Factors influencing patient experience in hospital wards: a systematic review

BACKGROUND

Patient experience plays an essential role in improving clinical effectiveness and patient safety. It's important to identify factors influencing patient experience and to improve quality of healthcare.

OBJECTIVE

To identify factors that influence patient experience in hospital wards.

METHODS

We conducted a systematic review including six databases; they were PubMed, CINAHL, Embase, PsycInfo, ProQuest, and Cochrane. Studies were included if they met the inclusion criteria. The JBI checklist was used to perform quality appraisal. We used 5 domains of the ecological model to organize and synthesize our findings to comprehensively understand the multi-level factors influencing the issue.

RESULT

A total of 138 studies were included, and 164 factors were identified. These factors were integrated into 6 domains. All domains but one (survey-related factors) could be mapped onto the attributes of the ecological framework: intrapersonal, interpersonal, institutional, community, and public policy level factors. All factors had mixed effect on patient experience. The intrapersonal level refers to individual characteristics of patients. The interpersonal level refers to interactions between patients and healthcare providers, such as the caring time spent by a nurse. The institutional level refers to organizational characteristics, rules and regulations for operations, such as hospital size and accreditation. The community level refers to relationships among organizations, institutions, and informational networks within defined boundaries, such as a hospital located in a larger population area. Public policy level refers to local, state, national, and global laws and policies, including health insurance policies. The sixth domain, survey-related factors, was added to the framework and included factors such as survey response rate and survey response time.

CONCLUSION

The factors influencing patient experience are comprehensive, ranging from intrapersonal to public policy. Providers should adopt a holistic and integrated perspective to assess patient experience and develop context-specific interventions to improve the quality of care. PROSPERO REGISTRATION NUMBER CRD42023401066.

Measuring Team Functioning During the COVID-19 Pandemic: Perspectives of Cancer Care Team Members

Background

In a public health crisis such as COVID-19, cancer teams face significant challenges including acute work disruptions, rapid shifts in clinical practice, and burnout. Within this context, it is crucial to explore team functioning from the perspectives of multiple stakeholders.

Objective

This quantitative pilot study aimed to 1) measure perceptions of multi-stakeholders on key indicators of team functioning (Team Effectiveness, TE, and Team Relational Coordination, TRC) during COVID-19 and its transition, and 2) document whether patient perceptions of TE/TRC are significantly associated with their cancer care experiences.

Methods

A descriptive design with repeated measures was used. Through convenience sampling, participants were recruited from two outpatient cancer clinics at a large university-affiliated hospital, in Montréal, Qc, Canada. Sixty-six participants (ie, 13 healthcare professionals, 40 patients, 6 informal caregivers, and 7 volunteers) completed e-measures at T1 (years 2021-2022) and n = 44 at T2 (year 2023).

Results

At T1, participants reported high perceptions of Team Effectiveness (scale 1 to 6) M = 4.47; SD = 0.7 (Mdn = 4.54; IQR: 4.06-5) and Relational Coordination (scale 1 to 5) M = 3.77; SD = 0.77 (Mdn = 3.81; IQR: 3.12-4.38) with no significant differences in perceptions across the four groups. At T2, no significant changes in TE/TRC perceptions were found. At both time points, patient perceptions of TE/TRC were significantly correlated with positive cancer care experiences (Spearman rank correlation rs ranging from 0.69 and 0.83; p < 0.01).

Conclusion

To our knowledge, this is the first study documenting perceptions of cancer team functioning amidst the pandemic as reported by multiple stakeholders. Significant relationships between patient perceptions of TE/TRC and their cancer care experiences underscore the importance of including patients' views in team functioning processes. Future work should rely on larger sample sizes to further explore key elements of optimal team functioning.

Team Dynamics and Collaborative Problem-Solving for Lunar Construction: Lessons From Complex Construction Scenarios on Earth

OBJECTIVE

This paper surveys the existing literature surrounding problem-solving and team dynamics in complex and unpredictable scenarios, and evaluates the applicability of studying Earth-based construction teams to identify training needs for Lunar construction crews.

BACKGROUND

Lunar and other space exploration construction crews will work in extreme environments and face unpredictable challenges, necessitating real-time problem-solving to address unexpected contingencies. This work will require coordination with Mission Control and autonomous assistants, so crew training must account for multi-agent, distributed teamwork.

METHOD

A narrative literature review identified processes, attributes, and skills necessary for the success of Lunar construction teams. We summarized relevant frameworks and synthesized collective findings into over-arching trends and remaining research gaps.

RESULTS

While significant literature exists surrounding team performance, very little systematic inquiry has been done with a focus on Lunar construction crews and operations, particularly with respect to dynamic problem-solving and team-based decision-making. Established and standardized metrics for evaluating team performance are lacking, resulting in significant variation in reported outcomes between studies.

CONCLUSION

Lunar and other space exploration construction teams will need training that focuses on developing the right approach to team-based problem-solving, rather than on preparing response execution for known contingencies. An investigation of successful Earth-based construction crews may facilitate the development of relevant metrics for training future Lunar construction crews.

APPLICATION

Metrics and team training protocols developed for future Lunar construction teams may be adaptable and applicable to a wide range of extreme teams facing uncertain challenges, such as aircrews, surgical teams, first responders, and construction crews.

Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration

BACKGROUND

An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams.

METHODS

This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups.

RESULTS

A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel.

CONCLUSION

Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.

The effect of human resource development practice on employee performance with the mediating role of job satisfaction among Mizan Tepi University's academic staff in Southwestern Ethiopia

Purpose

This study examined the effect of human resource development practices on employee performance, with job satisfaction as a mediating variable among academic staff at Mizan Tepi University.

