interdisciplinary teamwork and collaboration -...
TRANSCRIPT
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
Debisette_PTR_CH07_01-04-11_159-190.indd 159Debisette_PTR_CH07_01-04-11_159-190.indd 159 4/1/2011 7:47:09 PM4/1/2011 7:47:09 PM
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
Debisette_PTR_CH07_01-04-11_159-190.indd 160Debisette_PTR_CH07_01-04-11_159-190.indd 160 4/1/2011 7:47:10 PM4/1/2011 7:47:10 PM
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
Debisette_PTR_CH07_01-04-11_159-190.indd 161Debisette_PTR_CH07_01-04-11_159-190.indd 161 4/1/2011 7:47:10 PM4/1/2011 7:47:10 PM
162 ANNUAL REVIEW OF NURSING RESEARCH
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
Debisette_PTR_CH07_01-04-11_159-190.indd 162Debisette_PTR_CH07_01-04-11_159-190.indd 162 4/1/2011 7:47:10 PM4/1/2011 7:47:10 PM
Interdisciplinary Teamwork and Collaboration 163
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
Debisette_PTR_CH07_01-04-11_159-190.indd 163Debisette_PTR_CH07_01-04-11_159-190.indd 163 4/1/2011 7:47:10 PM4/1/2011 7:47:10 PM
164 ANNUAL REVIEW OF NURSING RESEARCH
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
Debisette_PTR_CH07_01-04-11_159-190.indd 164Debisette_PTR_CH07_01-04-11_159-190.indd 164 4/1/2011 7:47:10 PM4/1/2011 7:47:10 PM
Interdisciplinary Teamwork and Collaboration 165
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.
Debisette_PTR_CH07_01-04-11_159-190.indd 165Debisette_PTR_CH07_01-04-11_159-190.indd 165 4/1/2011 7:47:10 PM4/1/2011 7:47:10 PM
166
TA
BL
E 7
.1C
urri
cula
Aut
hor
Prog
ram
Org
aniz
atio
nC
onte
nt
Dev
elop
men
tC
onte
nt a
nd S
truc
ture
Eva
luat
ion
Dod
d et
al.
(200
9)M
ater
nal C
hild
H
ealt
h (M
CH
) Le
ader
ship
Tr
aini
ng
Con
sort
ium
Uni
vers
ity
of N
orth
C
arol
ina,
C
hape
l Hill
(U
NC
-CH
)
Facu
lty
from
var
ious
di
scip
lines
in
the
MC
H
Con
sort
ium
Inst
ruct
iona
l ove
r ac
adem
ic y
ear
incl
ude
orie
ntat
ion,
lead
ersh
ip
wor
ksho
p, c
onfl i
ct r
esol
utio
n/fa
cilit
atio
n, c
ultu
ral c
ompe
tenc
e,
fam
ily-p
rofe
ssio
nal c
olla
bora
tion
, le
ader
ship
refl
ect
ion.
Qua
litat
ive
feed
back
from
pa
rtic
ipan
ts a
nd
facu
lty.
Dum
ont
et a
l. (2
010)
Pati
ent-
Cen
tere
d C
are:
Bet
ter
Trai
ning
for
Bett
er
Col
labo
rati
on
Prog
ram
Uni
vers
ity
of
Lava
l, Q
uebe
c C
ity
Can
ada
Facu
lty
in
Scho
ols
of
Nur
sing
, M
edic
ine
and
Soci
al W
ork
45 h
ours
of c
lass
room
tim
e; d
esig
ned
for
stud
ents
to
acqu
ire
know
ledg
e,
skill
s an
d at
titu
des
spec
ifi c
to fi
ve
prio
riti
zed
skill
set
s: (
1) p
arti
cipa
tion
an
d pa
rtne
rshi
p w
ith
pati
ents
and
fa
mili
es; (
2) in
tera
ctio
n sk
ills;
(3)
pr
ofes
sion
al r
oles
and
res
pons
ibili
ties
; (4
) co
llabo
rati
on; (
5) r
efl e
ctio
n.
Stud
ent
self-
adm
inis
tere
d Li
kert
qu
esti
onna
ire
usin
g a
5-po
int
scal
e.
