Running Head: LEADERSHIP QI PROJECT 1

Leadership QI Project Paper

Serena Blalock

Bon Secours Memorial College of Nursing

Dr. Barbara Ellcessor, DNP, RN, RNC-OB

NUR 4144 Professional Role Development: Servant Leadership

March 20, 2018

Honor Code “I Pledge..”

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“Interprofessional collaboration has become accepted as an important component in

today’s health care and has been guided by concerns with patient safety, quality health-care

outcomes, and economics” (Engel & Prentice, 2013). The quality improvement topic that I

choose to represent on my orthopedic unit, would be interprofessional collaboration. I wanted to

use this topic because all too often, we see the different specialty doctors not communicating

with each other. All of them come and visit their patients, but none of them are aware what tests

or guidelines have been given by the other doctors. One doctor doesn’t see why the patient can’t

walk on their injury, while the surgeon put the patient on a non-weight bearing status. This not

only puts extra work on the nurse for clarification purposes, but also confuses the patient. In

order to implement a quality improvement project on interprofessional collaboration for my unit,

I would utilize the four domains of leadership and the five practices of exemplary leadership to

bring this into action.

As a nurse manager, the first issue that I would address would be the values of the unit.

This is the first domain of leadership, also known as the head. As a unit we would need to work

together to make interprofessional collaboration a team effort. We would need to educate the

staff about the proper way to address a physician or a pharmacist whom is not practicing

interprofessional collaboration. We need to show respect through this change while also striving

toward growth for the unit. We can use evidence-based practice to inform those whom are

hesitant that “research has identified that effective teamwork is essential in order to enhance care

provision and health outcomes for patients” (Price, Doucet, & Hall, 2014). Working together as a

team will make this an achievable goal that could not only be implemented on our unit but

throughout the entire hospital system. It will take a little bit of extra time in the beginning of the

process, but just like every other part of a routine it will get easier with time.
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The next issue that I would address on my unit, would be my intent for implementing

interprofessional collaboration. This is the second domain of leadership, also known as the heart.

“It is widely accepted that interprofessional collaboration improves patient outcomes through

enhanced communication among health-care providers and increased accessibility to services”

(Engel & Prentice, 2013). My main priority as a nurse manager is improving patient outcomes.

“Its primary requirement is providing benefits to patients and meeting users' expectations”

(Supper et al., 2015). I want my patients to be treated with respect and be shown the

compassionate care that they deserve. Some patients stay in the hospital for more days than are

necessary. Implementing interprofessional collaboration on my floor, could decrease patient’s

time of stay in the hospital. If the doctors were all on the same page, then they could get more

done in a day together. A patient could potentially have more answers to what’s going on with

their care plan progression. We can increase their access to services because if the doctors,

nurses, and case managers are on the same page from the start, then that could decrease the

length of stay and improve the quality of the stay. Therefore, the overall our overall intent would

be to improve patient outcomes.

After providing my intent, I would then move onto putting the work into progress. This is

known as the hands phase of the domain of leadership. “Findings suggest that nurses and

physicians do not share the same views concerning the effectiveness of their communication and

nurses' role in the decision-making process of the patients' care” (Matziou et al., 2014). As a

nurse manager, I want this to change on my floor. I want a mutual sense of respect between the

two professions. I want for physicians not to see nurses as beneath them, but rather as their safety

net between themselves and the patient. The physicians give the orders, but do not know the

patients as well as the nurses know them. Sometimes the nurse even has to ask for orders that the
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physician forgot. It is not that the doctor didn’t want the patient to not have a proper diet tray

brought up, it’s that they simply forgot. As a team we work together to fix each other’s mistakes

so that the patient’s wellbeing is the main focus. “Therefore, in everyday practice, both nurses

and physicians should acknowledge the importance of their effective communication and they

should develop and implement interprofessional teamwork interventions to improve

collaboration” (Matziou et al., 2014). Through hard work and the willingness to work together as

a team, this unit can turn this idea into an everyday practice.

Finally, the last domain of leadership is the habits, or what keeps us grounded during this

change on the unit. “It is likely that professionals' beliefs and values are determining factors for

collaboration” (Supper et al., 2015). Once we have established what the values and beliefs that

need to be implemented, we can then focus on how to stay grounded in that place. We can

implement having solitude for our facility if they need a few minutes to recuperate from a

situation. This will ground them so that they are able to get back to work at one hundred percent

for the team. Anyone can take a moment of prayer to themselves so that they can become re-

grounded. When the interprofessional collaboration team is refueled by God then more things are

possible. When we are able to incorporate God into the workplace then we can build supportive

relationships with the team. Getting the interprofessional team on the same page professionally

and spiritually will greatly benefit our patients. A more total form of healing can occur if every

person who interacts with the patient is able to pour the unconditional love of God into their

work. As a manager I want my staff and other people who come onto my floor be grounded in

themselves, because then we may help ground others and promote healing for our patients.

As a nurse manager I will model the way for the rest of my unit. I will make sure that my

actions match the requests that I have made for interprofessional collaboration. I want to be an
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example for my team to follow. I will be the leader to my unit, in the way that I want

interprofessional collaboration to begin. If team members feel uncomfortable at first addressing

the issue, I will encourage them to come and find me so that I may help with the situation. This is

where I want to educate my staff so that they can know the game plan on getting other

professions onto our set of values that we want to implement. We want to update doctors before

they go into the patient room for the morning, so that they have the most accurate information for

their patients. I also want other doctors that may do their rounding later in the morning to take

initiative to look at other doctor’s notes so that they are not pushing all of the work on the nurses.

