Collaboration In Health Care Teams Research Articles

Relationship between Interprofessional Communication and Health Care Team Collaboration

Relationship between Interprofessional Communication and Health Care Team Collaboration

Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study

BackgroundCollaborative practice in healthcare has been recommended to improve the quality of antimicrobial stewardship interventions, a behavioral change in antimicrobial use. Insufficient knowledge regarding antibiotic resistance, the fear of complications from infections, and how providers perceive antibiotic use and resistance are likely to influence prescribing behavior. This study's objective was to identify the knowledge and belief healthcare professionals' differences about antibiotic stewardship. MethodsThis cross-sectional survey study of three hospitals in the East Java province, Indonesia utilized a 43-item questionnaire to assess antimicrobial stewardship knowledge and belief. There were 12 knowledge questions (total possible score: 12) and 31 belief questions (total possible score: 155). The Kuder Richardson 20 (KR-20) and Cronbach alpha values of the questionnaire were 0.54 and 0.92, respectively. ResultsOut of the 257 respondents, 19% (48/257) had a low scores of knowledge, and 39% (101/257) had low scores on belief about antibiotic stewardship (101/257). Most midwives had a low scores on knowledge (25/61) and low scores on belief (46/61). Respondents with high scores on belief were 17% (10/59) physicians, 15% (4/27) pharmacists, 8% (5/65) nurses, and 3% (2/61) midwives. ConclusionAmong healthcare professionals, knowledge and belief differences concerning antibiotic stewardship vary widely. These differences will affect their capability, behavior, and contribution to the healthcare team collaboration and performance. Further studies are needed to evaluate the correlation between the level of inter-professional collaboration and the quality of the antibiotic stewardship implementation.

Exploring students' perceptions and opinions about an institutional hierarchy of healthcare professionals and its impact on their inter- professional learning outcomes

Context: Institutional hierarchy is a phenomenon associated with clinical tribalism. Inter-professional learning is thought to improve a healthcare team's collaboration and communication. Aim: The aim was to evaluate student understanding of institutional hierarchy and perceptions and opinions on their participation in inter-professional learning. Method: Using a questionnaire, this study gathered the opinions of fourth year pharmacy students who had completed two inter-professional learning sessions. Quantitative and qualitative analyses were conducted. Results: Students (87.7%, n=50) were aware of the institutional hierarchy concept, listing the order as doctors, pharmacists, nurses then allied health. 61.4% (n=35) were willing to participate in inter-professional learning sessions. Students (70.1%, n=40) agreed that inter-professional learning sessions have added benefit to patient-centred care, and to understanding different healthcare roles in depth (82.5%, n=47) but failed in diminution of the hierarchical ideology. Conclusions: Inter-professional learning sessions did not change students' opinions about posiGoning of doctors as the top of the healthcare institutional hierarchy.

