,

M

alam

is,

Gia

snet

sova

, Ts

iora

, &

Gri

tsi-

Ger

ogia

nni

(201

0)

To in

vest

igat

e th

e le

vel o

f co

llabo

rati

on, a

s pa

rt o

f or

gani

zati

onal

cul

ture

in

the

envi

ronm

ent

of a

n IC

U

in H

ippo

krat

io H

ospi

tal,

The

ssal

onik

i, G

reec

e.

ICU

per

sonn

el,

and

othe

r co

oper

atin

g cl

inic

al

depa

rtm

ents

and

la

bs in

the

Hos

pita

l (N

= 1

96).

Des

crip

tive

stu

dyQ

uest

ionn

aire

was

ad

min

iste

red

to

mea

sure

tea

mw

ork

and

pati

ent

safe

ty

atti

tude

s in

hig

h-ri

sk

area

s; p

arti

cipa

nts

wer

e al

so a

sked

to

desc

ribe

per

sona

l pe

rcep

tion

of

the

qual

ity

of

colla

bora

tion

and

co

mm

unic

atio

n.

Teac

hing

tea

mw

ork

skill

s an

d te

am c

once

pts

shou

ld

beco

me

a si

gnifi

cant

par

t of

med

ical

and

nur

sing

ed

ucat

ion

and

trai

ning

if w

e w

ant

to a

chie

ve a

sub

stan

tial

im

prov

emen

t in

qua

lity

of h

ealt

h ca

re s

ervi

ces,

es

peci

ally

in h

igh

risk

are

as

such

as

ICU

’s.

Man

n et

al.

(200

6)To

des

crib

e ho

w t

he

appl

icat

ion

of c

rew

re

sour

ce m

anag

emen

t, a

220

staf

f ( M

Ds,

R

Ns,

res

iden

ts, a

nd

supp

ort

staf

f) in

the

Des

crip

tive

stud

yO

ccur

renc

e of

ad

vers

e ev

ents

on

the

L&D

uni

t

Teac

hing

clin

icia

ns t

o be

have

as

tea

mm

ates

will

impr

ove

staf

f att

itud

es a

nd e

nhan

ce


179

(Con

tinue

d)

conc

ept

used

by

mili

tary

an

d co

mm

erci

al fl

ight

te

ams,

on

L&D

uni

ts c

an

impr

ove

pati

ent

safe

ty

and

redu

ce la

wsu

its.

Labo

r an

d D

eliv

ery

Uni

t at

an

acad

emic

m

edic

al c

ente

r in

Bo

ston

, MA

.

who

se e

tiol

ogy

rela

ted

to fa

ilure

s in

co

mm

unic

atio

n an

d/or

tea

mw

ork

perf

orm

ance

in a

n L&

D u

nit,

w

hich

can

impr

ove

mat

erna

l an

d ne

onat

al o

utco

mes

and

re

duce

mal

prac

tice

cla

ims.

Man

ser

(200

9)To

exa

min

e cu

rren

t re

sear

ch o

n te

amw

ork

in

high

ly d

ynam

ic d

omai

ns

of h

ealt

h ca

re s

uch

as O

Rs,

IC

Us,

ED

s, o

r tr

aum

a an

d re

susc

itat

ion

team

s w

ith

a fo

cus

on a

spec

ts r

elev

ant

to t

he q

ualit

y an

d sa

fety

of

pat

ient

car

e.

Broa

d re

view

of

vari

ous

heal

th-

rela

ted

data

base

s yi

elde

d 27

7 ar

ticl

es

fulfi

lling

the

in

clus

ion

crit

eria

w

hich

wer

e fu

rthe

r ca

tego

rize

d an

d re

fi ned

, res

ulti

ng

in 1

01 p

ublic

atio

ns

chos

en fo

r in

-dep

th

revi

ew.

E

vide

nce

from

thr

ee m

ain

area

s of

res

earc

h su

ppor

ts t

he

rela

tion

ship

bet

wee

n te

amw

ork

and

pati

ent

safe

ty: (

1) S

tudi

es

inve

stig

atin

g cr

itic

al in

cide

nts

and

adve

rse

even

ts h

ave

show

n th

at t

eam

wor

k pl

ays

an

impo

rtan

t ro

le in

the

cau

sati

on

and

prev

enti

on o

f adv

erse

ev

ents

. (2)

Res

earc

h fo

cusi

ng

on h

ealt

h ca

re p

rovi

ders

’ pe

rcep

tion

s of

tea

mw

ork

dem

onst

rate

d th

at (

a) s

taff

perc

epti

on o

f tea

mw

ork

and

atti

tude

s to

war

d sa

fety

-rel

evan

t te

am b

ehav

ior

wer

e re

late

d to

th

e qu

alit

y an

d sa

fety

of p

atie

nt

care

and

(b)

per

cept

ions

of

team

wor

k an

d le

ader

ship

st

yle

are

asso

ciat

ed w

ith

staf

f w

ell b

eing

, whi

ch m

ay

impa

ct c

linic

ian

abili

ty t

o pr

ovid

e sa

fe p

atie

nt c

are.


