Knowing your team in the intensive care unit: an ethnographic study on familiarity

ABSTRACT

Effective interprofessional team function is integral to high-quality care in the intensive care unit (ICU). However, little is known about how familiarity develops among teams, which may be an important antecedent to effective team function and quality care. To examine team familiarity and how it impacts ICU team function and care, we conducted an ethnographic study in four ICUs (two medical ICUs, one mixed medical-surgical ICU, and one surgical ICU) in two community hospitals and one academic medical center. We conducted 57.5 h of observation, 26 shadowing experiences, and 26 interviews across the four ICUs sequentially. We used thematic analysis to examine familiarity among the team. We found that ICU team members become familiar with their team through interpersonal, relational interactions, which involved communication, time working together, social interactions, trust, and respect. Our findings underscore the relational aspect of effective teams and demonstrate that time working together, social interactions, communication, developing trust, and respect are pathways to familiarity and optimal team function. Leveraging unique and creative ways to enhance the relational aspects of ICU teams could be an area for future research and lead to improved ICU outcomes.

KEYWORDS:

• Collaboration
• critical care
• interprofessional teams
• teamwork

Acknowledgments

We would like to acknowledge and thank the study sites, participants, clinicians, and clinical collaborators that were integral to the completion of this study and our findings.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13561820.2024.2329968

Additional information

Funding

Funding for this study provided in part by Agency for Healthcare Research and Quality (K08HS024552, PI Costa) and National Institutes of Health National Heart, Lung, and Blood Institute Loan Repayment Program Award (L30HL134114, PI Costa). Funders had no role in the design or conduct of study or interpretation of results.

Notes on contributors

Deena Kelly Costa

Deena Kelly Costa is an Associate Professor at Yale School of Nursing and Yale School of Medicine. She has nearly 10 years of adult critical care nursing experience and in her research studies how to improve ICU teams and ICU care.

Emily M. Boltey

Emily Boltey, PhD, RN is currently a simulation nurse educator at the VA Pittsburgh Simulation Center. She conducted the work presented in this manuscript while completing her doctoral studies at the University of Michigan School of Nursing. Dr. Boltey’s research interests include the intersection of patient safety, interprofessional teamwork, and simulation training.

Elizabeth A. Mosley

Elizabeth A. Mosley, PhD, MPH is an Assistant Professor at the University of Pittsburgh School of Medicine and affiliate faculty at Emory University Rollins School of Public Health. She uses qualitative and quantitative methods to study healthcare systems and health equity. While her primary area is doula care and maternal healthcare teams, she partnered with Dr. Costa’s lab to help lead qualitative methods for this ethnography of interprofessional team dynamics in the ICU. Dr. Mosley’s research has been funded by the NIH, PCORI, and private foundations. She is also a full spectrum doula, who provides care in hospital settings.

Milisa Manojlovich

Milisa Manojlovich, PhD, RN, FAAN is a Professor in the School of Nursing at the University of Michigan. Her program of research seeks to advance patient safety by improving communication. Dr. Manojlovich directs the Pivot Hub, a research center dedicated to improving patient safety through the use of innovative qualitative methods such as video-reflexive ethnography. She is also an Associate Editor for BMJ Quality & Safety.

Nathan C. Wright

Nathan Wright is a Research Associate in the Yale School of Nursing and is a trained cultural anthropologist. His research has focused on teamwork in healthcare and improvements to healthcare delivery. Additional research interests include qualitative methodology, social infrastructure, and the creation of social spaces.