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Building the Multidisciplinary Team. AACN Nurse Manager Priorities Thursday September 19, 2013 Julie Lindeman Read, RN, M.S. Area Quality Leader Kaiser Foundation Hospitals Fremont Medical Center Fremont, CA Chapter President, South Bay AACN. Learning Objectives.

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building the multidisciplinary team

Building the Multidisciplinary Team

AACN Nurse Manager Priorities

Thursday September 19, 2013

Julie Lindeman Read, RN, M.S.

Area Quality Leader

Kaiser Foundation Hospitals

Fremont Medical Center

Fremont, CA

Chapter President, South Bay AACN

learning objectives
Learning Objectives
  • Identify various stages of team development
  • Describe methods to build a highly effective multidisciplinary team
  • Discuss strategies to improve multidisciplinary collaboration
together everyone achieves more
Together Everyone Achieves More
  • Theory
    • How teams work
    • Stages of Team Development
  • Application
    • Building a collaborative multidisciplinary leadership team in the Critical Care Unit
    • Building your unit-based multi-disciplinary care team
what is a team
What is a team?

A small number of people with complementary skills who are committed to a common purpose, set of performance goals, and approach for which they hold themselves mutually accountable

-Katzenbach and Smith

multidisciplinary team math
Multidisciplinary Team Math

“2+2 =8”

Kohn and O’Connell, 2007

The 6 Habits of Highly Effective Teams

what are your teams
What are your teams?
  • Hospital Executive Leadership
  • Nursing Leadership (Hospital)
  • Critical Care Division
  • Nursing Leadership (ICU)
  • Unit Leadership Team (Multi-disciplinary)
  • Staff committees
  • Multi-disciplinary care team on your unit
essentials for a team
Essentials for a team
  • Common commitment and purpose
  • Performance Goals
  • Complimentary Skills
  • Mutual Accountability
common commitment and purpose
Common commitment and purpose
  • Purpose is distinctive
  • Purpose specific to the group
  • Promote member buy-in
  • Whole becomes greater than the individual contributions
performance goals
Performance Goals
  • Compelling - Develop shared purpose
  • Often are developed outside the team
  • Specific and measurable
  • Well communicated and understood
complimentary skills
Complimentary Skills
  • Technical or functional expertise
  • Problem-solving skills
  • Decision making skills
  • Interpersonal skills
mutual accountability
Mutual Accountability
  • Built-in accountability
  • Seek to achieve milestones in a coordinated way
  • Responsibilities clear
  • Every individual is responsible for success or failure in achieve shared goals
stages of team formation
Stages of Team Formation
  • Forming
  • Storming
  • Norming
  • Performing

Theory developed by Bruce Tuckerman, 1965

  • High dependency on leader
    • Guidance and direction
    • Clarification of purpose and objectives
  • Little agreement on team goals
  • Individual roles and responsibilities unclear
  • Processes unclear or ignored
  • Members test tolerance of system and leader

Kohn and O’Connell

6 Habits of Highly Effective Teams

pp 56-63

  • Clarity of purpose increases but uncertainty persists
  • Decisions difficult
  • Team members vie for position
  • Team members may challenge leader
  • Cliques, factions, power struggles
  • Compromises may be required
  • Need to focus on goals
  • Agreement and consensus
  • Commitment and unity strong
  • Leader plays a facilitating and enabling role
  • Roles and responsibilities are clear and accepted
  • Big decisions made by group agreement; small decisions delegated to individuals or small teams within the group
  • Team may engage in fun and social activities
  • Team discusses and develops processes and working style
  • Respect for the leader
  • Some leadership is shared by team
  • Clarity on purpose and processes
  • Shared vision
  • Focus on over-achieving goals
  • Shared decision making with leader
  • Team has a high degree of autonomy
  • Team works toward achieving the goal and also attended to relationship, style, and process
  • Little direction is needed from the leader; may ask leader for assistance with personal and interpersonal development
drexler sibbet team performance model
Drexler/Sibbet Team Performance Model
  • Stage 1: Orientation
  • Stage 2: Trust building
  • Stage 3: Goal Clarification
  • Stage 4: Commitment
  • Stage 5: Implementation
  • Stage 6: High Performance
  • Stage 7: Renewal
6 habits of highly effective teams
6 Habits of Highly Effective Teams
  • Entrusting Team Members with Appropriate Roles
  • Establishing and Regulating Team Norms
  • Thinking Laterally
  • Strengthening Emotional Capacity to Improve Team Relationships
  • Expanding Team Self-Awareness
  • Practicing Empathy and Respectfulness
establishing a multidisciplinary leadership team in the critical care unit
Establishing a Multidisciplinary Leadership Team in the Critical Care Unit
  • Why bother?
  • Where should you start?
  • What are the rewards?
  • What are the potential barriers?
aacn standards for establishing and sustaining a healthy work environment
AACN Standards for Establishing and Sustaining a Healthy Work Environment