830 Voice Activated Tool: A Successful Assistance for Patients with Limited Hand Function

Abstract Introduction Burn survivors require significant assistance in physical functions and independence during their recovery and rehabilitation phase. Amputation, splints, bulky dressings, and pain attribute to limited or lack of hand mobility. Voice activated tools (VAT) have rapidly grown in popularity including in healthcare. Prior to the implementation of this project, patients mostly depended on soft touch call lights which were suboptimal for most patients. We piloted VAT to assist in hand functions of patients with limited or lack of hand mobility. Methods The project was piloted in collaboration with IT, Occupational Therapy, Nursing, and patients’ family. IT enabled with uninterrupted source of wireless network connection in the patients’ room. Voice assistance was incorporated both through mobile phone and an added virtual assistant tool. Patients’ personal devices were used to promote utilization of stored information in the device. Occupational therapist assisted in mounting the device through a spring clamp and gooseneck cell phone holder to visualize the device screen. Speech therapists, nurses, and patient family helped in training the patient to voice appropriate commands. The patient utilized VAT for a wide variety of purposes including calling nurses, ordering hospital meals, phone calls, music, web browsing, and more. A survey was done to evaluate health care team’s opinion on VAT usage. Results Of the total burn team members, 34 (77%) staff responded to the survey including physicians, nurses, therapists, and nursing assistants. All survey responders reported VAT as a useful tool to be offered to all future patients with limited hand mobility. Majority (74%) of responders witnessed or participated in the successful use of VAT during the pilot period. Survey participants reported three reasons for the current soft touch call light system to be suboptimal: 1.Too sensitive, 2. Not all patients can use it 3. Conclusions Voice activated tool can be successfully utilized for assisting patients with limited hand mobility considering the current available tool is suboptimal. Adoption of a simple and popular technology of VAT can be easily incorporated in hospitals through collaboration of health care team. Applicability of Research to Practice Use of VAT could be successfully implemented for other hospital units including paralyzed patients, blind, and patients with orthopedic conditions or trauma to hands. Additionally, VAT could be incorporated in to rehabilitation and home training of patients with limited hand mobility. Further, VAT could be considered in the designing and planning of hospitals.

Gender issues in physician–nurse collaboration in healthcare teams: Findings from a cross‐sectional study

The aims of the study were (a) to assess whether the proportion of female nurses and female physicians in a given unit influences the attitude of collaboration between nurses and physicians as reported by nurses, and (b) to examine how these two dimensions interact to influence attitudes towards cooperation. Available studies have documented that gender influences the collaboration between physicians and nurses, but no have explored the influence of specific combinations-such as a high proportion of female nurses and a high proportion of female physicians. A cross-sectional study involving 700 nurses working in 36 hospital units in Italy. The validated Italian version of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration was used. A three stages hierarchical linear regression was performed by entering: (a) the control variables at the individual and at the unit levels, (b) the proportion of female nurses and physicians and (c) the two-way interaction. A total of 430 nurses participated; the average Jefferson Scale of Attitudes towards Physician-Nurse Collaboration total score was 48.64±5.27. At the second and third stages of the hierarchical linear regression model (explaining 12.8% and 14.1% of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration variance, respectively), having more female RNs as staff (model two: ß=0.61, p=<.1; model three: ß=0.69, p=<.05) was significantly associated with higher Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores; differently, higher physician-nurse ratios (model two: ß=-4.09, p=<.05; model three: ß=-4.54, p=<.01), and more female physicians (model two: ß=-1.06, p=<.05; model three: ß=-1.29, p=<.01) were associated with lower Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores. There is a decreased collaboration as reported by nurses when predominantly male nursing teams interact with teams with more female physicians. However, in units lead by female physicians, having more female members among the nursing team, ensures increased attitudes of collaboration as reported by nurses. With the increasing proportion of female physicians and male nurses, unit mangers should be prepared to manage their influence on interprofessional cooperation.

Cultivating Acute Care Rehabilitation Team Collaboration Using the Kawa Model

Purpose: Effective healthcare team collaboration is imperative for quality client-centered care, job satisfaction, and overall morale. Rehabilitation team collaboration can be impacted by high productivity demands, differing backgrounds of individual team members, and the unpredictable healthcare environment. The Kawa (river) model, a culturally-neutral model of occupational therapy practice, has been shown to improve communication and collaboration with its use of metaphors, but its utility in various contexts to enhance collaborative practice is still being explored. The purpose of this study was to implement an evidence-based teambuilding intervention with use of the Kawa model to investigate the impact on acute care rehabilitation team collaboration. Method: A 5-week pretest-posttest study was completed with a group of eight rehabilitation team members, consisting of occupational therapists, physical therapists, and a speech language pathologist, in an acute care setting. Pre and post-surveys were utilized to gather quantitative and qualitative data on perceptions of team collaboration, knowledge of the Kawa model, and the model’s utility for collaboration. Results: Outcomes showed overall mean improvements in agreement that the Kawa model provides a common method of communication, and 100% of the participants agreed or strongly agreed that use of the Kawa model can improve acute care rehabilitation team collaboration. Qualitative post-survey responses indicated an enhanced understanding of the components of effective team collaboration. Conclusions &amp; Recommendations: Team collaboration was cultivated with use of the Kawa model. The model provided a successful method for the acute care team to openly discuss and collaboratively problem-solve how to maximize their team flow. Further study of the Kawa model’s utility to improve collaboration in various contexts with broader participant groups is recommended, as well as study of longitudinal effects of a teambuilding intervention with use of the Kawa model.

