Patient Engagement
as Team Sport:
Building a Culture of
Interprofessional Collaboration

Healthcare organizations (HCOs) can develop and sustain interprofessional teams that plan, implement, monitor, evaluate and enhance their education, patient engagement and empowerment initiatives.

Read the full text below or Download PDF Version

Background

Interprofessional collaborative teams have the power to re-charge healthcare organizations (HCOs) and the entire healthcare system. These teams embrace the contributions of executives, managers, clinicians, employees, community leaders, vendors, and, of course, patients and consumers. They improve satisfaction, loyalty and retention. And, they catalyze business and clinical performance, productivity and innovation.

But sustaining interprofessional collaboration is still a challenge, especially as healthcare priorities shift, workloads increase and budgets shrink. Unfortunately, some healthcare leaders still view interprofessional, collaborative teams as a quick fix for short-term projects and problems.

The future demands that healthcare leaders take a different tack, recognizing that interprofessional collaboration is neither a Band-Aid nor magic elixir. Instead, interprofessional collaboration must emerge as an enterprise-wide standard, value and process. Among the interprofessional collaboration priorities for healthcare leaders are the following:

  • Make collaboration possible, especially in situations where complex issues and challenges call for diverse perspectives.
  • Showcase the benefits and advantages of interprofessional collaboration in enhancing patient engagement.
  • Involve all levels of the HCO in interprofessional collaboration for improved patient engagement.
  • Infuse collaboration into the HCO’s culture, day-to-day operations and existing patient engagement initiatives.

The Case for Interprofessional Collaboration for Patient Engagement

Interprofessional collaboration delivers multiple benefits to HCOs, according to Michelle Troseth, MSN, RN, DPNAP, FAAN, Chief Professional Practice Officer, Elsevier Clinical Solutions. Among them are the following:

  • Mobilize the contributions of individuals, while leveraging a team’s collective brainpower.
  • Explore ideas and generate solutions that reach far beyond the limited perspectives of individual team members.
  • Give a voice to healthcare professionals from all levels within an HCO and from diverse professions, units, departments, divisions and entities across the care continuum.
  • Link the contributions of individuals to high-priority clinical and business strategies, from population health and value-based reimbursement, to performance management and patient, provider and community engagement.
  • Provide team members with a sense of purpose and belonging. “Engaged professionals are more likely to take on new projects and challenges and embrace change,” says Troseth.
  • Enhance HCO flexibility and agility. “Collaboration allows HCOs to develop and bring services to market faster, enhancing HCO revenues and competitive positions,” says Troseth.

“Healthcare coordination focuses on individual goals, contributions and achievements,” says Peter Edelstein, MD, Chief Medical Officer, Elsevier Clinical Solutions. “Interprofessional collaboration zeroes in on collective strategy and achievement, relying on give-and-take discussions of ideas to generate fresh approaches to enhanced clinical and business performance.”

Many HCOs have relied on interprofessional collaboration to forge relationships, break down professional and service silos, foster cross-functional quality improvement, and spur enterprise-wide innovation. However, if healthcare leaders restrict collaboration to existing teams or single levels of an HCO, they find it tough to sustain its benefits.

Roadblocks: “What We Have Here is a Failure to Collaborate”

The 1967 film Cool Hand Luke popularized the statement: “What we have here is a failure to communicate.” Healthcare leaders could easily make a similar statement about interprofessional collaboration focused on patient engagement and other issues. Interprofessional collaboration fails for multiple reasons, including the following:

  • Obsession with Activity: “If healthcare leaders view collaboration as an activity, team members probably won’t demonstrate the behaviors required for long-term, enterprise-wide collaboration,” says Sonika Mathur, Senior Vice President and General Manager, Patient Engagement, Elsevier Clinical Solutions. “You can’t facilitate interprofessional collaboration simply by insisting that it happen.”
  • Lack of Knowledge: Healthcare leaders sometimes fail to invest in education and training, including coaching and mentoring on interprofessional collaboration – from the ability to maintain trust and reach consensus, to the skill required to embrace change and foster ongoing communication.
  • Suits Only: HCOs sometimes restrict collaboration education to the C-Suite, top-tier executives or high-performing employees, neglecting rank-and-file staff members. “Interprofessional collaboration demands that everyone get involved and speak and live the language of collaboration,” says Troseth. “Only then can HCOs sustain the benefits of collaboration.”
  • “If You Can’t Say Something Nice...”: Healthcare leaders sometimes stifle discussion and debate by insisting that team members brainstorm and avoid criticism of each other’s ideas, according to Edelstein. However, stifling criticism can stymie the development of new ideas and problem-solving strategies.
  • More than Simple Teamwork: “Interprofessional collaboration embraces interaction, debate and working together on a common goal,” says Edelstein. “Just because you put people with varied levels of knowledge, skill and competence on the same team doesn’t mean that they’ll collaborate to reach a common goal.”

