Interdisciplinary Team Working, Leadership and Professional Development

Introduction

In clinical practice, like any other professional field, the process of service delivery involves numerous interactions among multiple stakeholders. A typical day in hospital for instance, requires the patient to interact with numerous care providers, whose roles are interconnected in coordinated fashion. The ultimate goal of interaction among professional in healthcare setting is to ensure service delivery is integrated to the best outcome. To meet the goals of collaborative care, health practitioners have to establish an effective communication framework. A communication model that favors the collaborative care may involve the participation of various departmental staff, including physicians, nurses, technicians and others. Interdisciplinary communication occurs when the interaction staff representing various disciplines in the professional setting interact or share information to achieve a common goal. With interdisciplinary communication therefore comes effective leadership. When individuals are led with love, it draws a personal experience and confidence in them thus allowing them to deliver their best amazingly. The current paper seeks to identify various communication methods applied in interdisciplinary and professional care setting, and how they enable leaders to make decisions on change management for purposes of improved care within a clinical practice setting.

Concepts of Communication and Professionalism in effective teamwork

Gharaveis et al (2018) defined communication as the interchange or imparting of knowledge, information by speech, opinions and thoughts, which can not only be done in verbal form but also non-verbal form. As per Li et al (2018), a significant percentage of communication is more conducted by body language, tone, attitude, leaving only a few percentages of the intent and meaning based on actual words.

Whereas crucial content can be communicated through spoken word, the meaning of those words can be influenced by the manner of delivery, which includes how the speaker speaks, stands, or looks at the other person. However, according to Martin et al (2019), some critical information can also be delivered through handwritten notes, text messages, and emails, all of which have serious consequences if miscommunicated in the context of healthcare.

Mahmood et al (2021) defined collaboration in healthcare as the process in which health care professionals assume complementary roles and cooperatively work together by sharing responsibility and share decision-making to execute care patient plan. In this regard, Joseph et al (2021) stated that collaboration between healthcare nurses, physicians, and other healthcare professionals increases team member’s awareness of each other’s skills and knowledge, contributing to continually improving decision-making.

Effective healthcare teams are characterized by respect, collaboration, and trust. Ramaswamy et al (2017) argued that teamwork entails a system in which all the healthcare employees work together to achieve a common goal. Unlike the multidisciplinary approach whereby each team member is responsible for only the activities that are related to their disciplines and have separate goals for the patient, an interdisciplinary approach to teamwork has a joint effort on behalf of the patient with a common goal for all disciplines involved in the care plan (Khademian & Tehrani, 2017). According to Joseph et al (2021), the pooling of these specialized services contributes to the delivery of an integrated care plan. Ideally, the integrated care plan accounts for multiple assessments and treatment plans; and it coalesces these services to create an individualized care program that focuses on addressing the patient’s need. Consequently, as per Li et al (2018), the patient finds it easier to communicate with the cohesive team as opposed to numerous professionals who do not other team members’ roles in meeting their needs.

An extensive review of literature on collaboration, teamwork and communication reveals that there is hardly teamwork in clinical settings. For instance, a study by (17) revealed that relational, organizational and social structures contribute to communication failures that are large contributors to adverse clinical outcomes and events. Gharaveis et al (2018) also observed that members of healthcare teams may have different priorities of patient care, and the team may also be inconsistent with their verbal communication.

Another pool of researchers has studied the impact of nurse and physician disruptive behavior (defined as inappropriate confrontation, raging, verbal abuse, sexual or physical harassment) and its effect on the relationship between staffs, staff turnover and satisfaction, and patient outcomes such as adverse events, compromises on patient safety, medical errors poor quality of care that is liked to preventable mortality (Khademian & Tehrani, 2017). According to Gharaveis et al (2018), most of those effects are attributable to poor communication and ineffective teamwork.

Unfortunately, many healthcare workers are familiar with poor communication and teamwork, as a result of a culture of permissiveness and low expectation that has developed in healthcare settings (Khademian & Tehrani, 2017). As per Li et al (2018), this culture, which is characterized by health workers who come to expect an incomplete and faulty exchange of information can lead to medical errors because even conscious practitioners tend to ignore clinical discrepancies and red flags. They perceive these warnings as signals of routine repetitions of poor communication as opposed to worrisome, unusual indictors. Nonetheless, literature also shows that effective communication can lead to positive health outcomes in the form of more effective interventions, improved patient morale, family and patient satisfaction, better information flow, improved safety and decreased length of hospital stay (Khademian & Tehrani, 2017).