Assessment of Interprofessional Team Collaboration Scale (AITCS): Further Testing and Instrument Revision.

The need to be able to assess collaborative practice in health care teams has been recognized in response to the direction for team-based care in a number of policy documents. The purpose of this study is to report on further refinement of such a measurement instrument, the Assessment of Interprofessional Team Collaboration Scale (AITCS) first published in 2012. To support this refinement, two objectives were set: Objective 1: to determine whether the items from the data collected in 2016 load on the same factors as found for the 2012 version of the 37-item AITCS. Objective 2: to determine whether the items in the subscales of the AITCS could be reduced while retaining psychometric properties similar to those from the earlier versions of the AITCS. Initially, the overall data sets of 1002 respondents from two hospitals and four community agencies were analyzed for demographics and scale and subscale mean values, SDs, and mean item scores. After deletion of respondents because of missing data, 967 respondents were available for the first analysis. An exploratory factor analysis was then conducted to determine the factor structure. All respondents with any random missing data were further removed to reduce the data set to 676 responses, followed by a confirmatory factor analysis to find a model fit resulting in an item reduction in the scale. The result was a 23-item AITCS-II for practitioners that retained acceptable levels of reliability and validity within 3 subscales-partnership (8 items), cooperation (8 items), and coordination (7 items). The shortened version of the AITCS-II is a valid and reliable instrument that can be used to assess collaboration in health care teams in practice settings.

Student Competency Perceptions From Associate Degree to Bachelor Degree Completion.

A curriculum evaluation gap was addressed by exploring the final year of the Oregon Consortium of Nursing Education (OCNE) curriculum through student perception of competency and benchmark proficiency. Researchers used a mixed-methods design to explore RN to baccalaureate (RNBS) student self-assessment data on perceived benchmark proficiency. Students' written statements were coded into four attainment categories, ranging from not attained to strong. Researchers categorized strong attainment in the competencies of intentional learning, relationship-centered care, and clinical judgment, with moderate attainment in ethics, communication, health care team collaboration, and reflection on self-care. Competencies related to leadership, practicing within a broader health care system, and application of evidence in practice had limited attainment. The results support using attainment categories in the measurement of student self-reported competency. The findings could be used to support course and curriculum evaluation, student advising, and coaching, as well as to improve professional development opportunities for students moving through the curriculum. [J Nurs Educ. 2017;56(10):581-590.].

Improving Teamwork and Communication in the Operating Room Using Teamsteppss

In spite of initiatives to improve patient safety, preventable errors occur in healthcare, often with tragic results. Frequently, root cause analysis indicates sentinel events and errors can be attributed to poor communication and ineffective teamwork. Interprofessional education (IPE) has been shown to improve communication and collaboration in healthcare teams. The objective of this capstone project was to compare patient outcomes in one surgical department before interprofessional education using TeamSTEPPS® and simulation, with the same indicators after IPE. Group Contact Theory was the guiding theory for the project which sought to answer the following research question. Does interprofessional education (IPE) using TeamSTEPPS and simulation for members of the surgical team result in improved patient outcomes as evidenced by fewer negative Effects on Patient Care and fewer Serious Safety Events in the six months after IPE as compared with the six months before IPE? Retrospective data were analyzed from six months before and six months after IPE; the sample was 12 monthly reports on patient outcomes from one surgical department in an acute care, hospital in New England. Cross tabulations and Chi-square test for independence were used to examine frequencies and proportions of Effects on Patient Care and Serious Safety Events for the two, time periods. While practical significance was demonstrated by a reduction in Serious Safety Events after IPE, analysis of the data demonstrated no significant difference between pre-IPE and post-IPE data. Education and healthcare leaders may use project findings to develop more effective initiatives for students and healthcare team members to improve communication, teamwork, and patient outcomes.

