Developing a collaborative, humanistic interprofessional healthcare culture: a multi-site study

Introduction:Developing a collaborative, humanistic interprofessional healthcare culture requires optimal relational skills, respect, interpersonal cohesion, and role clarity. We developed a longitudinal curriculum to engender these skills and values in institutional leaders. We report results of a qualitative study at seven US-based academic health centers to identify participants’ learning. Methods:At each institution, participants from at least three different professions met in small group sessions twice-monthly over nine months. Sessions focused on relational capacities to enhance leadership and professionalism, and utilized critical reflection and experiential learning to promote teamwork, self-knowledge, communication skills, and address challenges encountered by a healthcare team. Participants completed reflective responses to open-ended questions asking what knowledge, insights, or skills they gained by working in this interprofessional group and applications of their learning. Five investigators analyzed the anonymized responses using the constant comparative method. Results:Overarching themes centered on relationships and the strength of the relational nature of the learning. We observed learning on three levels: a) Intrapersonal learning included self-awareness, mindfulness, and empathy for self that translated to reflections on application of these to teamwork and teaching; b) Interpersonal learning concerned relational skills and teaching about listening, understanding others’ perspectives, appreciation/respect for colleagues, and empathy for others; c) Systems level learning included teaching skills about resilience, conflict management, team dynamics and cultural norms, and appreciation of resources from interprofessional colleagues. Discussion:A curriculum focusing on humanistic teaching for leaders led to new insights and positive changes in relational perspectives. Learning occurred on multiple levels. Many learners reported revising previous assumptions, a marker for transformative learning. Humanistic faculty development can facilitate deep bonds between professions.

Orem’s Self-Care Deficit Nursing Theory: Relevance and Need for Refinement

The purpose of this article is to highlight the relevance of Orem’s Self-Care Deficit Nursing Theory (SCDNT) in contemporary and future practice, explicitly within the global self-care movement and interprofessional healthcare. The authors discuss the relevance and important strengths within Orem’s nursing theory and recommend theoretical refinement within the context of significant societal and healthcare transformation. The constructs of global people-centered care and population health, with related social determinants of health, are identified as critical areas for development if SCDNT is to have continued relevance for nursing practice. Implications for theoretical thinking and nursing education are recommended.

Optimizing Military Medicine: A Team Approach

ABSTRACT In order to best optimize health care, we need the right combination of individuals working on interprofessional health care teams, each joining with the right mindset, in the right places, and at the right times. In this special issue of Military Medicine, Dr. Lara Varpio and her team share their findings investigating the unique dynamics of Military Interprofessional Healthcare Teams. Such research is fundamental to advance excellence of military health care by finding, exploring, and addressing existing gaps in what we currently employ and capitalizing on what we know works well. In doing so, we can improve the effectiveness of our care teams and, as a result, optimize care of our wounded on the battlefield.

Ethical Bearing Is About Our Conduct: Ethics as an Essential Component of Military Interprofessional Healthcare Teams

ABSTRACT Introduction The need to maintain medical ethical standards during conflict and peace has been the source of considerable academic discourse. Although still an unsolved challenge, scholars have made significant contributions to the literature, constructing categorizations that can help military providers contend with ethical conflicts. However, insights into the ethical comportment of military interprofessional healthcare teams (MIHTs) have yet to be reported. Materials and Methods This interview-based study collected insights from 30 military healthcare providers who participated in and/or led MIHTs. Altogether, participants represented 11 health professions, both officers and enlisted military members, and the U.S. Army, Navy, and Air Force. Following Grounded Theory methodology, data were collected and analyzed in iterative cycles until theme saturation was reached. Results The research team identified two themes of ethical bearing that enable MIHT success in and across care contexts. One theme of successful ethical bearing is “raising concerns,” referring to speaking up when something needs to be addressed. The other is “making compromises,” where individuals have to make sacrifices (e.g., lack of equipment, non-sterile environment, etc.) to give patient care. Conclusions These data suggest that effective MIHTs have a collective moral compass. This moral compass is the team’s ability to judge what is ethically right and wrong, as well as the team’s willingness and ability to act accordingly—to consistently “do the right thing.” There is a collective moral compass, and while the team may not all agree on what exactly is true north—they are all bending that way.