It is important to note that fostering an environment of team collaboration may have various challenges to overcome. These challenges may include conflicting interest among team members, perceived loss of autonomy, clashing perceptions, territorialism, and lack of awareness of skills possessed by other team members (Joseph et al, 2021). however, most of these challenges can be overcome with effective conflict resolution approaches that foster mutual trust and respect.

These challenges always present in inevitable conflicts, and therefore leaders within the healthcare sector must develop effective ways of managing the conflicts. According to Li et al (2018), understanding that conflict might occur within a collaborative care setting and understanding the leader’s role in solving this conflict is important. Another important approach proposed by Joseph et al (2021), is evaluating reactions to conflict. Whether the team members compete, avoid or sulk in times of conflict, knowing how to respond to this conflict may be an effective approach in managing conflicts among healthcare teams.

Previously implemented change area

As a major determinant in effective change management, one of the areas I recommended in patient safety is to execute fall prevention in healthcare organizations. As a major threat to health, falls have caused some of the frequently observed injuries in patients, especially, the old adult population, necessitating the need for a quality and safety improvement plan. The healthcare facilities apparently incur a lot of costs in treating fractures and acquired injuries resulting from patient falls within the bounds of the facility (Barker, 2016). The safety improvement plan targeted a fall prevention program to reduce the cost of injuries due to patient falls within the facility.

The fall prevention was conducted in a telemetry unit that serves elderly cardiovascular disease patients, majorly above 65 years old. These patients are the most vulnerable to risks associated with falls within the health unit, thus best suited for the test of successful implementation of the program. In the plan, the hospital targeted a program called the Clinical Nurse Leader (CNL) which aimed at integrating professionals within the unit to participate as a team in the mission to reduce the fall rate of patients (Callis, 2016). The program had the following three major components, which present the deliverable measures of successful plan and implementation. The three elements to address in planning and implementing the prevention plan included quality improvement model, the proactive risk evaluation criteria and the standardized deliberate rounding in the inpatient (Cangany et al., 2017). I speculated that in the event of success, the program would ensure the incidents of patient falls reduce by great margin even as the rate of inpatient services required increases within the unit.

In assessing the quality improvement model, we intend to collaborate as nurse leaders to measure the events of patient falls per month against the length of time or intervals between consecutive events of patient injuries due to the falls. The staff, being important part of the process will deliver their compliance level to the intentional rounding within the facility (Coe et al., 2017). Ideally, as per Coe et al (2017), intentional rounding is a structured nursing approach whereby nurses conduct frequent checks on patients at specific times to assess their care needs. Each observation reflects how much the staff compliance measures up to the satisfaction standards of fall prevention within the unit. The interprofessional team was responsible for the interventions established to reduce the rate of patient falls as well as improve the effectiveness of the program.

As Clinical Nurse Leaders it was our duty to identify gaps in the hospital unit through microsystem assessment and to establish which factors cause the risk of patient falls. In this quality improvement approach, the CNL incorporated Institute for Healthcare Improvement (IHI) guidelines, as a tool to monitor and effect the change process aimed at reducing the rate of patient falls within the hospital unit (Stanley et al., 2018). The program further incorporated intentional rounding to assess and address needs such as pain and toileting that prompt patient falls within the hospital unit (Robinson, 2017). Also addressed through intentional rounding were the exposure risks such as positioning and need for personal belongings that trigger some events of the patient falls.

Based on IHI guidelines, we identified most risk factors associated with patient falls and injuries are related to physical and structural environment of the hospital unit. Inappropriate flooring presents one of the major risks that lead fall events, without which patients find it difficult to navigate the hospital and reach for their needs (Gluck et al., 2016). Inadequate lightning also poses risks to patients especially older adults who may be exposed to eye defects or odd sight in the facility (Krauss et al., 2017). Patient risks can also be triggered by inappropriate furniture, for instance making chairs with heights that fail to suit the patient, or beds without side rails to support the patient at rest. The plan also identified dementia-unfriendly environment as a factor that exposes patients to the risk of frequent fatigue and the events of fall within the unit.

