Myths about Collaborative Care

MYTH: Collaborative Care is just a fancy word for teamwork.

Truth: Collaborative Care is more complex than teamwork. While teamwork is an element, Collaborative Care is about communicating respectfully, trustfully and ultimately differently with the patient and their families and the professionals delivering care and/or service.

It is about being able to practice to your full scope of practice while understanding and embracing the roles of other health care providers working on the team. It is about evaluating and measuring a team's functioning and patient outcomes.

MYTH: Having a multidisciplinary team automatically makes it interprofessional.

Truth:  Having one of everyone doesn't automatically make a team collaborative. An interprofessional team is more about how a team works together and gets value from the team. Determining the right composition of a health care team should be driven by the needs of those in care.

MYTH: Teams intuitively know how to be teams.

Truth: Teams need to learn how to be teams. They also need to practice communicating more effectively, planning together and working together. Just like sports team practice before the big game, teams need to invest time into improving the way they work together.

Sometimes a pizza party can help improve the quality of care delivered the next day because it helps a team work together better. In fact the research suggests that teams taking time for regular team activities are more efficient.

MYTH: We don't have time for Collaborative Care.

Truth: It's important for managers and leaders to support teams in making time to work collaboratively and improving communication. Using a sports analogy, good teams don't just play together, they practice - and have time to plan, coach and mentor.

MYTH: Self reflection is all about what's not working and that's too big to consider where my team is concerned.

Truth: The assessment process created by the EXTRA team invites a team to first identify and then build on their strengths. "What are you doing well? Now, where do you want to take it? What do you want to work on? Where would excellence be on that spectrum?" asks Bowman.

MYTH: Collaborative Care is big and complex.

Truth: It's the small things - eight things, in fact, as the indicators suggest - that add up and help improve a team's collaboration. A shared space, for example, can be an important yet simple part of helping improve the way a team interacts.

MYTH: Physician's won't buy in to Collaborative Care.

Truth: While the current structure of our health system makes it easier for nurses and allied health to more readily embrace Collaborative Care, when physicians understand the potential to improve health outcomes, they are often willing to contribute to Collaborative Care.

True collaborative care can initially be viewed by physicians as a potential affront to their autonomy, or creating extra work. As physicians learn more about what's involved in being truly interprofessional, they soon realize that this boosts job satisfaction, staff morale and patient care - outcomes that truly enhance their work experience.

MYTH: The system works best when physicians are the leaders of health care teams.

Truth: It may be difficult to understand a different model for care but depending on the context, any member of the team could assume leadership for a person's care. While many people are familiar with a physician being responsible for leading and decision making, this new model invites each profession to be trained together in working collaboratively. Every member of the team is professionally accountable for their assessments and decision making so increased trust means working together in a more integrated way. Ultimately this improves health outcomes and care delivery.

An example is admitting someone to a medical teaching unit. In the old model, a physician would have been expected to perform that task. Working collaboratively, the rehab team might be the best leader to lead the admitting.

Another example is when a physician gets a call in the wee hours of the morning. Once the nurse has briefed the physician about the patient's issues, the physician gives the order over the phone. The leader at that moment is the nurse, who is physically there to assess the patient and is using their clinical judgement and decision making to consult with the physician. The physician trusts the nurse's clinical judgement and helps reach a collaborative decision about what's best for the patient at that time.

"There are times when it's perfectly appropriate for a physician to be the leader on a certain care team," says Komenda. "Physicians need to be rethinking their roles on teams and get over an initial change in thinking that allows us to work with instead of parallel to others on the health team. This improves job satisfaction and patient care is ultimately improved."

MYTH: We'll never be collaborative given perceived hierarchies and power differentials.\

Truth: Change takes time but respect and trust are important parts of Collaborative Care. In some cases it may require additional patience and self accountability to improve wounded communications or relationships between disciplines. Starting from a place of hoping to improve understanding, communication and ultimately care delivery is a beginning.

But Collaborative Care is a shift from individuals covering their own professional backsides to not only being professionally autonomous and accountable but also part of a team that interacts together and is accountable as a team.

MYTH: Once you've learned Collaborative Care, your learning is done.

Truth: Most people in the Region are just at the very early baby steps of knowing the Collaborative Care language and how to improve their team's collaboration. But Collaborative Care is an ongoing process that is never fully mastered, where there is continually room for growth and improvement. Part of this is because with a certain level of mastery, a different level of awareness and engagement is possible, and part of this is because of new technologies and information and the differing dynamics and opportunities that are presented through staff changes on a team.

"It's a constant journey. We don't want people to think that they're ever there because you're going to get a new team member join you, you're gonna keep tweaking, your unit may change your patient population and how you're doing your work, technology changes and there's new evidence available," says Bowman. "You may have the basics but there is always room for self evaluating, reflecting and challenging yourself to improve."