When working as an independent healthcare group member

Easily display you and your family’s member ID cards anywhere, anytime.

An interdisciplinary approach involves team members from different disciplines working collaboratively, with a common purpose, to set goals, make decisions and share resources and responsibilities.1

A team of clinicians from different disciplines, together with the patient, undertakes assessment, diagnosis, intervention, goal-setting and the creation of a care plan. The patient, their family and carers are involved in any discussions about their condition, prognosis and care plan.2

In contrast, a multidisciplinary approach involves team members working independently to create discipline-specific care plans that are implemented simultaneously, but without explicit regard to their interaction.3

Depending on the resources of the individual health service, a combination of the two approaches may be used when caring for older people.

Why is it important?

• Older people in hospitals often have a number of different diagnoses and consequently have multiple and complex needs. Compared to younger age groups, a greater proportion of older people require an interdisciplinary approach to their care in order to deal with complex multimorbidity, social and psychological issues.3
• The best possible outcomes for older people are achieved through a consultative, collaborative approach to care that actively involves the patient, their family/carers and an interdisciplinary team.1
• An interdisciplinary approach can help avoid risk averse thinking by weighing up the risk against benefits for the patient.
• An interdisciplinary approach can improve patient outcomes, healthcare processes and levels of satisfaction.4,5 It can also reduce length of stay 6,7 and avoid duplication of assessments, leading to more comprehensive and holistic records of care.8
• The opportunity for discussion created by interdisciplinary care planning can be used for the patient, their family and carers to develop their ongoing plan.3

How can you adopt an interdisciplinary approach to caring for older people?

The care team need to work together, utilising an interdisciplinary approach, to provide and implement a care plan that meets the patient’s goals and needs.

All health care professionals have a shared role in providing person-centred care for older people.

Elements integral to a successful interdisciplinary approach

Leadership

Positive leadership and management give clear direction and vision for the team through:

• Promoting an atmosphere of trust where contributions are valued and consensus is fostered.
• Ensuring that the necessary resources, infrastructure and training are available, as well as a mix of skills, competencies and personalities amongst team members.9

Person-centred practice

Well-integrated and coordinated care that is based on the needs of the patient can contribute to reducing delays to provision of care and duplicating assessment.1

• Involving the patient in all aspects of their care empowers them to speak up and contribute to decision-making.
• Formulating shared standardised interdisciplinary care plans and records of care to contribute to holistic and comprehensive person-centred care.

Teamwork

An interdisciplinary approach relies on health professionals from different disciplines, along with the patient, working collaboratively as a team. The most effective teams share responsibilities and promote role interdependence while respecting individual members’ experience and autonomy.9

• Ensure team members have clear goals, and an understanding of their shared roles and responsibilities within the team structure.5
• Participate in joint assessment, diagnosis and goal setting.
• Recognise the overlap in knowledge and expertise of staff from different disciplines.8
• Encourage team cohesiveness and creativity through team commitment and the identification of mutual goals.5
• Encourage less experienced team members to ask questions which may give rise to creative ideas and alternative perspectives.5
• Establish teams with members from diverse disciplines to foster higher overall effectiveness, and hold regular team meetings which are associated with higher levels of innovation.10

Communication

Communication across disciplines, care providers and with the patient and their family/carers, is essential to setting the goals that most accurately reflect the person’s desires and needs.

• Involve the patient’s GP or pharmacist to increase the success of the intervention.11
• Communicate openly to encourage genuine collaboration. A breakdown of communications between health professionals is a common factor in hospital errors and adverse events.4,12
• Document assessments and ensure clinical handover documents are completed thoroughly and stored in a central place.

1. Department of Human Services 2008, Health independence programs guidelines, State Government, Melbourne.

2. Jessup RL 2007, ‘Interdisciplinary versus multidisciplinary care teams: do we understand the difference?’, Australian Health Review, 31(3):330-331.

3. Continuing Care Section, Programs Branch, Metropolitan Health and Aged Care Services Division, Department of Human Services 2003, Improving care for older people: a policy for health services, State Government of Victoria, Melbourne. .

4. Fewster-Thuente L & Velsor-Friedrich B 2008, ‘Interdisciplinary collaboration for healthcare professionals’, Nursing Administration Quarterly, 32(1):40-48.

5. Youngwerth J & Twaddle M 2011, ‘Cultures of Interdisciplinary Teams: How to Foster Good Dynamics’, Journal of Palliative Medicine, 14(5):650-654.

6. Curley C, McEachern JE & Speroff T 1998, ‘A firm trial of interdisciplinary rounds on the inpatient medical wards – An intervention designed using continuous quality improvement’, Medical Care, 36(8):AS4-AS12.

