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

Figures & data

Figure 1 Interprofessional team management at the pediatric intensive care unit.

Notes: The example of a newborn with congenital AIS with a complication of an ischemic NEC shows the high diversity of multidisciplinary physicians and professionals involved at the pediatric intensive care unit.
Abbreviations: AIS, aortic isthmus stenosis; NEC, necrotizing enterocolitis.

Figure 2 Conceptual framework of interprofessional teamwork.

Note: Reproduced from Reeves S, Lewin S, Espin S, Zwarenstein M. A Conceptual Framework for Interprofessional Teamwork. Chichester, West Sussex; Ames, IA: John Wiley and Sons; 2010.⁹ With permission from John Wiley and Sons, Copyright © 2010.

Figure 3 Data sources.

Table 1 Daily challenges in the PICU

Challenges	Examples in the PICU
Health care providers have to work on multiple objectives with minimal oversight	Health care providers care for different patients at the same time
Health care providers must shift from one situation to another	Health care providers shift from the situation of a girl with suspected meningitis to the 2-year-old boy vomiting blood
There is a need to include different perspectives from various disciplines	Health care providers consider various types of information from the history of the patients, laboratory results, and the consultations with specialists
There is a need to collaborate across dispersed locations	The pediatric surgeon is in the operating theater and the infectious disease specialist comes from the outpatient department
Preplanned coordination is impossible	Many patients are presenting without appointment at very short notice
Complex information must be processed, synthesized, and put to use quickly	If the patient is deteriorating, health care providers have to make quick decisions of high importance

Table 2 Behaviors driving learning

Speaking up

Collaboration

Experimentation

Reflection

Note: Experimentation means not expecting to be right the first time.

Table 3 Leadership actions for organizing to learn

Frame the situation for learning

Make it psychologically safe

Learn to learn from failure

Span occupational and cultural boundaries

Note: Reproduced from Edmondson AC, Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy. San Francisco, CA: John Wiley and Sons 2012.²⁵ With permission from John Wiley and Sons, Copyright © 2012.

Table 4 Summary of challenges and solutions, including examples for implementation, to support patient safety through improved interprofessional team management

Key areas of interprofessional teamwork	Challenge	Solution	Examples supporting implementation
Relational factors: power and hierarchy	Sovereign power and professional autonomy are forces creating silos of specialization impeding interprofessional team management	Individual responsibility and accountability has to be embedded in a network of equivalent partners with a shared goal; promotion of shared mental models	Interprofessional meetings, workshops, and education activities promoting shared mental models; individual and team-based debriefing, feedback, coaching, and mentorship; 360° feedback
Relational factors: team composition and roles	The tension between senior and junior health care providers, physicians and nurses, and between parents of a child at the PICU and hospital staff hinders interprofessional team management	Promotion of a culture of mutual respect, shared mental models, and efficient communication between team members, including parents and relatives of patients	Interprofessional meetings, workshops, and education activities promoting a culture of respect; individual and team-based debriefing, feedback, coaching, and mentorship; 360° feedback; communication training
Processual factors: learning while working	How is it possible for the individual health care professional to support and learn competent, interprofessional team management within the busy daily routine workload?	Promotion of psychological safety and speaking up to support learning while working	Team-based debriefing, feedback, and coaching critically questioning how to do better while working; managerial and leadership focus on learning while working; simulation training
Processual factors: learning from failure	Learning from failure is a key element of all patient safety initiatives, but this is not happening naturally and many organizations fail to do so	Acknowledgment that failure is mandatory for learning; ensuring psychological safety, systematic analysis, and dissemination	Managerial and leadership focus on learning while working; mortality-and-morbidity conference; critical incident reporting system; dissemination of reported errors and solutions; rewards for error reporting
Organizational and contextual factors: leadership	Impact of patient safety initiatives is often small; what are important leadership principles to improve interprofessional team management for patient safety?	Acknowledgment of front line workers regarding important topics and possible solutions; individual willingness and motivation of every health care worker for leadership at every level	Acknowledging and supporting bottom–up initiatives and projects; individual and team-based debriefing, feedback, coaching, and mentorship; managerial and leadership focus on learning while working; rewards for individual projects
Organizational and contextual factors: culture change	Culture change is prerequisite for improved patient safety, but culture change is a huge operation surrounded with unpredictability and uncertainty over a long period of time	Change in small steps as an adaptation and a learning process; from the microlevel unit to the organization; transparency and dissemination	Acknowledging and supporting unit-based initiatives and projects; individual and team-based debriefing, feedback, coaching, and mentorship; managerial and leadership focus on learning while working; rewards for unit-based projects

Abbreviation: PICU, pediatric intensive care unit.

ReevesSLewinSEspinSZwarensteinMInterprofessional Teamwork for Health and Social CareA Conceptual Framework for Interprofessional TeamworkChichester, West Sussex; Ames, IAJohn Wiley and Sons2010

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EdmondsonACTeaming: How Organizations Learn, Innovate, and Compete in the Knowledge EconomySan Francisco, CAJohn Wiley and Sons2012

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