15.6 Interprofessional Approach to Health Care

Provider

A provider is generally the only team member who can write patient care orders, particularly for medications and treatments (Pistoria, 2022). They make medical diagnoses and often provide supervision for patient care teams. A team may include several types of providers. They are most often physicians; however, advanced practice registered nurses and physician assistants also have prescriptive authority.

Registered Nurse

Registered nurses (RNs) provide patients with skilled care, such as medication administration, procedures, and wound care. Patients in hospitals will likely see their RN more than any other interprofessional team member. RNs are often the first to detect condition changes and advocate for patient needs and desires. RNs may also be charge nurses (posting assignments and acting as points of contact for the unit), nurse managers, nurse supervisors, care managers, quality improvement specialists, or discharge coordinators, as well as additional roles throughout the healthcare system.

Licensed Practical Nurse/Licensed Vocational Nurse

A licensed practical nurse (LPN) has different educational requirements and fewer advanced skills than an RN and provides basic nursing care under the supervision of an RN or provider. Some nursing boards call these professionals licensed vocational nurses (LVNs), but LPNs and LVNs have essentially identical scopes of practice. In most agencies, LPN/LVNs manage basic patient care and provide medications under the supervision of RNs. They often have restrictions on the level of patient assessment and education they are licensed to provide. For example, in a hospital system, LPNs/LVNs may be unable to give IV push medications, hang blood, or perform full daily patient assessments. However, they may be the primary nursing staff on duty in a nursing home or skilled nursing facility.

Assistive Personnel

The category of assistive personnel (AP) includes a wide range of staff, such as nursing assistants (certified or not), home health aides, scrub techs, and medical assistants. These team members help nurses provide patient care. Their duties may include taking vital signs; transferring, bathing, feeding patients; and otherwise providing patient comfort. AP may be trained in more complicated procedures in some locations and circumstances. For example, many community living homes for people with disabilities employ medical technicians who have received additional training to assist patients with their medications. But these circumstances are based strictly on the laws of the state.

Respiratory Therapist

A respiratory therapist provides daily respiratory care such as breathing treatments and supportive care for many patients experiencing respiratory conditions. They also work closely with patients who are intubated and on mechanical ventilation or who use breathing machines for sleeping, and they participate on code and rapid response teams for patients who are experiencing distress or going into respiratory or cardiac arrest. They may also be called upon to evaluate if a patient needs to be discharged on oxygen, and they may assist in setting up home oxygen.

Physical Therapist

A physical therapist evaluates and treats patients who have difficulty moving. For example, a patient may struggle to walk, change positions, or move from chair to bed. Physical therapists often see patients who have become deconditioned due to bedrest or who have had orthopedic injuries or surgery. They work with patients on endurance and strength and help the team identify whether patients can stay safely at home after discharge or need physical therapy at a rehabilitation facility.

Occupational Therapist

An occupational therapist works with patients on activities of daily living. For example, occupational therapists may help patients who have had strokes or head injuries relearn to feed and dress themselves, bathe or toilet, and sometimes even cook or clean. They also assist the team in determining whether a patient is safe to be in their own home—particularly if they live alone.

Speech Therapist

A speech therapist works with patients on speech and communication and helps manage issues that occur with swallowing. Many patients develop difficulties in swallowing and with oral communication. Speech therapists conduct studies to determine if patients can safely eat different textures of food to prevent aspiration into the lungs. They also help to determine if patients have any other issues—such as neurological injury, brain damage, anxiety, or fear—that are affecting their speech.

Social Worker

A social worker provides the team with support and information and the patient with education about meeting their social needs. Social workers frequently help with discharge planning by identifying community services or resources for families and home health needs. They are often the clinician who liaises between an acute hospital setting and a skilled nursing or rehabilitation facility.

Pharmacist

A pharmacist does more than simply fill prescriptions. They reconcile medications and ensure patients are not ordered new medications incompatible with their current ones. Their presence saves time and reduces medication errors by increasing the chance for the correct medication and dosage to be ordered the first time. Additionally, they fill an integral role in patient and family education regarding medications and treatment plans. Pharmacists field inquiries regarding dosing, available formularies, and administration of medications, making them an excellent educational resource for healthcare providers.

Chaplain/Spiritual Care Provider

A chaplain, or spiritual care provider, is available in most care settings. Their role is to meet patients’ spiritual needs and ensure that a patient’s regular spiritual adviser is notified of their presence in the facility (if the patient wants them to know). Chaplains also provide spiritual care for family members as well as members of the healthcare team.

Other Team Members

This section has identified some of the most common healthcare team members, but the list has not been exhaustive. Nurses will encounter many others, such as patient advocates, laboratory personnel, radiology technicians, dietitians, and interpreters. Each member has their own roles and responsibilities—all in service to the goal of achieving the best patient outcomes possible.

Resource Allocation

A resource is anything required to perform effective patient care: both tangible items (such as supplies, patient rooms, financial resources, and staff) and intangible items (such as time and knowledge). While it may seem counterintuitive, interprofessional care frequently decreases the costs of the resources used by individual patients. In one study of over 110,000 primary care patients, team-based care patients were less likely to be seen in an emergency room or admitted to a hospital (Reiss-Brennan et al., 2016). They were also less likely to be seen by their primary care physicians, as other team members could often manage their concerns. Thus, by using resources more efficiently, team-based care ends up decreasing overall costs of care.

