Interprofessional collaboration

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© The Author(s) 2015
DOI: 10.1177/1715163515588106
Interprofessional collaboration in health care:
Lessons to be learned from competitive sports
Brennan Bosch; Holly Mansell, BSP, PharmD
Improved health care collaboration has been cited as
a key strategy for health care reform.1,2 Collaboration in health
care has been shown to improve patient outcomes such as
reducing preventable adverse drug reactions,3,4 decreasing
morbidity and mortality rates5,6 and optimizing medication
dosages.7 Teamwork has also been shown to provide benefits
to health care providers, including reducing extra work4 and
increasing job satisfaction.8 As a fourth-year pharmacy student at the University of Saskatchewan (BB), I have noticed this
shift becoming increasingly evident in our education, with the
incorporation of interprofessional-based learning activities and
relocation to a recently built health sciences building.
Having played competitive hockey for about 15 years, I
have been on both highly successful teams that went on to win
championships, as well as teams that were unable to function
effectively. What was it about these teams that contributed
to our successes or failures? Moreover, can these lessons be
extrapolated to health care teams?
Characteristics have been identifed in both sports and
health care that may influence team success.2,9 Examples
include accountability, communication, leadership, discipline,
coordination, having a clear purpose and having a strategy in
place. While a cooking recipe may consist of many ingredients (some perhaps to add flavour; others for consistency),
a few ingredients will always remain essential. Reflecting on
my experiences as an athlete and as a pharmacy student, 5 key
ingredients seem necessary for success in a collaborative team
(Table 1).
Role clarity
We have all seen examples of teams that consist of members
who are extremely talented and yet do not function effectively.
Conversely, some teams that are considered to lack skill succeed
where others fail. In a successful team, every single participant
is relied on to execute his or her unique role. For instance,
in the game of hockey, there are goal scorers, defensemen,
“grinders” and goalies. If a hockey team is composed of only
goal scorers, the other aspects of the game will be ignored and
the team will have weaknesses. Teams in health care consist of
diagnosticians, prescribers, medication experts and members
who tend to the ongoing daily needs of the patient. Each
expert adds a specifc value, creating a collective synergy so
that patient needs can be most effectively met.10 While role
clarity is essential, team members need to be comfortable
with some “overlap” of skills. Sometimes doing what is in the
best interests of the patient most efciently will require team
members to step outside their traditional professional role. A
defenseman, for instance, will take a shot at an open net should
the opportunity arise.
While some members within a team or collaborative relationship may take on more of a leadership role, everyone must
be enabled to contribute. Why would some commit to making
sacrifces for the betterment of a team if they felt their role was
insignifcant? Individual contributions need to be valued and
not underplayed. Yet, for maximum performance, the focus
needs to be on “team success.” Te old saying “Win as a team
and lose as a team” holds true in health care as well. Tus, a
team flled with members who know their individual roles, put
personal egos aside and feel appreciated increases the likelihood of team success and individual job satisfaction.11
Trust and confidence
Trust, one of the most important elements of a successful team,
is difcult to gain yet easy to lose. Developing trust takes time
and a lot of personal contact. Tis may be a challenge in some
health care settings due to logistical barriers such as rotating
staff schedules, which contributes to constantly changing teams.
If teams have the opportunity to work together daily, the development of confdence within the team is naturally facilitated.
Having just completed my Structured Practical Experience Program (SPEP) rotation at the Saskatchewan Transplant
Program, I had the opportunity to work with an effectively functioning team of pharmacists, physicians and nurses. Te health
care practitioners in this setting are hired by the transplant
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program and work together exclusively. Te pharmacists and
nurses partially attribute their team success to the fact that they
share an ofce and work so closely with one another. Proximity
and contact have led to an atmosphere where trust has been
built rather than lost. Exposure to other health care disciplines
and the opportunity to work collaboratively have been shown
to facilitate awareness and appreciation for interprofessional
roles.12 It is more likely that members of health care teams will
develop a mutual trust if they are aware of other professions’
roles and witness their capabilities frsthand.13 In addition, evidence shows that implementing interprofessional education
(IPE) earlier in health care curriculums can positively influence
students’ perception of teamwork.14 Efforts to incorporate IPE
into students’ education should therefore be encouraged, with
the goal of fostering future collaborative practice.
To develop team trust, it is essential that members are
confdent in their own abilities. It is noteworthy that the
athletes I have played hockey with who have gone on to win
championships and compete at the highest level (the National
Hockey League) have radiated individual confdence, which
in turn facilitated team confdence. When faced with pressure
situations, the team remained confdent because we trusted
each other and had spent countless hours together improving
our skills and forming good habits throughout the season.
Tis was evident in the transplant program, which deals with
complex patients and high-stress situations when organs for
transplant become available. Trust and confdence in one
another there kept the pandemonium in check, similar to
being down a goal with 30 seconds lef on the clock.
