Chapter 6: Professionalism

Learning Objectives

  • Assess why professionalism is important for those that work in all healthcare settings.
  • Analyze how healthcare professionals approach challenging situations when working alone and when working together.
  • Examine the components of professional conduct and the importance of interprofessional collaborative practice.

Introduction

What is professionalism? A profession is an occupation that involves mastery of complex knowledge and skills through prolonged training, education, or practical experience. Becoming a member of a specific profession doesn’t happen overnight. Whether you seek to be a physical therapist, medical laboratory scientist, athletic trainer, nurse, or health educator, each profession requires interested parties to invest themselves in learning to become a professional or a member of a profession who earns their living through specified expert activity. It’s much easier to define the terms “profession” and “professional” than it is to define the term “professionalism” because each profession will have its take on what it means to be a professional within a given field. According to the United States Department of Labor (n.d.), professionalism “does not mean wearing a suit or carrying a briefcase; rather, it means conducting oneself with responsibility, integrity, accountability, and excellence. It means communicating effectively and appropriately and always finding a way to be productive.” The U.S. Department of Labor’s book Skills to Pay the Bills: Mastering Soft Skills for Workplace Success goes on to note:

Professionalism isn’t one thing; it’s a combination of qualities. A professional employee arrives on time for work and manages time effectively. Professional workers take responsibility for their own behavior and work effectively with others. High-quality work standards, honesty, and integrity are also part of the package. Professional employees look clean and neat and dress appropriately for the job. Communicating effectively and appropriately for the workplace is also an essential part of professionalism.

Developing professionalism

Professionalism isn’t a single “thing” that can be labeled. Instead, professionalism refers to the aims and behaviors that demonstrate an individual’s level of competence expected by a professional within a given profession. By the word “aims,” we mean that someone who exhibits professionalism is guided by a set of goals in a professional setting. Whether the aim is to complete a project on time or help ensure higher quarterly incomes for the organization, professionalism involves striving to help one’s organization achieve specific goals. By “behaviors,” we mean specific ways of behaving and communicating within an organizational environment. Some common behaviors can include acting ethically, respecting others, collaborating effectively, taking personal and professional responsibility, and using language professionally. In the following sections, we will explore each of these behaviors separately.

Be Appropriate

Avoid oversharing personal or family information with your coworkers or boss. Be careful what you say and post about work (Mind Tools Content Team, n.d.). A best practice is to avoid talking about any work-related issues with people outside of your closest family and friends, and even then, you should be cautious. Word can spread like wildfire and you wouldn’t want to lose your job over hearsay. Refrain from complaining about work and posting negative work-related content on social media. Despite your privacy settings, you can’t be sure that that information won’t get back to your employers or colleagues.

Be Presentable and Dress Appropriately

Always maintain a level of professionalism through your work attire, hygiene, and visual presentation (Piccirilli, 2018). Take note of the workplace dress code; until you have a better idea of what it is, take a conservative and simple approach to dress. Even if your workplace is more casual in nature, it is important to come to work clean, neat, and well-groomed. If you are representing yourself professionally, you are helping the employer to be seen in a professional light as well.

Be Punctual and Respectful

Consistently showing up for work and showing up on time indicates that you’re serious about your job. It’s not only important to be punctual about arriving to work, but also to be on time for meetings and follow the prescribed times for breaks or other scheduled work gatherings. If you know you are going to be late, be courteous. Pick up the phone or send an email and let your employer know when you will be there (always offer to reschedule if that is more convenient for others). When you are able to meet your commitments, it tells an employer that they can depend on you.

Clarify Expectations and Ask for Feedback

Sometimes an employer may not have the time or resources to review your job expectations with you in detail. To ensure you’re performing adequately at your new job, review your job duties very carefully, then identify your main responsibilities and how much time you should be spending on each. This is a fail-proof way to ensure you’re on target with what your employer expects, however, if you are unclear about what this looks like, don’t hesitate to clarify at any time. Along the same lines, if you want to make sure you’re on the right track, set up a time to meet with your manager and ask for feedback on your progress so far (Indeed Editorial Team, 2021).

Be Honest and Own Your Mistakes

It’s not the end of the world if you make a mistake on the job, it just makes you human. The worst thing to do is to lie about it. If you take responsibility for your mistake and avoid making excuses, it will show a great deal of maturity (Half, 2016). Employers will appreciate your honesty and your ability to handle a situation like this. If you show them you’re willing to learn the proper way to do something, to avoid this happening again in the future, you will be more likely to build a trusting relationship (Piccirilli, 2018).

Follow Through on What You Say

Be a person of your word, if you can be relied on to do what you say you’re going to do, an employer is eventually going to see you as their go-to person (Mind Tools Content Team, n.d.). When your words match your behaviors, it makes it easier for an employer to trust you and they will ultimately be more likely to recommend, praise, and invest in you. On the contrary, not actively following through on what you say can paint a negative picture of you to an employer; they may assume you are undependable or even uninterested in the job.

Demonstrate a Positive Attitude

You may have experienced working with someone negative in the past, which is why it’s so important for employers to want their employees to exhibit positivity. If you have a bad attitude this may impact how well you do your job or how you communicate with other people. People tend to remember the bad things; you certainly don’t want your employer to remember you as the complainer. Positivity is a highly sought-after quality on the job, as it tends to be a morale booster and increase the enjoyment of a work environment significantly.

