Interprofessional Healthcare Leadership

By Rose O. Sherman, EdD, RN, FAAN

There is much discussion today about the importance of both interprofessional practice and education. Healthcare quality is dependent on strong teamwork. We have good evidence to suggest that when this teamwork is not present, there is an impact on communication, quality, safety and staff satisfaction. What we hear less about is interprofessional healthcare leadership. The late Peter Drucker, father of American Management theory, often said that culture eats strategy for breakfast. The point he was trying to make is that if you want to promote something in your environment, it better be embedded in the culture and that starts at the top. I was reminded of this last week when I attended a Robert Wood Johnson Nurse Fellows meeting where this was discussed.

How well do our top leaders work with one another? There is actually little research that has looked at this specific aspect of interprofessional practice. Most of what has been written is case-based. Prior to this conference, I asked ten CNO colleagues about their challenges with interprofessional leadership. They pointed out to me that with the movement to value-based purchasing and bundled services, every profession is becoming a cost center. There is impact when care expectations are not met that are sometimes leading to new areas of conflict. There were 4 major themes in the challenges they reported. These included:

Budget discussion and justification especially when budgets are siloed and there is competition for resources.
Staff productivity and assumption of new tasks and responsibilities in an ever changing healthcare environment.
Scope of practice issues
Service line and team leadership – do we need a captain of the ship or can we try dyad or triad leadership?

We know that to be an effective in interprofessional environments, you must be dedicated to boundary spanning leadership that recognizes the limitless possibilities that come with collaboration. Powerful boundaries such as those that happen in professional silos create borders that can splinter groups into Us and Them if we let it happen. We learned about strategies to avoid this at the RWJ conference from powerful national leaders such as Kameka Brown from the State Board of Nursing in California, Garrett Chang the Director of Advanced Practice at Stanford Health, Grace Wakulchik the COO at Akron Children’s Hospital and Karen Miller the former Dean and Vice the Chancellor at the University of Kansas. Walking the talk as a leader is extremely important. You cannot expect staff to function well on interprofessional teams without leadership role modeling. This requires a high level of trust, respect and willingness to focus on the bigger picture to achieve a shared vision. Excellent communication is the key as is comfort with ambiguity and uncertainty. A leader cannot be allowed to opt out of being a collaborative professional. A culture of civility is the cornerstone.

Unfortunately, some organizations silo by discipline their leadership training so these skills are not collaboratively learned. If we truly want more effective interdisciplinary teamwork, it starts with us – the leaders.