Methods

A standardized Likert-scale questionnaire was administered to academic staff members selected through stratified random sampling from eight colleges at Mizan Tepi University. Descriptive and inferential statistics, including a structural equation model and t-tests, were used for data analysis.

Results

The study found a significant positive correlation between human resource development practices and employee performance. Job satisfaction was identified as a mediator between HRM practices and employee performance. Specific dimensions of human resource development practices, such as training and development, academic career development, teamwork spirit, and counseling, had significant effects on employee performance, with both positive and negative impacts observed. Additionally, academic career development, succession planning, and counseling were found to have a statistically significant positive effect on the academic staff at Mizan Tepi University.

Conclusions

This study found that training and development, academic career development, teamwork, counseling, and job satisfaction significantly impact employee performance. The results of the regression analysis using the SEM model revealed that job satisfaction, training and development, and teamwork positively affect academic staff performance while negatively affecting academic career development and counseling. Academic career development, teamwork, counseling, and succession planning were found to have a positive effect on job satisfaction. The mediation analysis indicated that academic career development and counseling partially mediate employee performance, while succession planning fully mediates it. Therefore, focusing on training and development, performance appraisal, rewards, teamwork, academic career development, succession planning, and counseling is essential to enhancing job satisfaction among academic staff at Mizan Tepi University.

Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain)

BACKGROUND

The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19.

METHODS

A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method.

RESULTS

The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented.

CONCLUSIONS

The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.

Should the existing science of teams be applied to fluid teams? An exploration of fluid team effectiveness within the context of healthcare simulation

Introduction

Fluid teams have become increasingly prevalent and necessary for modern-day issues, yet they differ from more traditional teams, on which much of the current teams literature is based. For example, fluid teams are often comprised of members from different disciplines or organizational divisions who do not have a shared history or future, as they come together to perform a critical, time-sensitive task, and then disband. For these reasons, the mechanisms through which they function and perform may differ from those of more traditional teams, and research is needed to better understand these differences.

Methods

To this end, this study utilized critical incident techniques and thematic analysis to examine fluid teams within healthcare, one of the primary contexts in which they are prevalent. Interdisciplinary faculty and students in the medical field who encounter fluid teams within simulation-based education were prompted to reflect on key factors that facilitate or hinder fluid team effectiveness.

Results

Primary themes extracted pertained to the conditions fluid teams operate within (e.g., high-stress), the behaviors and emergent states that contribute to their success (e.g., communication), and the KSAO's of value for members of fluid teams to possess (e.g., readiness). These themes were then compared to existing literature, yielding the identification of some similarities but also many important differences between fluid and traditional teams.

Discussion

A series of practical recommendations for how to promote fluid team effectiveness is then presented.

Cancer Care Team Functioning during COVID-19: A Narrative Literature Review and Synthesis

Amid pandemics, health care teams face unprecedented challenges, requiring significant efforts to sustain optimal functioning and navigate rapid practice changes. It is therefore crucial to identify factors affecting team functioning in these contexts. The present narrative review more specifically summarizes the literature on key elements of cancer teams' functioning during COVID-19. The search strategy involved four main databases (i.e., Medline OVID, EMBASE, PsycINFO, and CINAHL), as well as Google Scholar, from January 2000 to September 2022. Twenty-three publications were found to be relevant. Each was read thoroughly, and its content summarized. Across publications, three key themes emerged: (1) swiftly adopting virtual technology for communication and interprofessional collaboration, (2) promoting team resilience, and (3) encouraging self-care and optimizing team support. Our findings underscore key team functioning elements to address in future pandemics. More research is needed to document the perspectives of broader-based team members (such as patients and lay carers) to inform more comprehensive evidence-based team functioning guidelines.

Exploring patient and caregiver perceptions of the meaning of the patient partner role: a qualitative study

BACKGROUND

The re-conceptualization of patients' and caregivers' roles in research from study participants to co-researchers ("patient partners") has led to growing pains within and outside the research community, such as how to effectively engage patients in research and as part of interdisciplinary teams. To support the growth of more successful research partnerships by developing a shared understanding of how patient partners conceptualize and contribute to their role, this study aimed to explore patient partners' motivations for engagement and understanding of their role.

METHODS

We conducted semi-structured interviews with participants (n = 13) of an online survey of activities and impacts of patient engagement in Strategy for Patient-Oriented Research projects. Eligibility criteria included being a patient partner that indicated interest in interview participation upon survey completion, the ability to read/write in English and provide informed consent. Data were analyzed thematically using an inductive, codebook thematic analysis.

RESULTS

Illuminating the lived/living patient and caregiver experience was central to how most patient partners conceptualized the role in terms of its definition, purpose, value, and responsibilities. Participants also identified four additional categories of motivations for becoming a patient partner and contributions that patient partners make to research that build upon and are in addition to sharing their lived/living experiences. Lastly, participants highlighted important connotations of the term patient partner, including temporal and context-specific considerations for the term "patient" and what "partner" may imply about the nature of the research relationship.

CONCLUSIONS

At the onset of partnership, academic researchers and patient partners must create the space necessary to discuss and understand each other's underlying motivations for partnering and their perspectives on the purpose, value, and responsibilities of the patient partner role. These early conversations should help unearth what research partners hope to get out of and feel that they are able to contribute to engaging, and in such contribute to the development of reciprocal relationships that work towards shared and valued goals. Trial registration Not applicable.