Roadmap: The Pathway to Interprofessional Collaboration
on Patient Engagement

Interprofessional collaboration breaks down silos so HCOs can become more creative, agile, flexible and ready to meet the changing needs of patients and consumers, says Troseth. But healthcare leaders must first build a foundation for interprofessional collaboration via the following actions:

1. Generate Trust
Interprofessional collaboration begins with the C-Suite. Chief executive officers (CEOs), chief operations officers (COOs), chief medical officers (CMOs) and chief nursing officers (CNOs) must join forces with C-Suite colleagues to sustain a climate of trust.

“Team members must feel they’re able to share their concerns, anxieties and opinions without fear of backlash, aggression or retaliation,” says Edelstein. “If team members feel threatened, they’ll be less likely to share. And that, in turn, will stifle innovation and creativity.”

“No team member wants to feel disrespected,” adds Mathur. “When team members see their contributions devalued or ignored, they’re more likely to detach, disengage and seek alternative channels to share their expertise and ideas.”

C-Suite executives and clinical leaders must measure and evaluate interprofessional collaboration on patient engagement by asking team members questions like the following:

  • Risk Taking: How is risk-taking encouraged on your team? Can you give me an example of a recent patient engagement-related conversation that involved risk-taking? How are team members acknowledged and rewarded for taking risks?
  • Safety and Security: How safe, secure and comfortable are team members in sharing their ideas and opinions? Can you offer an example of a patient engagement-related issue where team members may have felt some insecurity about sharing their ideas?
  • R-E-S-P-E-C-T: How are team members acknowledged for sharing their ideas and opinions about patient engagement? How are their ideas aggregated and assimilated into problem-solving and decision-making discussions?

By analyzing team members’ responses to the questions above, healthcare leaders can begin to assess the level of trust within the HCO.

2. Improve communications
Interprofessional collaboration will never occur without effective communication. Healthcare leaders must establish the relationship between interprofessional collaboration and patient engagement while providing frameworks, blueprints and roadmaps on how diverse entities within the HCO can collaborate.

Doing so requires team members at all levels of the HCO to develop greater self- awareness and awareness of others, advises Mathur. Among the skills team members must develop are the following:

  • Identify personal preferences for approaching interprofessional collaboration on patient engagement.
  • Pinpoint the communication and collaboration styles of team members.
  • Adjust communication styles and behaviors to facilitate decision making and consensus building on patient engagement.

3. Share vision and mission
“The best way to encourage investment in interprofessional collaboration is to offer people an opportunity to contribute to the HCO’s vision and mission,” says Edelstein. “Few things are more important than articulating the ‘why’ of interprofessional collaboration for enhanced patient engagement.”

Edelstein advises healthcare leaders to tell people how their work contributes to the goals of both the team and HCO and how interprofessional collaboration will move the needle on patient and consumer engagement. He believes that team members who embrace a broadened purpose are more likely to contribute to teams. Among the action steps for healthcare leaders suggested by Edelstein, Troseth and Mathur are the following:

  • Build and reinforce trust: “Create a climate where team members appreciate and believe in each other,” advises Troseth.
  • Facilitate communication: “Make it worthwhile for team members to engage in communications that are honest, clear, specific, concrete and positive,” suggests Mathur.
  • Connect to a broadened vision and purpose: “Tell people how and why their contributions will lay the groundwork for a culture anchored in interprofessional collaboration,” says Edelstein.

Among the benefits Edelstein sees in interprofessional collaboration are enhanced recruitment, engagement and retention, reduced conflict and stress, and higher levels of clinical and business performance, which translate into enhanced competitive advantage and a healthier bottom line.

