1 Gaps in Interprofessional Collaboration Jeffrey Bell, Moriah Berg, Laryn Campbell, & Kyreen Davidson Department of Nursing Education and Health Studies, Northwestern Polytechnic NS4005: Leadership in Nursing and Interprofessional Practice Sherry Lee Willet February 15th, 2024 2 Gaps in Interprofessional Collaboration Identifying gaps in interprofessional collaboration is key to establishing a unique framework that is successful for the healthcare team. Not only are interprofessional team’s paramount to patient success, but they act as a “well-oiled machine” by dynamically moving as a system of different functioning parts. In theory, an interprofessional team values patient-centred care above all else and acts through various mechanisms to provide quality healthcare. Within reality, there often exists gaps in care that need to be identified early and intervened upon effectively; moreover, four gaps in care are discussed here to provide awareness and changes in competencies from a student standpoint: role conflict, multicultural communication discrepancies, general miscommunication, and power hierarchies. By identifying, evaluating, and reflecting upon these gaps in care, we can ensure a better future of healthcare and enable quality centered care and patient safety. Role Conflict Role Conflict can arise from many diverse sources as when people with differing priorities and focuses begin to work together, nerves are bound to be frayed and team dynamics are bound to suffer. One method for reducing this conflict and hindrance to providing proper holistic patient care, is to enable different professions to work together through interpersonal collaboration, these skills can be built with training, education, and practice especially in cases of increasing the understanding of the scope of practice of some positions is for other disciplines (Vaseghi et al., 2022). Building that initial sense of respect and trust in what the other members of the health care team are capable of is pivotal to the functioning of the team (Johnson et al., 2021), and the leaders of those teams have a duty to ensure that the conflicts that do arise are dealt with in a 3 timely and appropriate manner. As nurses, we often are one of the closest professions to the patient’s bedside, one of the main duties of the Registered Nurse is to be the patients advocate (Schultz, n.d.). This position often will lead the nurse to be one of the leaders of the healthcare team which emphasises the importance of nurses being able to manage interdisciplinary conflict. Head nurses used 4 major themes or techniques when dealing with interdisciplinary conflict “(1) integrated-effective communication is a form of interdisciplinary conflict prevention; (2) a head nurse need to have wide insights and supple character to prevent conflicts with doctors; (3) a head nurse is responsible for coordination and negotiation to prevent Interdisciplinary conflicts; and (4) a head nurse creates conducive working environment to prevent interdisciplinary conflicts. (Ika, Novieastari, & Nuraini, 2019).” Barriers in Multicultural Communication With an ever-evolving population of multicultural professionals, healthcare teams are becoming increasingly dynamic in cultural variation. Cultural variation is tremendously helpful in bringing unique skills, education, perspective, and problem-solving skills; moreover, it brings forward resources and advocacy for the needs of multicultural patients in the hospital setting. Along with the plethora of benefits, multicultural teams hold the risk of miscommunication verbally, non-verbally, and through perceptions of normal versus abnormal. When multiculturalism is specific to any team, not only does cultural sensitivity need to become a priority among leaders, managers, and all team members, but communication strategies require more careful attention. Within multicultural teams, barriers may present via verbal language, body gestures, or generalized assumptions; receivers may not understand the sender's intended message. It is critical to understand all communications for the safety and care of the patient population. Verbal communication that is not fully understood should never be assumed or 4 glossed over to avoid confrontation or re-affirmation; for example, in the instance of “uncertainty avoidance,” which measures ambiguity discomfort (Aririguzoh, 2022). ‘Cross-cultural communication’ studies verbal and non-verbal communication among culturally diverse populations. (Aririguzoh, 2022) suggests several measures to improve multicultural communication: respecting power distance, individualism vs. collectivism, uncertainty avoidance, masculine and feminine roles, long-term orientations, time orientation (e.g. monochronic vs polychronic), low and high context, and exogenic endogenic mechanisms. Each multicultural mechanism represents a potential communication risk if they are disregarded. Ensuring that each team member understands their role, knows their voices matter, and can ask questions and clarify information ensures they feel included, valued, and knowledgeable. Discrepancies in verbal language may be addressed by using written notes, emails, translators, and group huddles to ensure proper collaboration and patient care. If there is a suspected miscommunication, team members feel safe in asking for help, and openness is encouraged. A culture of safety is developed, and misunderstandings are identified early. Every effort is made to ensure that successes are praised, and interventions are created efficiently for any communication gaps (McLaney et al., 2022). Interprofessional collaboration encounters multicultural influence more as time progresses; moreover, it is important to ensure a common language that avoids jargon, systems are easy to understand, and each professional has been well mentored on the tools available for communication (e.g., direct chats, access to translators, or meetings for clarity). Finally, multicultural communication gives people with high-end skills and education a chance to work in a healthcare practice devoted to patient safety and practice standards (McLaney et al., 2022). Miscommunication in Health Care Settings 5 Miscommunication is a mistake that is made in everyday life often, but in everyday life people’s lives are not put in danger, which they may potentially be with miscommunication in healthcare