Hal
lin e
t al
. (2
009)
Inte
rpro
fess
iona
l C
linic
al E
duca
tion
W
ard
(CE
W)
Team
wor
k Tr
aini
ng
Kar
olin
ska
Inst
itut
e,
Dan
dery
d H
ospi
tal,
Stoc
khol
m,
Swed
en
Facu
lty
in
scho
ols
of
med
icin
e,
nurs
ing,
oc
cupa
tion
al
ther
apy
and
phys
ioth
erap
y
2-w
eek
trai
ning
cou
rse
on c
linic
al
unit
; tra
inin
g oc
curr
ed o
n sp
ecifi
ed
CE
Ws
wit
h re
al p
atie
nts
rece
ivin
g ca
re;
stud
ents
wer
e di
vide
d in
to t
eam
s w
ith
facu
lty
from
eac
h di
scip
line
serv
ing
as
men
tors
.
Stud
ent
eval
uati
ons
ques
tion
nair
es a
t th
e en
d of
eac
h tr
aini
ng.
Debisette_PTR_CH07_01-04-11_159-190.indd 166Debisette_PTR_CH07_01-04-11_159-190.indd 166 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
167
AH
RQ
.gov
, N
ovem
ber
12, 2
010
Team
STE
PPS
Age
ncy
for
Hea
lthc
are
Res
earc
h an
d Q
ualit
y (A
HR
Q)
Dep
artm
ent
of
Def
ense
Pat
ient
Sa
fety
Pro
gram
in
con
junc
tion
th
e A
HR
Q
3-Ph
ase
appr
oach
whi
ch c
an b
e “d
osed
” ac
cord
ing
to o
rgan
izat
ion’
s ne
ed: (
1) O
rgan
izat
iona
l Ass
essm
ent,
(2
) Pl
anni
ng, T
rain
ing,
Int
erve
ntio
n,
(3)
Sust
ainm
ent.
The
Tra
inin
g pr
ogra
m
cons
ists
of a
2.5
day
“Tr
ain
the
Trai
ner”
w
orks
hop
follo
wed
by
a 4–
6 ho
ur
“Fun
dam
enta
ls”
wor
ksho
p fo
r cl
inic
al
staf
f and
a 1
–2 h
our
“Ess
enti
als”
w
orks
hop
for
nonc
linic
al s
taff.
Pre-
and
pos
t-tr
aini
ng
mea
sure
men
t of
st
aff s
atis
fact
ion
and
know
ledg
e;
ongo
ing
mea
sure
men
t of
impa
ct o
n pr
oces
ses
and
outc
omes
.
Vete
rans
Hea
lth
Adm
inis
trat
ion
(VH
A)
Med
ical
Te
am T
rain
ing
VH
AA
dapt
atio
n of
cr
ew r
esou
rce
man
agem
ent
theo
ry fr
om
the
avia
tion
in
dust
ry a
nd
in c
oord
inat
ion
wit
h th
e V
HA
Su
rgic
al Q
ualit
y Im
prov
emen
t Pr
ogra
m
Lear
ning
ses
sion
(le
ctur
e, in
tera
ctio
n,
vide
o in
stru
ctio
n); 4
qua
rter
ly
follo
w-u
p st
ruct
ured
tel
epho
ne
inte
rvie
ws
for
1 ye
ar t
o pr
ovid
e co
achi
ng, s
uppo
rt, a
nd a
sses
smen
t of
the
med
ical
tea
m t
rain
ing
impl
emen
tati
on.
Mea
sure
men
t of
pr
e- a
nd p
ost-
trai
ning
sur
gica
l m
orta
lity
rate
s.
Debisette_PTR_CH07_01-04-11_159-190.indd 167Debisette_PTR_CH07_01-04-11_159-190.indd 167 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
168 ANNUAL REVIEW OF NURSING RESEARCH
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.
