The blog article Intraprofessional Challenges for Interprofessional Collaboration highlighted that the differences in history and culture of all the distinctive heterogeneous disciplines acts as a force blocking interprofessional collaboration. Interprofessional Education is one methodology for inculcating at the very beginning of the education process an appreciation and respect that values the distinct benefits each interdisciplinary team member offers within a collaborative team. This education forms the basis for interdisciplinary teamwork. Then there is the established climate and culture that might clash with this new value system, along with the legacy interdisciplinary conflicts discussed in previous blog articles. One problem has been that the historic climate and culture trumps previous education.
An important aspect of teamwork is communication, and communication within these historical cultures and climates can be challenging. Most importantly, Hughes(2008) states that communication is a factor influencing patient safety:
“From a systems approach, avoidable errors are targeted through key strategies such as effective teamwork and communication, institutionalizing a culture of safety, providing patient-centered care, and using evidence-based practice with the objective of managing uncertainty and the goal of improvement.”
The Agency for Healthcare Research and Quality has developed an institutional framework for teamwork called TeamStepps. TeamStepps is “an evidence-based teamwork system to improve communication and teamwork skills among health care professionals.”
There are multiple contexts to provide this program, such as Rapid Response, Dental, Enhancing safety for patients with limited English proficiency, and long term care. The Rapid Response Module offers videos that demonstrate the adverse scenario where the inputs of the interdisciplinary collaborative team, including the patient, are not valued. Then there are great examples demonstrating the flow of care when the collaborative team uses excellent communication skills respecting every team members’ value.
Seven Crucial Conversations
I believe the IPEP community is striving for a flow of care that follows the latter scenario. In a previous blog I explored Team Dynamics and Medical Errors. This article covered the ability for the interprofessional team to engage in the Seven Crucial Conversations™. The adverse scenario presented above provides a realistic situation that is common to an adverse event -- poor team dynamics that do not focus on the patient first. Very specifically, the issues presented are well discussed in the Silence Kills study.
The study finds that seven categories of conversations are especially difficult and, at the same time, appear to be especially essential for people in healthcare to master—including:
1. Broken rules
3. Lack of support
5. Poor teamwork
In thinking about the context of my previous blog article, "Crucial Conversations for Interprofessional Teams," how many of the Seven Crucial Conversations™ can you identify in the adverse scenario mentioned above?
I imagine that the IPEP student is learning an appreciation for their health care interdisciplinary peers, but there are cultures and climates throughout the health care system that present many challenges. Institutionalizing TeamStepps and the VitalSmarts® Seven Crucial Conversations™ programs are well-established methods for facilitating teamwork. These tools might bridge adverse cultures and climates until the effects of interprofessional education permeate the health care culture.