4. Implementation: How to Execute on Interprofessional Collaboration for Patient Engagement
Healthcare leaders can do much to implement and promote interprofessional collaboration, especially if they involve clinicians and employees as patient engagement champions and advocates. Among the most vital implementation steps are the following:

  • Be what you seek: Healthcare leaders can function as living examples of interprofessional collaboration by reaching across departments, divisions and entities along the care continuum. They can also spearhead collaborative partnerships with community groups, employers, vendors, associations, foundations, think tanks, payers, universities and providers. “When healthcare leaders showcase the tools, tactics and strategies of interprofessional collaboration, they inspire people at all levels of the HCO to do the same,” says Mathur. “The result is an HCO infused with the mission, vision, values and spirit of interprofessional collaboration and the knowledge and skill to make it happen.”
  • Zero in on benefits, advantages and lessons learned: Healthcare leaders must link interprofessional collaboration to outcomes and achievements, advises Edelstein. Among the questions he advises healthcare leaders to address are the following:
    • Organizations: How has interprofessional collaboration influenced patient engagement levels within other HCOs—both within this service area and across the country?
    • Individuals: How will interprofessional collaboration on patient engagement improve the knowledge, skill, satisfaction and retention of employees, clinicians, managers and executives? How will interprofessional collaboration make work more productive, efficient and satisfying?
    • HCO: How will interprofessional collaboration on patient engagement influence HCO performance on dimensions like population health, outcomes improvement and value- based reimbursement? How will it move the HCO to the next level?
  • Put strategy, not technology first: “HCOs sometimes rush to invest in the latest patient and consumer engagement platforms before exploring the why and how of interprofessional collaboration,” says Mathur. “Technology doesn’t equal engagement; it facilitates and enables engagement, which is why technology must support HCO strategy, not the other way around.”
  • Liberate team members: All too often, healthcare leaders hover above collaborative teams, much like overinvested “helicopter parents” hover over college-aged children. A better approach, says Troseth, is for healthcare leaders to back off and get out of the way of collaborative teams. “Micromanagement stifles the free expression of ideas and the type of deep collaboration that leads to sustainable innovation,” she says. “While leaders should promote best practices and guidelines for interprofessional collaboration, they must also free team members to do their best.”
  • Integrate interprofessional collaboration into the HCO’s clinical and business workflow: “HCOs should avoid viewing interprofessional collaboration as one more competency to integrate into the skill sets of clinicians, executives and employees,” says Edelstein. “HCOs must integrate interprofessional collaboration into every aspect of work and performance.”
  • Support interprofessional collaboration: “Offer those who participate in interprofessional collaboration with opportunities for recognition and reward,” counsels Mathur.

Examples: HCOs could tie part of a team member’s bonus to how well she collaborates with others or champion collaboration through awards for team leadership, participation and the impact of interprofessional collaboration on care outcomes, satisfaction or HCO revenues.

5. Maintenance: Sustaining Interprofessional Collaboration
Sustaining interprofessional collaboration is vital to planning, design and implementation. Mathur, Troseth and Edelstein advise HCOs to do the following:

  • Revisit interprofessional collaboration: “Team members need a strategy and roadmap that provides clear goals,” says Mathur. “Let them explore how interprofessional collaboration can enhance morale, retention, competitive advantage and the HCO’s bottom line.” Just as vital is a roadmap designed with the input and buy-in of all current and prospective team members, not just healthcare leaders. Mathur recommends using visualization exercises to identify roadmap goals, touch points, timelines and individual roles and responsibilities.
  • Offer ongoing education in interprofessional collaboration skills: Healthcare leaders should deliver education and training that reinforces the building blocks of trust, communication and shared purpose and visions. “Every team member, from a nurse or managed care executive to a dietician or CFO, must have a professional development plan that embraces interprofessional collaboration,” says Edelstein. “HCOs should perform assessments of interprofessional collaboration skills and then design plans to overcome any gaps in knowledge, skill and experience.”
  • Edelstein advises HCOs to coach team members on how they can perform and excel in the following functions:
    • Understand and embrace change – within healthcare, technology, business, and society.
    • Solicit engagement ideas and opinions from team members.
    • Share engagement data, information and concepts.
    • Listen to and integrate team members’ ideas on patient engagement.
    • Deliver constructive feedback to team members.
    • Recognize and reward team members for their engagement contributions.
    • Reach consensus on engagement goals, objectives and strategy.
  • Align metrics that determine the success of interprofessional collaboration: “The last thing you want is a situation where one team member has to lose for another to win,” says Troseth. “Misaligned metrics and incentives can easily lead to conflict, silos, unintended exclusion, territorial battles and turf grabs.”
    She advises HCOs to align metrics, compensation arrangements and professional development plans across units, professions, departments, divisions and varied entities along the care continuum.
  • Mobilize every C-Suite and board member to facilitate interprofessional collaboration in a collaborative environment: “HCOs must give every employee a voice while they facilitate and sustain an environment anchored in interprofessional collaboration,” says Mathur. Among the behaviors she recommends for healthcare leaders are the following:
    • Impact: Track and synthesize the collaborative initiatives of other HCOs. Mathur suggests taking a closer look at HCOs like Beth Israel Deaconess Medical Center, Atrius Health, Children’s Hospital of Boston and Geisinger.
    • Advocacy: Model the skills and behaviors of interprofessional collaboration, including investing time to teach, coach and mentor interprofessional collaboration on patient engagement.
    • Future Focus: Resist short-term fixes in times of stress and crisis. Instead, focus on interprofessional collaboration to fulfill long-term goals and priorities like patient, consumer and provider engagement.
    • Investment: Invest financial and human resources to support interprofessional collaboration, taking special care to reward the process and outcomes of collaboration, including enhanced patient engagement.
    • Talent Management: Recruit, develop and nurture healthcare professionals with knowledge, talent, skill and experience in interprofessional collaboration.
    • Accountability: Insist on total accountability. Make sure HCO leaders model and reward interprofessional collaboration.

