1. Zuzelo, Patti Rager EdD, RN, ACNS-BC, ANP-BC, ANEF, FAAN

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The Institute for Healthcare Improvement advocates for its Triple Aim framework as an approach for enhancing the quality of health system performance by improving the patient care experience specific to both satisfaction and quality of care delivery, bettering the health of populations, and reducing the per person cost of health care.1 These ambitious goals rely on interprofessional collaboration, a team-based model of care that values partnership, communication excellence, and practice outside of traditional silo structures. The Future of Nursing report calls for interprofessional collaboration among health professionals and health care decision makers supported via class and clinical training activities.2 It is important for nurses and other health professionals to value and understand interprofessional collaboration and use this appreciation and knowledge to purposefully build collaborative models that emphasize working with others across professional lines in ways that capitalize on the unique expertise of varying disciplinary perspectives.


Health professionals should become familiar with documents describing interprofessional collaboration competencies and offering road maps for achieving the competence necessary for high-quality and safe health care. The Interprofessional Education Collaborative (IPEC) offers many resources that are useful tools for nurses and others interested in expanding their familiarity with interprofessional collaboration.3 The IPEC asserts that interprofessional collaborative practice is key to achieving care that is safe, high-quality, person-centered, and accessible and also drives improved health outcomes.4 The IPEC's mission is focused on partnering with academic institutions that educate students for the health professions so that they are well prepared to engage in interprofessional collaborative practice models upon entering the workforce4; in other words, IPEC partners with education programs so that students "hit the ground running" as collaborators and partners in health care practice. The IPEC Web site offers many resources, including archived webinars, conference information, recommended links, and competency standards.3


Core competencies for interprofessional collaborative practice were the visionary work of multiple stakeholder organizations representing varied health professions, including but not limited to the American Association of Colleges of Nursing, the American Association of Colleges of Pharmacy, and the Association of American Medical Colleges.5 These competencies evolved from a collective identification of desired principles for interprofessional collaboration such as patient/family centered, relationship focused, outcome driven, and community/population orientation.5 The Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel provides excellent background information to the interprofessional collaboration movement and presents the reader with information fundamental to an accurate and thorough understanding of the challenges, opportunities, and processes of interprofessional education and practice. Four competency domains are identified: Values/Ethics for Interprofessional Practice Competency; Roles/Responsibilities; Interprofessional Communication Competency; and Teams and Teamwork.5(p16) Many exemplars of programs in action are shared and their potential applicability to practice improvements is powerful.


Structured interprofessional education offers a planned strategy focused on teaching health professionals how to get along with the goal of building on unique professional strengths and ensuring high-quality patient outcomes. Working collaboratively to achieve health care excellence may appear to be an obvious goal for health care teams; however, there are barriers to collaborative practice that must be considered and addressed if interprofessional collaboration is to become a consistent reality. Disciplines have historically been educated in isolation except for multidisciplinary activities experienced during student clinical/practicum learning experiences. During these educational instances, students may interact with health professionals practicing in different fields; however, experiences are often unstructured, intimidating, and inconsistent. Undergraduate nursing students rarely interact with medical students or physicians during planned collaborative or team-based experiences. Many nursing students experience physician encounters only during chance occasions when paths cross during practice activities or when there is a need for a medical order or an opportunity to provide report.


Physicians have often been educated within systems that advocate for dominance,6 for example, serving in the role of "captain of the ship." This hierarchical model that anticipates deference does not nurture a practice model built on give and take, nor does it encourage openness about errors or the possibility of such. Leaders may be best selected by the type of task at hand and the expertise required to successfully meet the particular challenge. This expertise is not always, and perhaps is not often, medical expertise. In addition to barriers related to these historical power differentials, patients have been historically excluded in care decisions and their input has not been actively sought by medical care providers.6 Patient input and influence are critical to a patient-centered model of care called for in the Institute for Healthcare Improvement Triple Aim.


The Robert Wood Johnson Foundation advocates for interprofessional collaboration as a means to improving the quality and safety of patient care.7 Team work deficiencies and miscommunication contribute to a significant number of health care errors. Care coordination, particularly across specialties or during care transitions, is essential to reducing error rates. In addition to educating students of various health professions using collaborative, cross-disciplinary teaching models, there is a need to reeducate health professionals currently in practice.


One opportunity for team-focused care is TeamSTEPPS, a program created by the US Department of Defense and the Agency for Healthcare Research and Quality.7,8 TeamSTEPPS is an evidence-based set of teamwork tools focused on enhanced patient outcomes through improving communication and teamwork skills among health care professionals across disciplines.8 TeamSTEPPS is available online and is a free resource that includes a variety of tools and options including versions for office-based care, long-term care, a dental version, rapid response systems guide, training guide for using simulation in TeamSTEPPS training, and a ready-made TeamSTEPPS 2.0 curriculum.8 Nurses and other professionals will be interested in the large number of webinars that are also available on the TeamSTEPPS' Web site (


Interprofessional collaboration is a major initiative in health care that warrants the attention and commitment of health professionals, regardless of practice setting or professional role. Teamwork and the skillful, effective communication that is inherent in excellent team dynamics needs to be nurtured, modeled, and coached. Practicing professionals have an obligation to participate in rising to the challenge of the Triple Aim. Students need to be supported and engaged in learning experiences that cross traditional disciplinary boundaries and that promote dialogue, critique, and a spirit of mutual inquiry. Patients and families must be viewed as partners and as the focal point of care processes. There are tools available to encourage these culture changes, and planning the use of these tools provides an excellent opportunity to collaborate with an interprofessional team. A healthy work environment that supports collaboration and "best practice" is consistent with a holistic perspective that values the collective energies of the whole health care team, including patients and families.




1. Institute for Healthcare Improvement. Initiatives. IHI triple aim initiative. Published 2019. Accessed June 5, 2019. [Context Link]


2. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011. doi:10.17226/12956. [Context Link]


3. Interprofessional Education Collaborative. Resources. Published 2019. Accessed June 7, 2019. [Context Link]


4. Interprofessional Education Collaborative. Vision & mission. Published 2019. Accessed June 7, 2019. [Context Link]


5. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative; 2011. Accessed June 7, 2019. [Context Link]


6. Vega CP, Bernard A. CME/CE. Interprofessional collaboration to improve health care: an introduction. Medscape. Published February 11, 2016. Accessed June 5, 2019. [Context Link]


7. Robert Wood Johnson Foundation. What can be done to encourage more interprofessional collaboration in health care? Published 2018. Accessed June 7, 2019. [Context Link]


8. Agency for Healthcare Research and Quality. TeamSTEPPS. Published 2019. Accessed June 8, 2019. [Context Link]