Know and Understand Your Role and Your Scope of Practice and Ask for Help When Needed

Many of us make the mistake of wanting to prove we can do something on our own, or sometimes we’re just scared to ask for help because we think it might be seen unfavorably by our managers (Mind Tools Content Team, n.d.). The opposite of this is true; employers want you to ask questions and ask for help when you’re unsure of how to do something. Employers would rather you ask the questions you need in order to do the job correctly than potentially cost them time and money on careless, easily preventable mistakes. That being said, if you have a number of questions, collect them and schedule a time to meet with your manager to discuss them all at once – this will eliminate multiple interruptions.

Be a Problem Solver and a Peacemaker

Regardless of the job, we can’t escape day-to-day problems, whether they are personality differences between colleagues or roadblocks in our daily tasks or projects. What’s important for an employer to see is how you’re able to handle it when the situation is appropriate. An employer is seeking those that can manage conflict through effective negotiation and communication skills in a diplomatic, respectful, and calm manner. Furthermore, when you are able to manage unforeseen problems by identifying a plan and proposing possible solutions, you are taking this off the employer’s plate and allowing them to spend their time managing more pertinent concerns (Half, 2016). When an employer has to frequently intervene in these situations it can take away from how competently they view you in your role.

Be Self-Aware

Be honest with yourself (and others!) about your strengths and your challenges. Realize that you are not perfect and that every person needs to grow and learn continually throughout their careers. Self-evaluate regularly and set specific goals for yourself that are both measurable and achievable. When you experience conflict or misunderstandings, ask yourself what you could have done differently. When you receive constructive criticism, consider ways in which you can improve.

Stay Calm in Stressful Situations and Manage Disappointment

Emotional intelligence is a highly-valued trait, both in the career world and in everyday life. Resilience is closely related to emotional intelligence. In the video below, The Mind Tools Content Team (n.d.) explains that two vital components of emotional intelligence are becoming more self-aware to understand your own emotions and using active listening skills to learn empathy.

Media 6.1. Emotional intelligence in the workplace [Online video]. Copyright 2018 by MindToolsVideos.

Adapt to Change

With changes happening all around us, you’re bound to experience a number of work-related changes in your time. Being flexible and open-minded to those changes will help to reduce the amount of stress you are experiencing and allow you to navigate unexpected changes in your work environment in a more positive and constructive way. Work changes can take their toll on morale, when employees are more adaptable, they will help set the tone for a more seamless transition across the team.

Be Self-Motivated

Just like many workplaces, health and wellness workplaces are busy and employers value employees who can work with little-to-no supervision. This type of person sees what needs to be done and does it. They never sit idle and find ways to keep themselves busy by helping their colleagues or catching up on work that was left undone.

Be Organized

Organization skills are important in every aspect of life and are absolutely essential to the workplace. Being organized decreases stress, saves time, and increases productivity. Piccirilli (2018) suggests keeping a tidy workspace and using a planner. Read this article to help you improve your organizational skills.

Interprofessional Collaboration

Interprofessional Collaborative Skills

A critical skill for healthcare professionals is the ability to work efficiently and effectively with other healthcare workers. For example, a person working in patient care may need to interact with their core team, contingency teams, ancillary and support services, administration, and the patient. A team consists of two or more individuals who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership. Teams within healthcare must learn to communicate, coordinate, and effectively think and feel as a team by enacting necessary teamwork processes.

Teamwork processes can be defined as interrelated knowledge, skills, and attitudes that allow teams to work together to accomplish interdependent goals, such as problem-solving or providing optimal care to a patient. A team with the proper teamwork structure can anticipate the needs of other team members, dynamically adjust to a changing environment (including changing behaviors of team members), and have a shared understanding of what should happen.

  • Knowledge: Teams whose members have strong communication, leadership, situation monitoring, and mutual support capabilities yield important team outcomes such as shared awareness about what is going on with the team and progress toward its goal. Team members will also be familiar with the roles and responsibilities of their teammates.
  • Attitudes: When you work in teams in which the members have good communication, leadership, situation monitoring, and mutual support skills, team members are more likely to have a positive experience; you will enjoy working in teams and trust the intentions of your teammates.
  • Performance: You’ll be able to adapt to changes in the care plan. Team members will know when and how to back up each other. You’ll be more efficient in providing care; you will have a plan, and you will know who is supposed to do what, and how they are supposed to do it. Finally, your team will be safer, allowing the team to more readily identify and correct errors if they occur.

The knowledge, skills, and attitudes of teamwork complement clinical excellence and improve patient outcomes, because teams use feedback cycles and clearly defined tools to communicate, plan, and deliver better quality care.

All healthcare students must prepare to deliberately work together in clinical practice with a common goal of building a safer, more effective, patient-centered healthcare system. The World Health Organization (WHO) (2010) defines interprofessional collaborative practice as multiple health workers from different professional backgrounds working together with patients, families, caregivers, and communities to deliver the highest quality of care.

Effective teamwork and communication have been proven to reduce medical errors, promote a safety culture, and improve patient outcomes (Agency for Healthcare Research and Quality [AHRQ], 2015). The importance of effective interprofessional collaboration has become even more important as healthcare professionals advocate to reduce health disparities related to social determinants of health (SDOH). In these efforts, healthcare professionals work with people from a variety of professions, such as physicians, social workers, educators, policymakers, attorneys, faith leaders, government employees, community advocates, and community members. Healthcare students must be prepared to effectively collaborate interprofessionally after graduation (National Academies of Sciences, Engineering, and Medicine, 2021).

