Unit-Based Interprofessional Collaborative Practice Councils: Who Dat?

A Midwestern Regional Magnet® hospital noted undesirable trends in the National Database for Nursing Quality Indicators (NDNQI) Registered Nurse Satisfaction Survey, as it related to Nurse-physician relationships. Informal surveys were conducted among key stakeholders and yielded stories of situations that produced themes of disrespectful interactions, miscommunication, delays in making evidence-based change, and challenges in sustaining change. After a review of the existing scientific evidence and ongoing dialogue with key stakeholders, an organizational approach began to emerge that would align members of the interprofessional care team vs. the historical approach of decision-making in isolation.

The purpose of the work was to engage the interprofessional team in a collaborative forum and inspire a shared vision around enhancing outcomes and relationships; form and pilot the implementation of unit-based interprofessional collaborative practice councils for the most relevant acute care units.

A Donabedian approach was utilized to design the pilot for the intensive care unit, which also took into consideration additional existing structures within the organization (e.g. Baldrige Criteria, organizational values, AACN Healthy Work Environment, Iowa model for evidence-based practice, etc.) to force collaboration, as past performance had indicated that collaboration does not seem to occur by chance. Members of the interprofessional team included: hospitalist providers, pharmacists, dietitians, respiratory therapists, clinical nurses, unit management, clinical nurse specialists, education coordinators, cardiologists, clericals, social workers, and ad hoc guests. Team members were invited to assist in the design of the pilot and identify key priorities to address first. Meeting effectiveness became a foundational element to keep the pilot moving forward (Lencioni, 2002). A multitude of formal metrics and informal impressions were tracked to measure effectiveness.

Improvements have been realized in collaboration as defined by NDNQI nurse-physician relationships. A multitude of clinical and professional outcomes are being optimized (e.g. mobility, nurse autonomy, sepsis-related mortality, pediatric emergencies). Informal impressions have a more positive connotation and lines of communication have been established through formalized structures.

The pilot has since been extended to the mother baby unit and the medical unit, and evaluation is ongoing.