EUNICE S KIM | PORTFOLIO
Research Ideas
Problem Statement and Research Goal
My research focuses on finding ways to promote and support effective collaboration in health professionals. Effective collaboration is essential for positive outcomes real-world problem-solving. Collaboration is a complex phenomenon that varies in its manifestation depending on the situation, context, and stakeholders involved. The healthcare field’s interest in collaboration exploded in the last 20 years following a series of studies concerning the number of deaths resulting from medical errors partly caused by failures in collaborative processes (Institute of Medicine [IOM], 1999; James, 2013; US Office of the Inspector General [OIG], 2010). This includes errors in communication (e.g. incomplete information provided in handoffs and briefings), failure to execute roles and duties (e.g. passive staff, incomplete participation in procedures), and cognitive biases held by the staff (The Joint Commission on Accreditation of Healthcare Organizations [JCAHO], 2019).
Context: Collaboration in Healthcare
Much of the literature surrounding collaboration in healthcare is currently situated in interprofessional education and experiences (e.g. Hall & Weaver, 2001; Brock et al., 2013; MacNaughton et al., 2013). JCAHO and the Interprofessional Education Collaborative [IPEC] have created standards and guidelines outlining skills and competencies for health professionals to develop through training that focuses on improving interprofessional collaboration. However, not all collaborations occur in interprofessional contexts. For instance, a nurse communicating essential shift information to the nurse taking over, or a neuro consult provided to internal medicine could both be considered examples of collaboration between two providers caring for mutual patients. I am interested in finding ways to promote effective collaboration in contexts that include but is not limited to that of interprofessional nature. This leads to my first research idea, which is to explore the literature to understand the nature of collaboration as it manifests in the healthcare field and to identify key factors that are involved in collaboration.
Factors Influencing Collaboration
The goal of promoting effective collaboration centers around my desire to find ways to reduce risk of patient harm throughout the multifaceted process that is providing patient care in collaborative contexts. There is a wide range of actions identified as root causes in the reports mentioned above, but what interests me is finding the reasons behind these actions and the contexts in which they occurred. What was the situation behind the communication errors? Why were the staff passive in exacting their roles and duties? What kind of cognitive biases facilitated the collapse in decision-making processes that led to the medical error?
My initial exploration of the literature into finding the context behind how these errors occur has revealed the following key factors and constructs that influence collaboration.
Roles/Identities, Boundaries, and Responsibilities
One of the components of collaboration concerns how members internalize and understand their roles and related tasks (Hansen, 2006; Page & Donelan, 2003). Unclear boundaries in this aspect can set members of the care team on a path wrought with misunderstandings regarding expectations of work and task responsibilities (MacNaughton et al., 2013). A study by Liberati et al. (2015) on the disciplinary boundaries and their effects on patient care found that each discipline (e.g. nursing, medicine) shapes professional identities, develops its representation of what it means to care for patients, and regulates the boundaries and interactions between the health professionals. Thus, those engaging in collaborative work must first negotiate their perspectives on how to approach, process, and take part in caring for a mutual patient in order to achieve a shared understanding of each other’s roles/identities, boundaries, and responsibilities.
Open Communication
One of the core competency domains for interprofessional collaborative practice listed in the IPEC’s 2011 Expert Panel report is communication. The report mentions that dysfunctional communication patterns created from professional differences can keep members from sharing their expertise and feedback in a timely, sensitive manner. Communication in healthcare begins with the act of evaluating the information available and identifying the critical elements that one must relay to the other party. Health professionals regularly encounter situations of uncertainty (e.g. limited patient information and knowledge of the situation at hand) in which they must make decisions regarding patient care, often while constrained by time (e.g. emergency/critical care). This process requires members to engage in timely communication of essential information to one another throughout the series of decision-making events.
Conflict Resolution, Addressing Barriers to Cohesion
The American Medical Association (n.d.) states that the ability to discern and dissolve potential as well as existing barriers is a necessity for groups to ensure successful outcomes in collaborative work. Brown et al. (2011) identified key sources of conflict in collaborative work as a lack of understanding of members' roles, boundaries, and scopes of practice and differences in member beliefs regarding accountability. Effectively addressing and resolving these conflicts require members to openly communicate with one another, accepting responsibility for contributing to the conflict and showing a willingness to find solutions to the problem (Brown et al., 2011). This willingness was tied to a practice of humility, which involved listening to both sides of the story as members engaged in seeking solutions to conflict situations.
Theoretical Foundations
One commonality among the factors is the act of taking perspective, whether it is on the multiple perspectives surrounding a single situation or simply communicating one’s perspective while interpreting the other’s in the process of achieving a shared understanding (Brown et al., 2011; Weller et al., 2014; Zweibel et al., 2008). I am currently in the process of exploring the different theories related to multiple perspectives and the act of perspective-taking (Batson et al., 1997; Boland & Tenkasi, 1995; Epley et al., 2004), such as personal epistemology (Hofer & Pintrich, 1997; Kuhn et al., 2000; Schommer, 1990), communication (Berger, 2005; Griffin, 2006), and empathy (Duan & Hill, 1996; Shamay-Tsoory et al., 2009; Smith, 2006).
In the process of exploring these theories, I would like to develop a theoretical framework explaining how perspective-taking works in collaborative contexts through the proposed theories. My hope is that the theoretical framework I develop could inform me on identifying and creating potential pedagogical strategies for promoting students' awareness and evaluation of different perspectives in their team-based problem-solving activities.
I am also exploring the literature on existing pedagogical strategies that could be related to promoting perspective-taking, such as case-based learning (Choi & Lee, 2009; Hess et al., 2017), role playing (Nestel & Tierney, 2007), creative writing (Kerr, 2010), and so on. Eventually, I hope to integrate this pedagogical literature to my theoretical framework to elaborate on practical guidelines for pedagogical strategies and their known benefits. These guidelines will help me move to the next steps of my research, which are identifying, developing, validating and refining effective pedagogical strategies for promoting one's understanding of others' perspectives.
References
Almost, J., Wolff, A. C., Stewart‐Pyne, A., McCormick, L. G., Strachan, D., & D'souza, C. (2016). Managing and mitigating conflict in healthcare teams: an integrative review. Journal of advanced nursing, 72(7), 1490-1505.
American Medical Association. (n.d.). Collaborative Care. Retrieved November 12, 2019, from
https://www.ama-assn.org/delivering-care/ethics/collaborative-care