High-functioning health care teams can’t work effectively unless team members with different backgrounds and training know how to cooperate and work together, but that is difficult to achieve.
“For a hundred years or more, these professions have developed in parallel,” says William Branch Jr., MD, Carter Smith Sr. Professor of Medicine in Emory’s School of Medicine. “They work together according to certain traditions and rules, but without a lot of communication.”
The stakes are high: patients can suffer when these professionals fail to communicate. Now, however, a team of researchers based at Emory’s Nell Hodgson Woodruff School of Nursing, the Emory School of Medicine and the Emory Clinic as well as seven other U.S. teaching hospitals, reports developing successful techniques for overcoming the friction and misunderstanding that can arise when health care professionals with different roles come together to work with patients.
Their report, published in the journal BMJ Open, grows out of a new group-based development program for future health care teachers and leaders meant to instill attitudes of respect, collegiality, understanding and trust between the different professions. The program was tested in 2017 at five university-based health centers.
In the program, small groups of participants worked with each other and with facilitators twice a month, using critical reflection and experiential learning to improve collaboration in the kinds of difficult situations health care teams might encounter.
“It could be a role play that we do the next time we meet,” Branch explained. “It could be watching a videotape together. It could just be that people go out and do these things, then they come back and share stories of what they were able to do. This leads them to have ideas of further things to do towards better communication, better relationships, better teamwork.”
To measure the effectiveness of the program, instead of a survey or questionnaire, the researchers asked participants to write essays evaluating their experience with it and whether it changed their thinking. When authors analyzed these essays, strong and consistent themes emerged.
Participants repeatedly emphasized how much they had learned about building better relationships with other professionals. The three key themes were 1) intrapersonal skills such as becoming aware of their own biases; 2) interpersonal skills such as listening, empathy for others and understanding others’ perspectives; and 3) systems-level skills such as resilience, better team dynamics and knowing how to work through conflicts.
“It ultimately gave me a deeper meaning for the word ‘fellowship,’” one nurse stated in her essay. Another participant wrote, “Even knowing that we should not make assumptions, our brains tend to make them anyway, depending on our experiences. While not always bad, it is important to be cognizant of this and how someone with different experiences may view the same situation.”
Study participants often reported what they learned had long-term impacts on their thinking and feelings — what the investigators call “deep learning.” These impacts included more curiosity about other team members, greater empathy and increased respect. The investigators believe all of these helped members eliminate deep-seated biases and assumptions that previously conflicted with collaboration.
Despite the strong results, imparting these special skills was a slow process, Branch says. It meant finding ways for the participants to develop more trust, more open and honest communication and respect for the perspectives of teammates with job functions and orientations different from their own.
Some of the tasks seemed straightforward, such as getting to know their teammates as people, as well as professionals, and creating a safe, supportive environment in which ideas and information could be shared. Others, such as learning how to analyze and disclose a medical error, were difficult to put into health practice.
Ultimately, though, Branch believes the study shows that incorporating these types of holistic techniques could have a wide impact on interprofessional cooperation at health care facilities. However, making this change work requires adjusting practitioners’ longstanding attitudes as well as requiring them to master knowledge and skills not typically part of medical training.
“We teach people to listen,” he says. “Don't just jump in there. Pause and take in everything. The tone of the voice, the expression on the face, the nonverbal ways as well as the verbal ways, so that you get a real picture of what someone is communicating, and then try to mold the response that will be best.”