Interprofessional Collaboration in Health Care: Lessons from Competitive Sports PDF

COMMENTARY Interprofessional collaboration in health care: Lessons to be learned from competitive sports Brennan Bosch; Holly Mansell, BSP, PharmD Improved health care collaboration has been cited as goal scorers, the other aspects of the game will be ignored and a key strategy for...

COMMENTARY Interprofessional collaboration in health care: Lessons to be learned from competitive sports Brennan Bosch; Holly Mansell, BSP, PharmD Improved health care collaboration has been cited as goal scorers, the other aspects of the game will be ignored and a key strategy for health care reform.1,2 Collaboration in health the team will have weaknesses. Teams in health care consist of care has been shown to improve patient outcomes such as diagnosticians, prescribers, medication experts and members reducing preventable adverse drug reactions,3,4 decreasing who tend to the ongoing daily needs of the patient. Each morbidity and mortality rates5,6 and optimizing medication expert adds a specific value, creating a collective synergy so dosages.7 Teamwork has also been shown to provide benefits that patient needs can be most effectively met.10 While role to health care providers, including reducing extra work4 and clarity is essential, team members need to be comfortable increasing job satisfaction.8 As a fourth-year pharmacy stu- with some “overlap” of skills. Sometimes doing what is in the dent at the University of Saskatchewan (BB), I have noticed this best interests of the patient most efficiently will require team shift becoming increasingly evident in our education, with the members to step outside their traditional professional role. A incorporation of interprofessional-based learning activities and defenseman, for instance, will take a shot at an open net should relocation to a recently built health sciences building. the opportunity arise. Having played competitive hockey for about 15 years, I While some members within a team or collaborative rela- have been on both highly successful teams that went on to win tionship may take on more of a leadership role, everyone must championships, as well as teams that were unable to function be enabled to contribute. Why would some commit to making effectively. What was it about these teams that contributed sacrifices for the betterment of a team if they felt their role was to our successes or failures? Moreover, can these lessons be insignificant? Individual contributions need to be valued and extrapolated to health care teams? not underplayed. Yet, for maximum performance, the focus Characteristics have been identified in both sports and needs to be on “team success.” The old saying “Win as a team health care that may influence team success.2,9 Examples and lose as a team” holds true in health care as well. Thus, a include accountability, communication, leadership, discipline, team filled with members who know their individual roles, put coordination, having a clear purpose and having a strategy in personal egos aside and feel appreciated increases the likeli- place. While a cooking recipe may consist of many ingredi- hood of team success and individual job satisfaction.11 ents (some perhaps to add flavour; others for consistency), a few ingredients will always remain essential. Reflecting on Trust and confidence my experiences as an athlete and as a pharmacy student, 5 key Trust, one of the most important elements of a successful team, ingredients seem necessary for success in a collaborative team is difficult to gain yet easy to lose. Developing trust takes time (Table 1). and a lot of personal contact. This may be a challenge in some health care settings due to logistical barriers such as rotating Role clarity staff schedules, which contributes to constantly changing teams. We have all seen examples of teams that consist of members If teams have the opportunity to work together daily, the devel- who are extremely talented and yet do not function effectively. opment of confidence within the team is naturally facilitated. Conversely, some teams that are considered to lack skill succeed Having just completed my Structured Practical Experi- where others fail. In a successful team, every single participant ence Program (SPEP) rotation at the Saskatchewan Transplant is relied on to execute his or her unique role. For instance, ­Program, I had the opportunity to work with an effectively func- in the game of hockey, there are goal scorers, defensemen, tioning team of pharmacists, physicians and nurses. The health “grinders” and goalies. If a hockey team is composed of only care practitioners in this setting are hired by the transplant © The Author(s) 2015 DOI: 10.1177/1715163515588106 176  C P J / R P C J U LY / A U G U S T 2 0 1 5 V O L 1 4 8 , N O 4  COMMENTARY TABLE 1 Five essential ingredients for team success Sports teams Health care teams 1. Role clarity Examples in hockey include goal Examples include diagnosticians, Each member is relied on to execute his or her scorers, defensemen, grinders prescribers, medication experts unique role. and goalies. and members who tend to the Individual contributions should be valued, yet the patient’s daily needs. focus must be on team success. 2. Trust and confidence Facilitated by time spent Facilitated by proximity and time, Members must be confident in their own abilities together practicing. as well as exposure to other to develop team trust. health care disciplines. 3. The ability to overcome adversity Examples of adversity may Examples of adversity may include Challenges require every member to remain include a turnover in basketball dealing with complex patients committed to the collective goal despite setbacks. or a bad call in football. or staff shortages. 