Examining the implementation of collaborative competencies in a critical care setting: Key challenges for enacting competency-based education

Abstract

Interprofessional collaboration is recognised as an important factor in improving patient care in intensive care units (ICUs). Competency frameworks, and more specifically interprofessional competency frameworks, are a key strategy being used to support the development of attitudes, knowledge, skills, and behaviours needed for an interprofessional approach to care. However, evidence for the application of competencies is limited. This study aimed to extend our empirically based understanding of the significance of interprofessional competencies to actual clinical practice in an ICU. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers' perspectives, behaviours, and interactions of interprofessional collaboration in a medical surgical ICU in a community teaching hospital in Canada. Approximately 160 hours of observations were undertaken and 24 semi-structured interviews with healthcare workers were conducted over a period of 6 months. Data were analysed using a directed content approach where two national competency frameworks were used to help generate an understanding of the practice of interprofessional collaboration. Healthcare professionals demonstrated numerous instances of interprofessional communication, role understandings, and teamwork in the ICU setting, which supported a number of key collaborative competencies. However, organisational factors such as pressures for discharge and patient flow, staffing, and lack of prioritisation for interprofessional learning undermined competencies designed to improve collaboration and teamwork. The findings demonstrate that interprofessional competencies can play an important role in promoting knowledge, attitudes, skills, and behaviours needed. However, competencies that promote interprofessional collaboration are dependent on a range of contextual factors that enable (or impede) individuals to actually enact these competencies.

Cross-Disciplinary Care: A Systematic Review on Teamwork Processes in Health Care

“…This finding emphasizes that successfully crossing medical specialty and practice boundaries requires the bolstering of affective and motivational aspects of team function. Among these were both interventions aimed at enhancing values of openness (e.g., James, Page, & Sprague, 2016; Weinstein et al, 2018) and ethnographic studies describing existing attitudes (e.g., Goldman, Kitto, & Reeves, 2017; Hoffman & Redman-Bentley, 2012). As health care delivery continues to incorporate other consultants, specialists, providers, and ancillary staff in team-based care, researchers and administrators should ensure that attitudinal competencies are developed.…”

Incidence of Surgical Site Infections in Multicenter Study—Implications for Surveillance Practice and Organization

“…Therefore, this kind of organizational culture is going to result in a lack of protection for the patient’s safety: on days inconvenient for the best specialists, it will be expected of interns and novice nurses—who are placed at the bottom of the hierarchy—to remain on duty. Similar problems also apply to other groups of medical professionals, among others ICU setting staff [ 24 ] or diagnosticians [ 25 ].…”

“…Unfortunately, such organization culture—one that focuses on the effectiveness, efficiency and competence of staff—does not guarantee a high level of stability in HAIs control and prevention either. Unfortunately, the organizational culture change—from “orange” to „amber”—appears to be a challenging target for IPC teams [ 24 ]. That is because the interests of experts, e.g., highly qualified doctors in the specialty market, are the top priority.…”

Use of tabletop exercises for healthcare education: a scoping review protocol

“…According to the Centre for the Advancement in Interprofessional Education, IPE occurs when ‘two or more professions learn with, from and about each other to improve collaboration and the quality of care’ 4. IPE aims to develop competencies of collaborative practice in healthcare professionals including role clarification, patient-centred care, teamwork, collaborative leadership, interprofessional communication and interpersonal conflict resolution 5. Various pedagogical designs of IPE activities, such as tabletop exercises (TTX), have been used by healthcare educators to develop collaborative practice in healthcare professionals 6 7…”