1. Team Collaboration in the NICU
Dr. Chris Retajczyk
San Francisco Neonatology
California Pacific Medical Center

2. “Teamwork Raises Everyone's Game” Nov 7 2005
Robert Huckman and Gary Pisano of Harvard Business School analyzed the work of Pennsylvania heart surgeons who practice at more than one hospital
The professors found that the death rates from similar procedures performed by the same surgeon can vary as much as fivefold at different hospitals.
WHY?
results suggest that the surgeon's interactions with anesthesiologists, nurses and technicians are crucial to the outcome of the surgery.
findings suggest that the skills of the team, and of the organization, matter.

3. Why Collaboration is Important?
In a health care climate of
Demanding efficiency
Cost effectiveness
Quality improvement
Interprofessional collaboration hold the promise for improving patient care and creating satisfying work roles

4. What is Collaboration?
The complex process that requires intentional knowledge sharing and joint responsibility for patient care.
Can occur in short term or long term relationships between health professionals.
The challenge is to make the most of the interactions to produce the best patient outcomes.

5. The Nature and Benefits of Collaboration
Collaboration involves an exchange of ideas and views that considers the prospective of all- and agreement is always reached.
To be effective it requires:
Mutual respect
Trust
Tenacity

6. Is it worth the effort?
Kramer and Schmalenberg 2003, Nursing Management
Collaboration results in better hospital outcomes
Researched “Magnet” hospitals
Were able to link the quality of physician –nurse relationships and the quality of patient care outcomes

7. Is it worth the effort?
Collaboration is vital for patients but also the satisfaction of the health care providers.
It’s rewarding when:
Responsibility for patient well being shared
Professionalism is strengthened when all members are credits with success
Unfortunately contribution of nursing to the bottom line is not always easy to identify.

8. Collaboration Development Strategies
Develop Emotional Maturity
involving mastering of one’s own emotions and recognizing those of others
instills confidence and enhances one’s behavior within groups
foundation to effective collaboration

9. Collaboration Development Strategies
Emotionally Mature team members:
life-long learners
vigilant in identifying the latest best practices and in keeping their skills current
abandon perfectionist thinking and aim instead for constant improvement
are persistently positive, humble, and willing to take responsibility for failures and try again.

10. Understand the Perspectives of Others
nurses and physicians are strongly influenced by
the attitudes of their educators,
the unique jargon of their own disciplines
and their professional cultural norms
This professional socialization can present challenges to effective collaboration

11. Understand the Perspectives of Others
Nurses are typically socialized to press for consensus, which may make them appear tentative (Larson, 1999).
In contrast, physicians often focus on justice issues and are intent on ruling out alternatives.
Unfortunately, socializing students is typically discipline-specific and may not emphasize the strengths of other disciplines so as to strengthen collaboration skills.

12. Understand the Perspectives of Others
Interdisciplinary service learning opportunities have proven to be effective in developing collaborative skills
Registered Nurse-Resident Physician Preceptorship Program at the University of Kentucky
pairs new residents with registered nurses for eight-hour orientation shifts
working together on the nurses’ terms, the physicians directly encounter the unique functions, perspectives, and contributions of nursing

13. Understand the Perspectives of Others
When unique disciplinary perspectives are valued:
the uniqueness of each profession can be seen as an asset rather than a detriment to patient care.
Interdisciplinary collaboration with different skill sets and knowledge bases may result in creative and practical solutions that would not otherwise occurred.

14. Avoid Compassion Fatigue
Compassion fatigue and burnout can also pose barriers to effective communication
Compassion fatigue is triggered by the indirect trauma resulting from
dealing with the tragedy of patient demise
viewing painful procedures
experiencing the residual effects of exposure to human suffering

15. Avoid Compassion Fatigue
Cardinal signs of compassion fatigue are fatigue and lack of energy.
compassion fatigue may progress to burnout, a state with more severe, long-term symptoms that are difficult to reverse.
Burnout has been described as a syndrome of:
emotional exhaustion,
depersonalization towards patients
reduced sense of personal accomplishment

16. Avoid Compassion Fatigue
Communication with individuals who are experiencing compassion fatigue or burnout will be challenging and thus interdisciplinary collaboration can be difficult
Timely lifestyle changes and self-care measures are critical to prevent these negative states that work to the detriment of effective collaboration

17. Team-Development Strategies
Collaboration is essential for team development and ongoing positive performance
collaborative climates embody safe communication of and rewards for collaboration, problem-solving behaviors, and management of negative behaviors (LaFasto & Larson, 2001)

18. Team-Development Strategies
Team development includes the following tasks:
team building
respectful negotiation
conflict management
containment of negative behaviors
workplace design to facilitate collaboration.

19. Team-Development Strategies- Build the Team
Collaborative practice is not a process involving side-by-side efforts; rather it is a drawing together of the valued contributions
involves developing shared meanings (not simply information exchange) and building trust, which takes time and patience
common goal of patient well-being also enhances team unity

20. Team-Development Strategies-Negotiate Respectfully
Unequal power and authority influences interdisciplinary collaboration
balance power and authority might be to drop titles
Nurses negotiate from a position of strength when they recognize the substantial power they do possess

21. Team-Development Strategies-Manage Conflict Wisely
Nurses and physicians will not always agree.
when managed correctly, conflict is actually a desirable element without it -groupthink can occur
When conflict is acceptable, multiple solutions emerge, solutions not limited to those produced or endorsed by individuals with the greatest political clout.

22. Team-Development Strategies-Avoid Negative Behaviors
only one difficult personality to cast a pall of dominance, negativity, or distraction that derails collaborative efforts
avoid the blame game
Assertiveness is a great asset
Question care decisions calmly and directly
Refuse to play the doctor-nurse game

23. Team-Development Strategies-Design Facilities for Collaboration
Research has shown that space allotment in the practice site influences
productivity
work attitudes
confidentiality
the professional image of health care personnel
Lindeke, Hauck, & Tanner, 1998

24. Communication-Development Strategies
Need for effective communication between individuals in situations demanding quick responses,
such as crisis situations
In today’s fast-paced world, electronic communication

25. Communication-Development Strategies Communicate Effectively in Emergencies
Collaborative interactions are most effective and rewarding when they are efficient
tips include:
getting the facts from informed sources
not blowing issues out of proportion
responding promptly and calmly
and divulging only what others need to know and ethically ought to know.

26. Project openness with a friendly, courteous tone
Communication-Development Strategies- Use Electronic Communication Thoughtfully
Project openness with a friendly, courteous tone
Evaluate the content of received messages before reacting
Clarify your understanding of messages,
Send messages with only pertinent details, avoiding jargon
Summarize issues without being overly repetitious; be as brief as possible

27. Conclusion
Interdisciplinary collaboration can help to keep patient well-being central in spite of economic pressures
Mature, motivated health care professional teams must work together to thrive by fostering self-awareness and preventing burnout.
Leaders of collaborative teams will be optimistic and positive, inspiring hope in others when change is unsettling