Debisette_PTR_CH07_01-04-11_159-190.indd 168Debisette_PTR_CH07_01-04-11_159-190.indd 168 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
Interdisciplinary Teamwork and Collaboration 169
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)
Debisette_PTR_CH07_01-04-11_159-190.indd 169Debisette_PTR_CH07_01-04-11_159-190.indd 169 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
170 ANNUAL REVIEW OF NURSING RESEARCH
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
Debisette_PTR_CH07_01-04-11_159-190.indd 170Debisette_PTR_CH07_01-04-11_159-190.indd 170 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
171
TA
BL
E 7
.2O
rgan
izat
iona
l Mod
els
and
Trai
ning
App
roac
h
Aut
hor
Purp
ose
Popu
lati
onR
esea
rch
Des
ign
Inst
rum
ents
or
Met
hods
Find
ings
Dod
ds e
t al
. (2
010)
To d
escr
ibe
the
Uni
vers
ity
of N
orth
Car
olin
a/C
hape
l H
ill, M
ater
nal C
hild
Hea
lth
(UN
C-C
H M
CH
) Lea
ders
hip
Con
sort
ium
—co
llabo
ratio
n am
ong
fi ve
MC
H-f
unde
d tr
aini
ng p
rogr
ams—
and
to
delin
eate
the
evol
utio
n of
th
e le
ader
ship
cur
ricu
lum
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)
Debisette_PTR_CH07_01-04-11_159-190.indd 171Debisette_PTR_CH07_01-04-11_159-190.indd 171 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
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.
Debisette_PTR_CH07_01-04-11_159-190.indd 172Debisette_PTR_CH07_01-04-11_159-190.indd 172 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
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.
Debisette_PTR_CH07_01-04-11_159-190.indd 173Debisette_PTR_CH07_01-04-11_159-190.indd 173 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
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.
Debisette_PTR_CH07_01-04-11_159-190.indd 174Debisette_PTR_CH07_01-04-11_159-190.indd 174 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
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
.
Debisette_PTR_CH07_01-04-11_159-190.indd 175Debisette_PTR_CH07_01-04-11_159-190.indd 175 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
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.
Debisette_PTR_CH07_01-04-11_159-190.indd 176Debisette_PTR_CH07_01-04-11_159-190.indd 176 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
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
Debisette_PTR_CH07_01-04-11_159-190.indd 177Debisette_PTR_CH07_01-04-11_159-190.indd 177 4/1/2011 7:47:11 PM4/1/2011 7:47:11 PM
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
Debisette_PTR_CH07_01-04-11_159-190.indd 178Debisette_PTR_CH07_01-04-11_159-190.indd 178 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
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.
Debisette_PTR_CH07_01-04-11_159-190.indd 179Debisette_PTR_CH07_01-04-11_159-190.indd 179 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
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.
Debisette_PTR_CH07_01-04-11_159-190.indd 180Debisette_PTR_CH07_01-04-11_159-190.indd 180 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
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).
Debisette_PTR_CH07_01-04-11_159-190.indd 181Debisette_PTR_CH07_01-04-11_159-190.indd 181 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
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,
Debisette_PTR_CH07_01-04-11_159-190.indd 182Debisette_PTR_CH07_01-04-11_159-190.indd 182 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
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
hard
son
& S
torr
(2
010)
To id
enti
fy t
o w
hat
exte
nt
and
in w
hat
way
nur
sing
le
ader
ship
, col
labo
rati
on
and
empo
wer
men
t ca
n ha
ve a
dem
onst
rabl
e im
pact
on
pati
ent
safe
ty.
Lite
ratu
re r
evie
w
of a
bstr
acts
and
pa
pers
focu
sed
on
lead
ersh
ip, a
dvoc
acy,
in
terd
isci
plin
ary
wor
king
, em
pow
erm
ent,
and
co
llabo
rati
on.
Rev
iew
of
liter
atur
e
Sign
ifi ca
nt g
aps
exis
t in
re
lati
on t
o kn
owle
dge
of
the
exte
nt a
nd n
atur
e of
th
e ro
le o
f RN
s in
pat
ient
sa
fety
impr
ovem
ent.
H
uge
pote
ntia
l exi
sts
for
impr
ovem
ent
thro
ugh
nurs
ing
empo
wer
men
t, le
ader
ship
and
th
e de
velo
pmen
t of
too
ls t
o st
reng
then
and
sup
port
RN
s in
fl uen
tial
rol
e in
the
qua
lity
and
safe
ty m
ovem
ent.
Debisette_PTR_CH07_01-04-11_159-190.indd 183Debisette_PTR_CH07_01-04-11_159-190.indd 183 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
184
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
Schm
itt
et a
l. (2
001)
Des
crib
e th
e st
ate
of t
he s
cien
ce a
nd
sum
mar
ize
the
liter
atur
e on
inte
rdis
cipl
inar
y co
llabo
rati
on w
ith
emph
asis
on
geri
atri
c te
ams
from
195
0–19
95.