180

TA

BL

E 7

.2O

rgan

izat

iona

l Mod

els

and

Trai

ning

App

roac

h (C

ontin

ued)

Aut

hor

Purp

ose

Popu

lati

onR

esea

rch

Des

ign

Inst

rum

ents

or

Met

hods

Find

ings

(3)

Obs

erva

tion

al s

tudi

es o

n te

amw

ork

beha

vior

s re

late

d to

hig

h cl

inic

al p

erfo

rman

ce

have

iden

tifi e

d pa

tter

ns o

f co

mm

unic

atio

n, c

oord

inat

ion,

an

d le

ader

ship

tha

t su

ppor

t ef

fect

ive

team

wor

k.

Mer

ali e

t al

. (2

008)

To e

valu

ate

the

effe

ctiv

enes

s of

a

med

icat

ion

safe

ty p

roje

ct

to (

1) id

enti

fy a

reas

of

expo

sure

to

risk

and

mak

e re

com

men

dati

ons

to

enha

nce

med

icat

ion

safe

ty

wit

hin

the

hosp

ital

and

(2

) to

info

rm t

he

deve

lopm

ent

of a

m

edic

atio

n sa

fety

ch

eckl

ist

spec

ifi c

to t

he

OR

set

ting

.

Ane

sthe

siol

ogis

ts,

nurs

es, a

nd

phar

mac

ists

from

th

e O

R a

t a

larg

e te

achi

ng h

ospi

tal i

n O

ntar

io, C

anad

a.

Des

crip

tive

stu

dyA

n in

terd

isci

plin

ary

team

of c

onsu

ltan

ts

from

the

Ins

titu

te o

f Sa

fe M

edic

atio

n Pr

ac ti

ce (

ISM

P)

Can

ada

and

a re

pres

enta

tive

from

th

e U

S pe

rfor

med

a

targ

eted

sys

tem

atic

re

view

of m

edic

atio

n us

e in

the

OR

and

re

late

d pa

tien

t ca

re a

reas

. Dir

ect

obse

rvat

ion

was

us

ed in

eac

h ar

ea.

Syst

em w

eakn

esse

s

Enh

anci

ng w

orki

ng

rela

tion

ship

s am

ong

anes

thes

iolo

gist

s, p

harm

acis

ts,

and

nurs

es is

piv

otal

for

safe

med

icat

ion

prac

tice

s in

th

e O

R s

etti

ng. S

trat

egie

s de

velo

ped

and

impl

emen

ted

duri

ng t

he p

roje

ct w

ere

aim

ed a

t re

duci

ng t

he r

isk

of

inju

ry in

duce

d by

med

icat

ion

erro

rs.


181

(Con

tinue

d)

wer

e id

entifi

ed,

an

d 75

spe

cifi c

re

com

men

datio

ns

wer

e m

ade

to e

nhan

ce

med

icat

ion

safe

ty.

Mill

s et

al.

(200

8)To

ass

ess

the

effe

ctiv

enes

s of

coo

pera

tion

and

co

mm

unic

atio

n am

ong

surg

ical

tea

ms

and

ICU

te

ams.

Clin

icia

ns a

nd

adm

inis

trat

ors

from

the

ope

rati

ng

room

s an

d IC

Us

in 6

Vet

eran

s A

dmin

istr

atio

n m

edic

al c

ente

rs

(VA

MC

s) in

the

US.

T

he M

edic

al T

eam

Tr

aini

ng (

MT

T)

ques

tion

nair

e

The

MT

T w

as h

elpf

ul in

id

enti

fyin

g hi

dden

pro

blem

s w

ith

com

mun

icat

ion

befo

re

form

al t

eam

tra

inin

g le

arni

ng

sess

ions

. It

reve

aled

a p

atte

rn

of d

iscr

epan

cies

am

ong

phys

icia

ns a

nd n

urse

s in

w

hich

sur

geon

s pe

rcei

ve

a st

rong

er o

rgan

izat

iona

l cu

ltur

e of

saf

ety,

bet

ter

com

mun

icat

ion,

and

bet

ter

team

wor

k th

an e

ithe

r nu

rses

of

ane

sthe

siol

ogis

ts d

o.