Competition Versus Collaboration in Health Care Teams.

Innumerable teams have emerged in health care, spurred by the desire to improve patient quality and satisfaction, provide better population outcomes, and reduce per capita cost. Team leaders are faced with many choices in team development, such as collaboration or competition. Although each approach has unique advantages and disadvantages, is one approach better suited to building the teams needed in today's environment? This review examines these two distinct team-building approaches. A literature review of these two approaches in light of the theoretical frameworks of social identity theory and team role theory shows support for both ends of the spectrum; however, collaboration was linked more often with highly successful and effective teams. Ultimately, the literature demonstrates that collaboration is better suited to developing teamwork capable of achieving today's complex health care goals.

Interprofessional collaboration in health care teams for the maintenance of community-dwelling seniors' health and well-being in Canada: A systematic review of trials

Abstract Background Literature suggests that interprofessional (IP) teams in healthcare may offer better and more client-centered care, but little is known about their impact on health outcomes among seniors in home care. Purpose To systematically synthesize the Canadian evidence on the effectiveness of IP health care models on the health and well-being of community-dwellers aged ≥65 y receiving home care. Method We conducted a systematic search of indexed, peer-reviewed articles reporting on community-based healthcare models that included at least two different disciplines and published between January 2005 and December 2015. Discussion A total of six trials (Ontario n = 3, Quebec n = 2, and British Columbia n = 1) were included in the synthesis, being two fully collaborative. The synthesis suggests IP teams have greater positive effects on patient-reported measures of health (distal measures, e.g., increased satisfaction with care and quality of life) than direct measures of health (e.g., decreased visits to the emergency and hospitalization). Conclusion IP teams appear to positively impact some health outcomes. Models are, however, heterogeneous and lack of national representation, particularly from rural and remote areas.

Interprofessional Experiences and Attitudes Toward Interprofessional Health Care Teams Among Health Sciences Students

This study examined how the interprofessional experience, including education and practice, affects graduate health science students’ attitudes toward interprofessional practice in health care teams. Data were collected from 227 graduate students, using the Attitudes toward Health Care Teams (ATHCT) scale. Both social work and other health science students had positive attitudes toward interprofessional collaboration with regard to its ability to improve the quality of a patient’s care. The results from hierarchical linear regression analyses demonstrated that female students, older students, and students with longer interprofessional practice experiences had more positive attitudes toward interprofessional collaboration in health care teams. Based on these results, implications for interprofessional education are discussed.

Designing and evaluating an effective theory-based continuing interprofessional education program to improve sepsis care by enhancing healthcare team collaboration

Continuing interprofessional education (CIPE) differs from traditional continuing education (CE) in both the learning process and content, especially when it occurs in the workplace. Applying theories to underpin the development, implementation, and evaluation of CIPE activities informs educational design, encourages reflection, and enhances our understanding of CIPE and collaborative practice. The purpose of this article is to describe a process of design, implementation, and evaluation of CIPE through the application of explicit theories related to CIPE and workplace learning. A description of an effective theory-based program delivered to faculty and clinicians to enhance healthcare team collaboration is provided. Results demonstrated that positive changes in provider perceptions of and commitment to team-based care were achieved using this theory-based approach. Following this program, participants demonstrated a greater appreciation for the roles of other team members by indicating that more responsibility for implementing the Surviving Sepsis guideline should be given to nurses and respiratory therapists and less to physicians. Furthermore, a majority (86%) of the participants made commitments to demonstrate specific collaborative behaviors in their own practice. The article concludes with a discussion of our enhanced understanding of CIPE and a reinterpretation of the learning process which has implications for future CIPE workplace learning activities.