Rev
iew
art
icle
Prog
ress
has
bee
n m
ade
in m
ovin
g fr
om r
heto
ric
to s
olid
sci
ence
, wit
h th
e de
velo
pmen
t of
the
oret
ical
fr
amew
orks
, rig
orou
s de
sign
an
d m
etho
ds a
nd fo
cuse
d m
easu
rem
ent.
Vogw
ill &
R
eeve
s (2
008)
To e
xplo
re t
he
inte
rpro
fess
iona
l co
mm
unic
atio
n pr
acti
ces
and
need
s of
nur
ses
and
phys
icia
ns in
m
ulti
disc
iplin
ary
m
mee
ting
s (b
ulle
t ro
unds
).
Med
icin
e, n
ursi
ng,
OT,
PT,
soc
ial w
ork,
an
d ph
arm
acy
staf
f at
a g
ener
al in
tern
al
med
icin
e un
it in
a
larg
e te
achi
ng
hosp
ital
in C
anad
a.
Qua
litat
ive
Con
tent
ana
lysi
s ap
proa
ch. F
ield
no
tes
code
d us
ing
an a
dapt
ed v
ersi
on
of t
he T
eam
O
bser
vati
on
Prot
ocol
(T
OP)
ta
xono
my.
Insi
ght
was
pro
vide
d in
to t
he
com
plex
pro
cess
of m
anag
ing
and
exch
angi
ng in
form
atio
n in
bul
let
roun
ds. R
esea
rche
s su
gges
ted
intr
oduc
ing
stru
ctur
e to
the
pro
cess
of
info
rmat
ion
exch
ange
fo
r st
udy.
Debisette_PTR_CH07_01-04-11_159-190.indd 184Debisette_PTR_CH07_01-04-11_159-190.indd 184 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
185
TA
BL
E 7
.3In
stru
men
ts
Aut
hor
Inst
rum
ent
Con
tent
Dev
elop
men
tC
onte
nt a
nd S
truc
ture
Eva
luat
ion
Bale
s &
Coh
en
(197
9); R
ober
t Fr
eed
Bale
s, s
ocia
l ps
ycho
logi
st
Syst
em fo
r th
e M
ulti
ple
Leve
l ob
serv
atio
ns
of G
roup
s (S
MYL
OG
)
Base
d on
the
ory
deve
lope
d fr
om o
bser
vati
ons
of t
hree
mai
n bi
pola
r di
men
sion
s: d
omin
ant
vs. s
ubm
issi
ve; f
rien
dly
vs.
unfr
iend
ly; a
ccep
tanc
e vs
. no
nacc
epta
nce.
26-i
tem
que
stio
nnai
re a
sses
sing
fa
ctor
s kn
own
to c
ontr
ibut
e to
tea
m
effe
ctiv
enes
s E
valu
atio
n: T
eam
s pa
rtic
ipat
e in
tar
gete
d di
scus
sion
re
gard
ing
resu
lts
of q
uest
ionn
aire
to
eva
luat
e pe
rcep
tion
s of
tea
m
func
tion
ing
and
chan
ges
need
ed fo
r in
crea
sed
effe
ctiv
enes
s; N
eily
et
al
(201
0).
Team
s pa
rtic
ipat
e in
ta
rget
ed d
iscu
ssio
n re
gard
ing
resu
lts
of q
uest
ionn
aire
to
eval
uate
per
cept
ions
of
tea
m fu
ncti
onin
g an
d ch
ange
s ne
eded
fo
r in
crea
sed
effe
ctiv
enes
s.
Mill
s et
al.
(200
8); M
ills,
Pe
ter;
Nei
ly, J
ulia
; D
unn,
Edw
ard,
Ve
tera
ns H
ealt
h A
dmin
istr
atio
n
Med
ical
Tea
m
Trai
ning
Q
uest
ionn
aire
Ada
pted
from
the
VH
A T
eam
Tr
aini
ng q
uest
ionn
aire
to
elic
it
spec
ifi c
info
rmat
ion
from
m
embe
rs o
f clin
ical
tea
ms.
26 it
em q
uest
ionn
aire
mea
suri
ng
perc
epti
on o
f: or
gani
zati
onal
cul
ture
, co
mm
unic
atio
n, t
eam
wor
k, a
nd
hum
an fa
ctor
s aw
aren
ess
usin
g a
Like
rt s
cale
.
