Personal Experience
A patient named Lauren has been admitted to the ICU after being admitted and diagnosed in the emergency room with diabetic ketoacidosis. She was a 34-year-old female and had type 1 diabetes. As an on-call nurse in the ICU, I received the patient during admission. During handover, the emergency room nurse indicated that Lauren has been treated frequently in the past 6 months, with the same diagnosis of diabetic ketoacidosis. The ICU doctor had recognized the patient as well. The emergency room staff was concerned that she was not receiving the correct treatment due to the frequency of readmissions. Lauren has had a history of using drugs, which was relevant as indicated by a 2013 study by Isidro and Jorge that found that 20.6% of diabetic ketoacidosis patients are associated with recreational drug use, with a 70% readmission rate. However, upon ordering and running a toxicology report, no trace of drug use was found. Upon running additional tests to rule out differential diagnoses, the ICU team was stumped on how else Lauren could be helped to prevent readmissions in the future.
As a nurse, I was familiar with other roles, so I suggested consulting a dietician and a social worker with the premise that Lauren may have lacked knowledge and awareness regarding the use of insulin for her Type 1 diabetes. The dietician and social worker were briefed on the case and I shared my concerns with them. The information from the nurse helped to guide the assessment of the patient by these specialists. The dietician confirmed the insulin injection technique and scheduling, finding only small discrepancies which were quick to correct via the teach-back method, and could not have caused the diabetic ketoacidosis. Upon an interview with a social worker, it became evident that food insecurity could have played a role and Lauren could not adequately control her glucose levels with access to and foods with appropriate hypoglycemic indexes. Lauren relied on food stamps and soup kitchens for access to food, but only received aid for 3 out of 4 weeks each month. Using this information, the dietician suggested that Lauren could have caused hypoglycemia by taking the insulin dose without food. The episodes of diabetic ketoacidosis occurred periodically, likely at the time when Lauren ran low on food stamps.
Lauren was treated, and before discharge, received appropriate education from the dietician and nurses regarding insulin adjustment and monitoring her diet to avoid hypoglycemia. The social worker provided her with resources to apply for additional aid and addresses of local food banks. This situation represented various instances of interprofessional collaboration. First, the handover showed collaboration alongside competent handover procedures as the emergency room nurse shared critical information with me regarding the patient status and previous visits, which helped identify that there is a pattern. There was the standard collaboration between the ICU doctor and nurses including me, discussing the test results and potential options. Finally, the hospital social worker was brought on to collect information about the patient’s lifestyle and financial situation while a dietician assessed her diet and insulin management. With the combination of information, the underlying cause of Lauren’s admissions with diabetic ketoacidosis was found and she was provided with the education and tools to manage her health and well-being. The contributions of clinicians and specialists at various levels provided critical input in the diagnosis and treatment of a patient which presented a challenging case to hospital staff.
Vila Health
The Vila Health scenario demonstrates the importance of interdisciplinary collaboration in a rapidly evolving healthcare environment. Unfortunately, there is little evidence for success in this situation. The primary outcome of establishing an EHR system was achieved, with some collaboration between upper management and the facility administration, and the attempt to reinforce the system used by providing training. However, the approaches to the situation at every level were abysmal which led to really poor integration of Healthix. It was unsuccessful in terms that none of the staff who were responsible for managing and using the system were consulted or prepared that drastically slowed implementation. This was followed by a lack of communication, adequate training, or a unified approach that would have at least helped mitigate and navigate the change even if the EHR system was inadequate.
The main failure of interdisciplinary collaboration in this scenario stems from the lack of involvement of relevant stakeholders during the change management process. Corporate failed to communicate effectively with the facility administration, to recognize the needs, while management did not consult with IT regarding the new system nor did it stand up to corporate in emphasizing that the system would be neither helpful nor effective in this type of facility. The management staff did not consider the needs or possibilities of the IT staff once it became clear that the Healthix system will have to be established. IT staff were not provided enough resources to integrate the system which then reflected on the direct ability of nurses to use it. There is an evident lack of cooperation between nursing and IT staff, both being dismissive of each other. The training was mismanaged from the start by failing to resolve key technical issues with IT while not providing adequate support to frontline staff. Overall, this represented a failure of interdisciplinary collaboration which failed in managing human, financial, and technical resources.
According to Schleyer et al. (2016), clinical informatics specifically is more than a technical endeavor, it is a social activity as well, needing a combination of technical, procedural, organizational, and personal assets to succeed. A clinical informatics workforce has to develop as a team with aligned relationships and a team structure for maximum performance. Most work in establishing clinical informatics systems as seen in the scenario is done by multiple people on various teams or positions, ranging from management to IT to nurses. According to Jansen et al. (2008), collaborative practice is highly complex and vital in modern healthcare environments, but it must function properly with broad-based team structures, otherwise, it will result in fragmented services, lack of equitable funding, and procurement of resources to sustain the functions of a health organization. It also requires strategic and influential use of knowledge and management, to support the efforts of various interdisciplinary teams in practice, research, or administration.
Leadership in interdisciplinary health organizations requires a unique blend of knowledge and skills which focus on supporting innovation and improvement. According to Smith et al. (2018), the best leadership approach in such contexts is transformational leadership as it promotes change management with an emphasis on creativity and innovation. For interdisciplinary teams to excel, leadership must produce clarity of leadership and empowerment which fosters team-building elements due to the level of complexity required for this approach.
Interdisciplinary collaboration hinges on a multitude of factors including management, leadership, team dynamics, but one factor that is often overlooked is the organizational structure, including that of physical spaces that promotes collaboration. According to Morley & Cashell (2017), some strategies within an organization to foster interdisciplinary collaboration are to form organizational structures with architectural considerations – physical structure and functionality. For example, there should be immersive spaces that create a sense of team cohesion and support activities among staff members. If not possible, efforts should be taken to hold meetings with the involvement of various teams to ensure that everyone is up to date, can communicate their concerns, and by in sync regarding any changes. Managerial structures are important as well, for interdisciplinary teams to function in the workplace, there should be defined relationships between team members and the teams themselves with formal and informal considerations in their interactions. In Vile Health, it seems that the teams lack that cohesiveness and interaction, with each ‘discipline’ virtually functioning on their own. If there were well-defined interactions along with both physical and functional space for interactions, it is possible there could be improvements.
References
Isidro, M. L., & Jorge, S. (2010). Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis. Acta Diabetologica, 50(2), 183–187.
Jansen, L. (2008). Collaborative and interdisciplinary health care teams: Ready or not? Journal of Professional Nursing, 24(4), 218–227.
Morley, L., & Cashell, A. (2017). Collaboration in health care. Journal of Medical Imaging and Radiation Sciences, 48(2), 207–216.
Schleyer T., Moore H.E., & Weaver K. (2016). Effective interdisciplinary teams. In: J. Finnell & B. Dixon (eds), Clinical informatics study guide, pp. 343-376, Springer.
Smith, T., Fowler-Davis, S., Nancarrow, S., Ariss, S. M. B., & Enderby, P. (2018). Leadership in interprofessional health and social care teams: A literature review. Leadership in Health Services, 31(4), 452–467.