What can we learn from COVID-19?: examining the resilience of primary care teams

Introduction

The COVID-19 pandemic continues to place an unprecedented strain on the US healthcare system, and primary care is no exception. Primary care services have shifted toward a team-based approach for delivering care in the last decade. COVID-19 placed extraordinary stress on primary care teams at the forefront of the pandemic response efforts. The current work applies the science of effective teams to examine the impact of COVID-19-a crisis or adverse event-on primary care team resilience.

Methods

Little empirical research has been done testing the theory of team resilience during an extremely adverse crisis event in an applied team setting. Therefore, we conducted an archival study by using large-scale national data from the Veterans Health Administration to understand the characteristics and performance of 7,023 Patient Aligned Care Teams (PACTs) during COVID-19.

Results

Our study found that primary care teams maintained performance in the presence of adversity, indicating possible team resilience. Further, team coordination positively predicted team performance (B = 0.53) regardless of the level of adversity a team was experiencing.

Discussion

These findings in turn attest to the need to preserve team coordination in the presence of adversity. Results carry implications for creating opportunities for teams to learn and adjust to an adverse event to maintain performance and optimize team-member well-being. Teamwork can act as a protective factor against high levels of workload, burnout, and turnover, and should be studied further for its role in promoting team resilience.

Decision-making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department

Objective

Cervical spine imaging decision-making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergency department-trauma team dynamics may affect implementation of such a tool.

Methods

We interviewed (pediatric and general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons and ED nurses at 21 hospitals to ascertain how team dynamics affect the pediatric cervical spine imaging decision-making process. Data were coded following a framework-driven deductive coding process and thematic analysis was used.

Results

Forty-eight physicians, advanced practice providers, and nurses from 21 hospitals (inclusive of three US regions, trauma levels I-III, and serving towns/cities of various population sizes) were interviewed. Overall, emergency physicians and trauma surgeons indicate being generally responsible for pediatric cervical spine imaging decisions. Conflict often occurs between these specialties due to differential weighting of concerns for missing an injury versus avoiding radiation exposure. Participants described a lack of trust and unclear roles regarding ownership for the final imaging decision. Nurses commonly described low psychological safety that prohibits them from participating in the decision-making process.

Conclusions

Implementation of a standardized risk assessment tool for cervical spine trauma imaging decisions must consider perspectives of both emergency medicine and trauma. Policies to define appropriate use of standardized tools within this team environment should be developed.

All professions can benefit - a mixed-methods study on simulation-based teamwork training for operating room teams

BACKGROUND

Operating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants' reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace.

METHODS

In a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team. Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years. Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis.

RESULTS

All occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one's profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration.

CONCLUSION

Simulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.

Creativity, Critical Thinking, Communication, and Collaboration: Assessment, Certification, and Promotion of 21st Century Skills for the Future of Work and Education

This article addresses educational challenges posed by the future of work, examining "21st century skills", their conception, assessment, and valorization. It focuses in particular on key soft skill competencies known as the "4Cs": creativity, critical thinking, collaboration, and communication. In a section on each C, we provide an overview of assessment at the level of individual performance, before focusing on the less common assessment of systemic support for the development of the 4Cs that can be measured at the institutional level (i.e., in schools, universities, professional training programs, etc.). We then present the process of official assessment and certification known as "labelization", suggesting it as a solution both for establishing a publicly trusted assessment of the 4Cs and for promoting their cultural valorization. Next, two variations of the "International Institute for Competency Development's 21st Century Skills Framework" are presented. The first of these comprehensive systems allows for the assessment and labelization of the extent to which development of the 4Cs is supported by a formal educational program or institution. The second assesses informal educational or training experiences, such as playing a game. We discuss the overlap between the 4Cs and the challenges of teaching and institutionalizing them, both of which may be assisted by adopting a dynamic interactionist model of the 4Cs-playfully entitled "Crea-Critical-Collab-ication"-for pedagogical and policy-promotion purposes. We conclude by briefly discussing opportunities presented by future research and new technologies such as artificial intelligence and virtual reality.

Qualitative examination of collaboration in team-based primary care during the COVID-19 pandemic

OBJECTIVE

The objective of this study was to describe Ontario primary care teams' experiences with collaboration during the COVID-19 pandemic. Descriptive qualitative methods using focus groups conducted virtually for data collection.

SETTING

Primary care teams located in Ontario, Canada.

PARTICIPANTS

Our study conducted 11 focus groups with 10 primary care teams, with a total of 48 participants reflecting a diverse range of interprofessional healthcare providers and administrators working in primary care.

RESULTS

Three themes were identified using thematic analysis: (1) prepandemic team functioning facilitated adaptation, (2) new processes of team interactions and collaboration, and (3) team as a foundation of support.

CONCLUSIONS

Results revealed the importance of collaboration for provider well-being, and the challenges of providing collaborative team-based primary care in the pandemic context. Caution against converting primary care collaboration to predominantly virtual modalities postpandemic is recommended. Further research on team functioning during the COVID-19 pandemic in other healthcare organisations will offer additional insight regarding how primary care teams can work collaboratively in a postpandemic environment.

A Qualitative Examination of Interprofessional Teamwork for Infection Prevention: Development of a Model and Solutions

Health care-associated infections (HAIs), such as central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), are associated with patient mortality and high costs to the health care system. These are largely preventable by practices such as prompt removal of central lines and Foley catheters. While seemingly straightforward, these practices require effective teamwork between physicians and nurses to be enacted successfully. Understanding the dynamics of interprofessional teamwork in the HAI prevention context requires further examination. We interviewed 420 participants (physicians, nursing, others) across 18 hospitals about interprofessional collaboration in this context. We propose an Input-Mediator-Output-Input (IMOI) model of interprofessional teamwork in the context of HAI prevention, suggesting that various organizational processes and structures facilitate specific teamwork attitudes, behaviors, and cognitions, which subsequently lead to HAI prevention outcomes including timeliness of line and Foley removal, ensuring sterile technique, and hand hygiene. We then propose strategies to improve interprofessional teamwork around HAI prevention.