The Interprofessional Education Collaborative (IPEC) has identified four core competencies for effective interprofessional collaborative practice. This section will review content related to these four core competencies and provide examples of how they relate to different health professions.

IPEC COre Competencies

The Interprofessional Education Collaborative (IPEC) established standard core competencies for effective interprofessional collaborative practice. The competencies guide the education of future health professionals with the necessary knowledge, skills, values, and attitudes to collaboratively work together in providing client care. See Table 6.1 for a description of the four IPEC core competencies. Each of these competencies will be further discussed in the following sub-sections of this chapter.

Table 6.1: The Four IPEC Core Competencies

Competency 1: Values/Ethics for Interprofessional Practice

Work with individuals of other professions to maintain a climate of mutual respect and shared values.

Competency 2: Roles/Responsibilities:

Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of patients and to promote and advance the health of populations.

Competency 3: Interprofessional Communication

Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease.

Competency 4: Teams and Teamwork

Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.

Source: Core Competencies for Interprofessional Collaborative Practice: 2017 Update from the Interprofessional Education Collaborative.

Values and Ethics for Interprofessional Practice

The first IPEC competency is related to values and ethics and states, “Work with individuals of other professions to maintain a climate of mutual respect and shared values” (Interprofessional Education Collaborative, 2016). See the table below for the components related to this competency.

Components of IPEC’s Values/Ethics for Interprofessional Practice Competency

  • Place interests of clients and populations at the center of interprofessional healthcare delivery and population health programs and policies, with the goal of promoting health and health equity across the lifespan.
  • Respect the dignity and privacy of patients while maintaining confidentiality in the delivery of team-based care.
  • Embrace the cultural diversity and individual differences that characterize patients, populations, and the health team.
  • Respect the unique cultures, values, roles/responsibilities, and expertise of other health professions and the impact these factors can have on health outcomes.
  • Work in cooperation with those who receive care, those who provide care, and others who contribute to or support the delivery of prevention and health services and programs.
  • Develop a trusting relationship with patients, families, and other team members.
  • Demonstrate high standards of ethical conduct and quality of care in contributions to team-based care.
  • Manage ethical dilemmas specific to interprofessional patient/population-centered care situations.
  • Act with honesty and integrity in relationships with patients, families, communities, and other team members.
  • Maintain competence in one’s own profession appropriate to scope of practice.

Source: Core Competencies for Interprofessional Collaborative Practice: 2017 Update from the Interprofessional Education Collaborative.

Nursing, medical, and other health professional programs typically educate students in “silos” with few opportunities to collaboratively work together in the classroom or in clinical settings. However, after being hired for their first job, these graduates are thrown into complex clinical situations and expected to function as part of the team.

One of the first steps in learning how to function as part of an effective interprofessional team is to value each healthcare professional’s contribution to quality, patient-centered care. Mutual respect and trust are foundational to effective interprofessional working relationships for collaborative care delivery across the health professions. Collaborative care also honors the diversity reflected in the individual expertise each profession brings to care delivery (Interprofessional Education Collaborative Expert Panel, 2011)

Media 6.2. How does interprofessional collaboration impact care? The patient’s perspective (2/7) [Online video] by Darío García Rodríguez. Published under a CC BY 3.0 license.

ROLES AND RESPONSIBILITIES OF HEALTHCARE PROFESSIONALS

The second IPEC competency relates to the roles and responsibilities of healthcare professionals and states, “Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of patients and to promote and advance the health of populations” (Interprofessional Education Collaborative, 2016).

See the following box for the components of this competency. It is important to understand the roles and responsibilities of the other healthcare team members, and to recognize one’s limitations in skills, knowledge, and abilities. One should also ask for assistance when needed to provide quality, patient-centered care.

Components of IPEC’s Roles/Responsibilities Competency

  • Communicate one’s roles and responsibilities clearly to patients, families, community members, and other professionals.
  •  Recognize one’s limitations in skills, knowledge, and abilities.
  • Engage with diverse professionals who complement one’s own professional expertise, as well as associated resources, to develop strategies to meet specific health and healthcare needs of patients and populations.
  • Explain the roles and responsibilities of other providers and the manner in which the team works together to provide care, promote health, and prevent disease.
  • Use the full scope of knowledge, skills, and abilities of professionals from health and other fields to provide care that is safe, timely, efficient, effective, and equitable.
  • Communicate with team members to clarify each member’s responsibility in executing components of a treatment plan or public health intervention.
  • Forge interdependent relationships with other professions within and outside of the health system to improve care and advance learning.
  • Engage in continuous professional and interprofessional development to enhance team performance and collaboration.
  • Use unique and complementary abilities of all members of the team to optimize health and patient care.
  • Describe how professionals in health and other fields can collaborate and integrate clinical care and public health interventions to optimize population health.

Source: Core Competencies for Interprofessional Collaborative Practice: 2017 Update from the Interprofessional Education Collaborative.

Healthcare professionals communicate with several individuals during a typical shift. For example, during inpatient care, nurses may communicate with the following: patients and their family members; pharmacists and pharmacy technicians; providers from different specialties; physical, speech, and occupational therapists; dietary aides; respiratory therapists; chaplains; social workers; case managers; nursing supervisors, charge nurses, and other staff nurses; assistive personnel; nursing students; nursing instructors; security guards; laboratory personnel; radiology and ultrasound technicians; and surgical team members.

