Assessing and Addressing Interprofessional Teamwork in Hospitals

By Christopher Cheney

Hospitalists and nurses working on general medical services have varying perceptions of the quality of interprofessional collaboration, a recent research article indicates.

Earlier research has shown that teamwork and interprofessional collaboration are key elements of providing safe care and boosting patient satisfaction. However, there are several challenges to effective teamwork in the hospital setting such as the large size of medical care teams and physicians working across multiple care units with little opportunity to establish lasting work relationships with nurses and other staff members who are assigned to designated units.

The recent research article, which was published by The Joint Commission Journal on Quality and Patient Safety, is based on data collected from four U.S. hospitals that were participating in the Redesigning Systems to Improve Teamwork and Quality for Hospitalized Patients project. The project is crafted to establish and spread care models that increase interprofessional teamwork and improve outcomes for hospitalized patients.

Nearly 400 medical staff members participated in the study: 193 nurses, 94 nurse assistants, 80 hospitalists, and 13 resident physicians. The research generated two primary results:

  • 63.3% of hospitalists rated the quality of collaboration with nurses as high or very high, but only 48.7% of nurses rated the quality of collaboration with hospitalists as high or very high
  • Teamwork climate scores varied significantly across the four hospitals in the study

“This study found significant differences in perceptions of teamwork climate across sites and in collaboration across professional categories on general medical services. Given the importance in providing high-quality care, leaders should consider conducting similar assessments to characterize teamwork and collaboration on general medical services within their own hospitals,” the research article’s co-authors wrote.

Interpreting the data

The lead author of the research article told HealthLeaders that there are likely multiple causes for the perception gap on collaboration between hospitalists and nurses.

“It seems that physicians feel that they have the information they need, while nurses realize that they do not have the information they need. The team members lack a shared mental model of the plan of care. Nurses may be more aware of this lack of a shared mental model because they spend more time with patients and are responsible for administering the treatments such as medications, activity, and diet ordered by physicians,” said Kevin O’Leary, MD, MS, professor of medicine at Northwestern University Feinberg School of Medicine and medical director for quality at Northwestern Memorial Hospital in Chicago.

Other underlying causes of the perception gap on collaboration likely include differences in training, experience, and hospital culture, he said. “Teamwork challenges are probably more common in hospitals that continue to have a culture with steep hierarchies.”

The research article’s finding that there was significant variation in teamwork climate scores at the four hospitals in the study shows the importance of conducting baseline assessments of teamwork and collaboration at hospitals, O’Leary said.

“Baseline assessment of teamwork climate is important for two main reasons. First, it allows hospital leaders to identify whether an opportunity for improvement exists, or assessment may reveal that teamwork is going well. Second, if an opportunity for improvement exists, baseline assessment will serve as an important comparator to post-intervention assessment to determine whether teamwork has improved.”

Three complementary interventions can increase teamwork and collaboration between physicians and nurses, he said.

  • Assigning physicians to work in a minimal number of medical units
  • Establishing a co-leadership structure in medical units featuring physicians and nurses
  • Utilizing well-designed interprofessional rounds in medical units

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.