Similarities and differences in motivation in cross-disciplinary biomedical, policy, and education health science teams: a mixed methods comparative case study using the MATRICx

Purpose

This study aims to investigate individual motivations for participating in collaborative health knowledge producing teams (KPTs), as well as satisfaction gained by participation in science teams. The authors focus on understanding motivators across team types, levels of engagement and alignment within and across teams and need satisfaction in a total of six science teams. Areas of strong congruence and divergence of motivating factors can be aligned across (i) learning and professional growth satisfaction, (ii) respect, collegiality and enjoyment satisfaction and (iii) accomplishment and discovery satisfaction. Levels of satisfaction are hierarchically mapped showing their relation to more external and communal foci to motivations that seek satisfaction of individual needs.

Design/methodology/approach

This mixed method comparative study uses data from the motivation assessment for team readiness integration and collaboration (MATRICx) tool and themes generated from semi-structured interviews. This methodology provided a means to compare a hierarchy of motivations against levels of collaborative engagement, as well as individual needs satisfaction and ultimately the identification of higher and lower-level motivations related to self and external foci.

Findings

The findings indicate that there are both similarities and differences in motivations in different health science teams when one compares biomedical, education and policy teams. A comparison of MATRICx data from across team types and teams suggests areas of strong congruence as well as areas of divergence in motivation factors.

Originality/value

The paper and its findings use a novel tool along with qualitative research techniques to identify motivation in KPTs and uses these data to understand what type of needs satisfaction are important across three areas of health science teaming. Our research informs team leaders, facilitators and consultants about the important motivations team members have entering teams and has the potential to provide a blueprint to ensure peak performance as individual team members seek to address their ever-growing professional needs.

Prevalence and predictors of team-based care activities between primary care providers and embedded behavioral health providers: a national survey

Primary care (PC) settings increasingly use team-based care activities with embedded behavioral health providers (BHPs) to enhance patient care via group medical visits, conjoint appointments, team huddles, and warm handoffs. Aim 1 was to describe the variation of team-based care activities within integrated PC clinics. Aim 2 was to explore whether factors associated with the BHP (e.g., gender, training, and experience) and the PC setting (e.g., perceived teamwork) predict engagement in team-based activities. A national sample of eligible BHPs (n = 345; 14.2% response rate) completed an anonymous survey assessing the presence/intensity of team-based care activities. 90% of BHPs reported regularly engaging in team-based care activities with PC teams. Most engagement occurred when providing feedback to PC providers (90.4% at least daily) and during warm handoffs (90.4% at least once daily). Engagement in team-based care was predicted by the level of teamwork occurring within the PC clinic (βs = .41-.47; ps < .001) and BHP characteristics, such as the number of years spent in PC (βs = .24-.26, ps < .001). Although these data are promising, with many BHPs reportedly engaging in team-based activities with PC teams, there is significant variation. Researchers should continue to explore whether the engagement in these team-based care activities enhances patient care.

Task interruptions from the perspective of work functions: The development of an observational tool applied to inpatient hospital care in France The Team'IT tool

BACKGROUND

In France, hospital units responsible for providing inpatient care have few opportunities to address the issue of task interruptions. In Australia, the Dual Perspectives Method (DMP) has been developed to assess interruptions. The method makes it possible to link teamwork and interruptions, by considering the work functions that constitute the system.

OBJECTIVE

To develop a tool that can characterize interruptions from the point of view of work functions that is tailored to French hospital units providing inpatient care. The aim was to adapt the items recorded using the DPM and their response categories, and to study the acceptability of observing interruptions for participating teams.

METHOD

The items recorded in the DPM were translated and adapted taking into account the French definition of interruptions. This step identified 19 items that targeted the interrupted professional, and 16 that targeted the interrupting professional. The characteristics of interruptions were recorded in September 2019 among 23 volunteer teams in a region in western France. Two observers simultaneously observed the same professional. Observations lasted seven consecutive hours, and targeted all professional categories within the same team.

RESULTS

The characteristics of 1,929 interruptions were noted. The observation period was well-received by teams. The following terminology regarding the work functions of the interrupting professional was clarified: "coordination of institutional resources", in relation to "the establishment's support processes", "patient services", and "the patient's social life". We believe that our categorization of response modes is exhaustive.

CONCLUSIONS

We have developed an observational tool, Team'IT, which is tailored to inpatient hospital care in France. Its implementation is the first step in a system to support teams in managing interruptions, and will enable them to reflect on their working methods, and whether interruptions can be avoided. Our work is part of an approach that seeks to improve and enhance the safety of professional practices, by contributing to the longstanding, complex debate about the flow and effectiveness of patient care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03786874 (December 26, 2018).

Teamwork Training With a Multiplayer Game in Health Care: Content Analysis of the Teamwork Principles Applied

BACKGROUND

In health care, teamwork skills are critical for patient safety; therefore, great emphasis is placed on training these skills. Given that training is increasingly designed in a blended way, serious games may offer an efficient method of preparing face-to-face simulation training of these procedural skills.

OBJECTIVE

This study aimed to investigate the teamwork principles that were used during gameplay by medical students and teamwork experts. Findings can improve our understanding of the potential of serious games for training these complex skills.