Providing holistic, quality, safe, and effective care means every team member taking care of patients must work collaboratively and understand the knowledge, skills, and scope of practice of the other team members. The table below provides examples of the roles and responsibilities of common healthcare team members that nurses frequently work with when providing patient care. To fully understand the roles and responsibilities of the multiple members of the complex healthcare delivery system, it is beneficial to spend time shadowing those within these roles.

Healthcare Team Roles

Healthcare Team Roles

  • Advanced Practical Nurses (APRNs)
    • Coordinate patient care and may provide primary and specialty healthcare. They work independently or in collaboration with physicians.
  • Athletic Trainers (ATs)
    • Specialize in preventing, diagnosing, and treating muscle and bone injuries and illnesses. Not to be confused with fitness trainers and instructors.
  • Behavior Analysts
    • Observe and analyze the behavior of individuals in order to develop treatment plans that improve skill repertoires, safety, and quality of life. Includes Board Certified Assistant Behavior Analysts (BCaBAs) and Board Certified Behavior Analysts (BCBAs).
  • Chiropractors
    • Evaluate and treat patients’ neuromusculoskeletal system using spinal adjustments and manipulation, as well as other clinical interventions.
  • Clinical Laboratory Scientists (CLSs)
    • Perform medical laboratory tests that physicians, surgeons, or other healthcare practitioners order for the diagnosis, treatment, and prevention of disease.
  • Community Health Workers (CHWs)
    • Act as intermediaries between residents and healthcare and social services providers. They identify health-related issues, collect data, and discuss health concerns within the community.
  • Dentists
    • Diagnose and treat problems with patients’ teeth, gums, and related parts of the mouth.
  • Dietitians and Nutritionists
    • Help prevent or support treatment of health conditions such as heart disease, autoimmune disease, and obesity. They plan and conduct food service or nutritional programs to help people lead healthy lives.
  • Doctors of Osteopathy (DOs)
    • Physicians who, compared to MDs, place additional emphasis on the body’s musculoskeletal system, preventive medicine, and holistic (whole-person) patient care.
  • Emergency Management Directors (EMDs)
    • Prepare plans and procedures for responding to natural disasters and other emergencies. Directors work with government agencies, nonprofits, private companies, and the public.
  • Exercise Physiologists (EPs)
    • Develop fitness and exercise programs that help patients recover from chronic diseases and improve cardiovascular function, body composition, and flexibility. Not to be confused with fitness trainers and instructors or athletic trainers.
  • Health Education Specialists (HESs)
    • Teach people about behaviors that promote wellness. They develop strategies to improve the well-being of individuals and communities.
  • Licensed Practical Nurses (LPNs) and Licensed Vocational Nurses (LVNs)
    • Provide basic medical care to ill, injured, or convalescing patients or to persons with disabilities. They typically work under the supervision of registered nurses and doctors.
  • Medical and Health Services Managers and Administrators
    • Plan, direct, and coordinate medical and health services. They may manage an entire facility, a specific clinical area or department, or a medical practice for a group of physicians.
  • Medical Doctors (MDs)
    • Diagnose and treat injuries or illnesses and address health maintenance.
  • Occupational Therapists (OTs)
    • Treat injured, ill, or disabled patients through the therapeutic use of everyday activities.
  • Pharmacists
    • Dispense prescription medications to patients and offer expertise in the safe use of prescriptions.
  • Physical Therapists (PTs)
    • Help injured or ill people improve movement and manage pain. They are often an important part of preventive care, rehabilitation, and treatment for patients with chronic conditions, illnesses, or injuries.
  • Psychiatrists
    • Diagnose and treat mental illnesses through a combination of personal counseling (psychotherapy), psychoanalysis, hospitalization, and medication.
  • Psychologists
    • Study cognitive, emotional, and social processes and behavior by observing, interpreting, and recording how people relate to one another and to their environments. They use their findings to help improve processes and behaviors.
  • Registered Nurses (RNs)
    • Provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their families.
  • Respiratory Therapists (RTs)
    • Care for patients who have conditions that cause them to have trouble breathing.
  • Social Workers (SWs)
    • Help individuals, groups, and families prevent and cope with problems in their everyday lives. Clinical social workers and licensed clinical social workers diagnose and treat mental, behavioral, and emotional problems.
  • Speech-Language Pathologists (SLPs)
    • Assess and treat people who have speech, language, voice, and fluency disorders.

The coordination and delivery of safe, quality patient care demand reliable teamwork and collaboration across organizational and community boundaries. Patients often have multiple visits across multiple providers working in different organizations. Communication failures between healthcare settings, departments, and team members are the leading cause of patient harm (Rosen et al., 2018). Our healthcare system is becoming increasingly complex requiring collaboration among diverse healthcare team members.

The goal of good interprofessional collaboration is improved patient outcomes, as well as increased job satisfaction of healthcare team professionals. Patients receiving care with poor teamwork are almost five times as likely to experience complications or death. Hospitals in which staff report higher levels of teamwork have lower rates of workplace injuries and illness, fewer incidents of workplace harassment and violence, and lower turnover (Rosen et al., 2018). Valuing and understanding the roles of team members are important steps toward establishing good interprofessional teamwork. Another step is learning how to effectively communicate with interprofessional team members.

INTERPROFESSIONAL COMMUNICATION

The third IPEC competency focuses on interprofessional communication and states, “Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease” (Interprofessional Education Collaborative, 2016). This competency also aligns with The Joint Commission’s (2023) National Patient Safety Goal for improving staff communication. See the following box for the components associated with the Interprofessional Communication competency.

