Modern perioperative teamwork: an opportunity for interprofessional learning.
Abstract: The notion of different professional groups working and learning together is by no means new in healthcare. Members of each professional group within the perioperative environment frequently work and learn together in order to improve the care of the surgical patient. However traditional perioperative teamwork is being transformed as national and international directives bring members of the perioperative team closer together to promote the holistic care of the patient. As interprofessional teamwork increases an opportunity for interprofessional learning occurs.

KEYWORDS Interprofessional learning / Teamwork / Perioperative team
Article Type: Report
Subject: Public health (Research)
Employee motivation (Analysis)
Nurses (Training)
Patients (Care and treatment)
Patients (Health aspects)
Patients (Research)
Author: Quick, Julie
Pub Date: 11/01/2011
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: Nov, 2011 Source Volume: 21 Source Issue: 11
Topic: Event Code: 310 Science & research; 280 Personnel administration
Product: Product Code: 8000120 Public Health Care; 9005200 Health Programs-Total Govt; 9105200 Health Programs; 9911210 Motivational Techniques; 8043100 Nurses NAICS Code: 62 Health Care and Social Assistance; 923 Administration of Human Resource Programs; 92312 Administration of Public Health Programs; 621399 Offices of All Other Miscellaneous Health Practitioners
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 274790487
Full Text: Introduction

Within the perioperative environment, members of the perioperative team i.e. nurses, allied health professionals and doctors, regularly work together to provide care for patients undergoing surgery. Here, working and learning together often go hand in hand as team members learn about the needs and requirements of each profession. For instance, a scrub practitioner will learn about the surgeon's preferences for each procedure the more they work together and as such each team member will learn from each other (Wicker 2011). Traditionally this practice has enabled the smooth running of the operating list and enhanced the patient's surgical journey. Although each team member works towards a shared goal, namely promoting the health and wellbeing of the surgical patient through multidisciplinary teamwork, each professional group remains independent of the others.

Modern perioperative teamwork

Since the profile of interprofessional teamwork was raised over a decade ago (DH 1999, DH 2000) directives within healthcare are now transforming perioperative teamwork by recognising that professional groups must no longer work separately but come together to promote the holistic needs of the patient (Castro et al 1994). Consequently members of each professional group within the perioperative team are now working closer than ever within the operating theatre and beyond as they endeavour to improve patient care through the implementation of national and international directives that are transforming how members of the perioperative team work and learn together.

WHO Surgical Safety Checklist

International guidelines have been introduced that have transformed teamwork within the perioperative environment. The WHO Surgical Safety Checklist (WHO 2008) requires members of each professional group to work closely together in order to increase patient safety and reduce risk to the surgical patient. The checklist's six steps ensure effective and efficient teamwork by encouraging the development of good communication and interpersonal skills between all members of the perioperative team throughout the patient's perioperative journey.

The Productive Operating Theatre

Another initiative that aims to improve patient care within the NHS is a national programme currently being rolled out within operating theatres across the UK. The Productive Operating Theatre (TPOT) is designed to help motivate teams to review working practices in order to enhance patient care (NHSI 2011). TPOT's main aims are to increase patient safety and to improve team performance; these require the contribution of all team members at every level (Bloodworth 2011). By working together, each of the professional groups within the operating theatre can develop effective teamwork and increase patient safety (NHSI 2011).

It is clear from both of these directives that there has been a progression away from multidisciplinary teamwork--where all team members work independently towards a common goal--to interprofessional teamwork where team members collaborate and work together in order to promote the holistic well being of the patient through higher levels of communication and cooperation between all team members (Korner 2010). As interprofessional teamwork increases all team members begin to gain a deeper insight into the responsibilities of other professional groups. Through this insight an understanding develops that results in each professional group learning from, about and with each other and consequently an opportunity for interprofessional learning occurs.

Interprofessional learning

The main aim of interprofessional learning is to improve patient care by encouraging each professional group to gain an insight into the holistic care of the patient by drawing upon the knowledge, skills and expertise of each professional group (Salvage & Smith 2000). Consequently members of the perioperative team are able to respond more fully to patients' needs resulting in a direct improvement to patient care (CAIPE 2011a). However as team members work and learn together further benefits are revealed as members of each professional group begin to develop an understanding about the contribution of other professional groups.

In practice the principles of interprofessional learning also aim to:

* improve interprofessional, interpersonal and intraprofessional skills such as communication, problem-solving and reflection

* enhance professional practice by enabling each profession to improve practice to complement that of others

* instil professional values by showcasing professional roles and expertise in shared goals

* reduce interprofessional conflict by encouraging each member to respect the differences between and within each professional group

* increase professional satisfaction as each professional group develops an awareness of their own contribution and that of others.

(Adapted from CAIPE 2011a)

Consequently perioperative teamwork becomes more effective (Wicker 2011), patient care is indirectly improved, and interprofessional learning becomes an essential component of interprofessional teamwork that has been recognised by health organisations, academic institutes and professional bodies across the UK and overseas (DH 2002, DH 2003, RCN 2006, WHO 2010, CAIPE 2011b).