The program utilized a quality improvement model to address the incidents and causes of fall events in three main categories. The first step was to conduct a risk assessment, followed by proactive risks to patient falls, and finally the standardized rounding process to establish performance and compliance to safety measures by patients and staff (Mojares, 2018). The quality improvement model incorporated a team of professionals who reviewed and established causes of fall events as well as test the changes or improvements due to the implemented action plan (Spetz, 2017). A visual cue were availed by the team to present the current state of patient falls, analysis and discovery of causes, as well as change implementations in the program. As a result of the change and improvement model, the unit tasked the Clinical Nurse Leader the responsibility to monitor and capture the effectiveness of interventions (Morgan et al., 2017) The MST team addressed areas of fall prevention through a contingency diagram focused on inconsistent intentional rounding, unreliable assessment of fall risks, insufficient falls data and lead staff communication, as well as inadequate effective hand-off communication.

The team collected and applied data on current falls facilitated by trained nurses and patient care technicians (Sherman, 2018). The CNL applied the data associated with staff competencies to facilitate the training as well as share the impact of the program with team members. Through the rounds, nurse leaders informed and shared with other teams the plan to hold and make changes to the Unit’s safety strategies.

Reflection

In developing my clinical competency, one element of practice that has significantly improved since began my course is my approach to change leadership and change management. By this developing the above-mentioned proposed change in the practice area of patient fall, I was able to collaborate with the CNLs to develop an effective framework for implementing and evaluating change within the healthcare setting. In this section, I use the DIEP (describe, interpret, evaluate and plan) reflective strategy to explore how my change management and change leadership skills have significantly improved.

We reviewed the role of nurses and the contributions they could make to address the clinical issue of patient fall within the care setting. The most interesting thing I realized from this step of the process is that when a change agent focuses on their leadership strengths and weaknesses, they adapt to situations and learn how to put several points into work.

To improve the major project decisions, we took the time as a team to re-evaluate various parameters of the facility that do not meet the expected improvement outcomes. It was at the inception phase that environmental conditions required to execute fall prevention were analyzed, and the relevant theories integrated among team members to foster self-motivation and confidence in patients (Sikdar, & Payyazhi, 2014). In my team, I was particularly able to address the issue of self-confidence among the unit’s nurses as a means to create an open platform for the nursing team to come to share views and reach consensus on the problem of patient fall, and how the environmental conditions can be modified to suit improved outcomes.

Similarly, at the inception phase, we were able to evaluate parameters of the proposed change such as project definition, schedule, cost estimation, risks, feasibility, and preparation to implement or execute environmental change (Tkaczyk, 2015). We laid out strategy to assess the factors, trends and changing patient demographics; and track the interventions that can bring out improved performance. At the organization management level, I led the team in emphasizing the need to preempt and capitalize on change activities that would lead a better achievement of the project goals.

As I worked with the team to evaluate how fall prevention changes could be made in unit’s environment, I learned the role of technology in applying and monitoring change within a healthcare setting. The evolving technology as a change factor impacting performance came across to me as an important tool that could be used in creating a clinical environment that is safe and secure for not only the patients but also the staffs.

By conducting research on hospital physical planning and how to develop a safe working environment for both clinical staff and patients Al-Ali et al (2017), I developed critical skills to contribute innovate ideas based on local and global trends affecting service delivery as well as patient safety. There is strong reason to hold that the main goal of change and reorganization strategies in clinical care settings is to enable small health facilities regroup or to specialize their function to deliver professional services (Jayatileke & Lai, 2018).

A significant issue I have not addressed in my previous writing is that developing an excellent change management team will depend on effective leadership styles (Thakur & Mangla, 2019). Patient service improvement team starts at the top and works its way through to the lowest ranking staff in the unit. According to my evaluation standards, I sought to strike a balance between patient needs and the existing conditions available to build a case to the change implementation about the need to this area of service. as proposed by Mathews et al (2018), we also assessed the change management plan in flooring and intentional rounding by measuring the level of compliance and how the team demonstrated improved interpersonal skills.