Nei

ly e

t al

. (2

010)

To d

eter

min

e if

an

asso

ciat

ion

exis

ted

betw

een

Vete

rans

Hea

lth

Adm

inis

trat

ion

(VH

A)

Med

ical

Tea

m T

rain

ing

and

surg

ical

out

com

es.

Surg

ical

sta

ff at

74

VH

A fa

cilit

ies

acro

ss t

he U

S re

ceiv

ed t

he

trai

ning

and

108

fa

cilit

ies

wer

e an

alyz

ed.

Ret

rosp

ecti

ve

heal

th s

ervi

ces

coho

rt s

tudy

usi

ng

a co

ntem

pora

neou

s co

ntro

l gro

up.

VH

A d

ata

on r

isk

adju

sted

mor

talit

y ra

tes,

agg

rega

ted

by

faci

lity

as

Team

Tra

inin

g in

terv

enti

on w

as

inst

itut

ed b

y fa

cilit

y (i

.e.,

unit

of

anal

ysis

= fa

cilit

y)

The

74

faci

litie

s w

here

tea

m

trai

ning

occ

urre

d re

port

ed

an 1

8% r

educ

tion

in a

nnua

l m

orta

lity

(rat

e ra

tio,

0.8

2; 9

5%

confi

den

ce in

terv

al, 0

.76–

0.91

; p

= .0

1).


182

TA

BL

E 7

.2O

rgan

izat

iona

l Mod

els

and

Trai

ning

App

roac

h (C

ontin

ued)

Aut

hor

Purp

ose

Popu

lati

onR

esea

rch

Des

ign

Inst

rum

ents

or

Met

hods

Find

ings

O’L

eary

et

al.

(201

0)To

ass

ess

rati

ngs

of

team

wor

k an

d ba

rrie

rs t

o co

llabo

rati

on b

y pr

ovid

ers

on in

pati

ent

med

ical

un

its

and

barr

iers

to

colla

bora

tion

.

RN

s, P

CPs

, an

d m

edic

al

subs

peci

alty

co

nsul

tant

ph

ysic

ians

on

4 ge

nera

l med

ical

un

its

at a

753

-bed

ac

adem

ic h

ospi

tal

in C

hica

go, I

L

Cro

ss-s

ecti

onal

st

udy

wit

h a

qual

itat

ive

revi

ew

of c

omm

ents

.

Like

rt s

cale

-bas

ed

surv

ey t

o as

sess

te

amw

ork

rati

ngs,

ba

rrie

r ra

ting

s.

Qua

litat

ive

revi

ew o

f co

mm

ents

.

In t

he g

ener

al m

edic

al

inpa

tien

t se

ttin

g, d

iscr

epan

cies

am

ong

RN

s an

d M

Ds

exis

ted

in t

he r

atin

gs o

f col

labo

rati

on

and

barr

iers

to

team

wor

k.

Whe

reas

MD

s ra

ted

the

qual

ity

of t

eam

wor

k w

ith

RN

s fa

vora

bly,

RN

s pe

rcei

ved

team

wor

k as

sub

opti

mal

.

O’L

eary

et

al.

(201

0)To

ass

ess

the

impa

ct o

f an

inte

rven

tion

, Str

uctu

red

Inte

r-D

isci

plin

ary

Rou

nds

(SID

R)

on n

urse

s’ r

atin

gs

of c

olla

bora

tion

and

te

amw

ork.

Two

hosp

ital

ist

staf

fed

unit

s at

an

897

tert

iary

car

e te

achi

ng h

ospi

tal i

n C

hica

go, I

L

Con

trol

led

tria

l of

an in

terv

enti

on.

A 5

-poi

nt o

rdin

al

scal

e su

rvey

was

us

ed t

o ra

te t

he

nurs

es’ a

sses

smen

t of

col

labo

rati

on a

nd

com

mun

icat

ion.

SID

R h

ad a

pos

itiv

e ef

fect

on

nurs

es’ r

atin

gs o

f tea

mw

ork

and

colla

bora

tion

on

a ho

spit

alis

t un

it; h

owev

er

ther

e w

as n

o ef

fect

on

leng

th

of s

tay

or c

ost.

Rei

d Po

nte

et a

l. (2

007)

To d

escr

ibe

the

impl

emen

tati

on o

f a

new

inte

rdis

cipl

inar

y go

vern

ance

and

m

anag

emen

t st

ruct

ure

at

an a

mbu

lato

ry,

acad

emic

, com

preh

ensi

ve

canc

er c

ente

r.