settings. “Miscommunication, care continuity disruption, critical data omission, medication errors, and serious adverse outcomes during handoffs create a vulnerable gap in care.” (Freel & Fleharty, 2021). Communicating with one person back and forth is an easy task but working in a healthcare team and collaborating with multiple different professions throughout the day may be more difficult and concerns or issues may be missed. Creating a strong framework for communication to prevent errors that may result in a medical error should be a primary goal for a healthcare team practicing interprofessional collaboration. When good communication takes place there is a reduced risk for patient harm and it also helps to keep the costs of care down. Rabon (2018) states that miscommunication in healthcare costed roughly 1.7 billion in 2016. Interpersonal miscommunication is not the only problem details are also not communicated properly through technology. “Digital health being a relatively new implementation in healthcare entreats major gaps of communication between clinical staff.” (Rabon, 2018). According to Gernant (2023) communication is an essential part of good teamwork but when digital communication is used it does not reflect body language or tone which leads to misinterpretation and miscommunication. This gap in collaborative communication could be bridged by building a strong relationship with other disciplines who also know the importance of good communication. The way disciplines are able to communicate amongst each other has a direct impact on the patient. If the team wants a patient’s health to improve, they need to succeed as a team. Bed-side meetings with the patient and the family may be a way for everyone to address concerns. If health care providers disagree about the plan of care, they are able to talk about it after leaving the patient’s room. Taking the time to sort out 6 what is best for the patient and truly listening to one another is a key component of communication. There are multiple communication courses offered online that a team could take to improve communication whether it be interpersonal communication or through information and communication technology (ICT). Power Hierarchies An important aspect of team development is the ability to feel a sense of power over the work an individual completes (McKey & McKey, 2020). In most cases, this can be healthy and allows professionals to have an increased sense of competence and reward, however, in interprofessional relationships, power can hinder a team dynamic and create a hierarchical structure (Ambrose-Miller & Ashcroft, 2016; McKey & McKey, 2020). Factors such as level of education, compensation, and scope of practice can create perceived decision makers and leaders in the team despite the team working to the same goal of patient-centered care (Ambrose-Miller & Ashcroft., 2016; Wising et al., 2024). Ultimately, although initiating communication techniques and education on interprofessional roles can increase awareness, power dynamics still exist within multidisciplinary teams whether that is between physician-nurse or nurse and other team members due to workforce requirements (Rogers et al., 2024). Context can play a large role in the ability for conflict management to be used effectively for undervalued team members (Rogers et al., 2024). Wising et al. explains that patient outcomes, particularly in critical care settings, increase with teams working effectively and the appraisal of knowledge that specific team members put forward in emergent situations often denies the use of additional skills less competing personalities can contribute without an open communication style (2024). It is very important for professionals to reflect on the power dynamics they hold in their favour and focus them on a way that contributes to team learning, adaptation, and conflict 7 resolution (McKey & McKey, 2020). By active participation in understanding the roles of different parts of the multidisciplinary team, the ability for practitioners to share decision making and utilize complementary skills within the team can increase the productivity and accountability across the patient focus (Wising et al., 2024). Conclusion Role conflict, Multicultural communication, using proper communication methods, and power dynamics all take vital toles on providing critical care to patients who are in need. Trust and effective communication coupled with wide insights and ‘supple character’ are characteristics that help lubricate fractious team dynamics. Being certain to not use unclear turns of phrase or jargon that may confuse non-native language speakers because ineffective communication can cost precious time in critical patient situations which is also why choose the appropriate method of communication is so important, there is a continuum that the must be considered ranging from the urgency of the request and how comfortable the receiving person is with that particular method of communication. When there is communication within the team there is another important consideration that must be done which is the influence or power dynamics that come into play such as Doctor-Nurse or manager-worker, the creation of power dynamics can hinder the back-and-forth communication that is necessary when communicating critical care information especially without self-reflection and learning. Providing high-quality holistic health care mandates, a team with excellent cohesion and awareness of their roles and limitations, improving positive patient outcomes is what the interdisciplinary team is tasked todo gaps in their ability to do that can arise from breakdowns in the different ways people attempt and fail to communicate and understand others, by speaking clearly, plainly, and concisely we can bridge those gaps and provide excellent patient centered care. 8 References Ambrose-Miller, W., & Ashcroft, R. (2016). Challenges faced by social workers as members of interprofessional collaborative health care teams. Health & Social Work, 41(2), 101-109. https://www.doi.org/10.1093/hsw/hlw006 Aririguzoh, S. (2022). Communication competencies, culture and SDGs: effective processes to cross-cultural communication. Humanities and Social Sciences Communications, 9(1), 1– 11. https://doi.org/10.1057/s41599-022-01109-4 Freel, J., & Fleharty, B. (2021). 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