Challenges

Despite the endorsement of interprofessional learning within healthcare there remain several challenges ahead for the modern perioperative team. These emerge mainly from the historic diversity of each professional group within healthcare but also from the reluctance of many health professionals to embrace interprofessional teamwork. In the past this has given rise to conflict and rivalries within healthcare (Meads & Ashcroft 2005) both of which affect the opportunity for interprofessional learning (Castro et al 1994).

Power, status and education

Differences in professional culture have forged the segregation of each professional group within healthcare for years and continue to affect teamwork today (Headrick et al 1998, Salvage & Smith 2000). For years the differences in power, status and education have made professional relationships rarely clear-cut (Salvage & Smith 2000) since professional groups within the perioperative team found themselves working within a hierarchy that restricted teamwork and created conflict (Bond 1998). Not only were nurses and allied health professions historically seen as a subordinate part of the division of labour within healthcare (Freidson 1970, Miers 2000) which put doctors firmly in charge (Coombes 2004), but the traditional segregation of each professional group in academia has helped to maintain the separation throughout training and beyond, leaving practitioners unprepared for interprofessional teamwork (Glen & Leiba 2002). Since modern perioperative teamwork relies upon and values the contribution of all perioperative team members each professional group will develop a more equal footing in perioperative care, and medical autonomy will reduce (Morrall 2001, Stanley 2005). Consequently many of the historical differences will begin to disappear, encouraging both interprofessional teamwork and learning.

Professional identity

Despite the endorsement of interprofessional teamwork, health professionals may remain reluctant to embrace interprofessional practice because of the perceived threat to professional identity (Glen & Leiba 2002). For many members of the perioperative team the notion of working and learning together in practice may seem unusual due to the historical diversity of each professional group within healthcare. The differences in knowledge, skills and abilities between nurses, allied health professionals and doctors have not only defined each individual profession over the years but have also helped to inform the way in which members of each professional group view each other (Carpenter & Dickinson 2008). This has often lead to misconceived ideas about other professional groups, and resulted in conflict and rivalry within the team. Despite these differences, there are fine examples across the UK of interprofessional teamwork within the perioperative environment where members of different professional groups have developed successful working relationships (Quick et al 2010, Abraham 2011). There is also evidence that demonstrates that interprofessional teamwork is beneficial for patients (Korner 2010) proving that, if the historical differences between each professional group can be set aside, each member of the team can develop a clear understanding of the role of the other, whilst remaining true to their core professional values (DH 2010). Only then can professional identity be secured and interprofessional teamwork become effective (Bond 1998).

Conclusion

With current directives encouraging interprofessional practice within the perioperative team, now is the time for members to put to one side the traditional differences that have caused tension in the past and to capitalise upon the wealth of knowledge and skills that each member of the perioperative team has, recognising that all members of the team--nurses, allied health professionals and doctors, are able to learn from, with and about each other. Whether members gain new knowledge, form a new relationship or change preconceived attitudes, modern perioperative teamwork provides an ideal opportunity for interprofessional learning between all members of the perioperative team that ultimately improves the care of the surgical patient.

Task 1 Project

Skill and competence

Using library or internet resources identify the skills and competencies required for effective teamwork.

Notional Learning Hours

30 mins

Knowledge and Skills Dimension

Core 1: Communication

Core 3: Health, safety and security

Core 4: Service improvement

Core 5: Quality

Task 2 Review

The perioperative team

Think about your department and identify the different professional groups that work in or visit you department on a daily basis. Now identify the different knowledge, skills and abilities that each member of each group brings to the perioperative team. (Don't forget to include different grade/levels of staff within each group--from students to the most senior.)

Notional Learning Hours

1 hour

Knowledge and Skills Dimension

Core 1: Communication

Core 3: Health, safety and security

Core 4: Service improvement

Core 5: Quality

Task 3 Reflect

Reflect

Challenges

Have you been involved in an episode of perioperative care where you felt teamwork was ineffective? Using a reflective model of your choice examine what you feel were the barriers to the perioperative team working well together in this instance.

Notional Learning Hours

1 Hour

Knowledge and Skills Dimension

Core 1: Communication

Core 3: Health, safety and security

Core 4: Service improvement

Core 5: Quality

Task 4 Reflect

Effective perioperative teamwork

Now reflect upon on one episode of perioperative teamwork that worked well. Highlight the particular knowledge, skills and abilities of each team member that made this episode of teamwork effective.

Notional Learning Hours

1 hours

Knowledge and Skills Dimension

Core 1: Communication

Core 3: Health, safety and security

Core 4: Service improvement

Core 5: Quality

References

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Julie Quick

RCN, SCP, NMP

Surgical Care Practitioner, Walsall Healthcare NHS Trust, Manor Hospital, Walsall

No competing interests declared

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Correspondence address: Julie Quick, Day Unit Theatres, Manor Hospital, Moat Road, Walsall, West Midlands, WS2 9PS

Email: julie.quick@walsallhospitals.nhs.uk
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