The rules of the game: interprofessional collaboration on the intensive care unit team

Abstract

Background The intensive care unit (ICU) is a nexus for interspecialty and interdisciplinary tensions because of its pivotal role in the care of the hospital's most critically ill patients and in the management of critical care resources. In an environment charged with temporal, financial and professional tensions, learning how to get results collaboratively is a critical aspect of professional competence. This study explored how team members in the ICU interact to achieve daily clinical goals, delineate professional boundaries and negotiate complex systems issues. Methods Seven 1-hour focus groups were conducted with ICU team members in two hospitals. Participants consisted of four nursing groups (n = 27), two resident groups (n = 6) and one intensivist group (n = 4). Interviews were audio-recorded, anonymized and transcribed. With the use of a standard qualitative approach, transcripts were analyzed iteratively for recurrent themes by four researchers. Results Team members articulated their perceptions of the mechanisms by which team collaboration was achieved or undermined in a complex and high-pressure context. Two mechanisms were recurrently described: the perception of 'ownership' and the process of 'trade'. Analysis of these mechanisms reveals how power is commodified, possessed and exchanged as team members negotiate their daily needs and goals with one another. Conclusion Our data provide a non-idealized depiction of how health care professionals function on a team so as to meet both individual and collective goals. We contend that the concept of 'team' must move beyond the rhetoric of 'cooperation' and towards a more authentic depiction of the skills and strategies required to function in the competitive setting of the interprofessional health care team.

Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle

“…Clear articulation of each provider’s role can foster ownership and promote smooth team functioning allowing team members to complete the ABCDE bundle amidst a chaotic ICU environment. 24 Likewise, use of a unified ABCDE protocol, as opposed to separate protocols for each component of the bundle, may improve interprofessional role clarity and, thus, provider attitudes regarding the ABCDE bundle.…”

Interprofessional Collaboration between Residents and Nurses in General Internal Medicine: A Qualitative Study on Behaviours Enhancing Teamwork Quality

“…Effective teamwork is necessary for optimal patient care and is associated with better patient outcome [2], [3], [4], [5]. The hospital is a context of complex clinical practice, heavy workload, and numerous team shifts.…”

Interprofessional Collaboration on an Internal Medicine Ward: Role Perceptions and Expectations among Nurses and Residents

“…In the collaborative process, mutual respect and a match between the respective roles and expectations of doctors and nurses are required for communication, cooperation and contribution to a common goal [15]. To our knowledge, studies have more explored multidisciplinary teams in anesthesiology, emergency, and intensive care settings [16], [17], [18], [19] than in Internal Medicine.…”