Components of IPEC’s Interprofessional Communication Competency

  • Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function.
  • Communicate information with patients, families, community members, and health team members in a form that is understandable, avoiding discipline-specific terminology when possible.
  • Express one’s knowledge and opinions to team members involved in patient care and population health improvement with confidence, clarity, and respect, working to ensure common understanding of information, treatment, care decisions, and population health programs and policies.
  • Listen actively and encourage ideas and opinions of other team members.
  • Give timely, sensitive, constructive feedback to others about their performance on the team, responding respectfully as a team member to feedback from others.
  • Use respectful language appropriate for a given difficult situation, crucial conversation, or conflict.
  • Recognize how one’s uniqueness (experience level, expertise, culture, power, and hierarchy within the healthcare team) contributes to effective communication, conflict resolution, and positive interprofessional working relationships.
  • Communicate the importance of teamwork in patient-centered care and population health programs and policies.

Source: Core Competencies for Interprofessional Collaborative Practice: 2017 Update from the Interprofessional Education Collaborative.

Transmission of information among members of the healthcare team and facilities is ongoing and critical to quality care. However, information that is delayed, inefficient, or inadequate creates barriers to providing quality care. Communication barriers continue to exist in healthcare environments due to interprofessional team members’ lack of experience when interacting with other disciplines. For instance, many novice nurses enter the workforce without experiencing communication with other members of the healthcare team (e.g., providers, pharmacists, respiratory therapists, social workers, surgical staff, dieticians, physical therapists, et cetera). Additionally, healthcare professionals tend to develop a professional identity based on their educational program with a distinction made between groups. This distinction can cause tension between professional groups due to diverse training and perspectives on providing quality patient care. In addition, a healthcare organization’s environment may not be conducive to effectively sharing information with multiple staff members across multiple units. In addition to potential educational, psychological, and organizational barriers to sharing information, there can also be general barriers that impact interprofessional communication and collaboration. See the following box for a list of these general barriers.

General Barriers to Interprofessional Communication and Collaboration

  • Personal values and expectations
  • Personality differences
  • Organizational hierarchy
  • Lack of cultural humility
  • Generational differences
  • Historical interprofessional and intraprofessional rivalries
  • Differences in language and medical jargon
  • Differences in schedules and professional routines
  • Varying levels of preparation, qualifications, and status
  • Differences in requirements, regulations, and norms of professional education
  • Fears of diluted professional identity
  • Differences in accountability and reimbursement models
  • Diverse clinical responsibilities
  • Increased complexity of patient care
  • Emphasis on rapid decision-making

Source: O’Daniel & Rosenstein (2011).

Since teams and teamwork is a culmination of all that you have learned by reviewing the first three IPEC competencies, this book is dedicating an entire section to this topic next.

Teams and Teamwork

Now that we have reviewed the first three IPEC competencies related to valuing team members, understanding team members’ roles and responsibilities, and using structured interprofessional communication strategies, let’s discuss strategies that promote effective teamwork. The fourth IPEC competency states, “Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable” (Interprofessional Education Collaborative, 2016). See the following box for the components of this IPEC competency.

Components of IPEC’s Teams and Teamwork Competency

  • Describe the process of team development and the roles and practices of effective teams.
  • Develop consensus on the ethical principles to guide all aspects of teamwork.
  • Engage health and other professionals in shared patient-centered and population-focused problem-solving.
  • Integrate the knowledge and experience of health and other professions to inform health and care decisions, while respecting patient and community values and priorities/preferences for care.
  • Apply leadership practices that support collaborative practice and team effectiveness.
  • Engage self and others to constructively manage disagreements about values, roles, goals, and actions that arise among health and other professionals and with patients, families, and community members.
  • Share accountability with other professions, patients, and communities for outcomes relevant to prevention and healthcare.
  • Reflect on individual and team performance for individual, as well as team performance improvement.
  • Use process improvement to increase the effectiveness of interprofessional teamwork and team-based services, programs, and policies.
  • Use available evidence to inform effective teamwork and team-based practices.
  • Perform effectively on teams and in different team roles in a variety of settings.

Source: Core Competencies for Interprofessional Collaborative Practice: 2017 Update from the Interprofessional Education Collaborative.

Developing effective teams is critical for providing healthcare that is patient-centered, safe, timely, effective, efficient, and equitable (Interprofessional Education Collaborative Expert Panel, 2011). Healthcare professionals collaborate with the interprofessional team by not only assigning and coordinating tasks but also by promoting solid teamwork in a positive environment. A healthcare leader, such as a charge nurse, identifies gaps in workflow, recognizes when task overload is occurring, and promotes the adaptability of the team to respond to evolving patient conditions. The qualities of a successful team are described in the following box.

Qualities of a Successful Team

  • Promote a respectful atmosphere
  • Define clear roles and responsibilities for team members
  • Regularly and routinely share information
  • Encourage open communication
  • Implement a culture of safety
  • Provide clear directions
  • Share responsibility for team success
  • Balance team member participation based on the current situation
  • Acknowledge and manage conflict
  • Enforce accountability among all team members
  • Communicate the decision-making process
  • Facilitate access to needed resources
  • Evaluate team outcomes and adjust as needed

Source: O’Daniel & Rosenstein (2011).

