Physician, Nurse and Unlicensed Assistive Personnel Perceptions of Interdisciplinary Communication and Collaboration: A Phenomenological Study

As patients increasingly present to hospitals with more complex health issues, it is essential that health care providers work together to meet patients’ needs. Working together, however, is complicated and challenging.

Purpose: The purpose of this study was to explore physician, nurse and unlicensed assistive personnel (UAPs) perceptions of their individual roles in providing safe patient care, as well as explore their perceptions of each other’s roles. The study also aimed to gain a greater understanding of interdisciplinary communication and collaboration among physicians, nurses and UAPs to enhance patient safety.

Design: This phenomenological study used a purposive non-probability, criterion-based, convenience sample from a metropolitan hospital.

Theoretical Foundation: Malhotra’s (1981) Schutzian lifeworld phenomenological orchestra study provided the theoretical basis for the conductorless orchestra model, which guided this study. Orchestra members see and hear the musical score from different perspectives and call upon their individual stock of knowledge or talent to work together for a seamless symphony performance. Similarly, in a hospital individual physician, nurse and UAP talent must blend together to create the symphony of patient-centered care.

Methods: Semi-structured face-to-face, individual interviews were conducted and carefully transcribed. Then the interview transcriptions were coded with the aid of NVivo 9, a qualitative data analysis software program, to discover emergent patterns and themes (Saldaña, 2009).

Findings: The study suggests that physicians, nurses, and UAPs operate as separate healthcare providers most of the time. They barely speak to each other. A physician-nurse hierarchy exists, but may be changing. Physicians and nurses consult with each other at times, but UAPs are rarely included in any type of meaningful patient discussion. The study indicates a hierarchical, subservient relationship among nurses and UAPs. Many UAPs report that they feel nurses do not value their contributions.

Conclusions: The negative impact of medical errors on patient safety poses a major problem. Physicians, nurses and UAPs each provide portions of patient care. Valuable information could be missed due to lack of communication among these providers. The Institute of Medicine and accrediting agencies like the Joint Commission identified poor communication between health care providers as a major cause of adverse patient outcomes (Costello & Thompson, 2015; Mannahan, 2010; Morris & Mathews, 2014; Rouse, Delunas, Anderson & Anderson, 2010). Misunderstandings, conflict, differences of opinions and interests can interfere with effective interdisciplinary communications and collaboration (Weller, Barrow, & Gasquoine, 2011). Good communication and collaboration reflects independent and shared decision-making, which prevents fragmentation and increases the effectiveness of health care delivery (Ewashen, McInnis-Perry, & Murphy, 2013). To insure positive patient care outcomes in a hospital the longstanding hierarchical professional structure must be addressed and changed (Delunas & Rouse, 2014; Ewashen, McInnis-Perry & Murphy, 2013). Physicians, nurses and UAPs must recognize, understand and respect each other’s contributions. Members of each discipline should be included in patient care decisions. A patient care system based on the conductorless orchestra model flattens the hierarchy, recognizes each provider’s contributions to patient care and promotes communication and collaboration, which can prevent fragmentation of care and enhance patient safety.

Global Significance: Understanding and aligning physician, nurse and UAP individual and group values, attitudes, perceptions, competencies and patterns of behavior might help health care leaders develop patient safety systems that providers will embrace, thereby improving patient safety (Stavrianopoulos, 2012).