6. Interprofessional Collaboration for Enhanced Patient Engagement: The Role of Healthcare Leaders
Interprofessional collaboration for enhanced patient engagement is a journey, not a destination. Clinical and business leaders who think that they’ve discovered the Holy Grail of interprofessional collaboration are probably in for a surprise. Interprofessional collaboration requires ongoing attention to the following:

  • Lead by example: “Make sure that everyone in a clinical or business leadership position has the knowledge and skill to communicate and collaborate,” advises Troseth.
  • Build community: “People need to connect to each other,” says Edelstein. “Provide co–workers and colleagues with opportunities to get to know and learn from each other in non-work settings.”
  • Continue training in collaboration: “Discover how people perceive their communication, leadership and critical thinking skills,” says Mathur. “Then create programs to compensate for gaps in skill and knowledge.”
  • Delineate collaborative roles and responsibilities: “Interprofessional collaboration works best when everyone is on the same page,” says Mathur. “Make sure that all parties understand essential goals, responsibilities and deadlines.”
  • Assign roles that fit team members’ strengths: Adds Edelstein: “Build interprofessional teams based on what each professional brings to the table—from knowledge of consumers and family dynamics, to experience in patient and clinician education, re-design of care processes or partnership building.”
  • Continue to host productive work sessions: “Although every work session needs objectives and an agenda, resist the temptation to micromanage,” advises Troseth. “Respect every team member,  offering them the autonomy and confidence needed to achieve interprofessional collaboration success.”
  • Consider collaboration tools and software: “You’ll probably never have every team member in one place at one time,” advises Mathur. She recommends that HCOs develop their own tools to facilitate collaboration or invest in collaboration software developed by entities like Wrike, Liquid Planner, Igloo, Slack, Citrix, Teamwork, Zoho or Atlassian.

Moving Forward on Patient Engagement

Authentic interprofessional collaboration has the power to enhance provider, patient and consumer engagement. Doing so demands that healthcare leaders link every employee, at every level of the HCO, to a culture and environment grounded in the vision, values and process of interprofessional collaboration. Interprofessional collaboration has the power to:

Support the recruitment, retention and empowerment of clinical leaders and executives.

Turbocharge enterprise-wide transformation, innovation and productivity. Bring healthcare services to market faster and with greater impact. Boost the satisfaction, retention and loyalty of patients, consumers, clinicians and employees. Improve the HCO’s bottom line.

The result of interprofessional collaboration for patient engagement and other issues is simple: higher- performing HCOs, a more accessible, reasonably priced, quality-focused healthcare system, and healthier, more engaged patients and families.


About Michelle Troseth, MSN, RN, DPNAP, FAAN

Michelle is the Chief Professional Practice Officer of Elsevier Clinical Solutions. She has over 25 years of experience in co-designing and implementing evidence-based practice and technology infrastructures to support patient- centered care and interprofessional integration at the point of care across hundreds of healthcare settings.

Michelle is currently co-chair of the HIMSS TIGER Committee and Chair of the American Academy of Nursing’s Informatics & Technology Expert Panel. Michelle was the winner of the 2014 HIMSS Nursing Informatics Leadership Award.

Michelle has authored several chapters/articles and speaks on professional practice, evidence- based practice, informatics and cultural transformation.