Individual Final Project “INTER-PROFESSIONAL EDUCATION PROMOTING THE COLLABORATION BETWEEN PHYSICIANS & NURSES”

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.

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