Improving Interprofessional Communication and Collaboration

Contact Hours: 1

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Contact Hours: 1

This online independent study activity is credited for 1 contact hours at completion.

Course Purpose

To provide healthcare professionals an overview of common interprofessional communication and collaboration principles, and tools for conflict prevention within the healthcare setting. 

Overview

Interprofessional communication involves verbal, written, and non-verbal communication, and is a fundamental component of interprofessional collaboration.  To improve patient safety and outcomes, all healthcare professionals should communicate in a collaborativeresponsive, and responsible manner. This learning activity provides an overview of interprofessional communication and collaboration, principles, and common tools for conflict prevention.

Objectives

Upon completion of this activity, the learner will be able to: 

  • Describe interprofessional communication and collaboration
  • Understand the importance of interprofessional communication and collaboration
  • Review common principles of  interprofessional communication and collaboration
  • Review tools that help improve interprofessional communication and collaboration

Policy Statement

This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.

Disclosures

Fast CE For Less, Inc. and its authors have no disclosures. There is no commercial support.

Fast Facts: Improving Interprofessional Communication and Collaboration

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Case Study

Jessica Watson is a registered nurse who was newly hired to the Intensive Care Unit. She was previously employed in a Medical/Surgical ward for 5 years, and this is her first employment opportunity working in critical care. After receiving the change of shift report, Jessica began assessing her patients. She noticed that one of her patient’s condition is much different than what she received in report, and she notes that as evidenced by the recent lab results, the patient’s condition has worsened. Jessica needs to call the doctor, but she is hesitant in having the conversation with him. He is notorious for being impatient and tends to not listen to the nurses’ concerns. How would you suggest Jessica communicate with the physician to get what is needed, and better care for the patient? What advice would you give the physician? How can their interprofessional communication and collaboration be improved? These questions will be answered in the learning activity.

Definitions
Interprofessional CommunicationOccurs when healthcare professionals communicate with each other and patients in a transparent, collaborative and responsible way.
Interprofessional CollaborationOccurs when multiple healthcare professionals from different professional backgrounds work together and with patients to deliver the highest quality of care.
ConflictFailing to agree or be in accord .
HierarchyA system in which people or groups of people are ranked one above the other according to status or authority.
Introduction

Effective interprofessional communication and collaboration are key to improving patient outcomes. Opposite to this, poor communication and collaboration has shown to result in bad patient outcomes.² Poor patient outcomes are usually caused by preventable errors, and are often the result of multiple human factors, as opposed to one single error by an individual. Often, these failures are the result of inadequate communication. 

Communication affects all aspects of the healthcare delivery system, including the healthcare professional’s actions and patient safety.¹˒³ Historically, the physician was thought to be the most significant factor in delivering effective patient care. This ideology created a hierarchal structure that did not take into account that other healthcare professionals often are needed for quality patient care.¹⁰ Hierarchal ideology in regard to healthcare has resulted in barriers in communication and poor decision making.  As a result, the hierarchical approach to patient care has shown to have a detrimental impact on all those involved, including physicians, nurses, and patients.²˒¹⁰˒¹¹ One way in which the negative impact of hierarchal care is now being challenged is through encouraging assertion abilities amongst all staff members through education and training on interprofessional communication and collaboration.¹

Principles of Interprofessional Communication

Interprofessional communication involves verbal, written, and non-verbal communication within the healthcare team. The healthcare team can change during the course of treatment, and can include the dietician, nurse, patient, pharmacist, physician, various therapists, and any other healthcare professional providing care to the patient.⁶

  • Verbal communication may include conversations between two or more members of the interprofessional team.
  • Written communication  includes documentation notes in a patient’s chart, such diagnostic reports, discharge notes, emails and faxes, medication administration records, physician orders, progress notes, referral letters, and text messages.
  • Non-verbal communication involves meaning and interpretation conveyed through body language, including body position, eye contact, facial expressions, and gestures. 

Fundamentally, interprofessional communication is a portion of interprofessional collaboration. For instance, effective interprofessional communication leads to more collaborative efforts within a healthcare team of professionals, which results in improved patient safety and improved patient outcomes. There are several factors that can influence interprofessional communication in positive or negative ways and can therefore have positive or negative effects on healthcare professionals and patients.

The factors affecting interprofessional communication can be divided into three main categories: those related to the physical environment, those related to the context, and those related to communication styles of the people involved.

