This is an excerpt from Interprofessional Education and Collaboration by Jordan Utley,Cindy Mathena & Tina Gunaldo.
By K. Michelle Knewstep-Watkins, C. Michelle Longley, and Meghan M. Scanlon
Interprofessional Team Composition
Creating a highly effective health care team is rarely as simple as assembling a group of providers who are knowledgeable and experienced in their clinical practice. Commonly, the group members who will become a health care team are diverse with regard to knowledge, experience, values, and expectations. These differences can present challenges in aligning the team toward a common purpose and accepted processes for meeting the goals.
In some cases, there is an established group of experienced health care providers who have been working together to meet patient needs. These providers may have worked this way for decades, shared many experiences, developed their professional identities in relation to one another, and developed long-standing meaningful friendships. It is critical to recognize that the group may be diverse in the number of years of experience and years working together, which can mean there are established roles, routines, and habits well beyond the simple norms of a scope of practice. However, this does not necessarily mean that these health care providers are a high-functioning team. Similarly, other groups may have a majority of entry-level providers or providers who are new to the group or to serving a particular population, but these characteristics do not necessarily imply that they are a poorly functioning team.
A health care team is effective when all team members understand their role as part of the team as well as the roles and areas of expertise of other team members. One's role on a health care team should not be dictated wholly by profession. For example, patient safety is not solely the responsibility or role of nurses; instead, it is recognized as a shared role. However, it is important to recognize the recommendation of a dietitian in the creation of a patient's nutritional intake, because the dietitian is the professional with the greatest content knowledge in this area, even if other providers have an understanding of nutrition. See chapter 4 for a review of the evidence highlighting the impact of years of experience on IPE and IPCP.
Collaborative workplace environments are routinely associated with improved patient outcomes due to effective workflows and synergistic relationships. Even with shared goals and collaborative relationships, such environments require intentionality. Conflict is an inevitable part of working in teams and stems from individual, contextual, and intrapersonal characteristics that can significantly impair team cohesion and objectives.10 It is important for team participants and leaders to be familiar with sources of group conflict and implement strategies to resolve conflict effectively.
It is also valuable to recognize that teaming in a health care organization occurs on many levels. A team is defined as a group of people who assemble to achieve a common goal, which can occur in any organization regardless of size or complexity. Thus, health care organizations are composed of many layers of teams. The organization as a whole is a team, and additional levels of health care teams are nested within the organization to address cascading goals of the central goal. A medical center may also have diagnosis-centered service areas, such as orthopedics, which are teams within the organization. Additionally, formal teams can assemble to meet a specific need, such as a patient education committee, or informal teams may emerge organically in order to collaborate and address a concern.
Collaborative Corner: Sources of Conflict
Conflict can arise from individual characteristics, contextual factors, or intrapersonal conditions.11
- Individual characteristics—Individual team members enter group settings from different backgrounds with individualized values, opinions, and experiences that lead to assumptions about patient care needs and how to meet them.
- Contextual factors—Situations in which roles and responsibilities are unclear or group goals lack clarity can cause stress and conflict, particularly when combined with fast-paced environments, unpredictability, or high-stakes outcomes.
- Intrapersonal conditions—Conflict is common in circumstances of actual or perceived hierarchical relationships, inconsistent team membership and participation, or limited member or group accountability.
What methods or activities might assist in identifying and addressing individual characteristics, contextual factors, and intrapersonal conditions that contribute to conflict?