Subs
cale
Cro
nbac
h al
pha
scor
es a
ll >
0.70
; ove
rall
Cro
nbac
h al
pha
= 0.
881.
O’L
eary
et
al.
(201
0)
Team
wor
k an
d ba
rrie
rs t
o co
llabo
rati
on
asse
ssm
ent
Surv
ey d
evel
opm
ent b
ased
on
prev
ious
tool
s to
ass
ess
team
wor
k at
titud
es a
nd p
erce
ived
bar
rier
s us
ing
a Li
kert
sca
le, w
ith
com
men
t sec
tion
at th
e en
d fo
r op
en-e
nded
feed
back
on
team
wor
k an
d co
mm
unic
atio
n.
Adm
inis
tere
d el
ectr
onic
ally
th
roug
h a
web
-bas
ed m
echa
nism
.
Two
part
s: (
1) A
sses
smen
t of
pro
vide
r te
amw
ork
atti
tude
s an
d qu
alit
y of
co
mm
unic
atio
n an
d co
llabo
rati
on
wit
hin
thei
r ow
n di
scip
line
and
acro
ss
disc
iplin
es. (
2) R
atin
g of
bar
rier
s to
co
mm
unic
atio
n an
d te
amw
ork.
No
eval
uati
on o
f the
su
rvey
too
l rep
orte
d.
Debisette_PTR_CH07_01-04-11_159-190.indd 185Debisette_PTR_CH07_01-04-11_159-190.indd 185 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
186 ANNUAL REVIEW OF NURSING RESEARCH
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?
Debisette_PTR_CH07_01-04-11_159-190.indd 186Debisette_PTR_CH07_01-04-11_159-190.indd 186 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
Interdisciplinary Teamwork and Collaboration 187
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.
REFERENCESAiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staff-
ing and patient mortality, nurse burnout, and job dissatisfaction. JAMA: the Journal of the American Medical Association, 288(16), 1987–1993.
Aiken, L. H., Havens, D. S., & Sloane, D. M. (2009). The Magnet Nursing Services Recognition Program: a comparison of two groups of magnet hospitals. The Journal of Nursing Administration, 39(7–8 Suppl.), S5–14.
Bales, R. F., & Cohen, S. P. (1979). SMYLOG: A systematic multiple level observation of groups. New York, NY: Free Press.
Cashman, S., Reidy, P., Cody, K., & Lemay, C. (2004). Developing and measuring progress toward collaborative, integrated, interdisciplinary health care teams. Journal of Interprofessional Care, 18(2), 183–196.
Cesario, S., Morin, K., & Santa-Donato, A. (2002). Evaluating the level of evidence of qualitative research. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN/NAACOG, 31(6), 708–714.
Chung, H., & Nguyen, P. H. (2005). Changing unit culture: An interdisciplinary commitment to improve pain outcomes. Journal for Healthcare Quality, 27(2), 12–19.
Clarke, P. G. (2006). What would a theory of interprofessional education look like? Some sugges-tions for developing a theoretical framework for teamwork training. Journal of Interprofessional Care, 20(6), 577–589. doi:10.1080/13561820600916717
Clarke, S. P., & Aiken, L. H. (2003). Failure to rescue: Needless deaths are prime examples of the need for more nurses at the bedside. American Journal of Nursing, 103(1), 42–47.
Connor, M., Duncombe, D., Barclay, E., Bartel, S., Borden, C., Gross, E., . . . Ponte, P. R. (2007). Creating a fair and just culture: One institution’s path toward organizational change. Joint Commission Journal on Quality and Patient Safety/Joint Commission Resources, 33(10), 617–624.
Conway, J., Nathan, D., Benz, E., Shulman, L., Sallan, S., Reid Ponte, P., … Weingart, S. (2006). Key learning from the Dana-Farber Cancer Institute’s ten-year patient safety journey. American Society of Clinical Oncology. 42nd Annual Meeting, Atlanta, GA, 615–619.
Cronin, K. (2008). Transdisciplinary research (TDR) and sustainability. Report prepared for the Ministry of Research, Science and Technology (MoRST).
Dietrich, S. L., Kornet, T. M., Lawson, D. R., Major, K., May, L., Rich, V. L., & Riley-Wasserman, E. (2010). Collaboration to partnerships. Nursing Administration Quarterly, 34(1), 49–55.
