Sunday December 17th 2017

Nurses as leaders of high-performing interprofessional teams

Lisa Summers

The days of solo practitioners — whether a family physician or private nurse — are long gone. What the Institute of Medicine has called the “geometric rise in complexity in health care” has made the high-performing health care team a modern necessity.

The current focus on health system transformation and the implementation of the Affordable Care Act have underscored our need to build interprofessional teams and foster collegial relationships. In particular, payment reform is shifting the focus from individual billing and reimbursement to various forms of “value-based purchasing,” causing administrators, policymakers and clinicians to think critically about how best to identify not only the right care, for the right patient, at the right time, but also the right mix of providers to deliver the care.

Like much of health care transformation, this change is challenging. As noted in the 2010 IOM’s Future of Nursing report, “Despite its increasing recognition as the foundation for effective care into the future, team-based care and multidisciplinary care management remain if anything the province of classroom instruction and rarely connected to the practice setting.” Since the release, however, several key initiatives have moved us closer to the goal of team-based care.

In October 2012, the IOM published “Core Principles & Values of Effective Team-Based Health Care,” which discussed five personal values that tend to characterize members of effective teams: honesty, discipline, creativity, humility and curiosity. Although teams vary greatly in size, setting and members, for example, effective teams are built on five principles: shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes.

The American Nurses Association demonstrated its commitment to advancing nurses on high-performing interprofessional teams by conducting a dialogue forum at the 2014 ANA Membership Assembly. Work to implement the strategies discussed at the forum is ongoing.

Another recent example is the American College of Cardiology’s “2015 ACC Health Policy Statement on Cardiovascular Team-based Care and the Role of Advanced Practice Providers.” ANA participated in the think tank that helped inform the writing committee, which included nurses, a physician assistant and a pharmacist. In addressing questions of leadership, ACC notes that “leadership of health care teams can be situational, clinical or managerial, depending on the charge and the task that the team is undertaking.”  Like many members of the ACC writing team, cardiologist George Rodgers speaks positively of his experience working on teams, including teams led by someone other than a physician and “wanted the document to be flexible.”

Health care teams (and risk managers and the legal system) must also grapple with issues of accountability. While the American Medical Association continues to advocate for physician-led teams, ANA works to create a legal and regulatory framework that recognizes nurses as personally accountable for their practice to patients, their respective licensing board, the nursing profession and society. The notion that physicians should supervise care provided by APRNs or any other member of the team is outdated, and it is inappropriate to expect physicians, or any other provider, to accept responsibility or liability for care in which they have not been directly involved.

Both Rodgers and Janet Wyman, DNP, RN-CS, ACNS-BC, AACC, another member of the ACC writing committee, see the ACC statement as a beginning. ANA agrees with Wyman that the “statement has a lot of potential for moving the discussion forward,” and we welcome continued collaboration in our efforts to build truly patient-centered teams.

— Lisa Summers is the senior policy fellow in Health Policy at ANA.

Resources

ANA full practice authority document for language on accountability: www.nursingworld.org/principles

Improving care through high-performing interprofessional teams: American Nurse Today, September 2014. www.nursingworld.org/AmericanNurseToday/Health-safety-wellness-Sept-14.pdf

IOM Core Principles & Values of Effective Team-Based Health Care: http://nam.edu/perspectives-2012-core-principles-values-of-effective-team-based-health-care

2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of the Advanced Practice Provider: www.acc.org/latest-in-cardiology/articles/2015/05/11/11/44/health-policy-statement-addresses-roles-of-advanced-practice-providers-in-team-based-care?w_nav=CI

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