Background: Enhanced physician-nurse collaboration improves patient outcomes. Current interprofessional clinical learning environments, however, rarely engage physicians with nurses and are not based on high-performance team frameworks. Therefore, leaders at the University of Chicago Medicine developed the Improving GME Nursing Interprofessional Team Experiences (IGNITE) program to engage interprofessional healthcare teams, with hospitalist coaches, in institutional performance improvements. We aimed to study IGNITE’s impact on physician and nurse perceptions of interprofessional collaboration, and specifically, emerging high-performing team domains.
Methods: IGNITE members were invited to take part in 30-minute semi-structured interviews with trained sociologists not associated with IGNITE (September – November 2019). Questions were derived from research on the “big five” components of teamwork: Leadership, mutual performance monitoring, backup behavior, adaptability, and team orientation (Salas, Sims, Burke 2005). Subjects were asked about their interprofessional experience and education pre- and post-IGNITE and how IGNITE might be improved. Responses, uploaded to NIVIVO, were coded using grounded theory analysis by an independent reviewer. Selective coding was used to define themes until saturation. A second independent reviewer coded the data (interrater reliability, k = 0.61). Finally, a member check was performed to ensure an accurate representation of the study population.
Results: Sixteen participants (5 physicians, 10 nurses, and 1 social worker) across 6 units were interviewed. Analysis showed the emergence of high-performing team principles: Psychological safety (“it was sort of a judgment-free open-minded team.” – Physician”), effective team communication-shared goal setting, definitive roles, holding teammates accountable, and backup behavior. Personal and institutional reflections noted enhanced community and relationship building (“Having mutual recognition of one another…before that did not exist.” – Nurse), a better understanding of interprofessional roles, culture shifts, improved patient care, hospital leadership supported success, and IGNITE personnel supported success. Physicians understood the nursing workflow better. Nurses appreciated the challenges physicians faced more. Beyond the enhanced individual relationships and understanding, the noted culture shift demonstrates influence beyond IGNITE participants.
Conclusions: The IGNITE model, which includes hospitalist coaches in medicine and pediatrics, is associated with the emergence of high-performance teams. Participants felt an increased sense of community, improved understanding of roles, and institutional culture shifts extending beyond IGNITE team members. Future academic centers should consider implementing IGNITE.