Interprofessional team management in pediatric critical care: some challenges and possible solutions

Abstract

Background

Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous.

Methods

We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts.

Findings

The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one’s own unit, engagement of health care professionals occurs and projects become accepted.

Conclusion

Bottom–up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of fostering patient safety.

Keywords:

• pediatric intensive care unit
• patient safety
• interprofessional team management
• teamwork
• psychological safety
• organizational learning

Acknowledgments

There was no funding source for this review.

Author contributions

MS is responsible for the concept of the review, search strategy, and selection of articles; he has drafted the manuscript, confirms the final responsibility for the published version, and is accountable for all aspects of the work. SBP has contributed as second author to search strategy and selection of articles, has critically revised the manuscript, has given final approval for the published version, and is accountable for all aspects of the work. MB, MLA, and WHG have substantially contributed to the concept and content of the work, critically revised the manuscript, and given final approval for the published version, as well as being accountable for all aspects of the work. No person other than the authors listed has contributed significantly to the manuscript. The corresponding author confirms the final responsibility in submitting the manuscript. All authors had full access to all the data and approved the manuscript.

Disclosure

The authors report no conflicts of interest in this work.