METHODS

We investigated a web-based multiplayer game designed for training students' interprofessional teamwork skills. During gameplay, 4 players in different roles (physician, nurse, medical student, and student nurse) had to share information, prioritize tasks, and decide on next steps to take in web-based patient scenarios, using one-to-one and team chats. We performed a qualitative study (content analysis) on these chats with 144 fifth-year medical students and 24 health care teamwork experts (as a benchmark study) playing the game in groups of 4. Game chat data from 2 scenarios were analyzed. For the analysis, a deductive approach was used, starting with a conceptual framework based on Crew Resource Management principles, including shared situational awareness, decision-making, communication, team management, and debriefing.

RESULTS

Results showed that most teamwork principles were used during gameplay: shared situational awareness, decision-making (eg, re-evaluation), communication (eg, closed loop), and team management (eg, distributing the workload). Among students, these principles were often used on a basic level. Among experts, teamwork principles were used with more open forms of speak up and more justification of decisions. Some specific Crew Resource Management principles were less observed among both groups, for example, prevention of fixation errors and use of cognitive aids. Both groups showed relatively superficial debriefing reflections.

CONCLUSIONS

Playing a multiplayer game for interprofessional teamwork appears to facilitate the application of teamwork principles by students in all important teamwork domains on a basic level. Expert players applied similar teamwork principles on a moderately high complexity level. Some teamwork principles were less observed among both students and expert groups, probably owing to the artifacts of the game environment (eg, chatting instead of talking). A multiplayer game for teamwork training can elicit the application of important, basic teamwork principles, both among novices and experts, and provides them with a flexible, accessible, and engaging learning environment. This may create time for exercising more complex skills during face-to-face training.

Lessons and Insights From the Implementation of the Cohort Model for a PICU: A Case Study Research

OBJECTIVES

The subspecialty cohort model allows for creation of smaller diagnosis pools, enabling concentration of expertise and collaboration. Given unknown effects of this model on team dynamics in a PICU, we examined how the cohort-model implementation was perceived by our providers and how this organizational change affected the work environment.

DESIGN

Case study research approach consisting of surveys, operational observations, and semistructured interviews. A descriptive survey was derived from an integrated conceptual framework (i.e., teamwork and psychologic safety). Sensitized by the framework and quantitative survey data, we conducted a thematic analysis from field notes and interview data.

SETTING

A quaternary-care, children's hospital with a 31-bed PICU.

SUBJECTS

PICU providers and nurses and subspecialists.

INTERVENTION

Implementation of the subspecialty cohort model.

MEASUREMENTS AND MAIN RESULTS

A total of 308 and 269 responses from pre- and postcohort surveys, respectively, were analyzed. Overall, 76% of physicians and 74% of nurses viewed the cohort model favorably. Three themes emerged: community-from disruption to redistribution, transforming identity-expert or generalist, and expansive learning from focused practice. The findings provided insights, informed by a theory of "Community of Practice," as lessons learned and ways to enhance the cohort model.

CONCLUSIONS

Our transition to a cohort PICU model offers lessons on impacts of PICU model changes on communities and teams. These theory-informed insights and implications can guide others undergoing similar transitions.

A journey through interprofessional education: Students’ perspectives of teamwork in a transforming curriculum

Background. Student engagement in curricular transformation is topical at the University of Cape Town (UCT), including in its Faculty of Health Sciences (FHS). Teamwork, which is essential to contemporary interprofessional healthcare, is an objective of transformative health sciences education. This study offers a contemporary contribution from the perspective of students to earlier work on shared learning at UCT FHS.  Objectives. There is a paucity of research literature on this study’s target population. Therefore, a qualitative design was used to explore first-year health sciences students’ perceptions and experiences of teamwork within an undergraduate shared learning programme.  Methods. The primary data collection method was focus group discussion. Two additional qualitative methods, free-listing and pile-sorting, were used to expand upon data collected in the focus groups. Results were analysed thematically.  Results. The study sample (N=32) included first-year audiology, medical, occupational therapy, physiotherapy, and speech and language pathology students. The findings revealed that although their experiences of teamwork varied, students had a comprehensive perception of what teamwork entailed in their educational context. Therefore, the findings were used to generate a heuristic for teamwork learning for undergraduate health sciences students.  Conclusion. The study positions students to contribute tangibly to the curricular transformation process at their university. Students’ perspectives of teamwork may be useful in the future design and delivery of entry-level interprofessional courses aiming to instil teamwork skills.

The Mediating Effect of Group Cohesion Modulated by Resilience in the Relationship between Perceived Stress and Military Life Adjustment

This study’s purpose was to investigate the relationship among soldiers’ perceived stress, group cohesion, military life adjustment, and resilience. Specifically, we aimed to verify the mediating effect of cohesion and the modulating effect of resilience. In addition, we examined the mediated modulating effect of resilience within the comprehensive relationship among variables. The research participants comprised 300 soldiers from two different army troops, and a total of 285 data points were analyzed, excluding unfinished responses. The main results were as follows. First, we identified the mediated effect of cohesion in the relationship between soldiers’ perceived stress and their military life adjustment. Second, resilience showed a moderating effect in the relationship between soldiers’ cohesion and military life adjustment. Third, while on the path of moving from perceived stress to successful military life adjustment through cohesion, resilience modulated the relationship between cohesion and military life adjustment. Lastly, in this paper, we address this study’s implications and limitations.