true collaboration
“True Collaboration”
  • Partnership
  • Power of both sides valued by both
  • Recognition and acceptance of separate and combined practice spheres
  • Mutual safe-guarding of the interest of each party
  • Commonality of goals recognized by each party

Amer Nurses’ Assoc 1980. Nursing :A Social Statement. Kansas City, Mo.

why collaborate
Why collaborate?
  • To establish an effective multidisciplinary team all participants must be involved in problem-identification and


  • Improves cooperation across disciplines
  • Creates an environment that encourages high quality care


literature supporting collaboration
Literature Supporting Collaboration

“Collaboration between surgeons, anesthesiologists and nurses decreased risk- adjusted morbidity and mortality.”

-Young et al. (1997). Health Care Management Review

“Collaboration between physicians and nurses was related to better patient outcomes in ICUs”

-Baggs et al. (1992). Heart and Lung

“Job satisfaction and workplace empowerment positively related to collaboration”

-Laschinger et al. (2003). J NursAdm

case study
  • A real life experience with developing a collaborative ICU Leadership Team
  • The Team: Medical Director, ICU Manager, Critical Care Clinical Nurse Specialist, Respiratory Therapy Manager
  • 22 bed combined Medical-Surgical-Cardiac ICU in a Community Hospital within a large Managed Care Organization
create your vision
Create your Vision
  • Excellence in patient care
  • Continuous staff development
  • To make the ICU the “Best in the Bay Area”
establish goals
Establish Goals
  • Evidence-based practice
  • Multidisciplinary care
  • Advanced education
  • Organized systems
  • Standardized workflow
  • Staff participation
assess your current teamwork climate
Assess your current teamwork climate
  • Barriers
    • No established process to support collaborative model
    • Daily unit operations
      • Capacity/census growth
      • Nursing shortage
      • High staff vacancy
      • High use of registry,
      • Environmental challenges
  • Unit culture
    • Ingrained patient care practice
    • Exclusive focus on direct patient care
    • Individual based approach to problem solving
  • Lack of objective information on current performance
insufficient data for change
Insufficient Data for Change
  • Lack of demographic, quality and outcome data
  • Inaccurate quality data collection and analysis
  • Outcome data not linked to clinical practice
potential for fostering collaboration
Potential for Fostering Collaboration
  • People
    • Collaborative practice promoted by ICU leadership
    • Dedicated CNS
    • 24 hravailability of intensivists and manager
  • Unit structure
    • Combined ICU
    • 1:2 ratio
  • Multi-hospital system
    • Regional forum
    • Focused training program
    • Technology


organizing collaborative improvement
Organizing Collaborative Improvement
  • Define responsibilities and assignments
  • Strategic planning
  • Communicate with staff
  • Actively engage staff
role definition
Role definition
  • Defining Roles
    • Unit operations
    • Decision-making
  • Challenges
    • Breaking down the traditional roles
    • Respecting each other’s turf
    • Communication (within the team and with staff)
strategic planning
Strategic planning
  • Determine areas of focus
  • Development of timelines
  • Identify key personnel


communication of vision goals to staff
Communication of Vision/Goals to Staff
  • Being cognizant of previous leadership vision, direction, style
  • Understanding interpersonal relationships
  • Identifying staff motivation
  • Communication
    • Unified message
    • Staff input
    • Meeting logistics
changing the system
Out with the OLD