The ability to overcome adversity
At some point, all teams will be faced with adversity. In an
athlete’s world, this could be a turnover in basketball or the
referee making a bad call during a football game. Adversity
and challenges are part of health care delivery, whether it
be complex patients or dealing with staff shortages. It is
during these difcult situations that collaboration becomes
even more essential, and it is in the face of adversity that the
team’s true integrity is revealed. When teams are faced with
adversity, the tendency can be to pass blame and begin to
question the system, management or leadership. Challenges
require every member to remain committed to the ultimate
goal, which in the case of health care is patient care. Since
adversity is something that every team in any setting will
inevitably encounter, it is imperative that health care
providers working collaboratively become adept at dealing
with it effectively.
The ability to overcome personal differences
It is not always possible to get along with every team member,
but how those differences in opinions are handled is what truly
matters. When I played hockey in Medicine Hat, there were
arguments between team members on a daily basis, and it was
not uncommon for teammates to fght during practice. Despite
these disagreements, the players had the ability to move past
their differences and focus on the common goal. Team diversity should be viewed as a strength; it can bring about different viewpoints, facilitate innovation and problem solving15 and
have the potential to result in amazing outcomes.16 Te key
TABLE 1 Five essential ingredients for team success
Sports teams
Health care teams
1. Role clarity
• Each member is relied on to execute his or her
unique role.
• Individual contributions should be valued, yet the
focus must be on team success.
Examples in hockey include goal
scorers, defensemen, grinders
and goalies.
Examples include diagnosticians,
prescribers, medication experts
and members who tend to the
patient’s daily needs.
2. Trust and confdence
• Members must be confident in their own abilities
to develop team trust.
Facilitated by time spent
together practicing.
Facilitated by proximity and time,
as well as exposure to other
health care disciplines.
3. The ability to overcome adversity
• Challenges require every member to remain
committed to the collective goal despite setbacks.
Examples of adversity may
include a turnover in basketball
or a bad call in football.
Examples of adversity may include
dealing with complex patients
or staff shortages.
4. The ability to overcome personal differences
• Members must be able to overcome personal
differences even if they do not always get along.
Members must work towards a
common goal of winning the
game.
Members must work together,
putting patient care frst.
5. Collective leadership
• A philosophy that takes pressure off any one
individual and disperses it throughout the group.
Can help facilitate “buy-in” from
team players.
Collaborative leadership is 1 of
the 6 competency domains for
interprofessional education.
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is for everyone to work towards a common goal and have a
shared vision on how to achieve it.
Collective leadership
Collective leadership takes pressure off any one individual
and disperses it throughout the group. During my time in
Medicine Hat, I was fortunate to be coached by the current
coach of the Vancouver Canucks, Wilbrod Desjardins. He was
a true believer that each person is only as good as the people
they are surrounded by. Rather than relying exclusively on
the team captain, a leadership group consisting of 8 players
would convene regularly to discuss team issues. Tis group
approach helped to engage more individuals and facilitated
“buy-in” from the rest of the team. Te value of collective
leadership has been noted in both sports teams and health
care.17,18 In fact, collaborative leadership has been recognized
as 1 of the 6 competency domains for interprofessional education19 and has been given a priority for student learning in
this capacity.
Conclusion
In sports, winning is obviously more gratifying than losing,
and reflecting on my hockey career, the years we ended up
winning championships were the most enjoyable. I believe that
our successes during these years resulted because we had discovered a winning recipe for functioning effectively as a team:
while each person played a unique and fundamental role, we
practised collective leadership. We had built trust and confdence in our teammates, and we learned to put personal differences aside and overcome adversity. Tese factors were also
evident within the interdisciplinary team at the Saskatchewan
Transplant Program. Judging from their patient successes, it
leads me to believe that these 5 ingredients are essential in
health teams as well.
To conclude, the importance of interprofessional teamwork
in health care has been consistently highlighted. To increase
the likelihood of team success, the value of selecting individuals capable of embodying these core characteristics should not
be overlooked. ■
From the College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan. At the time of writing,
Brennan Bosch was a fourth-year pharmacy student at the University of Saskatchewan who was completing a Structured Practice
Experience Program (SPEP) rotation at the Saskatchewan Transplant Program, under the supervision of Dr. Mansell. Brennan
played competitive hockey for over 15 years, and his accomplishments include a Western Hockey League championship in 2006-07
with the Medicine Hat Tigers and the 2011-12 Canada West hockey title with the University of Saskatchewan Huskies. Contact holly
.mansell@usask.ca.
Author Contributions: B. Bosch wrote the initial draf of the manuscript and H. Mansell performed the revisions. Both authors
contributed to the theme and ideas.
Declaration of Conflicting Interests: Te authors declared no potential conflict of interest with respect to the research, authorship
and/or publication of this article.
Funding: Te authors received no fnancial support for the research, authorship and/or publication of this article.
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