Question

Collaborate effectively with inter—, intra— and multi-disciplinary and multi-cultural teams. Talk about issues in COVID 19 in this time of pandemic

Answer 1

Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes.

Method-

This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work.

Results-

Ten characteristics underpinning effective interdisciplinary team work were identified positive leadership and management attributes communication strategies and structures personal rewards, training and development appropriate resources and procedures appropriate skill mix supportive team climate individual characteristics that support interdisciplinary team work clarity of vision quality and outcomes of care and respecting and understanding roles.

Conclusions-

We propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate.

Keywords-Interdisciplinary team work, Competencies, Intermediate care, Transitional care, Allied health, Systematic review, Evidence synthesis, Qualitative research

Background-

Interdisciplinary team work is a complex process in which different types of staff work together to share expertise, knowledge, and skills to impact on patient care. Despite increasing emphasis on interdisciplinary team work over the past decade, in particular the growth of interdisciplinary education there is little evidence as to the most effective way of delivering interdisciplinary team work. This difficulty is compounded by the multifactorial nature of team work, which comprises the skill mix, setting of care, service organisation, individual relationships and management structures.

Most existing research explores the impact of one or a few of these aspects, rather than examining the relationships among several of these components on a range of staff and patient outcomes. Similarly, interventions designed to improve interdisciplinary team work tend to focus on specifics of team work activities such as sharing of patient files case-conferencing approaches or meeting style or frequency.To date, there is not a systematic framework around which these activities, or characteristics, of interdisciplinary working can be structured.

Terminology-

A wide range of terms are used to describe collaborative working arrangements between professionals. Terms such as interdisciplinary, interprofessional, multiprofessional, and multidisciplinary are often used interchangeably in the literature to refer to both different types of teams and different processes within them. They are also often used in conjunction with the term team work. However, there are some consistent distinctions that are useful to understand. The terms inter/multi-professional are generally narrower than the terms inter/multi-disciplinary and refer to teams consisting exclusively of professionals from different professions or disciplines, or at least to the relationships between professionals in teams that may also include other non-professional staff. The terms inter/multi-disciplinary are broader and include all members of healthcare teams, professional and non-professional. Other authors have suggested use of the prefixes multi-, inter- and trans- to reflect differing intensities of integration.

The focus of this paper is on inter/multi-disciplinary teams: the research, interventions, and data-gathering activities underpinning the study included all members of the respective healthcare teams. The term “interdisciplinary team” is used as a generic term of reference for these healthcare teams which included a range of health service workers, both professionals and non-professionals, with the majority being from professional groups. However, where authors have used the terms inter/multi/trans-professional or inter/multi-disciplinary the authors’ original terms will be used.

Interdisciplinary team work-

Previous research has investigated the fundamental concepts and features associated with team work. A concept analysis to explore the basic understanding of team work in the healthcare context drew on both healthcare and literature from other disciplines such as human resource management, organisational behaviour, and education, and proposed the following definition for team work in the health care context

“A dynamic process involving two or more health professionals with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care. This is accomplished through interdependent collaboration, open communication and shared decision-making. This in turn generates value-added patient, organisational and staff outcomes.”

This definition may be more optimistic and aspirational than realistic as it makes several assumptions about the characteristics that a team will possess. Enderby identified these characteristics to include a definable membership, group consciousness, shared vision, corporate sense of purpose, clear interdependence and interaction, and co-ordinated action.

Xyrichis and Ream’s literature analysis concludes that the outcomes from team work could be experienced at three levels (healthcare professionals, patients, and healthcare organizations) and that these outcomes have an impact on staff satisfaction, quality of care, control of costs, well-being and retention. Molyneux identified three indicators for positive team work personal qualities and commitment of staff, communication within the team, and the opportunity to develop creative working methods within the team. Further literature reviews have identified the importance of two themes on interprofessional team work, team structure and team processes within which specific categories emerged team premises, team size and composition, organizational support, team meetings, clear goals and objectives, and audit processes.

