title: Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel.
abstract: OBJECTIVE
  Historically, health care has primarily focused on physician, nurse, and allied healthcare provider triads. Using a phenomenological approach, this study explores the potential for hospital-based interdisciplinary care provided by physicians, nurses, and unlicensed assistive personnel (UAPs).
  
  
  METHODS
  This phenomenological study used a purposive nonprobability, criterion-based, convenience sample from a metropolitan hospital.
  Malhotra's (1981) Schutzian lifeworld phenomenological orchestra study provided the theoretical basis for the conductorless orchestra model, which guided this study. In an orchestra, each member sees and hears the musical score from a different vantage point or perspective and has a different stock of knowledge or talent; however, members work together to produce a cohesive performance. Like the orchestra, individual talents and perspectives of physicians, nurses, and UAPs can be collaboratively blended to create a symphony: enhanced patient-centered care.
  
  
  METHODS
  Qualitative semistructured face-to-face, individual interviews were carefully transcribed and coded with the aid of NVivo 9, a qualitative data analysis software program, to discover emergent patterns and themes.
  
  
  RESULTS
  The study suggests that most of the time physicians, nurses, and UAPs operate as separate healthcare providers who barely speak to each other. Physicians see themselves as the primary patient care decision makers. Many physicians acknowledge the importance of nurses' knowledge and expertise. On the other hand, the study indicates a hierarchical, subservient relationship among nurses and UAPs. Physicians and nurses tend to work together or consult each other at times, but UAPs are rarely included in any type of meaningful patient discussion.
  
  
  CONCLUSIONS
  Since physicians, nurses, and UAPs each provide portions of patient care, coordination of the various treatments and interventions provided is critical to prevent errors and fragmentation of care. Tensions, misunderstandings, and conflicts caused by differences of opinions and interests can interfere with effective interdisciplinary communications and collaboration. Improving patient safety in the hospital requires addressing the current hierarchical professional structure inherent in healthcare delivery. A hospital patient care model based on the conductorless orchestra model would mitigate hierarchy; recognize physician, nurse, and UAP contributions to care; promote improved communication and collaboration; and enhance patient safety.
  
  
  CONCLUSIONS
  Study results provide additional information supporting interdisciplinary communication and collaboration education and training among physicians, nurses, and UAPs to support positive patient care outcomes.
authors: Assistant Nursing Care Coordinator, Omicron Delta, Mount Sinai St. Luke's Hospital, New York, NY.
authors: Gwendolyn
authors: G
authors: Lancaster
authors: Stephanie
authors: S
authors: Kolakowsky-Hayner
authors: Joann
authors: J
authors: Kovacich
authors: Nancy
authors: N
authors: Greer-Williams
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003299:Cooperative Behavior; D003657:Decision Making; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D019555:Physician-Nurse Relations; D024382:Professional Role; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Collaboration; interdisciplinary communication; nurses; patient safety; physicians; teamwork; unlicensed assistive personnel