Alevra Robinson, an elderly woman confined to a wheelchair, has spent recent Thanksgiving holidays in a nursing home. The food was bland, the setting was sterile and, although friendly, most of the people around her were not family.
This year is different: For this first time in years, Robinson, 74, is hosting her own Thanksgiving dinner. For this remarkable occasion, Robinson has invited family and friends to her new apartment in Philadelphia to share turkey, stuffing and all the homemade fixings she can cook up in the days ahead—collard greens, cabbage, macaroni and cheese, eggnog and candied sweet potatoes.
What made the difference? She joined Living Independently for Elders (LIFE), a health care center in Philadelphia that helps low-income, frail or chronically ill older adults live on their own. Prior to her move, LIFE’s team of physical and occupational therapists taught her how to use the toilet, get into bed, clean up and take a bath, and assessed her new apartment to ensure it was wheelchair ready.
At LIFE, Robinson gets the kind of holistic support that cannot be provided by a single professional. And the benefits of this kind of teamwork are incalculable. “I can basically do what I want to do, and I’m happy,” Robinson says. “I don’t have to depend on anyone.”
Owned and operated by the school of nursing at the University of Pennsylvania and led by nurse practitioners, LIFE employs physicians; speech, occupational and physical therapists; social workers; dieticians; nurses’ aides; drivers; and others. Its successful model of interdisciplinary collaboration was highlighted in a groundbreaking report on the future of nursing that was released in October by the Institute of Medicine.
Supported by the Robert Wood Johnson Foundation (RWJF), the report called for a radical transformation of the nursing profession to meet increasing demands for health care at a time of significant demographic and health system changes.
One key way to do that, The Future of Nursing: Leading Change, Advancing Health says, is to enhance interdisciplinary collaboration and coordination in health care. “As the delivery of care becomes more complex across a wide range of settings, and the need to coordinate care among multiple providers becomes ever more important, developing well-functioning teams becomes a crucial objective throughout the health care system.”
Health professionals currently operate in separate spheres, the report’s authors write. But studies show that if they “break down the walls of hierarchical silos” and come together as a team—as is the case at LIFE—they will improve safety and quality of patient care.
Collaboration between Professions Starts with Interdisciplinary Education
To break down those walls, health professionals must begin working together before they actually start working, the report states. It calls on universities and training programs to expand interdisciplinary educational opportunities and programs to help foster collaboration among students before they enter the health workforce.
That, the authors say, will lead to more effective communication across disciplines and, ultimately, safer, more affordable, and higher quality care.
Susan C. Reinhard, R.N., Ph.D., F.A.A.N, senior vice president and director of the AARP Public Policy Institute and chief strategist at the Center to Champion Nursing in America, agrees. “These recommendations recognize that consumer health care quality and safety is improved when interprofessional collaboration is integrated into all levels of health care delivery—from education settings to practice to lifelong learning.”
The report recommends a variety of strategies to foster interdisciplinary education, including interprofessional orientation days and social events, joint faculty appointments, interdisciplinary coursework and clinic activities, and social networking sites that include students from a variety of health-related fields.
One program that takes interdisciplinary education to heart is the RWJF Ph.D. in Nursing with a Concentration in Health Policy at the University of New Mexico. Another is the Interdisciplinary Nursing Quality Research Initiative, a program funded by the Foundation that supports scholars from nursing and other disciplines to address gaps in knowledge about the relationship between nursing and health care quality.
Promoting interdisciplinary collaboration isn’t without its challenges. Health professionals may resist ceding certain responsibilities to other professionals with different kinds and levels of education, and health centers may face financial hurdles to providing comprehensive care from a full team of providers.
LIFE chief executive officer Daniel Drake, R.N., M.H.S.A., however, says it can be done.
The clinic is financially stable thanks to the capitated fees it receives, he says. At the same time, he adds, it generates considerable cost savings for the state while improving patient outcomes. LIFE clients experience fewer falls, pressure ulcers, preventable hospitalizations, and emergency room visits, according to the IOM report.
Patricia Gerrity, Ph.D., R.N., F.A.A.N., director of the Eleventh Street Family Health Services of Drexel University, a nurse managed health center that treats the mind, the body, the spirit and, thanks to a center dentist, the mouth, can attest to the benefits of interdisciplinary teamwork.
She tells the story of a middle-aged Black patient who lost a tremendous amount of weight—and turned his life around—thanks to her clinic’s team of providers.
In addition to receiving primary and preventive care at the center, the man took classes in weight loss, cooking, mindfulness and even joined yoga. As a result, he no longer faces bariatric surgery, is able to play with his children, and is enjoying life more.
Patients aren’t the only ones who benefit from interdisciplinary collaboration, adds Gerrity, who was named an Edge Runner by the American Academy of Nursing (AAN) in 2007. The Edge Runner program is a part of Raise the Voice, an initiative funded by RWJF and directed by the American Academy of Nursing.
“You start to break down the barriers between disciplines,” she says. “Each person learns something about the other person’s discipline, and it enriches their own practice.”