Educational impact of an assessment of medical students' collaboration in health care teams

This paper explores how structured feedback and other features of workplace-based assessment (WBA) impact on medical students' learning in the context of an evaluation of a workplace-based performance assessment: the teamwork mini-clinical evaluation exercise (T-MEX). The T-MEX enables observation-based measurement of and feedback on the behaviours required to collaborate effectively as a junior doctor within the health care team. The instrument is based on the mini-clinical evaluation exercise (mini-CEX) format and focuses on clinical encounters such as consultations with medical and allied health professionals, discharge plan preparation, handovers and team meetings. The assessment was implemented during a 6-week period in 2010 with 25 medical students during their final clinical rotation. Content analysis was conducted on the written feedback provided by 23 assessors and the written reflections and action plans proposed by the 25 student participants (in 88 T-MEX forms). Semi-structured interviews with seven assessors and three focus groups with 14 student participants were conducted and the educational impact was explored through thematic analysis. The study enabled the identification of features of WBA that promote the development of collaborative competencies. The focus of the assessment on clinical encounters and behaviours important for collaboration provided opportunities for students to engage with the health care team and highlighted the role of teamwork in these encounters. The focus on specific behaviours and a stage-appropriate response scale helped students identify learning goals and facilitated the provision of focused feedback. Incorporating these features within an established format helped students and supervisors to engage with the instrument. Extending the format to include structured reflection enabled students to self-evaluate and develop plans for improvement. The findings illuminate the mechanisms by which WBA facilitates learning. The educational features highlighted include effectively structured feedback processes, support for situated learning, a positive backwash (facilitation of learning through preparation for the assessment), and facilitation of informed self-assessment.

Communication Commentary: It Takes a Village: Effective Interprofessional Collaboration in Health Care Teams

Health care is changing. The technologies available for diagnostics are improving. The methods of acquiring and sharing information are burgeoning with the advent of the electronic medical record and information technology. Care is expected to be patient-centered, ensuring that the patient and familyunderstandtheoptionsavailable for treatment and are the decision-makers guiding care. In addition, health care is increasingly team-based. A broadly accepted definition of team-based health care is “the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care” (1). “The high-performing team is now widely recognized as an essential tool for constructing a more patient-centered, coordinated, and effective health care delivery system” (2, p. 3). With the literature burgeoning with new research findings, and with the research evidence that serves as the metric for quality of care continually changing, no single physician can absorb all of this information. Physicians must rely on specialists in other fields. Patient consumers are frequent utilizers of physician services. For example, the “typical Medicare beneficiary visits two primary care clinicians and five specialists per year,” as well as utilizing the ancillary services of diagnostic radiology, laboratory testing, pharmacy, and other services (3). Individuals suffering frommultiple

Promoting Collaboration in Health Care Teams through Interprofessional Education: A Simulation Case Study

This simulation study explores how the integration of interprofessional components into health care curriculum may impact professional stereotyping and collaborative behavior in care delivery teams comprised of a physician, a registered nurse, a physician’s assistant, a physical therapist, and a radiation therapist. As part of the agent-based modeling simulation, 500 students completed a curriculum with no IPE component and another 500 completed the same curriculum in which 25% of the courses being offered had IPE components embedded. The 500 students completing the non-IPE curriculum were asked to randomly form 100 health care delivery teams consisting of a member from each of the five professions examined in the study (i.e., MD, RN, PA, PT, and RT). The same was asked of the 500 students completing the IPE curriculum. The 100 teams in each group (constituting a total of 200 teams) were then asked to treat a patient over the course of a week. Findings indicate that the tendency for stereotyping was significantly lower (p<.001) for students attending curriculum containing IPE components, as compared to students attending curriculum without an IPE component. The individual and team mean scores for collaborative behavior – as represented by the number of links formed between team members throughout the seven-day period, during which the teams provided care to their patients - were significantly higher (p<.001).

