NCM 119A Nursing Leadership and Management

AY 2022-2023

Chapter VII

Intra-disciplinary and Multi-Disciplinary Team Work and Collaboration

There is an important but subtle difference between teamwork and

collaboration in nursing, and both are essential to ensure patient safety and care.
Collaboration refers to joint efforts between various independent teams or groups.
For example, if a pregnant patient shows signs of a heart issue, a cardiac surgery
team will be called to work together with those in the maternity ward. Teamwork
refers to the efforts within one team to produce the highest quality and most
efficient results. Whether in a small, focused health care organization or a large
hospital with many departments, both teamwork and collaboration are central to
health care.
Both multidisciplinary and interdisciplinary teamwork have been used in
healthcare in the past. However, although there is a clear difference between the
two approaches to care, many educational researchers and practitioners use these
terms interchangeably. The fundamental difference lies in the collaborative care plan
that is only developed in interdisciplinary patient interventions, as multidisciplinary
care does not emphasize an integrated approach to care.
Multidisciplinary teams are unable to develop a cohesive care plan as each
team member uses his or her own expertise to develop individual care goals. In
contrast, each team member in an interdisciplinary team build on each other’s
expertise to achieve common, shared goals. Therefore, it is crucial to indicate that
multidisciplinary teams work in a team; whereas, interdisciplinary teams engage in
teamwork.
Multidisciplinary collaboration offers genuine benefits to the patient,
including starting treatment sooner in many cases.
A team is defined as “a group of people working together to achieve common
purpose for which they hold themselves mutually accountable.” The establishment of
teams assumes that teams can outperform individuals when the task is complex,
members have a stake in the outcome, and where efficient use of resources is
necessary. Key elements of teamwork include members having a shared work product,
interdependent tasks, shared responsibility for producing results, commitment to a
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common approach, and collective management of relationships across organizational

boundaries.
An effective team is a one where the team members, including the patients,
communicate with each other, as well as merging their observations, expertise and
decision-making responsibilities to optimize patients’ care . Understanding the culture
of the workplace and its impact on team dynamics and functioning will make a team
member a good team player.
An interdisciplinary care plan is developed by answering these questions:
What are the issues? Who will be involved? What will the interventions be? What
are the goals of the intervention? When will re-evaluation occur?

Therefore, interdisciplinary care must occur to bring about improved patient

outcomes such as more efficient practice, an increased individualized and patient-
centered approach and improved quality in care. If healthcare professionals do not
have the same intervention goals, patients may suffer. Therefore, if practitioners
focus on a single, shared goal, a patient will be more successful in receiving the care
that they require.

In addition, the need for interdisciplinary care is increasing as a result of:

• The increasing knowledge and skill required to provide comprehensive care to
patients
• The increasing specialization in healthcare fields
• The growing encouragement to develop multi-faceted teams in healthcare, and
• The increased emphasis on continuity in care planning.

Therefore, changes in practice approaches and interventions need to take

place to advocate for the use of integrated care plans.

Learning Outcomes:
After the discussions, the learners should be able to:
1. Understand the concept of Team Work and Collaboration in Nursing,
2. Knowledge about the values and benefits of an effective team work,
3. Practice the different roles of nurses in team collaboration.
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A. Concept of Team Collaboration

The concept of “collaboration,” identified as critical to ensure quality health
care, is important to understand within the context of inter-professional teams.
Collaboration is described as conveying “the idea of sharing and implies
collective action oriented toward a common goal, in a spirit of harmony and trust,
particularly in the context of health professionals. Inter-professional collaboration is a
“negotiated agreement between professionals which values the expertise and
contributions that various healthcare professionals bring to patient care” and is most
effective when there is good communication and a value for diverse opinions among
team members.
Team collaboration is a communication and project management approach
that emphasizes teamwork, innovative thinking and equal participation to achieve
objectives.
- can be applied to multiple types of business relationships such as bosses
and subordinates, representatives from multiple teams, employees from two
partnering organizations and company agents with service providers, contractors,
volunteers or vendors.
Collaboration refers to the act of working with someone to produce
something, team collaboration in the workplace also incorporates corporate
culture and technology.
Goals of team collaboration include completing projects quickly and
efficiently, collectively brainstorming solutions and giving all team members a sense
of accomplishment.

Figure 1. Team Collaboration

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Successful teamwork is necessary for collaboration to occur. Teamwork

creates the environment to support the work that has the potential to result in
collaboration.

Elements of successful team collaboration

 Communication- This can range across providing clear instructions, asking for
clarification when necessary and listening to all members of the team. One
aspect of proper communication might be implementing a team messenger tool
that allows members to share files, make virtual calls and send updates in real
time.