Additionally, organizations that foster highly collaborative healthcare teams frequently find that team members report greater job satisfaction and engagement, leading to lower turnover rates (Morley & Cashell, 2017). It is very expensive to replace staff, so organizations with low turnover rates often can allocate resources into other areas.

Improved Adherence to Plan of Care

There are two ways to explore the idea of improved adherence to plan of care: from the perspective of healthcare professionals and from the perspective of patients. For healthcare professionals, having a collaborative practice is likely to improve the team’s adherence to the patient’s care plan. Team members are accountable to the team for performing their roles effectively and appropriately. This improves patient care by increasing the likelihood that plans of care will be maintained. Additionally, the extra communication and collaboration provided by the team structure decreases opportunities for confusion or error.

For patients, there is evidence that having a care team improves the patient’s chances to participate in their own self-care (Morley & Cashell, 2017). Collaborative teams increase patient education and engagement by being responsive to patients and respectful of their wishes, which in turn increases the patient’s participation in making care decisions, including the creation of a self-care plan to which they can adhere when the care team is not present.

Improved Quality of Care

Team-based care models have been shown to improve patient safety and quality of care. In the primary care study mentioned previously, patients in team-based care practices were substantially more likely to be screened for depression, be seen for an annual wellness exam, and participate in self-care plans for chronic illnesses than their counterparts in traditional practices (Reiss-Brennan et al., 2016).

Improved Outcomes

Interprofessional care teams have also been shown to improve overall patient outcomes. Many studies have shown improved outcomes on performance measures such as mortality, morbidity, and postoperative complications (Schmutz et al., 2019). For example, one study looked at high-risk patients who experienced frequent emergency room visits and hospitalizations or had elevated hemoglobin A1c levels (an indication of glucose control over a three- to six-month period for people with diabetes) (Guck et al., 2019). Each of these measures improved with an interprofessional, collaborative team approach to their care.

Setting Clear and Attainable Goals

Effective teams have clear purposes with attainable and measurable goals. There are a variety of strategies to develop attainable goals. When a group finds they are struggling with goal setting, they might first try a more focused approach. Consider a quality improvement team of nurses who want to improve the use of a patient care bundle for diabetes management (currently at 25 percent). They have a goal to improve the use of the patient care bundle but no clear strategy of how to get there. The team might consider using a strategy known as SMART to determine how to set a clearer goal and achieve it (see 2.3 Effective Communication) (Centers for Disease Control and Prevention, 2020). SMART is an acronym that represents five characteristics of strong goals:

• Specific: The goal must identify exactly what will be done and who or what will be involved and impacted.
• Measurable: The goal must state how the desired change will be measured and what amount of change is expected.
• Attainable: The goal must be possible to attain given the resources available and time allotted.
• Relevant: The goal must be reasonable to expect under the given circumstances.
• Timely: The goal must set a time frame for completion.

In the case of the diabetes management care bundle, the SMART goal might be the following: By January 31, 2024 [Timely], care managers will complete patient care bundles for patients with diabetes [Specific] at least 75 percent of the time [Measurable]. Assuming the circumstances make this improvement possible, the goal is also attainable and relevant. Once the SMART goal is set, the team can develop its strategy for ensuring the improvement occurs.

Improving Interprofessional Training

Interprofessional training and continuing education are important for all healthcare professionals. As previously discussed, agencies such as the Interprofessional Education Collaborative, which provide curriculum standards for schools of healthcare professions, have already established a critical niche in educating up-and-coming healthcare professionals. In addition, interprofessional continuing education has its own set of joint accreditation standards, determined by a collaboration between nursing, medical, and pharmacy groups (Joint Accreditation for Interprofessional Continuing Education, 2023). Hospitals and agencies can send staff to interprofessional continuing education opportunities to learn or maintain skills.

Providing Leadership Training

Leadership training is another possibility to improve nursing team performance. The TeamSTEPPS 3.0 program (see Quality Organizations for Nursing Practice) has a leadership training module that can be used to help leaders improve and that can be taken as self-study or used in classroom settings (Agency for Healthcare Research and Quality [AHRQ], 2023). The program recommends strategies such as ensuring the team is coordinated, monitoring plans, and communicating changes; encouraging team members to assist each other; and modeling effective teamwork. It also recommends that leaders employ strategies such as a “brief checklist” at the beginning of a project and a “debrief checklist” at the end to assist in continuous leadership improvement (AHRQ, 2023). See Figure 15.13 for examples provided by the AHRQ.

Figure 15.13 (a) The Brief Checklist can be used at the beginning of a project to ensure that all team members understand the plan. (b) The Debrief Checklist can be used at the end of a project to give team members an opportunity to reflect on the successes and struggles and provide feedback for continuous improvement. (credit a: modification of work “Brief Checklist” by Agency for Healthcare Research and Quality; Public Domain; credit b: modification of work “Debrief Checklist” by Agency for Healthcare Research and Quality; Public Domain)