Context

What is Interprofessional Collaboration (IPC)?

What do an electrical contractor, a chemist working in a laboratory, and LeBron James have in common? They all work in teams. To build a house, run a critical experiment, or win an NBA championship, these individuals need to rely on others to reinforce their work and move it toward a greater goal.

We have all participated in teams, but the culture of health care has long emphasized solo acts. The nurse acts apart from the physician, who is unaware of the physical therapist's role. Meanwhile, the pharmacist fails to communicate with members of the medical office staff, who are preoccupied by a new reality show in which LeBron James competes against construction workers and chemical engineers in a series of challenges.

This series will emphasize why interprofessional collaboration (IPC) is important, and it will provide concrete examples of how to make IPC work across multiple settings.

Interprofessional collaboration is defined as "when multiple health workers from different professional backgrounds work together with patients, families, carers (caregivers), and communities to deliver the highest quality of care."^[1] It is based on the concept that when providers consider each other's perspective, including that of the patient, they can deliver better care.

Why Is IPC Important?

IPC is where health care is headed right now. The triple aim of improving patient experience and satisfaction, improving the health of the population, and reducing costs is not attainable without IPC.

However, currently IPC is the exception, not the rule. Each of the health professions must shift its focus toward collaboration, partnerships, and sharing, rather than operate in silos. The quality and safety of care, and the need to contain costs, require all professions to work together in an environment of respect. With a projected shortage of healthcare providers, including physicians and nurses, it is imperative to rely on interprofessional practice to work collaboratively and more efficiently. As great an individual athlete as he is, LeBron James could not be successful without the collaboration of his teammates, coaches, trainers -- all of the staff who make up the team.

If the team's professionals do not communicate and collaborate, their performance suffers. In the healthcare field, poor communication is often cited as a root cause of medical errors. Effective teamwork and good working relationships can reduce errors and improve outcomes. This relationship of communication to quality and safety is highlighted in several Institute of Medicine (IOM) reports.^[2-4] In addition, patients are "handed off" with each transition in care, increasing the risk for error to the patient with each handoff. With efficient transfer of essential information, IPC can mitigate some of the risk associated with these transitions. IPC optimizes patient outcomes by improving communication and teamwork.

Another reason IPC is important is that it promotes coordination of care across the continuum of health care in all settings. Working as a team, the patient's care is coordinated throughout the healthcare continuum. This promotes sharing of knowledge and working toward a common goal where each professional learns about each other's roles and responsibilities from each other. IPC helps ensure better communication with less chance of error, whether a patient is being transferred from surgery to the intensive care unit or from an acute care setting to a long-term facility, for example.

Furthermore, IPC is critical for the success of patient-centered care. Patient-centered care is "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions."^[3] This replaces the traditional physician-centered system with one that revolves around the patient. Such a system works well with the team-based approach of IPC. With IPC, team members focus on the needs of the patient rather than on the individual contributions of each professional. This is essential to the overall success of the practitioner, as well as patient outcomes.

The National Center for Interprofessional Practice and Education believes that high-functioning teams can improve the experience, outcomes, and costs of health care.^[5] Several IOM reports also outline the "positive impact that interprofessional collaboration and teamwork can have on key dimensions of organizational performance."^[6]

Quality is more than a metric. In health care, it means that people live longer, better lives. IPC can play a crucial role in improving the quality of patient care. Currently, the annual number of deaths from medical errors in the United States may approach 200,000.^[7] Many of these errors occur among the most complex and high-risk inpatients. Therefore, it is noteworthy that a study evaluating the effect of adding a pharmacist during rounds in the intensive care unit demonstrated a two-thirds reduction in the number of potential adverse drug events.^[8] An estimated 99% of the pharmacists' suggestions were accepted by physicians.

In addition, a systematic review of 36 randomized controlled trials involving coordination of care demonstrated that coordination with IPC reduced the risk for hospital readmission by 19%.^[9] Older adults receiving coordination of care were more than 30% less likely to visit the emergency department.

Patients treated by IPC teams are also more satisfied with the care they receive. In one study, adding psychologists to primary care clinics resulted in improved ratings of mental health symptoms and quality of life among patients.^[10] This intervention also dramatically improved patients' confidence in their care.

Patients are not the only ones who may feel more satisfied by improvements in IPC. In a recent study of efforts to improve IPC on inpatient services at a large academic medical center, 95.8% of healthcare professionals involved in the intervention believed that IPC improved the quality of care and patient safety.^[11] These improvements should lead to happier providers and a better work environment overall.

What Are the Barriers to IPC?

Despite these benefits, it is clear that creating IPC is not easy. Many influential factors affect our relationship with one another. Although data are starting to emerge showing the value of team-based care, there are many obstacles to its implementation. Some of these include reimbursement, the culture of health care, and lack of information and role models.

From the financial perspective, IPC can clearly be effective as part of an accountable care organization (ACO) payer model. Currently there are more than 700 ACOs in the United States, serving an estimated 23.5 million patients.^[12] Still, this is a fraction of the overall health consumer marketplace. Spending resources on IPC is harder to justify in a traditional fee-for-service payer model.

Culture of health care:

The traditional culture of healthcare training and practice has been to work in silos. Professionals are not used to working collaboratively across disciplines. One study of a large urban teaching hospital showed that nurses and physicians caring for the same patients often could not identify each other and often had different priorities for them, suggesting that coordination of care was "less than optimal."^[13]

Several other cultural barriers exist. There is little exposure to each other's role and perspective. This fosters miscommunication, mistrust, conflict, and a lack of coordinated care. Second, physicians historically have been autonomous and dominant of other health professions, rather than collaborative. Third, patients themselves have traditionally not been a part of the decision making related to their care. Finally, there is resistance to change, as health professionals may be reluctant to adopt an IPC culture.

Despite the significant impact that IPC can have on the health system, it remains a fairly new concept. There are national organizations which evaluate and promote best practices for IPC, but what works in one healthcare setting does not necessarily apply to another. This series is designed to address this issue by providing concrete ideas regarding how to make IPC work at a local level.

Where Can IPC Work?

IPC may be effective in a variety of healthcare settings. The preliminary work on IPC was performed in high-intensity areas such as the operating room and intensive care unit. We have seen it successfully implemented in transplant teams, hospice, and rehabilitation. Further practice and research have expanded IPC to the outpatient clinic, pharmacy, and even community sites.

Conclusion

There are many benefits to IPC. It can improve safety and healthcare delivery, as well as reduce costs. It puts the patient at the center of the healthcare team's focus and allows all health professionals, with the patient, to collaboratively provide input, be part of the decision making, and improve outcomes. Although there are several obstacles to IPC, adopting this team-based culture of mutual respect and understanding is possible and, in fact, necessary.

Future articles in this series will address the following:

• The core competencies of interprofessional collaboration
• What makes effective teams
• How to implement interprofessional collaboration in various healthcare settings

CME Test