Chapter 3- Roles and Responsibilities
Learning Objectives
- Differentiate the responsibilities and roles of healthcare professionals.
- Assess the components of IPEC’s Roles and Responsibilities competency.
- Discuss how health professionals collaborate to improve patients’ health outcomes.
Introduction
In the ever-evolving field of healthcare, understanding the roles and responsibilities of different professionals is not just a requirement for those within the system; it’s a lens through which we can view the entire healthcare landscape. With the growing complexity of healthcare needs and the emphasis on patient-centered care, the orchestration of healthcare roles is more crucial than ever. In this chapter, we will explore how these roles are defined and differentiated and why it’s essential to respect each profession’s scope of practice. We will also review how these elements come together to address health needs in a world where healthcare extends beyond the confines of traditional medical settings into the heart of communities.
ROLES AND RESPONSIBILITIES FOR INTERPROFESSIONAL PRACTICE
The second IPEC competency relates to the roles and responsibilities of healthcare professionals and states, “Use the knowledge of one’s own role and team members’ expertise to address health outcomes” (Interprofessional Education Collaborative, 2023).
Components of IPEC’s Roles and Responsibilities Competency
- Include the full scope of knowledge, skills, and attitudes of team members to provide care that is person-centered, safe, cost-effective, timely, efficient, effective, and equitable.
- Collaborate with others within and outside of the health system to improve health outcomes.
- Incorporate complementary expertise to meet health needs including the social determinants of health.
- Differentiate each team member’s role, scope of practice, and responsibility in promoting health outcomes.
- Practice cultural humility in interprofessional teamwork.
Source: Core Competencies for Interprofessional Collaborative Practice: Version 3 from the Interprofessional Education Collaborative.
Understanding team members’ roles and responsibilities
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.
The table below provides examples of the roles and responsibilities of common healthcare team members, both within and outside of the healthcare system.
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.
- 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 physicians.
- 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.
- Medical Laboratory Scientists (MLSs)
- Perform medical laboratory tests that physicians or other healthcare practitioners order for the diagnosis, treatment, and prevention of disease.
- 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.
Scopes of Practice
Although many types of healthcare workers may work together on a team, some professionals are bound by a scope of practice. Legal scopes of practice for the healthcare professions establish which professionals may provide which healthcare services, in which settings, and under which guidelines or parameters. With few exceptions, determining scopes of practice is a state-based activity. State legislatures consider and pass the practice acts, which become state statutes or codes. State regulatory agencies, such as medical and other health professions’ boards, implement the laws by writing and enforcing rules and regulations detailing the acts.
Due to the state-based nature of this process, the practice acts and subsequent rules and regulations vary from state to state for the different professions. Some of the variances are relatively minor; others are significant. Some professions are not recognized in all states. Some professions are permitted to provide considerably broad ranges of services in some states but limited in others. Because legal scopes of practice can facilitate or hinder patients from seeing a particular type of health provider, the regulations have direct impacts on access to and cost of care. Quality of care may also be affected.
Coordinating roles across the Care Continuum
Effective healthcare extends beyond the immediate clinical team and involves collaboration with a broader network of services and healthcare professionals. Collaboration across the continuum of care, from prevention to rehabilitation, requires that each healthcare professional recognize where their responsibilities begin, how they intersect with others, and when they transition to the next person.
Social Determinants of Health
A patient’s health outcomes are influenced by more than the care they receive in a doctor’s office. The social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. They can be grouped into 5 domains:
- Economic stability
- Education access and quality
- Healthcare access and quality
- Neighborhood and built environment
- Social and community context
Social determinants of health, although experienced by individuals, exist at the community level. Healthcare systems that learn about the communities their patients live in, and the community-level barriers members can face to becoming and staying healthy, can better adapt their recommendations to people’s lives. They can be categorized into five key areas:
- Social context: (e.g., demographics, social networks, and supports; social cohesion; racial, ethnic, religious, and gender discrimination; community safety; criminal justice climate; civil participation).
- Economic context (e.g., employment, income, poverty).
- Education (e.g., quality of daycare, schools, and adult education; literacy and high school graduation rates; English proficiency).
- Physical infrastructure (e.g., housing, transportation, workplace safety, food availability, parks and other recreational facilities, environmental conditions, sufficiency of social services).
- Healthcare context (e.g., access to high-quality, culturally and linguistically appropriate, and health literate care; access to insurance; healthcare laws; health promotion initiatives; supply side of services; attitudes towards healthcare; and use of services).
Continuum of Care
The continuum of care can be defined as the provision of care from the entry of the patient into the system until care is no longer needed. The simplest way to envision this concept is “care from birth to death.” Another way to picture it is for a specific medical problem. Imagine the number of organizations that are involved in a severe injury from a motor vehicle accident. It could include emergency care to stabilize the patient, surgery to repair the injuries, and rehabilitation to return the patient to normal function. There are some specialized organizations such as rehabilitation institutions that provide care only in a specific phase of this continuum.
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.
Connecting Health Systems and Communities
Clinical-community linkages help to connect healthcare providers, community organizations, and public health agencies so they can improve patients’ access to preventive and chronic care services. Creating sustainable, effective linkages between the clinical and community settings can improve patients’ access to preventive and chronic care services by developing partnerships between organizations that share a common goal of improving the health of people and the communities in which they live. These linkages connect clinical providers, community organizations, and public health agencies.
The goals of clinical-community linkages include:
- Coordinating health care delivery, public health, and community-based activities to promote healthy behavior.
- Forming partnerships and relationships among clinical, community, and public health organizations to fill gaps in needed services.
- Promoting patient, family, and community involvement in strategic planning and improvement activities.