  • The first category represents the physical environment, which can often be noisy and have many moving parts including clients, families, and multiple members of interprofessional teams. In addition to the number of people, there may also be loud machines and overhead announcements present. All of this can result in sensory overload, especially in the patient or family member who is unfamiliar with the environmental sounds.  
  • The second category represents interprofessional communication within healthcare environments. This involves information in a complex, high acuity clinical situation. These complex situations can be caused by life-threatening conditions, death, uncertainty, fear, and anxiety, all of which can result in work overload. The stress that may be associated with high acuity situations can greatly influence the nature and intensity of interprofessional conversations. Likewise, the hierarchical relationships that exist in interprofessional teams and imbalances of power or ideas can also affect how individuals within a healthcare team communicate and interpret conversations.
  • The third category represents the notion that each group of healthcare professionals has their own culture and communication styles. Sometimes, these communication styles may not be effective when communicating with other healthcare professionals.
Conflict Prevention

Conflict can be described as failing to agree or be in accord. For example, two healthcare professionals may have different opinions on a treatment regimen, leading to a disagreement. Having differences in opinions alone does not lead to conflict.  Conflict arises when one healthcare professional’s behavior impedes another healthcare provider’s goals, which may result in anger, fear, and frustration.³

Many healthcare professionals will have differences in opinions with other healthcare professionals at some point. When effective communication occurs, the degree of conflicts is drastically reduced.  Likewise, conflict is also more likely to occur if interprofessional communication is ineffective. For instance, healthcare professionals may have differences in opinions and priorities in terms of patient care, and communication can become problematic when these perspectives contradict another’s. Other factors that may contribute to interprofessional conflict include lack of respect for another healthcare professional’s perspective, differences in age, education, ethnicity and culture, gender, and values, as well as elements related to professional roles such as responsibilities, power, and scope of practice.

Strategies to consider to prevent or manage conflict include:

  • Use a patient-centered approach to frame discussions

Patient-centered discussions ensures that the focus of the discussion is on the patient and respects their autonomy, voice, self-determination, and participation in their own care.

  • Use an evidence-based approach to make decisions

Using an evidence-based approach will help the healthcare professional to engage in discussions that are based on evidence, rather than personal preference.

  • Be open to hearing others’ perspectives

A healthcare professional can improve dialogue by being open to hearingdiscussing, and reflecting on the perspectives of all team members in addition to sharing their own perspective and rationales.

Effective Communication

Effective communication requires attentive listening skills and a collective commitment from all members of the healthcare team. In addition to this, to improve interprofessional communication, healthcare team members must consider each of the following¹⁴:

  • Always use simple and clear language
  • Be aware of non-verbal language and consider how facial and body gestures may affect what is trying to be conveyed
  • Engage in active listening and ask questions for clarification
  • Incorporate adequate, relevant, and timely information
  • Maintain eye contact and show confidence in what is being said
  • Show respect in communication patterns
  • Speak clearly with appropriate vocal intonation and at a moderate pace
  • Speak up and seek clarification if needed until a concern regarding a patient is addressed
  • The patient is always the first priority and any decisions and actions that affect the patient should be the focus of all discussions
Interprofessional Communication and Collaboration Tools

There are numerous resources to facilitate interprofessional communication and collaboration. These resources share the common goals of helping to provide structure andclarity, and assist in conveying succinct, comprehensive, and relevant information to another healthcare professional to improve patient outcomes. For example, nurses are often the first to observe a change in a patient’s condition. In those instances, the nurse must clearly state what they think is happening and explain what and why they think certain actions should be taken. However, regardless of how knowledgeable the nurse is, they may struggle to voice their concerns and their perspectives, particularly if they feel less empowered or marginalized by another healthcare professional. 

Introduction, Situation, Background, Assessment, Recommendation (ISBAR)

Several standardized tools have been developed to facilitate interprofessional communication and prevent and manage harassment, errors in the workplace, and miscommunication. The Introduction, Situation, Background, Assessment, Recommendation (ISBAR) tool, is one common communication tool that can be used to initiate effective communication when a healthcare professional must communicate with another healthcare professional about a patient. It provides a framework so that communication is focused, concise, and complete. Information to include when suing the ISBAR tool for communication consist of the following¹˒⁸:

I-Introduction

Identify yourself (name, title, work location) and pertinent details of the patient (name, age, gender)

Example: Dr. Jones,  my name is Susan Masterson, and I am a Registered Nurse who is caring for Mrs. Green, who is a 58 year old on the surgical ward in bed 112.