Upon establishing the needed change areas, we managed to integrate the collective action within the departments. Each of the nurses in charge of patients worked together with the Clinical Nurse Leaders to improve performance outcomes by communicating ideas and challenges associated with service delivery an patient fall, and those that affect patient movement within the hospital facility. In addition, we were able to develop a framework for the nurse leaders to monitor and follow up the progress in various change management parameters within each department.

One thing I realized during this change implementation process is that the reevaluation of leadership style by the change management team ensures that they develop appropriate leadership styles and are continually looking for opportunities to change their interpersonal behaviors (Vlados, 2019). A major function I assigned to the team members was was to observe patient responses on the areas that critically affected their safety, and capacity to take part in their daily health decisions alongside their care providers. I noted that patients were only able to comply or respond well to treatment process or build their confidence in care providers if perceived the environment safe and free from the risk of falling. The environment determined how convenient patients were enabled to move about, seek open and ventilated spaces, and accessed areas to share ideas and give collective opinions on areas to improve within the clinical facility.

I also learnt important values that relate to effective care, and to enable inter-professional team. Inter-disciplinary teamwork implies that professionals have to interact with one another to achieve common business or operational objectives. Therefore, in my second year of the course, I intend to learn, understand and master the concept and process of effective communication during a change implementation process, so that I can effectively participate in future practice improvement programs that require change management.

References

Al-Ali, A. A., Singh, S. K., Al-Nahyan, M., & Sohal, A. S. (2017). Change management through leadership: the mediating role of organizational culture. International Journal of Organizational Analysis.

Church, A. H., Gilbert, M., Oliver, D. H., Paquet, K., & Surface, C. (2016). The role of technology in organization development and change. Advances in Developing Human Resources, 4(4), 493-511.

Gharaveis, A., Hamilton, D. K., & Pati, D. (2018). The impact of environmental design on teamwork and communication in healthcare facilities: a systematic literature review. HERD: Health Environments Research & Design Journal, 11(1), 119-137.

Huber, G. P., & Glick, W. H. (Eds.). (2018). Organizational change and redesign: Ideas and insights for improving performance. Oxford University Press on Demand.

Sikdar, A., & Payyazhi, J. (2014). A process model of managing organizational change during business process redesign. Business Process Management Journal.

Holmes, S. (2014). What was learned about organization change and redesign. Organizational change and redesign: Ideas and insights for improving performance, 383.

Ingersoll, G. L., Fisher, M., Ross, B., Soja, M., & Kidd, N. (2017). Employee response to major organizational redesign. Applied Nursing Research, 14(1), 18-28.

Weick, K. E. (2016). Organizational redesign as improvisation. Organizational change and redesign: Ideas and insights for improving performance, 346, 379.

Tkaczyk, B. (2015). A playbook for positive organizational and change: Energize, redesign.

Strategic Change, 24(6), 527-540.

Smith, B. N., Montagno, R. V., & Kuzmenko, T. N. (2017). Transformational and servant leadership: Content and contextual comparisons. Journal of Leadership & Organizational Studies, 10(4), 80-91.

Northouse, P. G. (2018). Leadership: Theory and practice. Sage publications.

McLaughlin, C.P. and Kunk-Czaplicki, J.A., 2020. Leadership: Theory and Practice by Peter G. Northouse. Journal of College Student Development, 61(2), pp.260-261.

Mcleod, S. (2017). Maslow's Hierarchy of Needs. Simply Psychology.

Martin, G., Khajuria, A., Arora, S., King, D., Ashrafian, H., & Darzi, A. (2019). The impact of

mobile technology on teamwork and communication in hospitals: a systematic review. Journal of the American Medical Informatics Association, 26(4), 339-355.

Mahmood, L. S., Mohammed, C. A., & Gilbert, J. H. (2021). Interprofessional simulation education to enhance teamwork and communication skills among medical and nursing undergraduates using the TeamSTEPPS® framework. Medical Journal Armed Forces India, 77, S42-S48.

Rachmawati, A. W., &Lantu, D. C. (2014). Servant leadership theory development & measurement. Procedia-Social and Behavioral Sciences, 115, 387-393.

Reising, D. L., Carr, D. E., Gindling, S., Barnes, R., Garletts, D., & Ozdogan, Z. (2017). An analysis of interprofessional communication and teamwork skill acquisition in simulation. Journal of Interprofessional Education & Practice, 8, 80-85.

