The current, common practice of totally separate medical and nursing schools would change. Physicians and nurses have selected classes and clinical experiences together as students so that each group enters practice with a respectful, accurate knowledge of the other’s clinical contribution.
Interdisciplinary patient care rounds are the norm, and each discipline’s contribution is considered so essential that decisions are not made without all care providers weighing in.
Each patient, when able, and the patient’s family are integral members of the decision-making team so that the patient’s values and wishes are key components of the planning process.
All team members feel comfortable and supported in challenging care processes when the processes are perceived to be inaccurate, not evidence-based, or inconsistent with professional values or the patient’s values.
All team members actively seek and engage in educational programs that improve their communication and collaboration skills. Colleagues support each other in skill development and hold each other accountable for correcting lapses in respectful communication and collaboration patterns.
Techniques such as the situation-background-assessment-recommendation (SBAR) model18 are widely used to increase the effectiveness of communication, especially in critical situations.
Structured forums such as ethics committees are used effectively to support clinicians in resolving disputes, to provide clinicians a broader view of the issues, and to ensure that patients’ values and wishes and, if appropriate, those of the patients’ family members are identified and incorporated.
A high level of personal integrity characterizes the behavior of all team members.
Concerns about competence or the collaborative behaviors of team members are dealt with directly and respectfully so that patients are not harmed and team members receive support to correct communication and practice deficits.
Interdisciplinary educational efforts are the norm for staff education in health care, with research findings from each discipline incorporated into the content of clinical education.
“What is best for the patient” is driven by the patient’s perspective and values, integrating the best practice knowledge of each discipline.
Evaluation of care processes includes the evaluation of the burden that ineffective care systems place on patients and patients’ families, with quality improvement efforts designed to monitor and repair these broken systems.
Ongoing efforts to enhance patients’ safety include monitoring communication and collaboration patterns, and explicitly linking process improvements in these areas with improved outcomes related to patients’ safety.
An organization’s success (or failure) to transform its work environment and achieve patient-focused care is systematically tracked and improved through a comprehensive outcome-monitoring program.
Professional associations and other influential groups with a stake in the process support their members’ efforts to transform the members’ practice environments via Web sites, publications, and other strategies that foster the exchange of best practices, tools for effective transformation, and recognition of centers of excellence (eg, the AACN Beacon Award for Critical Care Excellence).
National regulatory and accrediting organizations such as the Joint Commission on Accreditation of Healthcare Organizations incorporate quality-of-care metrics that support this transformation of culture.