Implementation of a Customized Team Coaching Approach to Fuel Interprofessional Practices: BOOST.

Abstract

Purpose: Death by medical errors is so pervasive that it seldom makes headlines; in 2019, 173,040 deaths were attributed to medical errors—one of the top causes of death in the United States. Competent interprofessional collaboration is essential for improving quality and mitigating medical errors 1,2; yet, promoting collaborative practices at the organization level is not commonplace. 3,4 Barriers to implementing impactful IPE in the workplace range from a lack of shared mental models across professions to the logistical challenges of bringing multiple professions together to learn with, from and about each other. Approach: We developed a customized interprofessional program (BOOST: Building Optimal Outcomes by Strengthening Team Trust) using a team coaching approach to address the needs of teams and their members. BOOST promotes the development of high-impact teams that are high-functioning (internal dynamics), high-performing (output), and positively influence the larger systems. BOOST fosters the development of trust within teams to transform how team members interact and contribute to their shared goals. We implemented BOOST as proof of concept in a surgical team involving 2 professions. We gathered data about team interactions through focus groups and used that information to customize a curriculum that targeted relationship challenges present among these professions. We further modified the curriculum and enhanced our ability to capture the teams’ current and desired states by using a unique team assessment tool, High-Impact Engagement. 5 This tool captures perceptions about various aspects of team functioning and team interactions at the individual and team levels, as well as stakeholders providing narrative comments about the team’s performance through multisource feedback. Team coaching involves helping teams understand the motivation behind their actions and guiding them to collaboratively identify goals to move the team toward higher-impact states. At the core of this process is working with entire teams through coach-led sessions. The specific number of sessions/format depends on the needs/constraints of the teams. We offer BOOST to clinical teams across our organization that may be experiencing problems or that wish to improve their collaborative practices. Outcomes: We implemented BOOST in 3 different clinical settings with different team compositions and distinct team challenges (N = 64). Overall, teams were satisfied with the experience. We collected survey data, self-reflections, action plans, and observations of the coaching process. Our findings highlight 3 important areas within the work context. We observed that team interactions and discussions were most meaningful and successful when we were able to coach an entire team. Using team-based data resulted in team buy-in and full engagement in the coaching process. Having teams create mutually agreed-upon action plans facilitated adherence to action plans. Meaningful team interactions likely resulted from giving everyone a voice in the process of identifying challenges and potential solutions. Using team data likely contributed to team buy-in and active engagement, leading to their ability to focus on real issues and yield relevant and effective team conversations about requisite change. After teams completed their training and returned to their routine work, the agreed-upon action plans served as tangible reminders of their shared plans for improvement. A substantial limitation relates to the time and resources required to execute the program, from administering the survey instruments to training the coaches. Perhaps the biggest challenge is releasing clinical teams from patient-care duties, which requires leadership buy-in and commitment to improving interprofessional practices. Additionally, the self-selection of teams can potentially lead to favorable perceptions about the program. Significance: Building on initial successes, our next steps include measuring the impact of the program and identifying strategies for scalability. We have found that BOOST has helped teams address their most pressing team-related challenges and has enabled team members to engage in mutual learning and build trusting relationships.