I want to inspire my team so that we can all have this shared vision of interprofessional

collaboration. The next time that these patients come into the hospital we want it to be a better

experience. As a manager, I want a better stay for my patients. It will have to be a work in

progress first, because nothing worth having comes easy. My intent is to envision a future that

has a shorter hospital stay because my patients are taken care of in a timely manner. I want to

have doctors that have actually looked at the other consults, and write different progress notes

every day. I hope to inspire the surgeons that we regularly work with to enjoy coming onto our

floor because we are so organized with what is going on with their patient’s care. We should

want to enlist others so that they can see how well interprofessional collaboration can work if

everyone is willing to put in the effort. If I was able to inspire a shared vision to everyone that

came onto my floor, then a brighter future would be available for our patients.

Next thing to address as a manager is to challenge the process. Change isn’t always easy,

but when we place our values and full intent into it, then it may seem more achievable. As the

process goes forward, we can figure out which things are working out and which things could

use improvements. As a manager, I would search for opportunities for improvement within the
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system. I want to ask doctors what they think could be improved, as well as my nurses and the

other professions involved. This process is not a singular effort and therefore will take

everyone’s participation to make this change. “Interprofessional collaboration in primary care

can be defined as an integrative cooperation of different health professionals, blending

complementary competences and skills, making possible the best use of resources” (Supper et

al., 2015). Together as a team we can take the necessary risks in order to get better patient

outcomes; and we can overcome the challenges and work through them for a better future.

The next thing that I would work on would be to enable others to act. We want to be able

to share our values and show all of the hard work that we have put into this process. As a

manager, I want to foster a collaboration among my team because this is a job that cannot be

done by just one person. We must all take this as our own and encourage others to do the same.

There is strength in numbers, and when the numbers grow, then that means that more professions

are actively participating in the collaboration. “In the practice setting, interprofessional

collaboration has grown up alongside changes in health care delivery, particularly the move

away from single-practitioner models and patient–provider dyads, to team-based delivery of

care” (Haddara & Lingard, 2013). The change from single-practitioner to team-based delivery

didn’t happen overnight. We must understand that getting interprofessional collaboration to

occur on a hospital unit will take some time but together we will be able to accomplish it.

The last thing that I would do to implement the effects that interprofessional

collaboration could have on my unit would be to encourage the heart of my team. I would

recognize the great contributions that each person was doing in order to get the unit on track.

Recognizing the good that people are doing makes them want to be at their job because they feel

as though they are essential. We can use the things that keep us grounded like prayer and solitude
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to encourage other’s hearts. When we are able to share our faith in others, then they too feel

empowered to do great things. As a manager, I would ask my team to provide little victories to

me. This could mean getting someone to collaborate that was hesitant on the idea, or something

as simple as the feeling that the patient care was improved because of the team-based delivery of

care. When the little accomplishments are praised, then just imagine how good it will feel to

have a big victory.

In order to implement this into professional practice, it will take some team work. As the

manager I would want to see the doctors actively trying to incorporate the multiple doctors plans

of care so that the patient isn’t getting different answers based on their specialty. The patient

would have a much better understanding if the doctors knew what each other were doing for the

same patient as opposed to the patient or nurse having to explain what their other doctor had said

to them an hour ago. Doctor progress notes that were shared interprofessionally would be

helpful if they were put into the chart in a timely manner so that the next doctor could be on the

same page when he went to address the patient. I have seen the doctor literally copy the progress

note from the previous day. This gives the nurse little to work with when the patient asks what

their plan is for the day. It is unnecessary that they stay longer simply because the doctor isn’t

taking the time to check in on what is going wrong with the patient. I would also like to get the

doctors to work more with case managers in order to get the satisfaction that the patient deserves.

Nurses usually have to get the case managers involved in order to get the patient to a skilled

nursing facility when necessary. I would like to see the doctor make the connection and get the

case manager involved as soon as possible. I believe that this will decrease the length of stay for

the patient and allow the patient to leave feeling satisfied.

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I believe that if case managers, physicians, pharmacists, nurses and the different therapies

worked together more often, as opposed to separately, then patient outcomes would be improved.

Everyone seems to work through the nurse, and the process could take less time if more teams

within the same unit were on the same page. The main goal of interprofessional collaboration is

to get better patient outcomes. I want the process of having to be in the hospital to be a smooth

process with everyone on board to get the patient back to their normal self. Teamwork is at the

center of this idea because all of the professions must work together in order to benefit the

patient’s needs. We must show our intent for our patients needs through our hard work as a team.

The ability to lead others toward a common goal will make the goal seem much more attainable.

I want to have a quality healthcare system that leave the patient feeling healed on more than just

a physical level, and I think that is achievable through interprofessional collaboration.

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References

Engel, J., & Prentice, D. (2013). The ethics of interprofessional collaboration. Nursing

Ethics, 20(4), 426-435.

Haddara, W., & Lingard, L. (2013). Are we all on the same page? A discourse analysis of

interprofessional collaboration. Academic Medicine, 88(10), 1509-1515.

Matziou, V., Vlahioti, E., Perdikaris, P., Matziou, T., Megapanou, E., & Petsios, K. (2014).

Physician and nursing perceptions concerning interprofessional communication and

collaboration. Journal of interprofessional care, 28(6), 526-533.

Price, S., Doucet, S., & Hall, L. M. (2014). The historical social positioning of nursing and

medicine: implications for career choice, early socialization and interprofessional

collaboration. Journal of Interprofessional Care, 28(2), 103-109.

Supper, I., Catala, O., Lustman, M., Chemla, C., Bourgueil, Y., & Letrilliart, L. (2015).

Interprofessional collaboration in primary health care: a review of facilitators and barriers

perceived by involved actors. Journal of Public Health, 37(4), 716-727.