Debisette_PTR_CH07_01-04-11_159-190.indd 187Debisette_PTR_CH07_01-04-11_159-190.indd 187 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
188 ANNUAL REVIEW OF NURSING RESEARCH
Dodds, J., Vann, W., Lee, J., Rosenberg, A., Rounds, K., Roth, M., . . . Margolis, L. H. (2010). The UNC-CH MCH Leadership Training Consortium: building the capacity to develop interdis-ciplinary MCH leaders. Maternal and Child Health Journal, 14(4), 642–648.
Donabedian, A. (2000). Evaluating physician competence. Bulletin of the World Health Organization, 78(6), 857–860.
Drenkard, K. (2010). The business case for Magnet. The Journal of Nursing Administration, 40(6), 263–271.
Dumont, S., Briere, N., Morin, D., Houle, N., & Iloko-Fundi, M. (2010). Implementing an inter-faculty series of courses on interprofessional collaboration in prelicensure health science. Education for Health, 23(1), 395.
Fennell, M., Prabhu Das, I., Clauser, S., Petrelli, N., & Salner, A. (2010). The organization of mul-tidisciplinary care teams: Modeling internal and external infl uences on cancer care quality. Journal of the National Cancer Institute Monographs, 40, 72–80.
Goldsmith, J., Wittenberg-Lyles, E., Rodriguez, D., & Sanchez-Reilly, S. (2010). Interdisciplinary geriatric and palliative care team narratives: collaboration practices and barriers. Qualitative Health Research, 20(1), 93–104.
Hallin, K., Kiessling, A., Waldner, A., & Henriksson, P. (2009). Active interprofessional education in a patient based setting increases perceived collaborative and professional competence. Medical Teacher, 31(2), 151–157.
Hansson, A., Arvemo, T., Marklund, B., Gedda, B., & Mattsson, B. (2010). Working together–primary care doctors’ and nurses’ attitudes to collaboration. Scandinavian Journal of Public Health, 38(1), 78–85.
Havens, D. S. (2001). Comparison of nursing department infrastructure and outcomes: ANCC mag-net and nonmagnet CNEs report. Nursing Economics, 19(6), 258–266.
Henderson, A. J., O’Keefe, M. F., & Alexander, H. G. (2010). Interprofessional education in clinical practice: not a single vaccine. Australian Health Review, 34(2), 224–226.
Hobgood, C., Sherwood, G., Frush, K., Hollar, D., & Maynard, L. (2010). Teamwork training with nursing and medical students: Does the method matter? Results of an interinstitutional, interdisciplinary collaboration. Quality and Safety in Health Care. 19(6), e25.
Institute of Medicine. (1999). To err is human: Building a safer health system. Washington, DC: National Academies Press.
Institute of Medicine. (2001). Crossing the quality chasm. Washington, DC: National Academies Press.
Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academy Press.
Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academies Press.
Jeffries, P. R., (Ed). (2007). Simulation in nursing education: From conceptualization to evaluation. New York: National League for Nursing.
Kalisch, B. (2010, October/November). The impact of the level of nursing teamwork on the amount of missed nursing care. Nursing Outlook.
Klein, J. T. (2007). Interdisciplinary approaches in social science research. In W. Outwaite & S. P. Turner (Eds.), The Sage handbook of social science methodology (pp. 32–49). Los Angeles, CA: Sage Publications.
Kydona, C. H. K., Malamis, G., Giasnetsova, T., Tsiora, V., & Gritsi-Gerogianni, N. (2010). The level of teamwork as an index of quality in ICU performance. Hippokratia, 14(2), 94–97.
Lown, B. A., & Manning, C. F. (2010). The Schwartz Center Rounds: Evaluation of an interdisci-plinary approach to enhancing patient-centered communication, teamwork, and provider support. Academic Medicine: Journal of the Association of American Medical Colleges, 85(6), 1073–1081.
Debisette_PTR_CH07_01-04-11_159-190.indd 188Debisette_PTR_CH07_01-04-11_159-190.indd 188 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
Interdisciplinary Teamwork and Collaboration 189
Mann, S., Marcus, R., & Sachs, B. (2006). Lessons learned from the cockpit: How team training can reduce errors in L&D. Contemporary OBGYN, 1–7.
Manser, T. (2009). Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiologica Scandinavica, 53(2), 143–151.
