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Interdisciplinary Collaboration for Elder Care

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Objectives Define collaboration and the need for an

interdisciplinary approach to geriatric care.

Describe the types of teams and stages of team development

Differentiate education and skills among different professionals on geriatric healthcare teams

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ObjectivesDefine the principles of successful

teamwork, interdisciplinary collaboration, and steps in the care-planning process.

Discuss the concept of team conflict and conflict management skills.

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Collaboration is……shared planning, decision-making,

responsibility, and accountability

Importance of collaboration: Complexity of chronic and acute problems too

complex be managed by one provider Increases likelihood that issues will be

addressed Increases coordination of care More efficient care delivery

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Types of Teams Unidisciplinary Team: same discipline Multidisciplinary Team: different discipline;

members independently develop plan; fixed roles; members are consulted about plan of care; MD assumes leadership

Interdisciplinary Team: different disciplines; flexible roles, collaborative, and synergistic; partners in designing care plan; situational leadership

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Stage of Team Development FormingForming – creation stage; testing group norms;

define boundaries; polite but untrusting; understanding roles

StormingStorming – confronting stage; friction; jockeying for position; test out each other

NormingNorming – interdependence; establish norms and patterns; constructive expression of ideas and opinions; heading in the right direction

PerformingPerforming – develop solutions; interests are shared; will work together

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Education and Overlapping Skills Team members bring unique sets

of skills from their discipline

The team looks at medical, psychological, emotional, social, economic, living conditions, and nursing issues and interventions

ELEMENTS OF TEAMWORK: Coordination of services Shared responsibility Communication Mutual accountability

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Physician, MDPhysician, MD Nurse Practitioner (NP)Clinical Nurse Specialist

(CNS)

Nurse Practitioner (NP)Clinical Nurse Specialist

(CNS)

GeriatricianCAQ

GeriatricianCAQ

Physician Assistant (PAC)

Physician Assistant (PAC)

Social WorkerLSW, LMSW, ACP

Social WorkerLSW, LMSW, ACP

Psychologist, PhDEdD or PsyD

Psychologist, PhDEdD or PsyD

NURSE (RN, LPN)NURSE

(RN, LPN)PsychiatristPsychiatrist

Occupational Therapist

OT, OTA, COTA

Occupational Therapist

OT, OTA, COTA

Pharmacist, RPh, PharmD

Pharmacist, RPh, PharmD

Physical Therapist(PT)

Physical Therapist(PT)

ChaplainChaplain

DietitianDietitian

Interdisciplinary Collaboration

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Involve the rightstakeholders

Invite collaborators

from otherdisciplines

Negotiate, articulate

roles; establishownership Have a

PLAN OF ACTIONTIMELINESOUTCOMES

Minimizecompetition

EstablishTEAM RULES

STRUCTUREAgenda

TimelinesRoles

Identify right issue

Principles ofInterdisciplinaryCollaboration

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Effective Meetings

Structure 1. Agenda2. Timeline3. Roles are defined:

• Leader or Facilitator• Timekeeper• Recorder

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Team Rules…stay on targetAttendance and timeliness

Prepare materials ahead of time

Handling disruptions

Contributing to / participating in discussion

Appropriate ways to manage conflict

Acknowledge other professionals’ roles

Share information with respect and cooperation

Confidentiality of team discussions

Agreement that team goals represents all participants’ views

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TRUSTMinimal

Struggles for power

TRUSTMinimal

Struggles for power

Members support each

other

Members support each

other

Assignments are clear,

accepted and carried out

Assignments are clear,

accepted and carried out

Cooperation & coordination; decision by consensus

Cooperation & coordination; decision by consensus

Competent, professional, and

personally effective

Competent, professional, and

personally effective

Open, sharing, and

honest communicati

on

Open, sharing, and

honest communicati

on

Disagreement without tyranny

Constructive criticism without personal attack

Disagreement without tyranny

Constructive criticism without personal attack

Listen to each other Listen to

each other

Clear roles and

responsibilities

Clear roles and

responsibilities

Known and agreed-upon

purpose, goals and objectives

Known and agreed-upon

purpose, goals and objectives

EFFECTIVETEAM

EFFECTIVETEAM

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OVERARCHING TEAM GOALS:Patient’s: Family’s: Team’s:

ProblemProblem Expected OutcomeExpected Outcome Impact on Health Impact on Health and Quality of Lifeand Quality of Life

Strengths / Strengths / ResourcesResources

Plan Plan (Who/What /When) (Who/What /When) Includes gathering Includes gathering more informationmore information

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Activity: Care-Planning ProcessCase Scenario: Ms. JQuestions:What team members need to be

involved in this case?What are Ms. J’s most important health

issues, and who should be involved in managing these issues?

Develop a management plan for Ms. J.

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Team Outcomes Problems identified and discussed; patient and

family preferences considered

Medication management and lower cost

Focused on critical problems and set appropriate goals

Social Worker – applying for Medicaid and community services available

Financially feasible medication plan

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Team Process EvaluationNegotiate team prioritiesAgreed to specific assignmentsClear rolesStay engaged; group input; no SILO

mentalitySpecific disciplines provided expert

opinionsFollow up plan – Measurable

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Team Conflict Defined…

…competitive or opposing action of incompatibles; mental struggle; opposing needs, drives, wishes, internal and external demands

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When do conflicts occur?When any team member…. Feels pressure from group to assume a role Allocated roles are constraining / inhibiting

development Feels that sanctions imposed to induce him or her

to maintain a role; are not fair / commensurate Cannot develop acquired capabilities in assigned

role Wishes to go beyond definition of role

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Viewpoints on Conflict Competitive – one must win

Compromising – middle position; all parties give a little to gain

Collaborative – need of both / all are met

Accommodating – avoidance; accommodating

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Team Communication

Actively listen

Define the problem

Ask open questions

Clarify responses

Paraphrase and Reframe

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Conflict Management Attack the problem, not the person. Focus on what can be done Encourage different points of view Express feelings without blaming Accept ownership Listen to understand the other person's point of

view Respect the other person's point of view. Solve the problem while building the

relationship.

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Questions?