The effect of team-member knowledge, skills and abilities (KSAs) and a common learning experience on sourcing teamwork effectiveness

Purpose

A lack of sourcing-specific team research prevents a full understanding of sourcing teamwork effectiveness (STE). Moreover, the limited purchasing and supply management (PSM) team literature often tends to focus on an aggregate group level. The paper makes a step towards adopting an individual actor perspective on teamwork effectiveness with an emphasis on the context of sourcing, explicating the effects of team-member knowledge, skills and abilities (KSAs), and examining how these relationships are moderated by a common learning experience of strategic sourcing masterclass.

Design/methodology/approach

Based on a cross-sectional survey, this study analyses a sample of 90 sourcing team members from a global aerospace manufacturing company using hierarchical regression analysis.

Findings

The results suggest that four of the five KSAs positively and significantly affect STE; the exception was collaborative problem solving. Masterclass learning outcomes were found to positively moderate the effects of these KSAs on STE, again exclusive of the collaborative problem-solving KSA.

Research limitations/implications

Cross-sectional design focused only on the aerospace sector may affect generalizability. Further, longitudinal research designs would capture the effects of the common learning experience over an extended period.

Practical implications

Sourcing team members could be selected based on having KSAs which significantly affect teamwork effectiveness. Training and development for sourcing teams should combine guided reflexivity and cross-training to deliver learning outcomes that create similar team mental models.

Originality/value

The study provides an individual team-member perspective on the functioning of sourcing teams which is absent in the extant research. It contributes to the very limited research base on skills in PSM.

Employee-(ro)bot collaboration in service: an interdependence perspective

Purpose

Collaboration between frontline employees (FLEs) and frontline robots (FLRs) is expected to play a vital role in service delivery in these increasingly disrupted times. Firms are facing the challenge of designing effective FLE-FLR collaborations to enhance customer experience. This paper develops a framework to explore the potential of FLE-FLR collaboration through the lens of interdependence in customer service experience and advances research that specifically focuses on employee-robot team development.

Design/methodology/approach

This paper uses a conceptual approach rooted in the interdependence theory, team design, management, robotics and automation literature.

Findings

This paper proposes and defines the Frontline employee – Frontline robot interdependence (FLERI) concept based on three structural components of an interdependent relationship – joint goal, joint workflow and joint decision-making authority. It also provides propositions that outline the potential impact of FLERI on customer experience and employee performance, and outline several boundary conditions that could enhance or inhibit those effects.

Practical implications

Managerial insights into designing an employee-robot team in service delivery are provided.

Originality/value

This study is the first to propose a novel conceptual framework (FLERI) that focuses on the notion of human-robot collaboration in service settings.

Interprofessional communication in medical simulation: findings from a scoping review and implications for academic medicine

BACKGROUND

Interprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication.

METHODS

Electronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016-2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students.

RESULTS

Though diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment.

CONCLUSIONS

Educators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.

Novice nurses' experiences from teamwork in the emergency department: A qualitative content analysis

BACKGROUND AND AIM

Teamwork is assumed crucial in nursing. Nevertheless, nursing shortages in medical centers have thus far compelled nurse managers to use novice nurses. The present study aimd to explaining the challenges and experiences of novice nurses regarding teamwork in emergency departments.

MATERIALS AND METHODS

Using qualitative content analysis, 11 novice nurses working at emergency department, participated in this study. Data were collected with semi structured interview and analyzed by Graneheim and Lundman.

RESULTS

The data analysis led to the emergence of four themes of "essential teamwork skills development", "contradictory relationships between team members", "unpleasant feelings and experiences", and, "personal growth and maturation during teamwork".

CONCLUSION

Fostering different personal aspects as prerequisites for teamwork, novice nurses will be able to deal with unpleasant feelings and experiences as well as contradictory relationships between team members in an effective manner. This challenging experience will thus give rise to personal growth and maturation during teamwork among them in emergency department.

The role of E-leadership in ICT utilization: a project management perspective

Covid 19 presents a great challenge and opportunity for remote working, highlighting the need for electronically-mediated leadership in team tasks and performance. What is the role of leadership in improving utilization of information communication technologies (ICTs) in teamwork? Framed within the e-leadership and project management literature and employing a longitudinal field observation method over 8 months that involves 52 subjects and 172 observations, this study finds that (1) first, strong leaders employ a consistent and high-level use of ICTs throughout the whole process of group work, especially at the planning and closing stages of a project. (2) Second, strong leaders alternate the use of various ICTs to match specific tasks at different phases of the project. Two media platforms—team discussion forum and document sharing— stand out as the most important for strong leaders to build trust and execute tasks. (3) Finally, in a project management setting with a group of transient members with clearly-defined tasks and time-sensitive responsibilities, trust-building is a continual and highly significant leadership responsibility that precedes other leadership responsibilities. Trust is built largely through alternating the use of two rich ICT media (discussion forum and instant messaging) with two lean ICT media (document sharing and presentation display). These findings highlight a significant role of e-leadership in organizations which see the emergence of ICTs especially during crises like Covid 19.

Benevolent Leadership and Team Creative Performance: Creative Self-Efficacy and Openness to Experience

We examine the association between benevolent leadership and team creative performance in scientific research teams. Moreover, the mediating effects of creative self-efficacy and the moderating effects of openness to experience on the relationship were also analyzed. The study sample comprised 251 postgraduates from 58 scientific research teams in Chinese universities. Results revealed that benevolent leadership was positively related to team creative performance, and creative self-efficacy partially mediated this positive relationship. When team personality composition had a high average team level of or a low level of variance on openness to experience, the relationship between creative self-efficacy and team creative performance was stronger. The same situation also occurred as an indirect effect of benevolent leadership on team creative performance through creative self-efficacy. This study suggests that while people may pay focus on benevolent leadership and creative self-efficacy, team personality composition should also be considered in scientific research team practices.

