INTER-PROFESSIONAL EDUCATION PROMOTING THE
COLLABORATION BETWEEN PHYSICIANS & NURSES
Communication & Trust Issue between Nurses and
Physicians
The rapidly development of medical care system changed the health care
services delivery. Nowadays, the medical system is complex and the patient care
is delivered in integrated practice groups with multi-disciplinary
professionals. “How the patient care is
delivered” is same important as “what care is delivered”. Medical treatment is a manual process and
exposed to human errors.
According to Rahul Parikh (2011)(1), 80% of medical errors in hospitals
involve communication problems between health care professionals. The origin of
the communication problem between nurses and physicians could be due to the
rigid hierarchical system of the organization. In the New England Journal of Medicine, Stein
(1990)(2) described the relationship between nurse and physicians are under a
rigid hierarchy with physicians firmly in charge. Even though the nurses
regularly offered expert advice about patient care, they were expected to defer
to physicians. Nurses and physicians prevented open conflict but they also
avoided direct communication with each other. In the Harvard Business Review, “The essence
of execution of Promise-Based Management”, Sull & Spinosa(2007) (3), by
examining the commitments people make to colleagues and customers, executives
can figure out why work stalls and how to get it move again. The working relationship between nurses and
physicians are subject to the obstacles that made them fail to make or deliver
on promises. The organizational silos
hinder their coordination. Both of the
professionals are disengaged and their highly specialized of work made the organization
lacks agility and the organization is trapped in the status quote. The promise of “Patient Centered” to make
public by the key medical professional organization as the center of
interprofessional collaboration could be one of the way to reinforce the
health care workers commitment.
In most of the case, medical errors would associate with a huge amount
of malpractice cost, prolonged care cost and the legal cost. If we can improve the communication between
health care professional, it’s not only the malpractice cost could be saved.
The medical outcomes could be improved.
So as the job satisfaction and working relations between physicians and
nurses could be improved and increased.
It will contribute to the patient care environment as a whole. (Zoeticx,
Improving Patient Outcomes, 2013) (4)
According to Robert Hurley (2006)(5), what make people trust or not to
trust is based on the decision-maker factors and situational factors. For the situational factors, when the parties’
interests are not well aligned, less similarities between them, the higher
stakes, not reliable track records would make the trust level low. In the traditional health care professional
training, physicians and nurses were being trained under different health care
model. Each health care specialty professionals learned their own function
based on their specialty cultures with little interaction with other health
professions’ practices and perspectives. They are trained up as independent and
autonomy but missing links with their accountable for the overall functioning of
the health care delivery system. Such training practice caused the
miscommunication, competition and distrust. (6)(7)
Sub-Trend of the Health care Industry - Crew
Resources Management
In order to reduce the medical errors, US adopted the Crew Resources
Management (CRM) approach since late 1990s in the health care industry. The CRM
is originally used in the aviation industry in 1979 for many years and has been
generally shown to produce positive reactions, enhance learning, and promote
desired behavioral changes. (6)(7). According to the root cause analysis on
most of the fatal incidence in the aviation industry, the major cause is due to
the communication breakdown among the crew members that can be avoidable. The
CRM training has been defined as a set of instructional strategies designed to
improve teamwork in the cockpit by applying well tested training tools such as
performance measures, simulation exercise and interactive group debriefings
including human limitation, proposed action plans and resolving conflicts. When such practice brings into the health
care industry, it changed the organizational silos and a new form of “interprofessional
education” towards the nurses and physicians is well established and foster.
What is Crew Resources Management? Pls click to see a brief introduction.
What is Crew Resources Management? Pls click to see a brief introduction.
Interprofessional Education
As per the definition from World Health Organization (WHO),
“interprofessional education occurs when students from two or more profession, learn
about, from, and with each other to enable effective collaboration and improve
health outcomes. It’s for safer, better
and higher quality patient-center care. Through
such interprofessional practice and education, nurses and physicians are able
to understand one another’s role to enhance teamwork. According to J Rivera (2013) (8) The aims of
new form of interprofessional education include, Interactive learning, Improve
communication, Enhance collaborative competencies, Rivalries resolution and Improve
quality of care, relationships.
Trend of the Interprofessional Simulation
The medical care delivery and services are subject to dramatic changes
in last decades. Through a health care simulation, health care workers are able
to study ahead and experience the possible risk and uncertainties by means of
co-working in a virtual environment like a simulation set up. According to Joseph Barjis (2011)(9), health
care simulation can use extensively and classified as following scopes.
(1)
Clinical Simulation – mainly used to study,
analyse, and replicate the behavior of certain disease including biological
processes in human body.