- Types of clinical-community linkages include coordinating services at one location, coordinating services between different locations, and developing ways to refer patients to resources.
What do effective clinical-community linkages offer?
- Patients get more help in changing unhealthy behaviors.
- Clinicians get help in offering services to patients that they cannot provide themselves.
- Community programs get help in connecting with clients for whom their services were designed.
Strategies that improve access to clinical preventive services (such as screening and counseling), community-level activities, and appropriate medical treatment have been shown to reduce and prevent disease in communities. Collaborations between clinical, community, and public health organizations offer a win-win scenario for participating organizations, clinical teams, and patients.
Interprofessional Healthcare Team Collaboration: Choose Your Own Adventure Activity
Readers using a screen reader or screen magnification, please visit Appendix B to use a text-based version of this activity.
- Effective interprofessional collaboration involves professionals from both inside and outside of health systems.
- Interprofessional healthcare teams are often comprised of professionals with diverse roles, responsibilities, and scopes of practice.
- Together, healthcare teams can work to improve patient outcomes, which may require addressing the social determinants of health and working across the continuum of care.
- Continuum of Care – The provision of care from the entry of the patient into the system until care is no longer needed.
- Scopes of Practice – Establish which professionals may provide which health care services, in which settings, and under which guidelines or parameters.
- Social Determinants of Health – The conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health outcomes.
References And Attributions
Roles and Responsibilities for Interprofessional Practice
Interprofessional Education Collaborative Expert Panel. (2023). Core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/assets/core-competencies/IPEC_Core_Competencies_Version_3_2023.pdf
Understanding Team Members’ Roles and Responsibilities
“Roles and Responsibilities of Healthcare Professionals” 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.
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, flow, and clarity.
Scopes of Practice
“Promising Scope of Practice Models for the Health Professions” by Catherine Dower, JD, Sharon Christian, JD and Edward O’Neil, PhD, MPA, FAAN. Published by the Center for the Health Professions, University of California. Copyright 2007 UCSF Center for the Health Professions.
Coordinating Roles Across the Care Continuum
Social Determinants of Health
“Social Determinants of Health” from Healthy People 2030. Published by Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services under public domain.
“About SDOH in Healthcare.” Published by Agency for Healthcare Research and Quality under public domain.
Continuum of Care
“Healthcare Settings – The Places Where Care is Delivered: Lecture A” from The Culture of Healthcare as part of the Health IT Workforce Curriculum. Developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. Published under a CC BY-NC-SA 3.0 license.
“Roles and Responsibilities of Healthcare Professionals” 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.
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
Connecting Health Systems and Communities
“Clinical-Community Linkages.” Published by Agency for Healthcare Research and Quality under public domain.
Interprofessional Healthcare Team Collaboration: Choose Your Own Adventure Activity
Copyrighted images used with permission through a TechSmith Snagit license. Please see Appendix A for image credits.
Activity
Acknowledging Roles and Abilities of Team Members: A Simulated Geriatric Care Team Meeting With the Coopers by Kristine Kamm, Susan Simpkins, Amit Shah, Mary Quiceno, Roopali Gupta, and Kim Hoggatt Krumwiede. Published in MedEdPortal by the Association of American Medical Colleges under a CC BY-NC-SA license. Material was adapted to the H5P format. Content was edited for brevity and tone. Descriptions of role responsibilities were replaced to remain consistent with the textbook content. Branching questions, images, and videos were added.
Roles and Responsibilities
Occupation descriptions from the Occupational Outlook Handbook. Published by the U.S. Bureau of Labor under a public domain license. Lightly edited for clarity.
Videos
Summary. “A Person Having a Video Call” by cottonbro studio is licensed under the Pexels license.
Physician. “A Doctor Having Online Consultation on Her Laptop” by Tima Miroshnichenko is licensed under the Pexels license.
Physical therapist. “Person Doing Online Consultation” by Karolina Grabowska is licensed under the Pexels license.
Rehabilitation counselor. “A Male Teacher Teaching Online Classes” by Diva Plavalaguna is licensed under the Pexels license.
Long-Term Care Table Footnotes
1. National Institute on Aging. (n.d.). Long-term care facilities: Assisted living, nursing homes, and other residential care. U.S. Department of Health and Human Services. https://www.nia.nih.gov/health/assisted-living-and-nursing-homes/long-term-care-facilities-assisted-living-nursing-homes
2. Genworth. (2022). Genworth cost of care survey: Median cost data tables. [Annual median costs in Florida]. https://pro.genworth.com/riiproweb/productinfo/pdf/282102.pdf
3. AARP. (2022, January 27). How continuing care retirement communities work [National averages. Annual cost based on monthly average ($3,555) multiplied by 12]. https://www.aarp.org/caregiving/basics/info-2017/continuing-care-retirement-communities.html
4. National Institute on Aging. (n.d.). Aging in place: Growing older at home. U.S. Department of Health and Human Services. https://www.nia.nih.gov/health/aging-place/aging-place-growing-older-home
Conflict Resolutions
“Lessons from the Field: Promising Interprofessional Collaboration Practices.” 2015. White Paper, The Robert Wood Johnson Foundation, rwjf.org
“Person-Centered Care” by the Centers for Medicare and Medicaid Services. Published under public domain.
“Conflict Management” by Ronquillo, Y, Ellis, V. L., & Toney-Butler, T. J. Published by StatsPearls Publishing under a CC BY 4.0 license. Edited for brevity and consistency with its new context.
Image Descriptions
Image 3.1: A photo. A nurse and doctor sitting at a desk reviewing a laptop screen. [Return to Image 3.1].
Image 3.2: Infographic. Five icons represent the social determinants of health.. [Return to Image 3.2].