Individual rounding

Fragmented leadership communication

Reactive problem solving

Short-term goals

Ad-hoc meetings

In with the NEW

Multidisciplinary rounding

Joint leadership meetings

Strategic planning

Goals: immediate, future


Interdisciplinary team meetings

Changing the system
tools for achieving successful outcomes
Tools for achieving successful outcomes
  • Constant communication
  • Regular leadership team meetings
  • Jointly led staff meetings
  • Unit Advisory Council
  • Timelines
  • Practice Protocols
  • Data collection tools
  • Standardized Report to Leadership
  • Strategic Timeline with short and long term goals
measuring success
Measuring Success
  • Determine desired outcomes of collaboration
  • Assess baseline status
  • Establish timeframes for measurement
  • Course correct based on achievement of outcomes


avoiding the perils
Avoiding the Perils
  • Explain rationale for collaboration
  • Take into account the current unit culture
  • Set realistic goals
  • Communicate constantly
  • Communicate widely
  • Share your turf
  • Expect occasional setbacks
  • Have a plan for leadership transitions


reaping the rewards
Reaping the Rewards
  • Improved patient outcomes
  • Streamlined workflow
  • Knowledge exchange between disciplines
  • Shared successes
  • Increased job satisfaction
  • Ongoing professional collaboration
suggested outcome measures
Suggested Outcome Measures
  • Timely achievement of established goals
  • Improvement in clinical outcomes
  • Increased operational efficiency
  • Improvement in patient satisfaction scores
  • Improvement in staff perception of safety climate
  • Feedback from staff
the multidisciplinary care team
The Multidisciplinary Care Team
  • Value
  • Function
  • Members
  • Outcomes
  • Communication
  • Workflow
multidisciplinary care team members
Multidisciplinary Care Team Members
  • Intensivist
  • Primary Nurse
  • Respiratory Therapist
  • Charge Nurse or Asst Nurse Manager
  • Critical Care Pharmacist
  • Physical Therapist
  • Clinical Dietician
  • Social Work or Patient Care Coordinator
  • Infection Preventionist
  • Palliative Care Coordinator
  • Spiritual Care
tools for success
Tools for success
  • Determine Goals
  • Defined roles
    • Understand individual roles, expectation, and limitations
  • Implement Rounds
    • Participation
    • Scripts
    • Agreed upon outcomes
    • Time limits
  • Outcome measures
  • Share performance to goals frequently
  • Develop communication strategies
building your team
Building your team
  • Assess your current environment
  • Identify team members
  • Create your vision
  • Set performance targets (goals)
  • Communicate the vision and goals to the team
  • Develop team
    • Individual skills
    • Relationships
    • Trust
  • Adjust leadership style to stage of team development
  • Continue to nurture and develop team members
bibliography and references
Bibliography and References
  • American Association of Critical Care Nurses. AACN standards for establishing and sustaining healthy work environments: a journey to excellence. Am J Crit Care. 2005;14:187-197.
  • Baggs JG, Schmidt MH, Mushlin AI, et al. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27:1991-1998
  • Boyle DK, Kochinda C. Enhancing collaborative communication of nurse and physician leadership in two intensive care units. J Nurs Adm. 2004;2:60-70.
  • Brilli RJ, Spevetz A, Branson RD et al. Critical care delivery in the intensive care unit: defining clinical roles and the best practice model.CritCare Med. 2001;29:2007-2019
  • Disch J, Beilman G, Ingbar D. Medical directors as partners in creating healthy work environments. AACN Clin Issues. 2001;12:366-377
  • Halm MA, Gagner S, Goering M, et al. Interdisciplinary Rounds: Impact on Patients, Families, and Staff. ClinNurs Spec. 2003;17:133-142.
  • KatzenbachJR, Smith DK. Best of HBR 1993: The Discipline of Teams . HBR. July-August 2005
  • Katzenbach JR, Smith DK. The Wisdom of Teams. New York: Harper Collins, 2003.
  • Kohn SE and O’Connell VD. The 6 Habits of Highly Effective Teams. Pomptom Plains, NJ: Career Press; 2007.
  • LencioniP. The Five Dysfunctions of a Team. Jossey-Bass: San Francisco; 2002
  • Patterson K, Grenny J, McMillan R, and SwitzlerA. Crucial Conversations, 2nd ed. New York: McGraw-Hill; 2012.