“All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.” 

Health Professions Education –
A Bridge to Quality, Institute of Medicine, 2003

Imagine you are a new hire coming into the intensive care unit (ICU) for your first full day of work. You have a quick step and excitement in your eyes. You are ready to begin caring for your first patient because you are prepared, have new energy, and know you can provide safe quality care with compassion to the sickest of patients in the critical care setting. You know the pathophysiology of the critically ill patient, you have the skills to complete difficult procedures, and you learned to incorporate the five Institute of Medicine’s (IOM) education competencies1— providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics—into your practice.

In your new unit, you believe your colleagues are practicing patient-centered care through the multiprofessional team approach with evidencebased practice, while applying quality improvement processes and the latest technologies. This first day is going to be the best day of a new career!

But wait, you realize there are no multiprofessional rounds in the unit, daily goals are not being set for patients or their families, and evidence-based practice is considered a “new concept,” as patient care has been delivered in “a certain way” for many years. Actually, over time, you realize that maybe what you learned and have been practicing is not really happening in the ICU you are working in at all. You have found some resistance to new concepts from your colleagues, and you begin to question your education and your practice. You feel as if you have to make a decision: “Do I stay and fight to incorporate these competencies into practice? Do I become complacent and follow what the rest of the group is doing? Or do I just leave?” The decisions you make regarding these questions will impact not only your professional growth, but also the growth of the unit, the institution and the quality of patient care provided . In the example above, the individual who is new to the unit recognizes the importance of multiprofessional teams and the value of goal setting for the patient. What seems to be missing is the practice of using multiprofessional teams to set goals.

The Society of Critical Care Medicine (SCCM) has recognized and promoted the concept of a multiprofessional team approach to critical care for more than 30 years, as envisioned in the organization’s mission: “SCCM envisions a world in which all critically ill and injured persons receive care from integrated teams of dedicated experts directed by trained and present intensivist physicians. Multiprofessional teams use knowledge, technology and compassion to provide timely, safe, effective, and efficient patient-centered care.” The new hire knows that this vision is consistent with improving outcomes when working in a multiprofessional approach.

Critical care settings are the ideal environments to promote teamwork. The complexity of patient care, the needs of patients and their families, technological advances, and the demands of payors have placed additional stresses on critical care professionals. The critical care setting is the right place for a multiprofessional team. Utilizing teams will help to reduce redundancy or duplicate services, assist with developing solutions to complex problems of the changing patient status, and provide coordinated care. Multiprofessional teams have been shown to enhance quality, lower costs, and reduce errors.

Although the new hire faces the “this is how we have always done it” obstacle, the IOM has set the tone to change this type of environment. The IOM believes change begins in the academic centers. Traditionally, healthcare professionals were educated in “silos,” separated from one another during their education. When this kind of education is fostered and promoted, the end results are a feeling of hierarchy of roles, power relationships, and strengthening of professional identities. Individuals entering into the healthcare field as new students take a “silo” attitude into practice. This attitude begins to permeate the work environment and subsequently, the philosophy of “this is how we have always done it” perpetuates.

Healthcare delivery can no longer afford to run inefficiently by working in individual “silos.” Although “silos” may be common in the practice of many disciplines within the healthcare arena, the critical care practitioner strives for a multiprofessional approach, knowing this type of work environment will improve patient outcomes. The public is becoming much more aware of health issues, and they expect improved outcomes that are reflective of high quality care.

As the population ages and more healthcare networks are developed, the need to coordinate efficient, safe and high-quality patient care becomes vital. Most consumers are more educated now than they have been in the past. This is in part due to the vast network of the Internet and other media vehicles. Consumers want to be heard. They want to make decisions about their own healthcare. They want safe, quality care, and they want their care coordinated with consistent answers to their questions. Overall, consumers want healthcare professionals to understand their needs and provide the information they need to make informed decisions. Consumers do not want to be treated only as a “disease”; rather they are “interested in customized treatment recommendations that are responsive to their preferences and beliefs and reflect an understanding of their environment, including home life, job, family relationships, cultural background, and other factors.”1

So how can the new hire in this story make a change? Identifying a champion or role model who emulates team-building behavior and fosters personal and professional growth may be one solution. Healthcare professionals who believe in the team approach view new patients and their families as individuals and not as part of narrow, task-specific treatment regimens. Team members respond to the changing needs of the patient and family. Promoting a team environment will provide support to your colleagues and enhance creative problem-solving solutions.

Whether you are a new hire or veteran practitioner, many of you have been faced with the difficult decision of implementing change. The easiest decision may be to become complacent or just leave. However, the more challenging charge is to stay and dedicate yourself to creating an environment that emulates what you want to practice. If you are not ready to be a team leader, there may be others who just need a little help getting started. This is the beginning of a team!