By Bethany Robertson (@bdrclo)
In the last blog, I shared some history about those that have gone before me in building and IPE platform for us today. I am a bit ashamed actually, as I never entertained there was a history to IPE— but I have no earthly idea why I would not! As I mentioned I ‘met’ Madeline and knew of her extensive work in the field but truthfully, I had never heard of Bud Baldwin or John Gilbert. My head has been in the sand and I clearly chose to ignore there was a history to IPE before I joined the movement.
So comes my invitation to all of us to explore our personal history as it can help us charter a course for future work.
I was inspired to reflect on my own history after I recently read an article entitled, “An Interprofessional journey: a valedictory editorial” by Hugh Bar published in the Journal of Interprofessional Care. He begins the piece with the following introduction “Colleagues often recall how their interprofessional journeys began by accident. Permit me to share mine setting aside the habit of a lifetime trying to be detached and objective. Explore with me currents and undercurrents, celebrating successes and ruing failures, winning and losing friends”.
Permit me to share my history with Interprofessional Education (IPE). I fell into IPE serendipitously. I am a collaborative person by nature—I often refer myself as a “bridge builder” or “line crosser”. The definition, according to Collins Dictionary, means “efforts to establish communications and friendly contacts between people in order to make them friends or allies”. In terms of “line crosser”, Webster defines this as “someone who is known for crossing lines consistently without caring”. Depending on the event and context, a line crosser can be perceived as a negative action. In my case, my professional focus has been on building teams and in order to do that, you must come out of your silo and “cross the line” to understand, work with and support those not in your professional tribe. To your own professional tribe, this behavior can be perceived as defection, mal-alignment, and threatening. So save these frameworks for further discussion shortly.
In 2006, I decided to pursue a doctoral degree after having almost two decades of clinical practice and teaching. I was exploring topics for my project and I was very intrigued by the concept of communication and its role on patient outcomes. The more I investigated the concept, the more I was lead to a larger framework, which was teams, teamwork and its role in patient safety and quality. It was bit like pulling the starter thread on a ball of yarn, things began to unfold in my academic endeavors. While my classmates focused their doctoral work on deepening their understanding of a variety of aspects of disease states like dementia or diabetes, I “crossed a line” by navigating into the world of industrial/organizational psychology through an independent study at highly technical academic institution; a very different world than then nursing. I was exposed to organizational development concepts and principles and I learned that teamwork actually had a science with models that demonstrate positive outcomes in a variety of venues. As I learned more, it was clear that these models had great promise in addressing patient safety.
Fast forward into my post-doctoral work, I became a Co-PI on a Quality Safety Education For Nurses (QSEN) grant and as such, was charged with integrating teamwork competencies into the undergraduate nursing curriculum; and it is here where the value of IPE was brought home. While I had received a lot of theoretical knowledge in my doctoral studies, it was in the applied practice of ‘building a bridge’ with the school of medicine that I learned not only the complexities associated with a joint activity but the deep desire of students to get to know one another as well as their respective roles and responsibilities. It was apparent that this foundation work had value for not only students but also faculty facilitators we recruited to support our IPE activity. Since this epiphany, my work has always focused on either researching, teaching or leading inter-professional teams; however, it is constant work as there are cultural and structural challenges to inter-professional work in both academic and practice settings.
In March 2001, the Institute of Medicine (IOM) (now called the National Academy of Medicine) published a report on health care quality in the United States called Crossing the Quality Chasm: A New Health System for the 21st Century. It details how teamwork is a system property, one in which the system must support in order for us to consistently overt causing harm. It calls on healthcare to create safer systems/structures that support individuals to do the right thing: work in teams. Depsite this call to action, academia and practice have made very little headway in revamping our structures to facilitate more IPE and practice. Academia rewards individual work, research and teaching. We laud inter-professional work but we do not set up structures or systems to support this work. IPE with health professions students is not a default but rather as an ‘add on’ random experience or at best, becomes an elective. In practice, where you would think teams would naturally fall together, structures are not in place to facilitate natural organizing as a team, sharing information and engaging the patient as part of the team. Our workflows are not sync but rather we are like neutrons and protons flying around a nucleus but not in a coordinate or connected fashion and ultimately, patients suffer from our lack of coordination and communication.
What is the ‘bridge builders’ and ‘line-crossers’ supposed to do? The task seems daunting for so many reasons, least of which are the countercultural influences. However, what I have found is there are many people, who exist under the weighty influences and structures, which inherently believe in, value, want to be inter-professional, and they too are swept in the currents that prevent its natural team formation. When I find these people, AND many are the students, who have this kindred spirit we begin to brainstorm small tests of change. What is possible we can do together that is small; not requiring us to take on the ‘establishment’ yet engages learners, teachers, and practitioners. I use to think small was not good; big was better but as I have engaged in both sizes of activities, my opinion has changed. The second piece of advice I would give is to have faith that what you are doing will have an impact one day. The effort is great and the yield is seemingly small but longitudinally, there is substantive change. I have two separate and distinct stories of how the impact of participating in an IPE event I lead, had significant impact on individuals. The first created a practice-based model of interprofessional patient centered rounding of which he is known nationally and internationally and the other to have part of his professional activities is to teach teamwork skills to his colleagues. Their impact and spread is exponential.
I encourage you to become a ‘bridge builder’ and line-crosser this year. Look around you for ways you can start small with someone that values teamwork.
Don’t miss the third post in the series, coming out Tuesday, April 27, 2021!
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