When I first moved to San Francisco, I joined a co-ed volleyball league with my sister as a way to meet people. One of the guys on the team (who happened to be 6ft tall) didn’t get the message that volleyball was a team sport. When he received the ball, he would immediately send it back over the net. When we discussed the idea of 3 hits, (bump, set, spike), his response was that he had three degrees. Clearly, he was not receptive to feedback and somehow thought his surplus of education justified that. We didn’t know what his degrees were in, but they definitely were not in teamwork. Sometimes this dynamic shows up at the hospital when working with other professionals in a multidisciplinary setting.
There are so many variable factors that influence a successful interdisciplinary team. There are physicians and nurses who are genuinely collaborative and create environments where feedback is welcome. And there are nurses and physicians who create barriers to collaboration and are not receptive to input or feedback at all.
To truly embrace a collaborative, multidisciplinary approach, one in which all members have good communication skills (that involve active listening and the freedom to express concerns), know each other’s roles, prioritize the needs of the patient, and are competent providers. It sounds great on paper but it’s a bit more challenging to implement in reality.
While we feel as if the majority of the providers we work with are competent, there are still a few whom we have our concerns about and may not be best suited for each patient. And as we all have experienced, on occasion, there are weak members of the team who fall short of providing competent skills.
We all live busy, full lives, which often feels as if we are expected to do more with less. Sometimes balancing the needs of our patient assignments with the needs of the unit, inservices, and physician rounds do not always create ideal circumstances for the patient. For example, how much rest do patients get in a hospital? I realize, there are rare exceptions to this, but it’s fairly common to wake a sleeping patient to take vital signs. It’s an expectation to get it done and if you wait until the patient wakes up, it may not be convenient for the provider. We also can’t ignore our patients to let them sleep; What if there was a bad outcome and the chart revealed you didn’t have vital signs just so you could let your patient sleep?
We health care providers come from all walks of life. Some of us were raised in happy, nurturing homes that fostered effective communication whereas; others never acknowledged the pink elephant in the room and subsequently avoid confrontation at any cost. Even smaller minorities of us have sought personal self-development and focus on improving our communication skills.
Despite all this, we are expected to set aside our egos, not be defensive, communicate our needs and concerns clearly, listen effectively, work well with others and prioritize the needs of the patient over our own. This sounds like a magical place, right? It happens if you have the right players on the team. Sometimes, it’s a miracle when we can get through the day without harming each other. We all have peers and providers that we feel more comfortable collaborating with making for an effortless and welcoming environment. And we also have peers and providers whom we feel reluctant to speak freely and advocate for our patients with. This is the crux of the issue. If we don’t hold providers accountable and speak out and act as patient advocates, the multidisciplinary team is something we keep on paper and not in practice.