Collaboration is acknowledged as an important component of team processes. A concept analysis undertaken by Henneman. identified that collaboration “requires competence, confidence and commitment on the part of all parties. Respect and trust, both for oneself and others, is key to collaboration. As such, patience, nurturance and time are required to build a relationship so that collaboration can occur”. Identified factors that contribute to successful collaboration were joint venture, cooperative endeavor, willing participation, shared planning and decision-making, team approach, contribution of expertise, shared responsibility, non-hierarchical relationships and shared power based on knowledge and expertise. However, further reviews have found that the reality of shared planning and decision-making, and shared power is very different from the ideal. Given the context of interprofessional teams, members will automatically come from different professions, therefore in practice “shared decision-making” is likely to conflate individual team members making decisions within their own scope of practice with the ideal of all team members sharing in all decision-making processes, or in other words, “appropriate” decision making. Shared power and leadership may also be a challenge when complex traditional hierarchical relationships, particularly those involving medical practitioners, play a larger role and impact either implicitly or explicitly on team processes. McCallin suggests that shared leadership occurs only in smaller teams privileged with being free to choose all team members.

When considering the characteristics important for interprofessional team work within the context of organisational development, McCray points out that little attention appears to have been paid to the actual processes of interprofessional practice within organisational strategy, local workforce development planning, and individual continuing professional development.

Necessity of interdisciplinary team work-

The need for interdisciplinary team work is increasing as a result of a number of factors including

(1) an aging population with frail older people and larger numbers of patients with more complex needs associated with chronic diseases

(2) the increasing complexity of skills and knowledge required to provide comprehensive care to patients

(3) increasing specialization within health professions and a corresponding fragmentation of disciplinary knowledge resulting in no-one health care professional being able to meet all the complex needs of their patients

(4) the current emphasis in many countries’ policy documents on multi-professional team work and development of shared learning

(5) the pursuit of continuity of care within the move towards continuous quality improvement.

Workforce re-structuring to meet these needs requires that interdisciplinary teams must integrate changing organisational values with new modes of service delivery.While these changes impact across healthcare as a whole, there are certain sectors where these organisational challenges have encountered more widespread debate, in particular primary care, rehabilitation, and care of the elderly. Of these, primary care is perceived to have the least likely level of success with interdisciplinary team work. Indeed, some commentators suggest that an interdisciplinary culture may only be possible as new generations of healthcare professionals enter the workforce.

Despite the increasing focus on interdisciplinary team work over the past two decades, there is still no clear synthesis of the “essence” of what makes a good interdisciplinary team and a lack of empirical research to define what such a team might look like. Similarly, there is a lack of data identifying the processes of interdisciplinary team work and linking these with outcomes. Studies tend to focus on processes or outcomes, but rarely both or explore components of what defines an interdisciplinary team, without providing a clear guide on the attributes of good interdisciplinary team practice.

This paper draws on a published systematic review of the literature, combined with empirical data derived from interdisciplinary teams involved in the delivery of community rehabilitation and intermediate care services (CRAICs), to develop a set of competencies around effective interdisciplinary team practice. The research was contextualised in CRAICs.

CRAICs in England are community-based services frequently offering care for the elderly aimed at preventing admissions and facilitating earlier discharge from acute care. They exemplify the practice of interdisciplinary team work. Typically, CRAICs employ at least four different staff types, including nurses, physiotherapists and occupational therapists.They often exhibit high levels of joint working and role sharing, and employ a large proportion of support workers who, when used appropriately, have been shown to facilitate interdisciplinary practice in this setting. However, previous research by our team found a great deal of variety in the way that teams work together, and their levels of effectiveness as teams. In response, we developed an Interdisciplinary Management Tool (IMT) which was implemented iteratively, using an action research approach with 11 teams to explore the impact of the tool on those teams and their patient outcomes.

Methods

This research formed part of a much larger project designed to develop, implement and evaluate an intervention to enhance interdisciplinary team work through the development of an IMT. The IMT is a structured change management approach which marries published research evidence relating to interdisciplinary team work with the tacit knowledge of the particular team to develop a tailored approach to optimize their interdisciplinary team work.Development of the tool involved three systematic reviews, interactions with team members using an action research methodology, and capturing extensive, detailed qualitative and quantitative feedback from teams and service users.

The findings presented in this paper draw on a systematic review of the literature relating to the components of interdisciplinary team work and the qualitative data derived from the implementation of the IMT. This latter component of the study included the exploration of team members’ perceptions of the important components underpinning interdisciplinary team work. Themes from these two perspectives were then examined for areas of agreement and dissonance to arrive at a set of competencies for good interdisciplinary team work.