S-Situation

Identify any symptoms, clinical needs, and urgency of the situation

Example: Mrs. Green just arrived to the ward after having a hysterectomy earlier today.  Her blood pressure has remained stable; however her heart rate has been increasing. She has progressively complained of increased abdominal pain that has not been alleviated with any of the medications ordered. 

B-Background

Include diagnosis, comorbidities, lab results, diagnostic results, any medications, and allergies

Example: Mrs. Green was previously diagnosed with a fibroid uterus, and subsequently had a total abdominal hysterectomy because of abdominal pain, feeling full, and vaginal bleeding requiring blood transfusions. She does not have any other medical problems, no known drug allergies, and there are no new lab results to report.

A-Assessment

Provide a summary of what you think is going on

Example: Mrs. Green describes her pain as 9/10. Currently, her blood pressure is 98/52, heart rate is 115, her respirations are 19, and her temperature is 100.9. Her lung sounds are clear, but her abdomen is firm and tender to the touch.

R-Recommendation

State a clear recommendation with a time frame for improvement

Example: I’m concerned that she may be experiencing a complication from her surgery. I would like to draw labs to check for infection and bleeding. While we are waiting for the lab results, I would also like to address her pain.

When used concisely, the  ISBAR tool delivers an essential set of information while actively promoting critical thinking by the healthcare professional. One systematic review suggests that patient safety improved through the implementation of ISBAR, particularly when used in non-face-to-face communication, such as over the telephone. The standardized approach of the ISBAR can also give confidence to its user and help break down the barriers to communication between different healthcare professionals.

Appropriate Assertion

One tool that specifically addresses the role of confidence and assertion within interprofessional communication is the appropriate assertion tool.⁹ This tool helps with improving assertion when communicating with a healthcare professional. For instance, a nurse may feel intimidated when requesting assistance from an advanced practice nurse or physician. The appropriate assertion tool includes the following ⁷˒¹¹:

  • Get the healthcare professional’s attention
  • Express concern regarding the condition of the patient
  • State problem that is occurring
  • Propose an action to resolve the problem
  • Reach decision with the healthcare professional regarding what steps to take to resolve the problem
Huddles

Huddles are an additional tool used to promote clear communication across interprofessional teams during the delivery of health care.¹³ Huddles are described as tools for communicating changes in a plan of care.⁵˒¹³ Huddles are multidisciplinary, usually set at specific intervals within a shift or after an event and provide the opportunity to gain group focus and perspectives. Variances between different huddle formats exist; however, they usually require the following general structure: 

  • Set times, beginning and end of shifts, or on the hour throughout a shift
  • Mandatory attendance – from different interprofessional team members, such as physician, nurses, pharmacists, etc. 
  • Limited time – the huddle usually less than 15 minutes
  • Clear structure – The huddle should follow the same format and structure each time that it occurs to ensure that no information is omitted

An example of a huddle would be in the preoperative area of the surgical suites, where a huddle occurs prior to surgery, and identifies the patient, any allergies, the procedure being performed, the surgical positioning, any equipment and blood products needed, and the duration of the surgery. In this instance, the huddle helps identify any potential issues, and provides an opportunity to voice any concerns prior to proceeding to surgery.

Simulation

The role of simulation training in medicine is well established.¹ A review concluded that medical simulation training resulted in an overall positive effect on learning, knowledge, and skills and that these effects are transferrable into clinical practice.⁶ Moreover, the benefits of simulation training can be seen across the whole team and even improve team cohesiveness. 

The aviation industry revolutionized safety and error prevention through the adoption of Crew Resource Management (CRM), which focuses to improve effective communication through standardized terminology and procedures.⁷ For instance, simulation training has been used to evaluate and improve various communication styles between flight crews, which has greatly improved flight safety. Simulations similar to CRM have  also been used to improve communication in the military and the nuclear industry and have also been used to improve communication within the field of medicine. Simulated effective interprofessional communication in healthcare, such as clear communication and collaborative team dynamics has been shown to reduce the risk of preventable errors and has revealed that effective communication skills can be taught through simulation training. 

Culture change can occur in an environment where the patient is at the center of a shared mental model. Interprofessional simulation allows for the development of mutual respect and trust through a team rather than a single individual. The simulation is a safe environment for the deliberate practice of effective communication strategies within an interprofessional team.

