You may have the opportunity at some time to
create or develop an interdisciplinary team
in your primary care practice setting.
Building a strong interdisciplinary team requires
careful planning, commitment and constant nurturing.
This section is adapted from the Pew Health
Professions Commission Model Curriculum and
Resource Guide (1995). It describes the important
components of team formation. The student is
encouraged to read more information from this
guide that offers several case examples.
Membership on a health care team should ideally
be determined by the disciplines and skills
that are required for the effective realization
of the goals of the team. Some professionals
may only be required on an occasional basis
so it is often useful to consider a "core"
or "nuclear" team consisting of members
that regularly function together on a full-time
basis. Additional "extended" or "consulting"
individuals provide important skills and services
on an intermittent basis.
Visit again Drinka
Model. The Interdisciplinary Teamwork System Fig 2.5
In the early stages of development, the team
members need to spend time planning the following:
Goals, Tasks and Roles, Leadership and Decision-Making,
Communication, Conflict Resolution. This might
include considering members of the core and
extended teams, specific role definition for
each member and members role expectations,
definition of issues that need to be addressed
by the team as a whole, members information
needs, mechanism for coordinating exchange of
information, mechanism for evaluation outcomes
and making adjustments to the team.
In other words, a team needs to know where
its going, what it wants to do, who is
going to do it, and how it will get done.
Goals: It is often
helpful to begin with a broad mission statement
to which all members can subscribe. From this
statement, the team can then devise specific
goals that have clear, realizable endpoints
and objectives that provide a specific means
of achieving this goal. Prioritizing these goals
will further help to clarify the mission of
the team and serves as a useful activity to
develop team cohesiveness. The dimensions of
the goals may be long-term or short term or
may arise from professional needs, patient needs
or team needs.
The goads initially described by the team are
not necessarily fixed, and it is important to
continually re-examine, redefine, and re-prioritize
the goals of the team as required over time.
Tasks and Roles:
In primary care there is often some overlap
in the skills of the various providers. Several
professionals, for example, have expertise in
interacting with patients, forming care plans,
and educating patients. Several primary care
providers can diagnosis and treat illness. Thus,
rather than attempting to define rigid boundaries
of practice to segregate team members, it is
more valuable to develop effective ways of sharing
some responsibilities and tasks. See
section on Team Members for more information on members of a health care
It is better to begin by differentiating tasks
before negotiating roles in the process of defining
functions of team members. This emphasis on
tasks before roles tends to diminish issues
of professional territoriality and ownership.
The central issue in role negotiation is whether
traditional professional roles and skills are
unique or merely distinctive. Because of the
issue of overlapping skills, members must clearly
define the role expectations for the team. Are
expectations clearly defined? Do roles conflict
or are they compatible? Can an individual meet
The decisions of who does what can be guided
by provider availability, level of training,
or member preferences. As with the setting of
goals, it is important to periodically review
and revise member roles as necessary.
Pitfalls arising from lack
of role clarification:
- new members are confused regarding what
is expected of them and what they can expect
- increased conflicts between team members
- crises arise when members assume that someone
else was responsible for handling the situation
- team decisions are not carried out effectively
Leadership and Decision-Making:
There are several approaches to the leadership
of an interdisciplinary collaborative team.
Historically, physicians have had the role of
team leader in health care settings due to various
cultural, gender, and power factors. Still relevant
today remains the issue of legal responsibility
for patient care. An emerging pattern in many
primary care teams, however, involves equal
participation and responsibility on the part
of team members with "shifting" leadership
determined by the nature of the problem to be
solved. Emphasis by the team on "health
care" rather than the more narrow focus
of "medical care" broadens the roles
and responsibilities on non-physician providers.
See IDT Table, Methods of Interdisciplinary
Team Practice Drinka Table 2.5 (click on word
above or see IDT Table in resources section)
A team must address the following questions
in developing a mechanism for making decisions:
- What needs to be decided?
- Who should be involved in the process?
- What decision-making process should be
- Who will be responsible for carrying out
- Who needs to be informed about the decision?
An effective, coordinated team must have an
efficient mechanism for exchange of information.
At the simplest level, this requires the time,
space, and regular opportunity for members to
An ideal system for communication would include:
- a well-designed record system
- a regularly scheduled forum for members
to discuss patient management issues
- a regular forum for discussion and evaluation
of team function and development, as well
as related interpersonal issues
- a mechanism for communicating with the
external systems within which the team operates
Given the mixture of skills and professional
backgrounds, and the complexity of interdisciplinary
collaboration, a diversity of views and differences
of opinion are inevitable. It is important to
recognize, however, that conflict is both necessary
and desirable in order for the team to grow
and thereby develop greater efficiency and effectiveness.
Conflict encourages innovation and creative
problem solving, while successful confrontation
and resolution of differences engenders increased
trust and understanding between team members.
Signs of failure to deal effectively with conflict,
in contrast, include low morale, withdrawal,
lack of involvement, condescension, depression,
anger, and provider "burn-out."
Barriers to dealing effectively
with conflict include:
- an idealized sense of "togetherness"
that inhibits feedback and confrontation over
- a professional tradition of obedience to
authority and corresponding unwillingness
- "banding together" of members
of the same profession when there is disagreement
- misunderstanding of the roles, skills,
and responsibilities of other team members
Members need to focus on the overall mission
of the team and the care of the patient when
dealing with conflicts in order to avoid making
differences of opinion "personal."
Agree to ground rules before attempting to solve
the conflict. It may be helpful to have a team
facilitator who does not have a stake
in the outcome.
Negotiation strategies to consider:
- separate people from the problem (i.e.
diffuse the emotional component of the conflict
by showing respect, listening carefully, and
giving all parties an opportunity to express
- clarify the conflict/recognize the problem
- involved parties need to agree to work
toward a solution
- deal with one problem at a time, beginning
with the easier issues
- brainstorm about possible solutions
- focus on common interests, not positions
- use objective criteria when possible
- invent new solutions where both parties
- implement the plan
- evaluate and review the problem-solving
process after implementing the plan
Possible outcomes of team conflicts:
- avoidance: conflicting members avoid
each other or conflicting issues are avoided
in team discussion; leads to stagnation
- capitulation/domination: leaves
winners and losers; divisive for
- compromise: each party gives up
something important; may lead to divisiveness
and avoidance since members may feel that
they have lost out
- collaborative problem-solving: each
party states clear, observable terms; solutions
are sought that maximize net gains for both
parties; members feel positively about a solution
that is to the greatest benefit of the team
Health Professionals that are exposed early
in their training to working with interdisciplinary
teams will have more chance for success in team
building and team practice.
the following article to see
how nursing and medical students team for service
learning in community-based settings in the
District of Columbia.
Sternas Kathleen, OHare Patricia, Lehman,
Karen & Mulligan, Renee. (1999) Nursing
and medical student teaming for service learning
in partnership with the community: an emerging
holistic model for interdisciplinary education
and practice. Holistic Nursing Practice