The Ties That Bind: Camaraderie in Military Interprofessional Healthcare Teams

ABSTRACT Introduction Multiple aspects of interpersonal dynamics can help or hinder the success of teams, particularly those in a Military Interprofessional Healthcare Team (MIHT). One specific mechanism for MIHTs’ success is camaraderie and how these military teams are able to achieve, maintain, and enable the development of this important characteristic. Despite our understanding of military service members as being bonded like a family, we have a limited understanding of how this bond is translated into their MIHT experiences. Materials and Methods This study conducted interviews among 30 individuals who had participated in, led individual, and/or led many MIHTs, using a grounded theory methodology. Participants represented 11 different health professions, including officers and enlisted military members, and three branches of the U.S. military (e.g., army, navy, and air force). Data were collected and analyzed in iterative cycles until saturation was achieved. Results We identified six themes that shaped the overarching concept of camaraderie in MIHTs. These themes were (1) confidence in competent peers, (2) shared goals, (3) mutual respect, (4) desire to help one another improve, (5) personal is professional, and (6) bonds of military service. This paper describes each of these themes, provides illustrative examples from the data, and describes how these components contribute to MIHTs’ team dynamics. We present a model for how to understand these themes. Conclusions Through the identification and exploration of these aspects of camaraderie, we are able to better understand how MIHTs are able to be successful. MIHTs that demonstrated confidence in their brother/sister in arms possessed shared goals and missions, while maintaining mutual respect, a desire to help one another do better, and creating a personal and professional overlap tended to form stronger bonds of military service. Critically, these six aspects support a more nuanced understanding of the spirit of camaraderie and how it underpins MIHT success.

Situational Awareness: Forecasting Successful Military Medical Teams

ABSTRACT Introduction Military healthcare providers working in military interprofessional healthcare teams (MIHTs) require situational awareness (SA) to ensure safe and efficacious patient care. This study aimed to explore SA in MIHTs to understand how SA can be reinforced and maintained in MIHTs. The research team set out to answer two questions: “What aspects of individual and team SA are particularly important for MIHTs?” and “How can we enable military healthcare providers to be effective MIHTs members with robust SA?”. Methods This study used Grounded Theory methodology collecting perspectives from 30 study participants from various backgrounds, including 11 different healthcare professions from the U.S. Army, Air Force, and Navy. Each study participant had experiences participating in, leading one, or leading many MIHTs. Data were collected in three cycles and analyzed within each cycle until saturation was reached. Results Five themes were robustly represented in the data set regarding SA: (1) contextually informed adaptability, (2) readiness, (3) trust, (4) communication, and (5) mission focus. Conclusions The urgency often faced by MIHTs brings SA and the principles that underpin SA into sharper focus. The SA themes identified in this research may provide insight into training effectiveness, team strengths and weaknesses, and team performance.

Perseverance: An Essential Trait of Military Interprofessional Healthcare Teams

ABSTRACT Introduction Perseverance—doing something despite difficulty—is an asset to healthcare professionals, yet not all providers display this trait. The literature offers no conceptualization of perseverance as it relates to military caregivers. This research sought to explore the perseverance displayed by members of military interprofessional healthcare teams (MIHTs) and to construct a framework for explaining the role of perseverance in MIHTs’ collaborative work. Methods Using Grounded Theory, this interview-based study collected insights from 30 individuals who had participated in MIHTs and/or led MIHTs. Participants represented 11 different health professions, both officers and enlisted military members, and three branches of the U.S. military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until theme saturation was achieved. Results We identified practices through which perseverance was exhibited by members of MIHTs: (1) humility, (2) mission focus, (3) team effort, (4) failure is not an option, (5) comfort with discomfort, and (6) continuous improvement. We then clustered these practices into three subcategories, reflecting how certain practices may connect to support MIHT perseverance. Conclusions These six practices appear connected in significant ways to support the MIHTs’ efforts. Humility, mission focus, and team effort can help team members collaborate as a unified and mutually supportive team. From this base, MIHTs seemed able to become comfortable with discomfort and to refuse failure as an option. These orientations then allowed the team to engage in continuous improvement. Together, these practices may enhance team perseverance and ultimately team performance.

Knowledgeability and Identification: Explaining Military Interprofessional Healthcare Teams’ Excellence and Readiness

ABSTRACT The importance of successful interprofessional collaboration for effective patient care is generally acknowledged. Research into interprofessional collaboration has thus far been mainly situated in the civilian context and has mostly indicated barriers that prevent successful interprofessional collaboration. However, military interprofessional healthcare teams (MIHTs) seem to be exceptionally successful. Building on the overarching finding of the studies within this special edition—i.e., that MIHTs’ readiness and excellence are in part due to healthcare professionals’ “shared understanding” of what is needed to effectively serve on an MIHT—this commentary uses the theory of Landscape of Practice as a lens to further explain the processes through which healthcare professionals attain this shared understanding. Used within the fields of Health Professions Education and workplace learning, Landscapes of Practice (LoP) helps to explain how learning occurs within practice. It highlights how, by engaging within the various working environments belonging to a profession, social interactions between the various professionals within that environment form the conduit for learning. LoP highlights that the outcome of this learning process is “knowledgeability,” i.e., understanding of how to engage within the field and with its players, resulting in being an acknowledged member of the field. Fostered through a process called “identification,” professionals learn to see how their professional practice aligns with that of others and how to effectively collaborate with others. The commentary explains how the findings of the separate studies within this special edition strongly resonate with knowledgeability and identification. It is concluded that civilian interprofessional healthcare teams may benefit from incorporating characteristics of MIHTs in their training programs.