'You just really have to assert yourself:' social work, nursing, and rehabilitation counseling student experiences of providing integrated behavioral health services before and after the immediate start of COVID-19

BACKGROUND

Educators who train healthcare students to provide behavioral health services in primary care settings frequently encounter challenges as they work to ensure that students acquire the knowledge and skills to effectively function on interprofessional practice teams. This has become increasingly important during COVID-19, as interprofessional collaborative practice is needed more than ever to address the interrelated health, mental health, and social structural issues linked to the pandemic.

METHODS

We used qualitative focus groups to understand the experiences of 6 interprofessional teams (comprised of graduate social work, nursing, and rehabilitation counseling students; n = 19) providing behavioral health services in primary care settings before and after the immediate start of COVID-19. To triangulate data and enrich findings, one focus group with students' faculty supervisors was also conducted; n = 5). Data were analyzed using thematic analysis.

RESULTS

Four themes highlighted student participants' need to assert themselves at the beginning of their educational experience, to communicate and learn from one another to develop positive team dynamics, to contend with role confusion and missed opportunities for collaboration, and to manage the emotional impact of COVID-19 on learning.

CONCLUSION

Findings indicate that educators should work with clinical faculty and agency supervisors to orient students to ensure they have role clarity within the agency. Graduate students providing behavioral health services should also learn to work collaboratively within their scopes of practice to serve patients virtually, especially in preparation for public health emergencies.

Teaming: learning, competing, and innovating in the world of reproductive medicine

Healthcare teams must be deliberately cultivated to reach their full potential. Shifting focus from individual performance to a team's collective competence allows for targeted and evidence-based interventions that support teamwork and improve patient outcomes. We reviewed essential concepts drawn from team science and explored the practical applications of teaming. Reproductive endocrinology and infertility healthcare providers play a pivotal role by teaching, modeling, and fostering teaming attitudes and behaviors. Through teaming, we can maximize our teams' ability to learn, innovate, compete with other teams, and thrive in today's healthcare environment.

An integrative review and practical guide to team development interventions for translational science teams: One size does not fit all

As the need to tackle complex clinical and societal problems rises, researchers are increasingly taking on a translational approach. This approach, which seeks to integrate theories, methodologies, and frameworks from various disciplines across a team of researchers, places emphasis on translation of findings in order to offer practical solutions to real-world problems. While translational research leads to a number of positive outcomes, there are also a multitude of barriers to conducting effective team science, such as effective coordination and communication across the organizational, disciplinary, and even geographic boundaries of science teams. Given these barriers to success, there is a significant need to establish team interventions that increase science team effectiveness as translational research becomes the new face of science. This review is intended to provide translational scientists with an understanding of barriers to effective team science and equip them with the necessary tools to overcome such barriers. We provide an overview of translational science teams, discuss barriers to science team effectiveness, demonstrate the lacking state of current interventions, and present recommendations for improving interventions in science teams by applying best practices from the teams and groups literature across the four phases of transdisciplinary research.

A state-of-the-art overview of job-crafting research: current trends and future research directions

Purpose

In celebration of the 25th anniversary of the founding of Career Development International, a state-of-the-art overview of recent trends in job-crafting research was conducted. Since job crafting was introduced twenty years ago as a type of proactive work behavior that employees engage in to adjust their jobs to their needs, skills, and preferences, research has evolved tremendously.

Design/methodology/approach

To take stock of recent developments and to unravel the latest trends in the field, this overview encompasses job-crafting research published in the years 2016–2021. The overview portrays that recent contributions have matured the theoretical and empirical advancement of job-crafting research from three perspectives (i.e. individual, team and social).

Findings

When looking at the job-crafting literature through these three perspectives, a total of six trends were uncovered that show that job-crafting research has moved to a more in-depth theory-testing approach; broadened its scope; examined team-level job crafting and social relationships; and focused on the impact of job crafting on others in the work environment and their evaluations and reactions to it.

Originality/value

The overview of recent trends within the job-crafting literature ends with a set of recommendations for how future research on job crafting could progress and create scientific impact for the coming years.

Understanding and Optimizing Group Dynamics in Case-Based Collaborative Learning

Teamwork skills are recognized as a core competency of physicians. To more effectively prepare trainees for the demands of their future work, medical educators are increasingly turning to group-based instructional formats. We employ case-based collaborative learning (CBCL) - a format which requires daily in-class discussion and collaboration in assigned small groups. While students overwhelmingly embraced CBCL as stimulating and thought-provoking, some students reported that social dynamics among group members adversely impacted their experience. Using mixed methods, we demonstrate that a short intervention that asked students to discuss how they can best learn together improved small group dynamics, and promoted psychological safety among peers. Importantly, no specific instruction in team work was required, students overall had a clear understanding how they could improve, but they did not know how to start this conversation with each other. To promote team learning, we propose that educators emphasize students' accountability to their peers' learning in addition to their own, and devote some time in class for teams to reflect and discuss how to improve learning with each other. Our observations are of interest to anyone frequently relying on group work without peer assessment or formal feedback on group performance.

Team learning process: a longitudinal study in dynamic situation

Purpose

This paper aims to explore team learning processes used by soccer players in a professional training context by focusing on their identification and evolution for 22 months.

Design/methodology/approach

A soccer team from a professional academy participated to this study based on six training sessions. Qualitative data on training sessions were collected. Data analysis followed four steps: reporting the game timeline and behaviours connected to each situation; coding verbal data by delineating meaningful units of activity; classifying meaningful units of activity according to team learning processes derived from previous studies; and providing a temporal graph representing occurrences of team learning processes at each training session.