7. Curley C, McEachern JE & Speroff T 1998, ‘A firm trial of interdisciplinary rounds on the inpatient medical wards – An intervention designed using continuous quality improvement’, Medical Care, 36(8):AS4-AS12.

8. Jacob A, Roe D, Merrigan R & Brown T 2013, ‘The Casey Allied Health Model of Interdisciplinary Care (CAHMIC): Development and implementation’, International Journal of Therapy & Rehabilitation, 20(8):387-395.

9. Nancarrow SA, Booth A, Ariss S, Smith T, Enderby P & Roots A 2013, ‘Ten principles of good interdisciplinary team work. Human Resources for Health’, 11(1):1-11. doi:10.1186/1478-4491-11-19.

10. Xyrichis A & Lowton K 2008, ‘What fosters or prevents interprofessional teamworking in primary and community care? A literature review’, International Journal of Nursing Studies, 45:140-153.

11. Nazir A, Unroe K, Tegeler M, Khan B, Azar J & Boustani M, 2013, ‘Systematic Review of Interdisciplinary Interventions in Nursing Homes’, Journal of the American Medical Directors Association, 14(7):471-478.

12. Mansah M, Griffiths R, Fernandez R, Chang E & Thuy Tran D 2014, ‘Older folks in hospitals: the contributing factors and recommendations for incident prevention’, Journal of Patient Safety, 10(3):146-153.

1. Mitchell P, Wynia M, Golden R, McNellis B, Okun S, Webb CE, et al. Core Principles and Values of Effective Team-Based Health Care Discussion Paper. Washington, DC: Institute of Medicine; 2012. [Google Scholar]

2. World Health Organization. Being an effective team player Available from: URL: http://www.who.int/patientsafety/education/curriculum/who_mc_topic-4.pdf Accessed 2Decemeber 2014.

3. Compassion in practice – nursing, midwifery and care staff – our vision and strategy, the Chief Nursing Officer for England’s Conference. 4 December 2012. Available from: http://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf Accessed 19August2013.

4. Frampton S, Guastello S, Brady C, et al. Patient centered care improvement guide. VII.A. Communicating effectively with patients and families Boston: Planetree, Inc. and Picker institute; 2008. pp 77–199. Available from: 1. URL: http://www.patient-centeredcare.org/chapters/chapter7a.pdf Accessed 19August2013. [Google Scholar]

5. Naylor MD, Coburn KD, Kurtzman ET, Prvu Bettger JA, Buck H, Van Cleave J. et al. Inter-professional team-based primary care for chronically ill adults: State of the science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings Philadelphia, PA; March 24–25, 2010. [Google Scholar]

6. Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med 1994; 121:866–872. [PubMed] [Google Scholar]

7. Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med 2008; 168:1755–1760. [PubMed] [Google Scholar]

8. Williams RG, Silverman R, Schwind C, Fortune JB, Sutyak J, Horvath KD, et al. Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care. Ann Surg 2007; 245:159–169. [PMC free article] [PubMed] [Google Scholar]

9. Sentinel Event Alert, Issue 30: Preventing infant death and injury during delivery http://www.jointcommission.org/Sentinel_Event_Alert_Issue_30_Preventing_infant_death_and_injury_during_delivery_Additional_Resources/. Accessed November25, 2014.

10. Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery 2003; 133:614–621. [PubMed] [Google Scholar]

11. Olsen L, Young PL. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary National Academies Press; 2010. Available from: http://www.nap.edu/openbook.php?record_id=12750 Accessed November25, 2014. [Google Scholar]

12. Famadas JC, Frick KD, Haydar ZR, Nicewander D, Ballard D, Boult C. The effects of interdisciplinary outpatient geriatrics on the use, costs and quality of health services in the fee-for-service environment. Aging Clinical and Experimental Research 2008; 20:556–561. [PubMed] [Google Scholar]

13. Boult C, Green AF, Boult LB, Pacala JT, Snyder C, Leff B. Successful models of comprehensive care for older adults with chronic conditions: Evidence for the Institute of Medicine’s Retooling for an Aging America report. Journal of the American Geriatrics Society 2009; 57:2328–2337. [PubMed] [Google Scholar]

14. Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA 2004; 291:1246–1251. [PubMed] [Google Scholar]

15. Gawande A. Cowboys and Pit Crews Harvard Medical School Commencement Address, 2011. [Google Scholar]

16. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical Practice Guidelines We Can Trust Washington (DC): National Academies Press (US); 2011. Available from: http://www.nap.edu/openbook.php?record_id=13058&page=R1 Accessed November25, 2014. [Google Scholar]

Page 2

The benefits of effective teamwork