 Transparency- Along with open lines of communication, dialogue needs to be

transparent. This includes setting clear goals, defining roles and responsibilities
upfront and informing members when problems arise.

 Employee engagement - Keeping employees on the team engaged and

interested in collaborating will make the project more efficient overall. This can
be achieved by identifying and maximizing each team member's strengths as
each person will bring something valuable to the project.

 Compromise - If disagreements arise, team members need to be prepared to

compromise for the best interest of the group. Choosing team members with a
positive attitude that are willing to meet in the middle ensures that the entire
team as a whole will be more successful.

 Conflict management - Effective team collaboration may result in minimal

conflicts, but a management strategy needs to be put in place if those issues
arise. Conflict management could be handled individually with the team leader
or as a group conversation.

 Reliability - Once the goals and duties are identified for each team member,
it is the job of the entire team to hold accountability. Team collaboration will fail
if certain team members fall short of their expectations and need others to pick
up their slack.
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 Diversity - Having a team with a diverse set of skills, expertise and

perspectives will foster a more holistic approach to team collaboration.

Figure 2: Team Collaboration

Values, Principles and Benefits of Effective Team

The following are five personal values that characterize the most effective members
of high-functioning teams in health care:

Honesty: A high value is put on effective communication within the team, including
transparency about aims, decisions, uncertainty, and mistakes. Honesty is critical to
continuous development and for maintaining the mutual trust, which is prerequisite
for a high-functioning team.

Discipline: Team members carry out their roles and responsibilities with discipline,
even when it seems inconvenient. Such discipline allows teams to develop and stick
to their standards and protocols even as they seek ways to improve.

Creativity: Team members are excited and motivated to tackle emerging problems
creatively. They see even errors and some unanticipated bad outcomes as potential
opportunities for improvement.

Humility: Team members do not believe that one type of training or perspective is
uniformly superior to the training of others, though they recognize differences in
training. They also recognize that they are human and will make mistakes. Hence, a
key value of working in a team is that fellow team members can rely on each other
to help recognize and avert failures, regardless of where they are in the hierarchy.
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Curiosity: Team members are dedicated to reflecting upon the lessons they learned
in their daily activities and using this reflective experience in continuous professional
development and the functioning of the team.

Principles of Team-Based Health Care

There are many models to describe effective teamwork. Historically, these

have come from other industries, such as the aviation’s crew resource management
(CRM).

To provide patients with the best care, nurses in leadership roles should
maintain the following teamwork and collaborative principles:

Shared goals: The team, including the patient and, where appropriate, family
members or other support persons, generate a common and clearly defined purpose
that includes collective interests and demonstrates shared ownership.
Example: improving patient care, shortening response times, and decreasing waste.

Clear roles: There are clear expectations for each team member’s functions,
responsibilities, and accountabilities, which optimize the team’s efficiency and often
make it possible for the team to take advantage of division of labour, thereby
accomplishing more than the sum of its parts. Mutual trust and respect: Team
members earn each other’s trust, creating strong norms of reciprocity and greater
opportunities for shared achievement. They respect and appreciate the role of each
other. They also respect each other’s talents and beliefs, in addition to their
professional contributions. Effective teams also accept and encourage a diversity of
opinions among members. Each member must understand their role and
expectations to achieve the team goal.

Effective communication: This is crucial for the teamwork success. The team
prioritizes and continuously refines its communication skills. It has consistent and
accessible channels for complete communication, and used by all team members
across all settings. Because nurses interact with many people, from patients to
practitioners, they must develop keen listening skills.
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Measurable processes and outcomes: Reliable and timely feedback on successes

and failures should be agreed and implemented by the team. These are used to track
and improve performance immediately and put strategies for the future.

Leadership: Effective team leaders facilitate, coach and coordinate the activities of
other team members. Effective leadership is a key characteristic of an effective team.
The best leaders can adapt to different circumstances based on the team, patient
care goals, and the needs of the health care organization. Quality leaders must be
flexible while helping their team members and other departments in an open and
respectful manner.

Benefits of effective teamwork

Effective teams can improve care at the level of the organization, the team itself as a
whole, the individual team member and the patient

Several barriers exist to establishing and maintaining effective teamwork in health

care:

Changing roles

In many health-care teams, there is considerable change and overlap in the roles
played by different health-care professionals. These changing roles can present
challenges to teams, in terms of acknowledgement and role allocation.

Changing settings

Some changes in the nature of health care such as increased delivery of care for
chronic conditions require the development of new teams and the modification of
existing teams.