TeamSTEPPS

TeamSTEPPS® is an evidence-based framework used to optimize team performance across the healthcare system. It is a mnemonic standing for Team Strategies and Tools to Enhance Performance and Patient Safety. The AHRQ (2012) and the Department of Defense (DoD) developed the TeamSTEPPS® framework as a national initiative to improve patient safety by improving teamwork skills and communication.

Media 6.3. TeamSTEPPS Overview [Online video]. Copyright 2015 by AHRQ Patient Safety.

Team structure

A healthcare leader establishes team structure by assigning or identifying team members’ roles and responsibilities, holding team members accountable, and including patients and families as part of the team.

Communication

Communication is the first skill of the TeamSTEPPS® framework. As previously discussed, it is defined as a “structured process by which information is clearly and accurately exchanged among team members” (AHRQ, 2014). All team members should use these skills to ensure accurate interprofessional communication:

  • Provide brief, clear, specific, and timely information to other team members.
  • Seek information from all available sources.
  • Use ISBAR (Identify, Situation, Background, Assessment, and Recommendation) and handoff techniques to communicate effectively with team members.
  • Use closed-loop communication to verify information is communicated, understood, and completed.
  • Document appropriately to facilitate continuity of care across interprofessional team members (AHRQ, 2014).

Leadership

Leadership is the second skill of the TeamSTEPPS® framework. As previously discussed, it is defined as the “ability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources” (AHRQ, 2014). An example of a healthcare team leader in an inpatient setting is the charge nurse.

Effective team leaders demonstrate the following responsibilities:

  • Organize the team.
  • Identify and articulate clear goals (i.e., share the plan).
  • Assign tasks and responsibilities.
  • Monitor and modify the plan and communicate changes.
  • Review the team’s performance and provide feedback when needed.
  • Manage and allocate resources.
  • Facilitate information sharing.
  • Encourage team members to assist one another.
  • Facilitate conflict resolution in a learning environment.
  • Model effective teamwork (AHRQ, 2014).

Three major leadership tasks include sharing a plan, monitoring and modifying the plan according to situations that occur, and reviewing team performance. Tools to perform these tasks are discussed in the following subsections.

Sharing the plan

Healthcare team leaders identify and articulate clear goals to the team at the start of the shift during inpatient care using a “brief.” The brief is a short session to share a plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, and anticipate outcomes and contingencies (AHRQ, 2014)

Monitoring and modifying the plan

Throughout the shift, it is often necessary for the team leader to modify the initial plan as patient situations change on the unit. A huddle is a brief meeting before and/or during a shift to establish situational awareness, reinforce plans already in place, and adjust the teamwork plan as needed (AHRQ, 2014). Read more about situational awareness in the “Situation Monitoring” subsection below.

Reviewing the team’s performance

When a significant or emergent event occurs during a shift, such as a “code,” it is important to later review the team’s performance and reflect on lessons learned by holding a “debrief ” session. A debrief is an informal information exchange session designed to improve team performance and effectiveness through reinforcement of positive behaviors and reflection on lessons learned (AHRQ, 2014).

Situation Monitoring

Situation monitoring is the third skill of the TeamSTEPPS® framework and is defined as the “process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning (AHRQ, 2014). Situation monitoring refers to the process of continually scanning and assessing the situation to gain and maintain an understanding of what is going on around you. Situation awareness refers to a team member knowing what is going on around them. The team leader creates a shared mental model to ensure all team members have situation awareness and know what is going on as situations evolve. The STEP tool is used by team leaders to assist with situation monitoring (AHRQ, 2014).

STEP

The STEP tool is a situation monitoring tool used to know what is going on with you, your patients, your team, and your environment. STEP stands for Status of the patient, Team members, Environment, and Progress toward goal (AHRQ, 2014).

Cross-monitoring

As the STEP tool is implemented, the team leader continues to cross-monitor to reduce the incidence of errors. Cross-monitoring includes the following:

  • Monitoring the actions of other team members.
  • Providing a safety net within the team.
  • Ensuring that mistakes or oversights are caught quickly and easily.
  • Supporting each other as needed (AHRQ, 2014).
I’M SAFE checklist

The I’M SAFE mnemonic is a tool used to assess one’s own safety status, as well as that of other team members in their ability to provide safe patient care. See the I’M SAFE Checklist in the following box (AHRQ, 2014). If a team member feels their ability to provide safe care is diminished because of one of these factors, they should notify the charge nurse or other nursing supervisor. In a similar manner, if a nurse notices that another member of the team is impaired or providing care in an unsafe manner, it is an ethical imperative to protect clients and report their concerns according to agency policy (AHRQ, 2014).

I’m Safe Checklist
  • I: Illness
  • M: Medication
  • S: Stress
  • A: Alcohol and Drugs
  • F: Fatigue
  • E: Eating and Elimination

Mutual Support

Mutual support is the fourth skill of the TeamSTEPPS® framework and is defined as the “ability to anticipate and support team members’ needs through accurate knowledge about their responsibilities and workload (AHRQ, 2014). Mutual support includes providing task assistance, giving feedback, and advocating for patient safety by using assertive statements to correct a safety concern. Managing conflict is also a component of supporting team members’ needs.

Task assistance

Helping other team members with tasks builds a strong team. Task assistance includes the following components:

  • Team members protect each other from work-overload situations.
  • Effective teams place all offers and requests for assistance in the context of patient safety.
  • Team members foster a climate where it is expected that assistance will be actively sought and offered (AHRQ, 2014).