Culturally sensitive collaborative care models: Exploration of a community-based health center.

This qualitative focus group (FG) study describes an interdisciplinary health care team's collaboration while serving an underprivileged patient population. Collaboration was explored with diverse personnel from support staff to upper administration at a nurse-managed community-based health center in the northeastern region of the United States. Biopsychosocial theory and a feminist ecological framework were used to explore how multiple contextual variables of patients and their providers influence the collaborative process of 39 staff. Content analysis revealed facilitators and barriers to collaboration. Providers' perceptions of care revealed a patient-centered approach with serendipitous family and community involvement. Recognized challenges included the need to improve family and community involvement, develop ongoing cultural sensitivity training for staff at the center, and hire more providers who match the ethnic and racial makeup of the center's clientele.

The Model of Quality of Life Improvement for Chronic Patients in Community by Using Social Support

Problem statement: Caring for a chronically ill-patients is a complex process which require the cooperation and social support to manage a chronic disease. It need an interaction of a large number of actors or collaborations from health care personnel of different organizations. Questions were raised to develop an appropriate intervention and the model of QOL improvement for chronic-patients in the community. Approach: To (1) develop the Quality Of Life (QOL) improvement for chronic illness patients in community by using social support program (2) evaluate the effects of the program on perception of illness, severity of illness, benefits and barriers of health promotion, health behaviors, Quality Of Life (QOL) and stress level. Participatory Action Research (PAR) was used. It was consisted of two phrases. The participants in first phase including with nurses, nutritionist, patients, caregivers, Village Health Volunteers (VHVs) and research team. The second phrase was to implement the interventions and evaluation. A total of 10 VHVs and 50 participants who met the inclusion criteria. The intervention composed of 2 main programs; (1)The VHVs were trained for 1 month as a comprehensive program to be a healthcare team collaboration. (2)The chronically ill-patients received main interventions including self-care education, apply Thai traditional medicine and home visits. Descriptive statistics and t-test were use to evaluate the pre-post intervention. Results: The majority of the participants were female (n = 38,76%), with the mean age of 66.68 years (SD = 17.20), 85% caring by their children and 42.5% by their relatives. Most participants came from low income family (40%). The post test score on each item showed that after intervention, changed scores on all five items (before-after), how ever the changes were statistically significantly (<0.05) by some items, they were perceive of benefits and barriers of health promotion, health behaviors and stress level.. The rest as perceive of illness, perceive of severity of illness and QOL were not statistically significant (>0.05). Conclusion: The findings suggested the set of interventions were effective to improve QOL of chronic patients and it was the appropriate model. To improve health care providers’s knowledge, skills and increasing of collaborations among multidisciplinary team, Local Administration Organization (LAO). VHVs and Health Care Service Centre were strongly recommended to work with chronic patients.

The determinants of successful collaboration: A review of theoretical and empirical studies

Successful collaboration in health care teams can be attributed to numerous elements, including processes at work in interpersonal relationships within the team (the interactional determinants), conditions within the organization (the organizational determinants), and the organization's environment (the systemic determinants). Through a review of the literature, this article presents a tabulated compilation of each of these determinant types as identified by empirical research and identifies the main characteristics of these determinants according to the conceptual work. We then present a “showcase” of recent Canadian policy initiatives – The Canadian Health Transition Fund (HTF) – to illustrate how the various categories of determinants can be mobilized. The literature review reveals that very little of the empirical work has dealt with determinants of interprofessional collaboration in health, particularly its organizational and systemic determinants. Furthermore, our overview of experience at the Canadian HTF suggests that a systemic approach should be adopted in evaluative research on the determinants of effective collaborative practice.