Debriefing

Debriefing is another tool used for improving interprofessional communication and is often used within simulation training.¹⁰ Debriefing is a two-way discussion between the facilitator and the learner at the end of a simulation session.¹⁰ Multiple strategies for debriefing exist; however, in general, the aim is to hold a conversation where the facilitator guides learning and reflection so the interprofessional team can learn both from themselves and one another. The most commonly used methods for debriefing are reflection through instructor guided and video-assisted debriefing. With proper debriefing, simulation provides insight into different interprofessional teams’ vantage points, allowing for an environment of mutual support. 

Conclusion

Healthcare professionals from multiple disciplines must effectively communicate and facilitate healthcare delivery through teams rather than individual providers. Failures of inter-professional communication and collaboration can lead to compromised patient care, medical errors, increased sentinel events, tension, and inefficiency.  Barriers to team communication in healthcare can be overcome by teaching effective communication strategies, training interprofessional teams in a cohesive environment such as simulation, and restructuring disparate interprofessional teams to an integrated group with common goals. 

Good communication within the interprofessional team reduces medical errors. Many barriers to effective communication exist, in part because of the complex nature of human communication and hierarchal concerns. However, these barriers are recognized, and the importance of interprofessional communication in providing safe patient care is paramount. There are multiple interprofessional communication and collaboration training tools that have been created, and they have proven to improve clear communication and collaboration. These training tools have been developed and used with positive effect in multiple sectors, including aviation and medicine to help reduce communication errors and improve patient care delivery. Achieved through simulation, and through implementing the training tools outlined above, medical care is safest with good interprofessional communication and collaboration.

References
  1. Anderson, K. T., Appelbaum, R., Bartz-Kurycki, M. A., Tsao, K., & Browne, M. (2018). Advances in perioperative quality and safety. Seminars in Pediatric Surgery27(2), 92-101.
  2. Bittner-Fagan H., Davis J., Savoy M. (2018). Improving Patient Safety: Improving Communication. FP essentials, 463:27-33.
  3. Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse Education in Practice19, 36-40.
  4. Gamboa O.A., Agudelo S. I., Maldonado M.J., Leguizamón D.C., Cala S.M. (2018). Evaluation of two strategies for debriefing simulation in the development of skills for neonatal resuscitation: a randomized clinical trial. BMC Research Notes, 11(1):739. 
  5. Jones K.J., Crowe J., Allen J.A., Skinner A.M., High R., Kennel V., Reiter-Palmon R. (2019). The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project. BMC Health Services Research, 19(1):650.
  6. MacDonald-Wicks L., Levett-Jones T. (2012). Effective teaching of communication to health professional undergraduate and postgraduate students: A Systematic Review. JBI Library of Systematic Reviews,10(28 Suppl):1-12.
  7. Masiello I., Mattsson A. (2017). [Medical simulation training – an overview of the evidence]. Lakartidningen,114.
  8. Müller M., Jürgens J., Redaèlli M,Klingberg K., Hautz W.E., Stock S (2018).  Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ Open. 8(8).
  9. Omura, M., Levett‐Jones, T., & Stone, T. E. (2019). Design and evaluation of an assertiveness communication training programme for nursing students. Journal of Clinical Nursing28(9-10), 1990-1998. 
  10. Pajalich, L. (2019). Collaboration in healthcare delivery interprofessional. Journal of Interprofessional Education & Practice15, 112-113. 
  11. Pattni, N., Arzola, C., Malavade, A., Varmani, S., Krimus, L., & Friedman, Z. (2019). Challenging authority and speaking up in the operating room environment: A narrative synthesis. British Journal of Anaesthesia122(2), 233-244.  
  12. Pena G., Altree M., Field J., Sainsbury D., Babidge W., Hewett P., Maddern G., (2015). Nontechnical skills training for the operating room: A prospective study using simulation and didactic workshop. Surgery, 158(1):300-9.
  13. Provost S. M., Lanham H. J., Leykum L. K., McDaniel R. R. Jr, Pugh J., (2015). Health care huddles: managing complexity to achieve high reliability. Health Care Management Review, 40(1):2-12.
  14. Sonali, S., & Kaur, H. (2020). The human factor: The critical importance of effective teamwork and communication in providing quality and safe care. Journal of Clinical Engineering45(3), 150-154.  
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