Feedback

Feedback is provided to a team member for the purpose of improving team performance. Effective feedback should follow these parameters:

  • Timely: Provided soon after the target behavior has occurred.
  • Respectful: Focused on behaviors, not personal attributes.
  • Specific: Related to a specific task or behavior that requires correction or improvement.
  • Directed towards improvement: Suggestions are made for future improvement.
  • Considerate: Team members’ feelings should be considered and privacy provided. Negative information should be delivered with fairness and respect (AHRQ, 2014).

Advocating for safety with assertive statements

When a team member perceives a potential patient safety concern, they should assertively communicate with the decision-maker to protect patient safety. This strategy holds true for all team members, no matter their position within the hierarchy of the healthcare environment. The message should be communicated to the decision-maker in a firm and respectful manner using the following steps:

  • Make an opening.
  • State the concern.
  • State the problem (real or perceived).
  • Offer a solution.
  • Reach agreement on next steps (AHRQ, 2014).
Two-challenge rule

When an assertive statement is ignored by the decision-maker, the team member should assertively voice their concern at least two times to ensure that it has been heard by the decision-maker. This strategy is referred to as the two-challenge rule. When this rule is adopted as a policy by a healthcare organization, it empowers all team members to pause care if they sense or discover an essential safety breach. The decision-maker being challenged is expected to acknowledge the concern has been heard (AHRQ, 2014).

CUS assertive statements

During emergent situations, when stress levels are high or when situations are charged with emotion, the decisionmaker may not “hear” the message being communicated, even when the two-challenge rule is implemented. It is helpful for agencies to establish assertive statements that are well-recognized by all staff as the implementation of the two-challenge rule. These assertive statements are referred to as the CUS mnemonic: “I am Concerned – I am Uncomfortable – This is a Safety issue!” (AHRQ, 2014).

Using these scripted messages may effectively catch the attention of the decision-maker. However, if the safety issue still isn’t addressed after the second statement or the use of “CUS” assertive statements, the team member should take a stronger course of action and utilize the agency’s chain of command. For the two-challenge rule and CUS assertive statements to be effective within an agency, administrators must support a culture of safety and emphasize the importance of these initiatives to promote patient safety.

Managing conflict

Conflict is not uncommon on interprofessional teams, especially when there are diverse perspectives from multiple staff regarding patient care. Nurse leaders must be prepared to manage conflict to support the needs of their team members. When conflict occurs, the DESC tool can be used to help resolve conflict by using “I statements.” DESC is a mnemonic that stands for the following:

  • D: Describe the specific situation or behavior; provide concrete data.
  • E: Express how the situation makes you feel/what your concerns are using “I” statements.
  • S: Suggest other alternatives and seek agreement.
  • C: Consequences stated in terms of impact on established team goals while striving for consensus (AHRQ, 2014).

The DESC tool should be implemented in a private area with a focus on WHAT is right, not WHO is right.

Key Takeaways

  • Professionalism means conducting oneself with responsibility, integrity, accountability, and excellence while also communicating effectively and appropriately.
  • A critical skill for healthcare professionals is the ability to work efficiently and effectively with other healthcare workers.
  • Healthcare professionals collaborate with the interprofessional team by not only assigning and coordinating tasks but also by promoting solid teamwork in a positive environment.

Vocabulary

  • Brief – A short session to share a plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, and anticipate outcomes and contingencies
  • Communication – Structured process by which information is clearly and accurately exchanged among team members
  • CUS – Mnemonic to catch the attention of a decision-maker during emergent situations; stands for “I am Concerned – I am Uncomfortable – This is a Safety issue!”
  • Debrief – An informal information exchange session designed to improve team performance and effectiveness through reinforcement of positive behaviors and reflection on lessons learned
  • DESC – Mnemonic to manage conflict among team members; stands for Describe the situation or behavior, Express how it makes you feel or what your concerns are, Suggest other alternatives and seek agreement, and Consequences (impact on established team goals)
  • Huddle – A brief meeting before and/or during a shift to establish situational awareness, reinforce plans already in place, and adjust the teamwork plan as needed
  • I’M SAFE – Mnemonic tool used to assess one’s own safety status and the safety status of other team members
  • Interprofessional Collaborative Practice – Multiple health workers from different professional backgrounds working together to deliver the highest quality of care
  • Leadership – The ability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources
  • Mutual Support – The ability to anticipate and support team members’ needs through accurate knowledge about their responsibilities and workload
  • Professionalism – Conducting oneself with responsibility, integrity, accountability, and excellence
  • Situation Monitoring – The process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning
  • STEP Tool – A situation monitoring tool; stands for Status of the patients, Team members, Environment, and Progress toward goal
  • TeamSTEPPS® – An evidence-based framework to optimize team performance across the healthcare system
  • Teamwork Processes – The interrelated knowledge, skills, and attitudes that allow teams to work together to accomplish interdependent goals

Chapter 6 Test Yourself

Instructions: Select one of the gray boxes below to see if your answer is correct.

Chapter 6 Crossword puzzle

Instructions: Type in your answers below to fill in the crossword puzzle.

Please see Appendix C for an offline copy of the Chapter 6 Test Yourself activity. To view interactive H5P elements that have been excluded from this version of the text, please visit it online here: https://pressbooks.uwf.edu/healthcarecareerfoundations/?p=44#h5p-26

References And Attributions

Introduction

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U.S. Department of Labor (n.d.). Professionalism. https://www.dol.gov/sites/dolgov/files/odep/topics/youth/softskills/professionalism.pdf

Developing Professionalism

Interpersonal Relationships at Work” in Interpersonal Communication- A Mindful Approach to Relationships by Jason S. Wrench, Narissra M. Punyanunt-Carter, and Katherine S. Thweatt. Published by Milne Library Publishing under a CC BY-NC-SA 4.0 license.