(2)
Operational Simulation – mainly used for capturing,
analyzing, and studying health care operations, service delivery, scheduling, health care
business processes, and patient flow
(3)
Managerial Simulation – mainly used as a tool for
managerial purposes, decision making, policy implementation, and strategic
planning
(4)
Educational Simulation – mainly used for training
and education purpose, where virtual environments and virtual and physical
objects are extensively used to augment and enrich simulation experiment.
Following are two short video showing how the medical simulation education work.
Simulation intertwines evidence-based practice and patient safety to
engage students. (Galloway, 2009)(10).It is believed that the interprofessional
simulation is able to foster teamwork, develop the behavioral skills, enhance
the quality of health care services, collaboration and problem solving between
nurse and physicians. The learning objective of the simulation was to
facilitate a mutual and professional respect among health care professionals in
an educational setting that would be modeled in clinical practice. Students can learn about the critical
thinking and practice communication skills with other professionals. It will increase the collaboration and
knowledge sharing. According to Julie
Thomas (2005)(11), the ultimate success
of any knowledge management system requires that information be useful, timely,
and accurate. And most important is
shared. The interprofessional simulation
education enables people to share instead of hoard the knowledge. People would not afraid to speak up under the
simulation set up. In the new strategy, professionals are able to link the
responsibilities and their activities under the set up. The new organizations
silos that reinforce the coordination are established. As a result, the IPE will get well prepare for
them to work on the patient center care more effectively and efficiency in
outcomes.
Difficulties of interprofessional education
Evidence showed that the IPE bring a lot of benefit, however it face
quite some challenges in implementation. Major issue is about the logistics
concerns. Not many universities/colleges
can offer the interprofessional education as it involves huge amount of set up
and support. According to Lambert et al., (2010)(12) the challenges include:
(i)
Additional space to accommodate a multi discipline
simulation center.
(ii)
The coordination of multiple schedules
(iii)
Meeting each program’s specific accreditation
requirement, particularly when considering clinical hours
(iv)
Costly in high-fidelity simulators
According to Milway and Saxton (2011)(13), how to
create impact through learning is based on 4 key elements which are “Supportive
Leaders”, “Intuitive Knowledge Processes”, “Culture of Continuous Improvements”
and “Defined Learning Structure”. In the
IPE, the difficulties are major due to the organization learning process that
is not able to embed in different profession practice. The organizational
structure is also the key concern as not all hospital is able to support the
IPE learning. Organization should pay
more effort to work out he challenge in order to create the impactful
interprofessional simulation education.
Exploring
Social Media’s Potential in Interprofessional Education
With consider the difficulties to implement the interprofessional
simulation education, there are study to explore social media’s potential in
interprofessional education. The popular
usage of smart phone and head held devices that change our communication
practice.. Technology use is cited by millennial
individuals as the defining characteristics of their generational cohort, and
more than 75% of them report using social media.
According to Jeff Caine (2013)(14), social media applications such as
Facebook, Twitter, and blogs have become part of mainstream society and are
currently being used throughout health professions education. Many medical educators recognize that the
online interaction can help to overcome the challenges and difficulties of IPE.
Different health care professionals can
obtain multi-disciplinary perspectives under the shared online space. By
building up a virtual community and network, members can work as a team under
the same platform to solve the problem and everyone can contribute their idea.
Although some people might consider the virtual community is informal. However,
Jeff Caine (2013) (14) specified that, we cannot underestimate of the social
medial that can shape the socialization among different professions. It also fosters
the innovation to solve the problem through the building of peer culture on the
social platform. According to Ed Catmull
(2008)(15), what makes the successful of Pixar as a forward looking studio is
about the 3 Operating Principles: Everyone must have the freedom to communicate
with anyone, it must be safe for everyone to offer ideas, and we must stay
close to innovations happening in the academic community. In the health care industry, the social medial
platform can definitely offer another way out for freedom communication and
inspire the innovative discussion.
The social media communication can also be considered as evidence-based
communication. We can measure the
interactions over time and you can interpret the data from across multiple platforms.
The social media can help to build the
foundation for lifelong interprofessional learning. The open communication also encourages member’s
engagement, credibility, discoverability and respect. (Sean
Cranbury, QWQHC)(16)
Conclusion
The patient-centered
care transformed the interprofessional collaboration ppractice
between physicians and nurses. In
reality, interprofessional collaboration is already occurring on the
ground. However, the problem is at the
organizational level. (Robert Wood Johnson Foundation, 2013)(17) As mentioned
by Gratton & Erickson (HBR 2007)(18), there are Eight factors that lead to
success of building a collaborative team. One of the key difficulty for the
collaboration between nurses and physicians could be the inadequacy of
executives open foster the collaboration. Different organization still concern own
influencing status and interest that failed to invest in a signature
relationship practice. Seniors
executives were not likely demonstrated a collaborative model. All of the collaboration is built on the values of
trust, empathy, respect and honesty,
which are all the elements of a performing team.