4. The ability to overcome personal differences Members must work towards a Members must work together, Members must be able to overcome personal common goal of winning the putting patient care first. differences even if they do not always get along. game. 5. Collective leadership Can help facilitate “buy-in” from Collaborative leadership is 1 of A philosophy that takes pressure off any one team players. the 6 competency domains for individual and disperses it throughout the group. interprofessional education. program and work together exclusively. The pharmacists and The ability to overcome adversity nurses partially attribute their team success to the fact that they At some point, all teams will be faced with adversity. In an share an office and work so closely with one another. Proximity athlete’s world, this could be a turnover in basketball or the and contact have led to an atmosphere where trust has been referee making a bad call during a football game. Adversity built rather than lost. Exposure to other health care disciplines and challenges are part of health care delivery, whether it and the opportunity to work collaboratively have been shown be complex patients or dealing with staff shortages. It is to facilitate awareness and appreciation for interprofessional during these difficult situations that collaboration becomes roles.12 It is more likely that members of health care teams will even more essential, and it is in the face of adversity that the develop a mutual trust if they are aware of other professions’ team’s true integrity is revealed. When teams are faced with roles and witness their capabilities firsthand.13 In addition, evi- adversity, the tendency can be to pass blame and begin to dence shows that implementing interprofessional education question the system, management or leadership. Challenges (IPE) earlier in health care curriculums can positively influence require every member to remain committed to the ultimate students’ perception of teamwork.14 Efforts to incorporate IPE goal, which in the case of health care is patient care. Since into students’ education should therefore be encouraged, with adversity is something that every team in any setting will the goal of fostering future collaborative practice. inevitably encounter, it is imperative that health care To develop team trust, it is essential that members are providers working collaboratively become adept at dealing confident in their own abilities. It is noteworthy that the with it effectively. athletes I have played hockey with who have gone on to win championships and compete at the highest level (the National The ability to overcome personal differences Hockey League) have radiated individual confidence, which It is not always possible to get along with every team member, in turn facilitated team confidence. When faced with pressure but how those differences in opinions are handled is what truly situations, the team remained confident because we trusted matters. When I played hockey in Medicine Hat, there were each other and had spent countless hours together improving arguments between team members on a daily basis, and it was our skills and forming good habits throughout the season. not uncommon for teammates to fight during practice. Despite This was evident in the transplant program, which deals with these disagreements, the players had the ability to move past complex patients and high-stress situations when organs for their differences and focus on the common goal. Team diver- transplant become available. Trust and confidence in one sity should be viewed as a strength; it can bring about differ- another there kept the pandemonium in check, similar to ent viewpoints, facilitate innovation and problem solving15 and being down a goal with 30 seconds left on the clock. have the potential to result in amazing outcomes.16 The key C P J / R P C J U LY / A U G U S T 2 0 1 5 V O L 1 4 8 , N O 4  177 COMMENTARY is for everyone to work towards a common goal and have a Conclusion shared vision on how to achieve it. In sports, winning is obviously more gratifying than losing, and reflecting on my hockey career, the years we ended up Collective leadership winning championships were the most enjoyable. I believe that Collective leadership takes pressure off any one individual our successes during these years resulted because we had dis- and disperses it throughout the group. During my time in covered a winning recipe for functioning effectively as a team: Medicine Hat, I was fortunate to be coached by the current while each person played a unique and fundamental role, we coach of the Vancouver Canucks, Wilbrod Desjardins. He was practised collective leadership. We had built trust and confi- a true believer that each person is only as good as the people dence in our teammates, and we learned to put personal dif- they are surrounded by. Rather than relying exclusively on ferences aside and overcome adversity. These factors were also the team captain, a leadership group consisting of 8 players evident within the interdisciplinary team at the Saskatchewan would convene regularly to discuss team issues. This group Transplant Program. Judging from their patient successes, it approach helped to engage more individuals and facilitated leads me to believe that these 5 ingredients are essential in “buy-in” from the rest of the team. The value of collective health teams as well. leadership has been noted in both sports teams and health To conclude, the importance of interprofessional teamwork care.17,18 In fact, collaborative leadership has been recognized in health care has been consistently highlighted. To increase as 1 of the 6 competency domains for interprofessional edu- the likelihood of team success, the value of selecting individu- cation19 and has been given a priority for student learning in als capable of embodying these core characteristics should not this capacity. be overlooked. From the College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan. At the time of writing, Brennan Bosch was a fourth-year pharmacy student at the University of Saskatchewan who was completing a Structured Practice Experience Program (SPEP) rotation at the Saskatchewan Transplant Program, under the supervision of Dr. Mansell. Brennan played competitive hockey for over 15 years, and his accomplishments include a Western Hockey League championship in 2006-07 with the Medicine Hat Tigers and the 2011-12 Canada West hockey title with the University of Saskatchewan Huskies. Contact [email protected]. Author Contributions: B. Bosch wrote the initial draft of the manuscript and H. Mansell performed the revisions. Both authors contributed to the theme and ideas. Declaration of Conflicting Interests: The authors declared no potential conflict of interest with respect to the research, authorship and/or publication of this article. Funding: The authors received no financial support for the research, authorship and/or publication of this article. References 6. Hall D, Buchanan J, Helms B, et al. Health care expenditures and therapeutic 1. Romanow RJ. 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