Strategies for improving results.
- Interprofessional collaboration can be added to bedside rounding and other existing teams.
- Patient engagement and satisfaction improves with interprofessional collaboration.
- Health outcomes improve when interprofessional teams work collaboratively.
Interprofessional collaborative teams that include nurses, physicians, social workers, pharmacists, and physical and occupational therapists can help healthcare organizations improve patient and family experiences, ensure good outcomes, and reduce costs. Successful collaboration also enhances the workplace. Nurses working in organizations that have received American Nurses Credentialing Center Magnet® designation report that true team collaboration enhances a healthy work environment.
However, even when nurses work alongside other professionals every day and teamwork is a job expectation, effective collaboration can be challenging. Several strategies—
safety huddles, patient rounds, safety rounds, daily goals, shared care and discharge plans, structured family meetings, and shared department training—can improve collaboration.
Short (less than 10 minutes) interprofessional safety huddles held at the beginning of each shift focus on sharing safety and quality successes and concerns from the previous day, discussing safety and quality issues for patients on the day’s schedule, updating mandated quality and safety measures, encouraging input about other safety and quality concerns, and sharing announcements or information. Each shift’s huddle should occur at a designated time every day and be led by the most senior nurse or provider. Having a clinical voice lead the huddle encourages teams to take the initiative for managing safety and quality.
A structure for the huddle (for example, working clockwise from person to person or passing an object to designate who’s talking) prompts each team member to share concerns. Using a checklist helps keep the meeting organized.
According to Fencl and Willoughby, some organizations have found that safety huddles increase hand hygiene compliance and decrease the rates of central line-associated bloodstream and catheter-associated urinary tract infections. In addition, they found that patient satisfaction scores increase when using this approach. Publicizing and celebrating these successes as team wins also encourages collaboration.
The goal of interprofessional team rounding with the patient and family is to share critical patient care information and develop a collaborative care plan. These rounds can occur at the bedside or in a conference room, but bedside rounding has become popular as a way to coordinate care among shifts of interprofessional providers and staff. All members of the interprofessional team should be invited to participate in rounds, but patients and family, nurses, pharmacists, physical therapists, social workers, and physicians are most frequently present during rounds.
The team discusses the patient’s health and family concerns, daily care, treatment goals, and discharge plans. Health, quality, and safety matters are reviewed, and all team members participate in decision-making.
Interprofessional rounds improve patient care and satisfaction among providers.
Many organizations use interprofessional safety rounds to promote a just culture that focuses on evaluating choices and processes that impact safety and quality, not the outcome of the event or assigning blame. The safety team typically divides its members into pairs who walk through up to eight patient care areas and meet with various staff members. Using scripted questions, the team talks with staff from all professions and records their comments, identifying their roles but not their names.
At debriefings, the safety team evaluates near-miss causes, adverse events, and system issues. When concerns are noted, an action plan is developed to address them, and specific staff members are assigned for follow-up. The safety team should immediately address any identified concerns that pose imminent risks.
Daily goals worksheet
Daily goals worksheets can help interprofessional teams track safety and care quality by identifying one or two daily targets for patients to meet and improve their care. The worksheets help communicate patient needs and risks and verify goal completion. Including patients and families in goal development improves their understanding and participation and increases satisfaction. The daily goal worksheets also can streamline communication among team members and reduce work duplication.
Shared care and discharge plans
A shared care and discharge plan—written or as part of the patient’s electronic health record—can be used for interprofessional team collaboration in all clinical settings. Rather than depending on separate medical, behavioral, and nursing treatment plans, a shared plan combines all aspects of care, with each team member offering a unique perspective that enhances a holistic care approach. When patients and family members are included in care and discharge planning, they have an opportunity to develop, participate in, and negotiate their care; voice their concerns; and ensure they’re ready for discharge.
Successful shared care and discharge planning helps move the relationship among patients, family members, and the care team from one of dependence to one of independence, where the patient feels in control of healthcare decisions. Shared decision-making also helps team members coordinate service, increasing quality care and patient satisfaction. The shared care plan should be evaluated regularly and updated as needed.
Structured family meetings
Structured family meetings can be the ideal place for implementing successful interprofessional team collaboration. Similar to huddles and rounding, family meetings focus on patient and family concerns. The meeting should have a leader who creates an agenda, structures the meeting, summarizes the discussion for all participants, assigns team members to take action, and conducts follow-up. Patients expect more than just physical symptoms and disease information; they want the team to address broader issues such as their role in society, well-being, support, and psychosocial concerns. Active patient participation (talking to the patient rather than about them) can help increase patients’ sense of independence and improve adherence to care plans. Structured interprofessional family meetings also can increase care team empathy.
For organizations that haven’t established collaborative interprofessional teams, shared training is an easy way to introduce them. When healthcare professionals and staff attend continuing education and training sessions together, they’re in a risk-free environment that gives them insight into each other’s roles. Talking freely about a common goal can help team members empathize, appreciate the challenges of other professions, and strengthen bonds. In addition, seeing how training is completed from multiple viewpoints establishes rapport for future exchanges that may help the team make better care decisions later.
Implementing an interprofessional collaborative team process without adding to nurses’ responsibilities can be challenging. However, creating daily teamwork opportunities—via rounding, shared care plans, family meetings, and more—makes it possible for all professionals invested in patient care to come together. The benefits to patients, families, and providers make it a worthwhile initiative.
Lorie B. Sigmon is an assistant professor in the school of nursing at the University of North Carolina Wilmington.
Ambrose-Miller W, Ashcroft R. Challenges faced by social workers as members of interprofessional collaborative health care teams. Health Soc Work. 2016;41(2):101-9.
American Nurses Credentialing Center. 2019 Magnet® Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2017.
Berwick DM, Nolan TW, Whittington J. The triple aim: Care, health and cost. Health Aff. 2008;27(3):759–69.
Brass SD, Olney G, Glimp R, Lemaire A, Kingston M. Using the patient safety huddle as a tool for high reliability. Jt Comm J Qual Patient Saf. 2018;44(4):219-26.
Committee on Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes; Board on Global Health; Institute of Medicine. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington, D.C: National Academies Press; 2015.
Dekker PS. Just Culture: Balancing Safety and Accountability. 2nd ed. Farnham, UK: Ashgate; 2012.
Fencl JL, Willoughby C. Daily organizational safety huddles: An important pause for situational awareness. AORN J. 2019;109(1):111-8.
Moss E, Seifert PC, O’Sullivan A. Registered nurses as interprofessional collaborative partners: Creating value-based outcomes. Online J Issues Nurs. 2016;21(3):4.
Urisman T, Garcia A, Harris HW. Impact of surgical intensive care unit interdisciplinary rounds on interprofessional collaboration and quality of care: Mixed qualitative-quantitative study. Intensive Crit Care Nurs. 2018;44:18-23.
Walter JK, Sachs E, Schall TE, et al. Interprofessional teamwork during family meetings in the pediatric cardiac intensive care unit. J Pain Symptom Manage. 2019;57(6):1089-98.
World Health Organization. Framework for action on interprofessional education and collaborative practice. 2010. who.int/hrh/resources/framework_action/en