The root cause analysis uncover the medical error is due to the
miscommunication. These are the
behavioral skills that were not taught in the traditional health care training. It
signified that the nurses and physicians are failed to equip with pre-requisite
skills before. Communication is the
center of interprofessional collaboration.
To start the dialogue, the
interprofessional education is redesigned as to foster a common ethical value
and new partnership working culture. Interprofessional simulation education
creating a culture of safety. Such IPE
practice fit in the successful factors to build a collaborative team about
“Supporting a strong sense of community”, “understanding role clarity and task
ambiguity”, “Assigning team leaders for both task and relationship oriented”
and “building on heritage relationship” through the education. It seems the IPE could be a good strategy and
intervention to build the collaborative relationship between the two
professionals.
Although it proved with a lot of benefit, the logistics arrangement and
cost still be the challenges for compulsory implementation. The use of social networking could be the way
in order to improve the quality of interprofessional education.
Source: http://listverse.com/2013/05/29/10-horrible-cases-of-medical-malpractice/
The social networking communication also faced challenges about the
security issue and privacy concerns. In
my opinion, the art of social networking could form part of the IPE program but
could not able to replace all. As per
Alex Sandy Pentland (2012)(19), the most valuable form of communication is face
to face. Energy levels within a team are
not static. We can only through meeting to create engagement. Through the
interaction to create exploration. Face
to face communication should be the most effective way to promote
interprofessional collaboration.
Reference:.
(1) Doctors could learn something about medical handoffs from the Navy by
Rahul Parikh - Los Angeles Times April 2011
(2) Stein L, et al. The doctor-nurse game revisited. The New England Journal
of Medicine. 322(8):546-549, February 22, 1990. - See more at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=686652#sthash.kyoCac6s.dpuf
(3) Donald N.Sull and Charles Spinosa, “Promise-Based Management – The
essence of Execution” Harvard Business Review, April 2007, hbr.org
(4) “Preventable Medical Errors: A $30 Billion Opportunity”, Zoeticx
Improving Patient Outcomes, Mar 25, 13
(5) Robert F. Hurley, “The Decision to Trust”, Harvard Business Review, Sept
2006
(6) Salas E, Rhodenizer L, Bowers CA.
The design and delivery of crew resource management training: exploiting
available resources. Hum Factors 2000;42(3):490-511
(7) Salas E, Burke CS, Bowers CA, eta al. Team training in the skies; does
crew resource management (CRM) training work?Hum Factors 2001;43:641-74
(8) Slide from J Rivera, Interprofessional Education and Assessment Presentation
at Reynolds July 2012 Meeting
(9) Joseph Barjis, “Healthcare Simulation and its Potential Areas and Future
Trends”, SCS M&S magazine, 2011/n1 (January)
(10) Galloway, S. (2009), Simulation techniques to bridge the gap between
novice and competent healthcare profession.
The Online Journal of Issues in Nursing, 14(2)
(11) Julie Thomas (2005), “Why Does Knowledge Management Still Matter?”, TD,
February 2005
(12) Lambert, C., Stone, C., Cameron, D., & Hoar, S. (2010). Getting to
yes: How multiple disciplines agree on a primary care curriculum. Retrieved
January 23, 2011, from http://dcahec.gwumc.edu/pdf/NAO_Presentation. Pdf.
(13) Katie Smith Milway & Amy Saxton, “The Challenge of Organizational
Learning”, Stanford Social Innovation Review, Summer 2011
(14) Jeff Caine, EdD & Katherine Chretien, MD (2013), “Exploring Social
Media’s Potential in Interprofessional Education”, Journal of Research in
Interprofessional Practice and Education (JRIPE), Vol.3.2@2013, www.jripe.org
(15) Ed Catmull, How Pixar Fosters Collective Creativity, Harvard Business
Review, September 2008
(16) Sean Cranbury, Director, Communications and Social Media,Monkeytree
Creative http://www.qwqhc.ca/documents/JUNIORC-SEANCRANBURY.pdf
(17) “How to Foster Interprofessional Collaboration Between Physicians and
Nurses?”, Robert Wood Johnson Foundation, January 9, 2013, Program Result
(18) Lynda Gratton and Tamara J. Erickson, “8 Ways to Build Collaborative
Teams” Harvard Business Review, November 2007
(19) Alex “Sandy” Pentland, “The New Science of Building Great Teams”,
Harvard Business Review, April 2012