Health-care hierarchies

The strongly hierarchical structure of health care can be counterproductive to well-

functioning and effective teams where all members’ views are considered.
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Individualistic nature of health care

Many health-care professions, such as nursing, dentistry and medicine, are based on
the autonomous one-to-one relationship between the health care provider and
patient. While this relationship remains a core value, it is challenged by many
concepts of teamwork and shared care.

Instability of teams

Some health-care teams are transitory in nature, coming together for a specific task
or event (e.g. Trauma team).

Failing teamwork leads to accidents

Reviews of high-profile incidents have identified three main types of teamwork

failings, namely, unclear definition of roles, lack of explicit coordination and other
miscommunication.

Resolving disagreement and conflict

The ability to resolve conflict or disagreement in the team is crucial to successful

teamwork. This can be especially challenging for junior members of the team or in
teams that are highly hierarchical in nature.

1. Hospital Setting
Collaboration in health care is defined as health care professionals assuming
complementary roles and cooperatively working together, sharing responsibility for
problem-solving and making decisions to formulate and carry out plans for patient
care.
Collaboration between physicians, nurses, and other health care
professionals increases team members’ awareness of each others’ type of
knowledge and skills, leading to continued improvement in decision making.
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2. Community Setting
Patient care is the top priority in nursing. For patients to receive the best
health care possible, nurses must communicate with relevant professionals about
their patients’ treatment plan while also understanding the role of each assigned
team member. In essence, nurses serve as a bridge between doctors, patients, and
the hospital. Teamwork and collaboration are critical to this role.
Community Health Workers (CHW’s) serve as a means of improving
outcomes for under-served populations. However, their relationship within health
care teams is not well studied.

Assessment is a core function of public health. Many local health

departments have traditionally conducted community health assessments —
approximately 60 percent in the last five years. Many hospitals also have conducted
or participated in community health needs assessments related to community
benefit programs. Collaborative work will allow local health departments and
hospitals around the country to build upon their existing expertise, relationships and
experiences to conduct various improvement initiatives partnering together around
specific goals.

These efforts to partner around community health assessment and

improvement planning span four types of strategies: networking, coordinating,
cooperating and collaborating. With such collaboration, community health
assessment and improvement activities can be precursors to real gains in population
health and an integral part of continuous improvement processes towards that goal.

A. Development of Team and Collaboration

A team that works together succeeds together. Collaboration among nurses
and staff ensures more efficient, effective patient care and a more supportive
environment where team members can develop in their practice.
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Different types of teams can be identified in health care systems:

Core teams

 These are directly involved in caring for the patient.

 They usually consist of team leaders and members who are direct-care providers
such as nurses, dentists, pharmacists, doctors, assistants…etc. They also include
case managers.

Coordinating teams

The group responsible for operational management, coordinating functions and

resource management for core teams.

Contingency teams

Formed to deal with emergencies or specific events (e.g. cardiac-arrest teams,

disaster-response teams,. etc).

Ancillary teams/services

The group supports services that facilitate patient care such as cleaners or
domestic staff.

Support services and administration

Those who provide indirect, task-specific services in a health-care facility

support services. It includes secretaries and the executive leadership of a unit or
facility. This team has 24-hour accountability for the overall functioning of the
organization. In order for any team to form and develop in a way that makes it
coherent, effective and strong enough to face future challenges, research have
shown that it usually passes through the following stages:

A. Forming: Typically characterized by ambiguity and confusion. Team

members may be unclear about tasks at this stage. They have not yet chosen to work
together and may communicate in a superficial and impersonal manner.
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B. Storming: A difficult stage when there may be conflict between team

members and some rebellion against the assigned tasks. Team members may get
frustrated here when do not progress well in the tasks.

C. Norming: Open communication between team members is established

and the team starts to confront the task at hand. Generally accepted procedures and
communication patterns are established.

D. Performing: The team focuses all of its attention on achieving the goals.
The team is now close and supportive, open and trusting, resourceful and effective.

After being formed and continue to develop, Healthcare teams interact

dynamically and have the common goal of delivering health services to patients. In
order to succeed, the team members need to share certain characteristics, which
include :

 Possess specialized knowledge and skills and often function under high-
workload conditions.

 Know their role and the roles of others in the team(s) and interact with one
another to achieve a common goal.

 Act as a collective unit, as a result of the inter-dependency of the tasks

performed by team members.

 Possess specialized and complementary knowledge and skills.

 Take decisions.