Findings

Results showed that soccer players used 13 team learning processes during training sessions. Two processes are mainly mobilized to visualize the situation and to plan. A temporal graph was edited to represent processes evolve over training sessions. The latter illustrated a stability in team learning processes mobilization during the 22 months follow-up.

Research limitations/implications

This study complete knowledges about team learning by providing a fine-grained understanding of how players learn in teams and how team learning processes evolve over time.

Practical implications

This paper can help practitioners who manage teams in high temporal pressure situations to design adapted training programs.

Originality/value

This exploratory study highlights that the team learning processes usually mobilized “off-field” could also be used by team members in high temporal pressure situations, “on-field”. This study offers an original longitudinal approach that fits with some recent calls for contribution about team activity and could benefit to other research fields.

Improving handover competency in preclinical medical and health professions students: establishing the reliability and construct validity of an assessment instrument

BACKGROUND

As part of the worldwide call to enhance the safety of patient handovers of care, the Association of American Medical Colleges (AAMC) requires that all graduating students "give or receive a patient handover to transition care responsibly" as one of its Core Entrustable Professional Activities (EPAs) for Entering Residency. Students therefore require educational activities that build the necessary teamwork skills to perform structured handovers. To date, a reliable instrument designed to assess teamwork competencies, like structured communication, throughout their preclinical and clinical years does not exist.

METHOD

Our team developed an assessment instrument that evaluates both the use of structured communication and two additional teamwork competencies necessary to perform safe patient handovers. This instrument was utilized to assess 192 handovers that were recorded from a sample of 229 preclinical medical students and 25 health professions students who participated in a virtual course on safe patient handovers. Five raters were trained on utilization of the assessment instrument, and consensus was established. Each handover was reviewed independently by two separate raters.

RESULTS

The raters achieved 72.22 % agreement across items in the reviewed handovers. Krippendorff's alpha coefficient to assess inter-rater reliability was 0.6245, indicating substantial agreement among the raters. A confirmatory factor analysis (CFA) demonstrated the orthogonal characteristics of items in this instrument with rotated item loadings onto three distinct factors providing preliminary evidence of construct validity.

CONCLUSIONS

We present an assessment instrument with substantial reliability and preliminary evidence of construct validity designed to evaluate both use of structured handover format as well as two team competencies necessary for safe patient handovers. Our assessment instrument can be used by educators to evaluate learners' handoff performance as early as their preclinical years and is broadly applicable in the clinical context in which it is utilized. In the journey to optimize safe patient care through improved teamwork during handovers, our instrument achieves a critical step in the process of developing a validated assessment instrument to evaluate learners as they seek to accomplish this goal.

Practical Opportunities for Biopsychosocial Education Through Strategic Interprofessional Experiences in Integrated Primary Care

Even with the expansion of primary care teams to include behavioral health and other providers from a range of disciplines, providers are regularly challenged to deliver care that adequately addresses the complex array of biopsychosocial factors underlying the patient's presenting concern. The limits of expertise, the ever-changing shifts in evidence-based practices, and the difficulties of interprofessional teamwork contribute to the challenge. In this article, we discuss the opportunity to leverage the interprofessional team-based care activities within integrated primary care settings as interactive educational opportunities to build competencies in biopsychosocial care among primary care team members. We argue that this approach to learning while providing direct patient care not only facilitates new provider knowledge and skills, but also provides a venue to enhance team processes that are key to delivering integrated biopsychosocial care to patients. We provide three case examples of how to utilize strategic planning within specific team-based care activities common in integrated primary care settings-shared medical appointments, conjoint appointments, and team huddles-to facilitate educational objectives.

Evaluating teamwork development in combat training settings: An exploratory case study utilising the Junior Leaders' Field Gun competition

A behaviourally-anchored observational rating scale (BAORS) of teamwork based upon the 'Big Five' teamwork model (Salas et al., 2005) was selected and adapted for use in a combat training setting - a UK military field gun competition. The teamwork development of 16 newly-formed teams training to master a historic tactical drill was evaluated over the course of a week-long residential programme. Training culminated in a timed field gun competition. Teams were trained and mentored in respects to teamwork and taskwork by experienced military instructors. Teamwork was assessed at the outset and end of training. Significant improvements were evident on all teamwork process dimensions, with the greatest improvement seen in teams' shared understanding of teamwork roles and strategies (shared mental models). The lack of an association between teamwork development and final drill performance is explored, as is the utility of the measurement protocol developed for teamwork assessment in other settings.

Integrating Behavioral Health into Primary Care: The Role of Psychiatric Nursing in the Development of the Interprofessional Team

BACKGROUND

Integrated behavioral health in a primary care setting is a paradigm shift that requires academic reconfiguration on how health care professionals are educated and trained in the clinical arena.

METHOD

An academic university was able to create interprofessional didactic and clinical learning experiences for students within the Schools of Nursing, Social Work, Health Professions-Rehabilitation Counseling Department and Pharmacy resulting in improved models for patient care delivery.

RESULTS

Interdisciplinary faculty developed the didactic, clinical and evaluative areas based on the HRSA grant work plan. Deliverables included 18 modules, case studies focused on population health, and team-focused standardized patient experiences to test their behavioral health and psychiatric skills in a primary care setting.

CONCLUSIONS

Faculty from the different disciplines were able to collaborate on the deliverables, take the opportunities to engage students and collaborate on scholarly presentations at a national, state and local professional organizations. Academic course for interprofessional practice has been developed and implemented as an outcome of this grant.