McClure, M., Poulin, M., Sovie, M., Wandelt, M. (2002). Magnet Hospitals: Attraction and retention of professional nurses. American Nurses Association. Silver Spring, MD: Nursesbooks.
Mills, P., Neily, J., & Dunn, E. (2008). Teamwork and communication in surgical teams: implica-tions for patient safety. Journal of the American College of Surgeons, 206(1), 107–112.
Merali, R., Orser, B. A., Leeksma, A., Lingard, S., Belo, S., & Hyland, S. (2008). Medication safety in the operating room: teaming up to improve patient safety. Healthcare Quarterly (Toronto, Ont.), 11(3 Spec No.), 54–57.
Neily, J., Mills, P. D., Young-Xu, Y., Carney, B. T., West, P., Berger, D. H., . . . Bagian, J. P. (2010). Association between implementation of a medical team training program and surgical mor-tality. JAMA: The Journal of the American Medical Association, 304(15), 1693–1700.
O’Leary, K. J., Haviley, C., Slade, M., Shah, H., Lee, J., & Williams, M. (2010). Improving team-work: Impact of structured interdisciplinary rounds on a hospitalist unit. Journal of Hospital Medicine, 1–4.
O’Leary, K. J., Ritter, C. D., Wheeler, H., Szekendi, M. K., Brinton, T. S., & Williams, M. V. (2010). Teamwork on inpatient medical units: assessing attitudes and barriers. Quality & Safety in Health Care, 19(2), 117–121.
Oliver, D. P., Tatum, P., Kapp, J. M., Wallace, A. (2010). Interdisciplinary collaboration: The voices of hospice medical directors. American Journal of Hospice and Palliative Care Medicine, 1–8. OnlineFirst, published May 3, 2010, as doi:10.1177/ 1049909110366852.
O’Mahony, S., Mazur, E., Charney, P., Wang, Y., & Fine, J. (2007). Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. Journal of General Internal Medicine, 22(8), 1073–1079.
Petri, L. (2010). Concept analysis of interdisciplinary collaboration. Nursing Forum, 45(2), 73–82.Pratt, S. D., Mann, S., Salisbury, M., Greenberg, P., Marcus, R., Stabile, B., . . . Sachs, B. P.
(2007). John M. Eisenberg Patient Safety and Quality Awards. Impact of CRM-based train-ing on obstetric outcomes and clinicians’ patient safety attitudes. Joint Commission Journal on Quality and Patient Safety/Joint Commission Resources, 33(12), 720–725.
Reese, C. E., Jeffries, P. R., & Engum, S. A. (2010). Learning together: Using simulations to develop nursing and medical student collaboration. Nursing Education Perspectives, 31(1), 33–37.
Reid Ponte, P., Gross, A. H., Winer, E., Connaughton, M. J., & Hassinger, J. (2007). Implementing an interdisciplinary governance model in a comprehensive cancer center. Oncology Nursing Forum, 34(3), 611–616.
Richardson, A., & Storr, J. (2010). Patient safety: A literature [corrected] review on the impact of nursing empowerment, leadership and collaboration. International Nursing Review, 57(1), 12–21.
Schmitt, M. H. (2001). Collaboration improves the quality of care: methodological challenges and evidence from US health care research. Journal of Interprofessional Care, 15(1), 47–66.
Tress, B., Gunther, R., & Fry, G. (2006). Defi ning concepts and the process of knowledge produc-tion in integrative research. Chapter 2 in Tress, B. et al. From Landscape Research to Landscape Planning—Aspects of integration, education and application. Wageningen UR Frontis Series 12 ISBN 1402039786 pp 13–26. Retrieved July 25, 2008, from http://library.wur.nl/frontis/landscape_research/02_tress.pdf
Vogwill, V., & Reeves, S. (2008). Challenges of information exchange between nurses and physi-cians in multidisciplinary team meetings. Journal of Interprofessional Care, 22(6), 664–667.
Woods, N. F., & Magyary, D. L. (2010). Translational research: Why nursing’s interdisciplinary col-laboration is essential. Research and Theory for Nursing Practice, 24(1), 9–24.
Debisette_PTR_CH07_01-04-11_159-190.indd 189Debisette_PTR_CH07_01-04-11_159-190.indd 189 4/1/2011 7:47:12 PM4/1/2011 7:47:12 PM
Copyright of Annual Review of Nursing Research is the property of Springer Publishing Company, Inc. and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.