Five Ways to Improve Nurse-doctor Collaboration

CHICAGO — Getting nurses and doctors on the same page is integral to providing the best possible patient outcomes, and one conflict-ridden hospital’s successful effort to improve teamwork offers salient lessons for other healthcare leaders who want to do the same, according to a Hospitals & Health Networks Daily article.

The organization in question, identified only as an East Coast hospital, failed in previous efforts to improve relations among doctors and nurses in one of its subspecialty groups, leaving executives worried that the conflict would hurt the quality of patient care. So the hospital worked with an outside consultant to implement a complex workflow process for interdisciplinary bedside rounds.

There were several keys to the hospital’s ability to boost team-based care, according to the article, including:

• Use of Robert’s Rules of Order to establish ground rules for constructive collaboration, which outline specific communication practices that encourage team members to appreciate others’ viewpoints, disagree respectfully, and look for common ground;

• Use of a self-assessment tool to help team members identify conflict-related behaviors;

• Involvement of leadership, including an administrative leader committed to change as well as the chief medical officer and chief nursing officer;

• Individual, sub-group, and whole-group coaching that focused on practicing new, constructive behaviors; and

• Collaboration on a “high-impact project” with clear performance expectations to test how well clinicians can implement their new teamwork strategies.

The results were clear. “Hospital executives initially concerned about poor teamwork could now report positive feedback from nurses and physicians alike,” wrote Barbara Eiser, president of Leading Impact Inc., which focuses on executive coaching, team transformation, and leadership training.

The methods Eiser advocates are similar to Rochester General Hospital’s eight-week resident boot camp, which brings together first-year internal-medicine and pharmacy residents, nurse-practitioner students, and respiratory therapists to learn teamwork skills to deal with high-stress situations, FierceHealthcare previously reported. The University of Virginia Medical Center also uses simulations to bolster nurse-doctor collaboration, with a “room of errors” in the pediatric intensive-care unit challenging clinicians to spot problems among a group of high-tech infant mannequins attached to monitors.