Measuring the Process of Interprofessional Collaboration in the Care of Critically Ill Adults

Abstract

Interprofessional collaboration (IPC), the process by which clinicians integrate their skills and knowledge to make a clinical decision or attain a patient-centered goal, is theorized to improve the quality and safety of critical care. The process of IPC is particularly important in the care of mechanically ventilated (MV) adults—a vulnerable group of critically ill patients whose care requires close collaboration between nurses, respiratory therapists, and physicians. However, a rigorous evaluation of IPC and its effects on care delivery is lacking due to measurement limitations. Specifically, prior measurement approaches have failed to operationalize IPC as a dynamic process. One possible measurement solution is applying time-motion methods, an approach from industrial and operations engineering that focuses on evaluating processes, to quantify IPC. In the current study, I tested the feasibility of using time-motion methods to measure the process of IPC in the care of MV patients. Applying the necessary steps for a time-motion study, I first developed a task list describing the IPC process and then I collected observational data in one ICU on the process of IPC in the care of MV patients using a time-motion tool. To create the task list, I analyzed a set of previously collected qualitative data consisting of observations, shadowing experiences and interviews with ICU clinicians working in two ICUs in Southeastern Michigan. Once the task list was developed, member-checking interviews were conducted with ICU clinicians to assess the validity of the developed task list. The final task list included ten “enablers to collaborative activities” and eight “collaborative activities” (18 IPC behaviors total). I defined “enablers” as the ways clinicians transition into or facilitate collaboration and “collaborative activities” as those clinician behaviors that indicate direct engagement in collaboration. The task list was incorporated into the time-motion tool which I trained two observers, in addition to myself, to use to collect the observational data. To test the feasibility of using time-motion methods to measure the IPC process, we recruited nurses, respiratory therapists, and physicians working at a single ICU in Southeastern Michigan to participate in 3-4 hours long observations in which we collected data on the process of IPC in the care of MV patients using the time-motion tool. Following each observation session, observers also provided written feedback on their experiences collecting the data and using the tool. Descriptive statistics were analyzed to describe the frequency, and duration, at which clinicians engaged in the different behaviors on the task list. Furthermore, the observers’ feedback was analyzed to identify strengths and challenges with the current data collection approach. In total, we collected 61 hours of observation with 18 different ICU clinicians (6 RNs, 6 RTs, and 6 MDs). Most of the IPC behaviors were observed at least once on 50% or more of the observation days. The results indicated wide variation in the frequency, and duration, at which the different clinician roles engaged in specific enablers and collaborative activities. After evaluating the observers’ feedback, refinements to the time-motion tool and data collection approach were identified and should be tested in future work. Overall, collecting time-motion data on the process of IPC in the care of MV patients in a single ICU was found to be feasible. Clinicians engaged in IPC in diverse ways which underscores the complexity of the IPC process.