Qua

litat

ive,

de

scri

ptiv

e st

udy.

Lead

ersh

ip

inte

rvie

ws

Four

yea

rs in

to t

he

proj

ect,

the

str

uctu

re o

f in

terd

isci

plin

ary

gove

rnan

ce

is fi

rmly

in p

lace

. Cha

nge

in a

ccom

plis

hed

mor

e re

adily

tha

n pr

ior

to t

he

impl

emen

tati

on. A

cul

ture

th

at p

rom

otes

acc

ount

abili

ty,


183

(Con

tinue

d)

com

mun

icat

ion,

res

pect

an

d co

llabo

rati

on h

as b

een

esta

blis

hed.

Ree

se e

t al

. (2

010)

To in

vest

igat

e th

e us

e of

a fr

amew

ork

for

the

colla

bora

tive

med

ical

and

nu

rsin

g m

anag

emen

t of

a

surg

ical

pat

ient

wit

h co

mpl

icat

ions

.

Seni

or le

vel

bacc

alau

reat

e nu

rsin

g st

uden

ts

and

thir

d-ye

ar

med

ical

stu

dent

s fo

r a

larg

e M

idw

este

rn

univ

ersi

ty.

Des

crip

tive

stu

dyT

he S

imul

atio

n D

esig

n Sc

ale

and

the

Sati

sfac

tion

and

Se

lf-C

onfi d

ence

Sc

ale.

Col

labo

rati

on

was

mea

sure

d us

ing

a co

llabo

rati

on

scal

e de

velo

ped

by

the

rese

arch

ers.

Col

labo

rati

ve

sim

ulat

ions

may

im

prov

e in

terd

isci

plin

ary

com

mun

icat

ion

and

ulti

mat

ely

impr

ove

pati

ent

care

.

Ric

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184

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185

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2) R

atin

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No

eval

uati

on o

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su

rvey

too

l rep

orte

d.



in health care institutions. The success of these programs has been largely mea-sured using pre and post testing methods to demonstrate effectiveness, as well as satisfaction surveys and other qualitative measures of perceived improvements in working relationships and collaboration. Studies evaluating the longer term impact of training programs on interdisciplinary collaboration in the work set-ting are needed. Narrowing and standardizing the “dose” of teamwork training applied across study groups is also a challenge and must be accomplished to build a body of knowledge regarding the effectiveness of educational interventions.

Although the role of health care leaders in promoting interdisciplinary col-laboration is widely discussed, very little research has been conducted to assess the impact of different leadership and organizational structures on assuring and advancing teamwork and collaboration. Research in this area is especially impor-tant if organizations are to create the kind of work environments promoted by the IOM and the ANCC’s Magnet Recognition Program, environments that are characterized by inclusiveness, transparency, teamwork, and collaboration.

Outcome data demonstrating actual improvements in the quality of patient care as a result of interdisciplinary teamwork are beginning to emerge, but remain scarce in the literature and should be a focus of future research. Because of the myriad interactions that occur in the health care environment among clinicians and between clinicians and patients, it is challenging to isolate and measure the impact of specifi c interactions on patient outcomes. Like all other areas related to collaboration, studies in this area would benefi t from greater methodological rigor and improved instrumentation.

Developing programs and models to assure and advance interdisciplin-ary collaboration among practicing clinicians is especially important in light of ongoing efforts to reform the U.S. health care system and enhance health care quality, safety, and cost effectiveness. Interdisciplinary collaboration is integral to many of the programs supported by the reform legislation, including the devel-opment and implementation of accountable care organizations, “health home” initiatives, and other programs aimed at improving the care of patients with complex conditions. Answering the following research questions will heighten nurses’ understanding of interdisciplinary collaboration and support them in developing structures that make a difference in the patient and family experience and patient, workforce, and fi nancial outcomes.

When interdisciplinary team members collaborate effectively, what effect 1. does it have on clinical outcomes over time?How does effective interdisciplinary collaboration among clinicians caring 2. for patients with chronic conditions affect the experience and perceptions of family members?



Is an interdisciplinary care team delivery model more or less costly in terms 3. of human resources, use of ancillary services, medication management?Do interdisciplinary care teams that function effectively provide safer care?4. What organizational structures are most effective in assuring that inter-5. disciplinary collaboration and teamwork actually happen consistently and effectively?

Answering these and other questions will help organizations advance inter-disciplinary collaboration and teamwork and maximize its impact on patient safety, organizational effectiveness, the practice environment, and patient, work-force, and organizational outcomes.

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