When Interprofessional Teamwork Efforts Fail

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

A manager recently asked me how she could build Interprofessional teamwork on her surgical unit when the surgical residents had been given the option of opting out on bedside rounds. Her patient satisfaction scores involving communication with health providers were low. Her process to introduce the rounding was well thought out. Families and patients expressed appreciation for the opportunity to have all the team members together to discuss care. She was sure that customer service scores would improve over time. Then without notice or discussion, the rounds were discontinued because key physician team members complained to the CEO that it interfered with the pace of their work.

Healthcare has been described as a team sport because the contributions of each discipline are so interdependent. Quality healthcare outcomes only happen in environments where there is strong interprofessional teamwork. A team of experts does not necessarily mean that you have an expert team. Teamwork itself must be built. Yet getting interprofessional teams on the same page, or even together in the same place to communicate can be challenging. The concept of everyone being involved and participating is key to effective interdisciplinary work. The stakes are high if this does not happen. Most medical errors involve breakdowns in communication among team members. Ineffective interprofessional teamwork is a patient safety issue, and some experts believe it is strongly correlated to higher patient mortality.

Nurse leaders are being taught about the need to create a culture that strongly values interprofessional teamwork. On interprofessional teams, decisions are reached collectively by the group. Involvement and participation in patient care decisions is the key to effective group functioning. Interprofessional team work requires individual involvement. Professionals cannot be allowed to opt out because given the opportunity, some will as happened to this manager.

In thinking through why the rounding initiative had failed, the manager realized that she had not established a sense of urgency for the change. She had failed to talk about a common goal such as improvement in patient-centered communication as a critical success factor and the return on investment of stronger interprofessional teamwork. We can sometimes assume that professionals will see the value in interdisciplinary teamwork without being explicit about the benefits. In the course of their training, providers have a tendency to become socialized into their own professions and subsequently develop negative biases and naïve perceptions of the roles of other members of the health care team.

To practice effectively on an interprofessional health care team, there should be a clear understanding of other members’ unique contributions: their educational backgrounds, areas of high achievement, and limitations. Every discipline has a unique culture, language and a mental model in how they approach patient situations. This needs to be respected and listened to. Professionals are often surprised about the knowledge and clinical abilities of other disciplines. This respect may not happen initially but does grow over time. The manager realized she needed to reboot her efforts and do a more effective job of marketing the strategy to both the surgeons and the executive team.