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Caring for today’s acutely ill hospital patients calls for a collaborative, interdisciplinary approach.  When it comes to rating collaboration, however, physicians rate their collaboration with nurses more highly than nurses rate that collaboration, notes a recent study.

“A Multisite Study of Interprofessional Teamwork and Collaboration on General Medical Services” published in the December 2020 issue of The Joint Commission Journal on Quality and Patient Safety examined four nonprofit hospitals with between 200 and 350 beds located in the Southeast U.S., Midwest, and West. In each hospital, two medical units participated in the study. The research gathered the views of hospitalists, residents, nurses, and nursing assistants.

As the bar chart shows, some 63% of hospitalists rated the collaboration with nurses as high or very high, while roughly 49% of nurses rated the quality of collaboration with hospitalists as high or very high.

Nurses and doctors view collaboration differently.

Percentage of respondents rating collaboration as high or very high quality. ​[CLICK TO ENLARGE. CLICK BACK ARROW TO RETURN] ​Source: The Joint Commission Journal on Quality and Patient Safety

The article notes that the discrepancy between nurses’ and physicians’ perceptions of collaboration mirrors findings from other studies conducted in operating rooms,  ICUs, and labor and delivery units.

The explanation for differing perceptions between nurses and physicians, the study notes, may be partially explained by differences in status/authority, gender, training, and patient care responsibilities. Workflow differences, poorly designed communication technology, and strained relationships also serve as barriers to collaboration. What’s more, the article notes, hospital-based physicians are often spread across multiple units, giving them little opportunity to collaborate with nurses and other professionals who work on designated units.

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Healthcare Hierarchy: “Hint and Hope” v. Direct, “to the Point” Communication

Two forces may be at play in these different ratings of collaboration: the hierarchy of healthcare and the different ways doctors and nurses communicate, says Milisa Manojlovich, PhD, RN, one of the study researchers and Professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor.  “Whenever you have a hierarchical structure, it causes discrepancies in perception. So the physicians may perceive that they’re collaborative, but the nurses feel that they’re being told what to do. They’re not necessarily being invited to participate. And so this discrepancy is part of the problem.”

In addition, physicians use a “quick, to the point way of communicating,” notes Manojlovich. In contrast, nurses often use a form of communication known as “hint and hope” – hinting at what the nurse wants, in the hope of getting that from the physician.

Direct is Best

To address these issues, Manojlovich suggests that nurses speak more directly: “Directly ask for something that you want, and say why you want it.” The nurse then is doing more of the “cognitive work” needed, she notes.

Second, clinicians should develop a good relationship with each other, she notes. Once a good working relationship exists, “our collaboration actually improves.”

The results of this study are part of a larger project called the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) project, funded by the Agency for Healthcare Research and Quality. The project, notes the article, seeks to establish and disseminate the optimal model of care to improve interprofessional teamwork and outcomes for hospitalized patients.

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Louis Pilla
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