B. Tools for Facilitating Health Care Team Work

Patient safety often relies on effective communication and good teamwork.
Simple tools are at hand to help teams work together efficiently. Although health
professionals tend to think they are good at communicating, many patient safety
incidents, complains and negligence claims incriminate communication failure
and/or poor teamwork. Good teamwork requires effective communication,
leadership, situational awareness and mutual support. Simple tools and techniques,
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such as those used in the Team STEPPS training method, can help improve
communication and teamwork, which can in turn decrease the risk of harm.
Caring for patients is a team activity. Effective patient care relies on individual
staff, in a ward or department, working together effectively. The team may comprise
excellent individual nurses or doctors who are knowledgeable and skilful in a clinical
sense, but for this to benefit patients, there also needs to be good collaboration with
each other.

When errors happen, it is not usually due to lack of technical knowledge

about a disease or drug, but to poor communication or teamwork (Yule et al, 2006;
Gawande et al, 2003). For example, a technically skilled nurse may diagnose a
patient’s sepsis, but ensuring the case is escalated in good time also requires the
non-technical skills of communication and teamwork.

C. Nurses Role
Collaborative care is a healthcare model which aims to improve patient
outcomes through inter-professional cooperation. This will commonly include a
primary or tertiary care team working with allied health professionals – such as
dieticians, physiotherapists or mental health professionals – or medical specialists.

Effective collaboration encourages patients, families and healthcare

providers to be active participants in the treatment process which in turn promotes
improved quality outcomes, improvements in patient experience, patient safety, and
effective use of resources.

Some of the hallmarks of collaborative care involve prioritizing patients,

commitments from those in leadership positions to ensure inter-professional
collaboration, effective communication across the team, and contributions from
practitioners who are all equally and highly experienced.

The role of nurses in collaborative care

Nurses are the only clinical professionals who are specially trained to
understand the roles of other healthcare providers, this training provides a strong
foundation for successful collaboration.
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Effective communication is critical for a collaborative care plan to work;

nurses are trained to have adaptability, empathy, and communication skills, which
allows for them to be excellent leaders and members of a care team.

Nurses’ ability to understand and assess a patient’s clinical, emotional, and

social needs can help them to call upon available resources and create a patient-
focused care plan. As nurses are offering direct patient care around the clock, they
have a unique and focused view of how that care should be provided.

Nurses can be role models in their honest and open communication with
team members about the quality of patient care which is being provided and the
work environment.

The benefits of collaborative nursing

The ‘Ways Of Working In Nursing, Resource Package’ issued by New South Wales
Government outlines the following ways in which collaborative nursing can be
beneficial for nurses;

 Allows nurses from various backgrounds and levels of expertise to perform their
duties effectively
 Ensures that temporary staff and ‘transitioning to practice’ nurses have improved
supervision by senior nursing staff
 Takes advantage of knowledge and experience of each team members, which also
leads to professional development and increased knowledge for junior staff
 Reduction in staff isolation and a more supportive working environment
 Patient outcomes and satisfaction is improved
 Individual team members can familiarise themselves with each other’s skills and
capacities
 Significantly reduced risk of missed care (any patient care which is omitted or
delayed)
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 The workload is shared which can reduce nurse stress levels and potential manual
handling injuries
 Increased job satisfaction and morale
 Nursing duties are made easier if team members are working together in a close
environment and can assist and support one another

Collaborative care has proven to be highly beneficial for nurses, patients and overall
performance of healthcare teams by increasing patient safety and also providing
nurses with valuable healthcare experience and insight.

Such outcomes can only suggest that the use of collaborative healthcare teams will
increase in numbers across hospitals around the country to provide optimal services
to patients in the future.
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References:

Andrew Booth, Steven Ariss,Tony Smith, Pam Enderby,and Alison Roots4 Susan A
Nancarrow, “Ten principles of good interdisciplinary team work,” Human
Resource Health, 2013: 1-11.

Franklin, Catherine M. et. Al. Interprofessional Teamwork and Collaboration

Between Community Health Workers and Healthcare Teams : An Integrative
Review., January 2015.

Mitchell P, Wynia M, Golden R, McNellis B, Okun S, Webb CE, et al. Core

Principles and Values of Effective Team-Based Health Care Discussion Paper.
Washington, DC: Institute of Medicine; 2012.

Robson, W. (2016) Tools and techniques to improve teamwork and avoid patient
harm. Nursing Times; 113: 1, 24-27.

https://searchhrsoftware.techtarget.com/definition/team-collaboration
https://www.ncbi.nlm.nih.gov/books/NBK2637/
https://healthtimes.com.au/hub/nursing-careers/6/guidance/ht1/nurses-in-
collaborative-care-teams/2020
https://www.chausa.org/publications/health-progress/article/january-february-
2013/public-health's-role-collaborating-for-healthy-communities