Purposeful interprofessional team intervention improves relational coordination among advanced heart failure care teams

• Published in: Journal of interprofessional care 2019-09, Vol.33 (5), p.481-489
• Main Authors: Abu-Rish Blakeney, Erin, Lavallee, Danielle C, Baik, Dawon, Pambianco, Susan, O'Brien, Kevin D., Zierler, Brenda K.
• Format: Article
• Language: English
• Subjects: Cardiology; Clinical medicine; Clinical outcomes; Communication; Cooperative Behavior; Coordination; Cross-Sectional Studies; Female; Health care delivery; health services research; Health status; Heart failure; Heart Failure - therapy; Humans; Implementation; Inpatient care; Integrated care; Interdisciplinary aspects; Interprofessional collaboration; Interprofessional Relations; Intervention; Male; Nurses; Patient Care Team; Pharmacists; Professional development; professional relations; Surveys and Questionnaires; team culture; team-based care; Teams; Teamwork; Workforce
• ISSN: 1356-1820; 1469-9567
• DOI: 10.1080/13561820.2018.1560248

Effective delivery of healthcare is highly interdependent within and between interprofessional (IP) care teams and the patients they serve. This is particularly true for complex health conditions such as advanced heart failure (AHF). Our Academic Practice Partnership received funding to carry out IP workforce development with inpatient AHF care teams. Our objectives were to (a) identify challenges in team functioning that affected communication and relationships among the AHF care teams, (b) collaboratively identify a focal work process in need of improvement, and (c) test whether facilitated the implementation of team training and work process changes would lead to improvements in team communication, relationships, and process outcomes. The health-care team identified implementation of structured IP bedside rounds (SIBR) as the preferred approach to improving collaborative care. Utilizing a cross-sectional pre/post design, changes in team communication and relationships before and after a team intervention that included TeamSTEPPS training and SIBR implementation, were assessed using a validated Relational Coordination (RC) survey. The study population included AHF care team members (n ~ 100) representing seven workgroups (e.g., nurses, pharmacists) from two inpatient cardiology units at a 450-bed academic medical center in the Pacific Northwest during 2015-2016. Improvements in RC scores were demonstrated across all seven RC dimensions from baseline (Year 1) to follow-up (Year 2). Percent change on each of the seven dimensions ranged from 3.57% to 9.85%. Changes were statistically significant for improvements between baseline and follow-up on all but one of the seven RC dimensions (shared knowledge). The IP team intervention was associated with improvements in RC from baseline to follow-up. Additional research is needed to assess patient perspectives and outcomes of the IP team intervention. Findings of this study are consistent with the growing body of RC and SIBR research and provide a useful model of an IP team-based intervention in clinical practice.