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ABSTRACT
Interprofessional collaboration (IPC) is an important aspect of high-quality care in intensive care units (ICUs). The practice of IPC, however, is complex and the components that constitute IPC are not well defined. We sought to identify distinct behaviors embedded in clinician workflow that indicate engagement in the IPC process. We conducted a clinical ethnography in two ICUs in southeastern Michigan. From March 2017 to March 2019, we collected 31 hours of observations and completed 12 separate clinician shadowings and 12 interviews with ICU nurses, physicians, and respiratory therapists. We applied an iterative analytical approach to identify two types of IPC behaviors which we a priori labeled as “enablers” (i.e. the ways clinicians transition into or facilitate collaboration) and “collaborative activities” (i.e. behaviors clinicians use to directly collaborate with other professionals). 18 IPC behaviors were identified – ten “enablers” and eight “collaborative activities.” Specifically, the enablers include: active listening, approach, coordinating work, intraprofessional consultation, invitation, nonverbal accessibility, reflexive questioning, sending pages/call, validation, and verbal accessibility. The collaborative activities are: correction, fill in the gap, information exchange, negotiation, providing help, socializing, teaching/training, and troubleshooting. By identifying IPC behaviors embedded in clinician workflow, our results may support more focused assessments of IPC in practice and guide clinicians toward behaviors they can use to engage in the IPC process.
Author note
Contents from this manuscript were previously published in an abstract for the American Thoracic Society 2020 conference.
Acknowledgments
Emily Boltey is a postdoc fellow with the Interprofessional Advanced Fellowship in Clinical Simulation at VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. This study was conducted while completing her doctoral studies at the University of Michigan, Ann Arbor, Michigan. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.
Disclosure statement
No potential conflict of interest was reported by the authors.
Data sharing
Due to the limited sample and settings in the same geographical area, we are unable to share the dataset for this study to maintain participant confidentiality.
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/13561820.2023.2202218.
Additional information
Funding
Notes on contributors
Emily Boltey
Emily Boltey is a postdoctoral fellow in the Interprofessional Advanced Fellowship in Clinical Simulation at VA Pittsburgh.
Theodore Iwashyna
Amy Cohn is a Professor of Industrial and Operations Engineering and a Professor of Health Management and Policy at the University of Michigan. Dr. Cohn is also the Faculty Director for the Center for Healthcare Engineering and Patient Safety at the University of Michigan.
Theodore Jack Iwashyna is a physician-scientist and board-certified intensivist who studies long-term outcomes in survivors of critical illness.
Amy Cohn
Amy Cohn is a Professor of Industrial and Operations Engineering and a Professor of Health Management and Policy at the University of Michigan. Dr. Cohn is also the Faculty Director for the Center for Healthcare Engineering and Patient Safety at the University of Michigan.
Theodore Jack Iwashyna is a physician-scientist and board-certified intensivist who studies long-term outcomes in survivors of critical illness.
Deena Costa
Deena Costa is a nurse researcher who studies the structure and processes of interprofessional teams in the ICU.