Barker, W. (2014). Assessment and prevention of falls in older people. Nursing older people, 26(6).

Callis, N. (2016). Falls prevention: Identification of predictive fall risk factors. Applied nursing research, 29, 53-58.

Cangany, M., Back, D., Hamilton-Kelly, T., Altman, M., & Lacey, S. (2017). Bedside nurses leading the way for falls prevention: An evidence-based approach. Critical care nurse, 35(2), 82-84.

Coe, L. J., St John, J. A., Hariprasad, S., Shankar, K. N., MacCulloch, P. A., Bettano, A. L., & Zotter, J. (2017). An integrated approach to falls prevention: a model for linking clinical and community interventions through the Massachusetts Prevention and Wellness Trust Fund. Frontiers in public health, 5, 38.

Gluck, T., Wientjes, H. J. F. M., & Rai, G. S. (2016). An evaluation of risk factors for in-patient falls in acute and rehabilitation elderly care wards. Gerontology, 42(2), 104-107.

Joseph, A., Chalil Madathil, K., Jafarifiroozabadi, R., Rogers, H., Mihandoust, S., Khasawneh,

A., ... & McElligott, J. T. (2021). Communication and teamwork during telemedicine-enabled stroke care in an ambulance. Human Factors, 0018720821995687.

Jayatilleke, S., & Lai, R. (2018). A systematic review of requirements change management. Information and Software Technology, 93, 163-185.

Krauss, M. J., Evanoff, B., Hitcho, E., Ngugi, K. E., Dunagan, W. C., Fischer, I., ... & Fraser, V. J. (2016). A case-control study of patient, medication, and care-related risk factors for inpatient falls. Journal of general internal medicine, 20(2), 116-122.

Khademian, Z., & Tehrani Neshat, B. (2017). The relationship between interpersonal communication skills and nursing students’ attitudes toward teamwork. Sadra Medical Journal, 5(2), 99-110.

Li, J., Talari, P., Kelly, A., Latham, B., Dotson, S., Manning, K., ... & Williams, M. V. (2018). Interprofessional Teamwork Innovation Model (ITIM) to promote communication and patient-centred, coordinated care. BMJ quality & safety, 27(9), 700-709.

Mojares, J. (2018). Quality Improvement in Reducing Falls in a Medical-Surgical-Telemetry Unit.

Morgan, L., Flynn, L., Robertson, E., New, S., Forde‐Johnston, C., & McCulloch, P. (2017). Intentional Rounding: a staff‐led quality improvement intervention in the prevention of patient falls. Journal of Clinical Nursing, 26(1-2), 115-124.

Matthews, J., Love, P. E., Mewburn, J., Stobaus, C., & Ramanayaka, C. (2018). Building information modelling in construction: insights from collaboration and change management perspectives. Production Planning & Control, 29(3), 202-216.

Robinson, L. (2017). Self-Management and Adherence with Exercise-Based Falls Prevention Programmes for Older People with Long-Term Conditions: A Framework for Physiotherapy Practice (Doctoral dissertation, Northumbria University).

Ramaswamy, R. S., Tiwari, T., Ramaswamy, H. F., & Akinwande, O. (2017). Teamwork and communication in interventional radiology. Journal of Radiology Nursing, 36(4), 261-264.

Sherman, R. O. (2018). Lessons in innovation: Role transition experiences of clinical nurse leaders. JONA: The Journal of Nursing Administration, 40(12), 547-554.

Spetz, J., Brown, D. S., & Aydin, C. (2017). The economics of preventing hospital falls: demonstrating ROI through a simple model. JONA: The Journal of Nursing Administration, 45(1), 50-57.

Thakur, V., & Mangla, S. K. (2019). Change management for sustainability: Evaluating the role of human, operational and technological factors in leading Indian firms in home appliances sector. Journal of cleaner production, 213, 847-862.

Stanley, J. M., Gannon, J., Gabuat, J., Hartranft, S., Adams, N., Mayes, C., ... & Burch, D. (2018). The clinical nurse leader: a catalyst for improving quality and patient safety. Journal of Nursing Management, 16(5), 614-622.

Vlados, C. (2019). Change management and innovation in the “living organization”: The Stra. Tech. Man approach. Management Dynamics in the Knowledge Economy, 7(2), 229-256.

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