Interprofessional team management in pediatric critical care: some challenges and possible solutions

Abstract

Background: Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous.

Methods: We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts.

Findings: The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one's own unit, engagement of health care professionals occurs and projects become accepted.

Conclusion: Bottom-up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of fostering patient safety.

Keywords: interprofessional team management; organizational learning; patient safety; pediatric intensive care unit; psychological safety; teamwork.

Figure 1

Interprofessional team management at the pediatric intensive care unit. Notes: The example of a newborn with congenital AIS with a complication of an ischemic NEC shows the high diversity of multidisciplinary physicians and professionals involved at the pediatric intensive care unit. Abbreviations: AIS, aortic isthmus stenosis; NEC, necrotizing enterocolitis.

Figure 2

Conceptual framework of interprofessional teamwork. Note: Reproduced from Reeves S, Lewin S, Espin S, Zwarenstein M. A Conceptual Framework for Interprofessional Teamwork. Chichester, West Sussex; Ames, IA: John Wiley and Sons; 2010. With permission from John Wiley and Sons, Copyright © 2010.

Figure 3

Data sources.