Professionalism” in Career Guide for Health and Wellness Office Administrative Professionals by Ellen Dilgert. Published by eCampusOntario under a CC BY-NC-SA 4.0 license. Lightly edited for brevity and to change to American spelling conventions.

Half, R. (2016, March 4). 30 character traits of mentally strong peoplehttps://www.roberthalf.com/blog/management-tips/30-character-traits-of-mentally-strong-people

Indeed Editorial Team. (2021, July 20). 17 performance review tips for employees. Indeed. https://ca.indeed.com/career-advice/career-development/performance-review-tips-for-employees

Mind Tools Content Team. (n.d.). Professionalism meeting the standards that matter. Mind Tools. https://www.mindtools.com/pages/article/professionalism.htm

Piccirilli, G. (2018, January 2). Knowledge center: 10 characteristics of professionalism in the workplace. AAPC. https://www.aapc.com/blog/40477-10-characteristics-of-professionalism-in-the-workplace/

Emotional Intelligence in the Workplace” [YouTube video] by MindToolsVideos. All rights reserved.

Interprofessional Collaboration

Interprofessional Collaborative Skills

Module 1. Introduction” and “Module 2: Evidence-Base: Team Structure” from TeamSTEPPS® Fundamentals Course developed by the Agency for Healthcare Research and Quality. Published under public domain for noncommercial use. Lightly edited for brevity, clarity, and flow. For more information, visit www.ahrq.gov/teamstepps.

Collaboration Within the Interprofessional Team Introduction” in Nursing Management and Professional Concepts by Chippewa Valley Technical College. Published by the Wisconsin Technical College System under a CC BY 4.0 license.

TeamSTEPPS: National implementation research/evidence base. U.S. Department of Health and Human Services. https://www.ahrq.gov/teamstepps/evidence-base/safety-culture-improvement.html

National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982

World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice

IPEC Core Competencies

IPEC Core Competencies” in Nursing Management and Professional Concepts by Chippewa Valley Technical College. Published by the Wisconsin Technical College System under a CC BY 4.0 license. Lightly edited for consistency with its new context.

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. https://ipec.memberclicks.net/assets/2016-Update.pdf

Values and Ethics for Interprofessional Practice

Values and Ethics for Interprofessional Practice” in Nursing Management and Professional Concepts by Chippewa Valley Technical College. Published by the Wisconsin Technical College System under a CC BY 4.0 license.

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. https://ipec.memberclicks.net/assets/2016-Update.pdf

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. https://ipec.memberclicks.net/assets/2011-Original.pdf

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Roles and Responsibilities of Healthcare Professionals

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Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. https://ipec.memberclicks.net/assets/2016-Update.pdf

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. The American Psychologist, 73(4), 433-450. https://doi.org/10.1037/amp0000298

Healthcare Team Roles

Behavior Analysts description provided by Sarah Kent.

29-1223.00 – Psychiatrists” by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA). Published under a CC BY 4.0 license.

Occupation descriptions from the Occupational Outlook Handbook except where noted. Published by the U.S. Bureau of Labor under a public domain license. Lightly edited for brevity and flow.

Interprofessional Communication 

Interprofessional Communication” in Nursing Management and Professional Concepts by Chippewa Valley Technical College. Published by the Wisconsin Technical College System under a CC BY 4.0 license.

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. https://ipec.memberclicks.net/assets/2016-Update.pdf

The Joint Commission. 2023). 2023 Hospital national patient safety goals. https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2023/hap-npsg-simplified-2023-july.pdf

O’Daniel, M., & Rosenstein, A. H. (2011). Professional communication and team collaboration. In: Hughes R.G. (Ed.). Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US); Chapter 33. https://www.ncbi.nlm.nih.gov/books/NBK2637

Teams and Teamwork

Teams and Teamwork” in Nursing Management and Professional Concepts by Chippewa Valley Technical College. Published by the Wisconsin Technical College System under a CC BY 4.0 license. Lightly edited for consistency with its new context.

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. https://ipec.memberclicks.net/assets/2016-Update.pdf

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. https://ipec.memberclicks.net/assets/2011-Original.pdf

O’Daniel, M., & Rosenstein, A. H. (2011). Professional communication and team collaboration. In: Hughes R.G. (Ed.). Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US); Chapter 33. https://www.ncbi.nlm.nih.gov/books/NBK2637

TeamSTEPPS

Teams and Teamwork” in Nursing Management and Professional Concepts by Chippewa Valley Technical College. Published by the Wisconsin Technical College System under a CC BY 4.0 license. Lightly edited for clarity and consistency with its new context.

Agency for Healthcare Research and Quality. (2012). TeamSTEPPS 2.0. https://www.ahrq.gov/teamstepps/instructor/index.html

TeamSTEPPS Overview” [YouTube video] by AHRQ. All rights reserved.

Agency for Healthcare Research and Quality. (2014). Pocket Guide: TeamSTEPPS. https://www.ahrq.gov/teamstepps/instructor/essentials/pocketguide.html#communication

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Career Cornerstones: Establishing a Foundation for a Career in Healthcare Copyright © 2023 by Katherine Greene and Andrea Nelson is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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