Barriers and Solutions to Interdisciplinary Teamwork in the Medical, Private, and School Settings
1/20/2017 3:13 PM
It may take time for universities to comprehensively adopt interprofessional education, but more immediate change may occur by motivated professionals who are already practicing on interdisciplinary teams or who wish to initiate these services within their facility. This post will discuss some of the barriers to initiating interdisciplinary teamwork, and strategies to overcome some of those barriers.
Most clinicians in private and school sectors may identify that limited time for collaboration is the most significant barrier. For hospital and private therapists, Rogers and Nunez (June, 2013) suggested one of the most significant challenges in engaging in interdisciplinary teamwork is the fee-for-service model. Under this system, collaboration and team meetings are not billable services and thus are not in the interest of businesses needing to make a profit. These businesses may attempt to maximize the number of clients that their therapists work with to increase potential profit. It is up to advocates at the national and state level to work with Medicare/Medicaid and private insurers to develop reimbursable billing codes for non-direct patient/client care.
Fortunately, transitioning towards an outcomes-based reimbursement healthcare model is in the near future (though it is unclear how this may change with healthcare reform under a new administration) and it is possible that hospital and private providers may place more emphasis on collaborating with an interdisciplinary team to accelerate progress and reduce misuse/overuse/underuse of services. Unfortunately, this does not help clinicians to meet immediate collaboration needs. It remains imperative to create administrator buy-in to allow clinicians and teachers to consult with one-another. This is especially significant for private providers who have limited visits with clients due to insurance coverage. Perhaps these clinicians could attempt to put in additional time to collaborate with school teams outside of regular hours and track progress on these patients; these data could be compared to rates of improvement from previous clients whose teams were not collaborated with. These data could then be presented to administrators as hard-evidence for why time for collaboration is necessary.
Once achieving availability for meetings, we can then experience a barrier in aligning times to meet across providers and tools to access meetings electronically. While the task of coordinating a meeting with one individual is not always a challenge, establishing a meeting with an entire school team, private therapists, and clinical specialists can be nearly impossible. To help bridge this gap, I would encourage providers to consider the use of free online meeting schedulers (e.g., Survey Monkey, Doodle). These free tools allow all parties to list their potential availability (and lets you see who has not yet responded). Unfortunately, it is often the responsibility of coordinator to remind individuals to respond to these meeting requests and ensure that everyone lists availability. Lack of free HIPAA-approved secure video platforms also creates a barrier for those who cannot coordinate a visit in person. To this writer’s knowledge, all videoconference platforms that are currently used for telehealth have a fee associated with use. Secure video platforms are needed to provide team trainings, hold regular meetings, and ensure a personal interaction among the team.
An additional barrier that prevents teams from collaborating is lack of a quick and secure way to discuss progress, problems, and other needs with the wider team. Often, clinicians are forced to e-mail and/or set-up time to converse on the phone. It would be ideal if there were an online HIPAA-approved social network platform in which providers of all disciplines could create a professional profile. In this social network, private groups could be established in which only a child’s providers (including clinical specialists, therapists, and school staff) could access. In these groups, providers could post clinical updates, assistive technology use, goals, and the shared collaborative long-term objective. Such a network will require significant buy-in from professional associations and providers, as well as an innovative and dedicated company to take on such a task.
Due to a variety of reasons, it might not be possible for every provider to be at all meetings. When this is the case, we must still find a way to share the missing team member’s expertise with the group, and to provide the meeting information to the missing professional. Further, that professional must have the opportunity to be a part of the team decision making process. This will often fall to the responsibility of the meeting coordinator to ensure that all stakeholders have been heard.
Perhaps the most important limitation is the human-factor. For many individuals to make change, there often must be some personal benefit. In the current fee-for-service model, private providers would see no personal benefit for engaging in collaboration, with the possible exception of networking. In fact, many professionals in school or in the private sector may find that taking time to collaborate would prevent them from engaging in other activities. The “human-factor” I refer to is altruism, and I believe it is one of the reasons why most of us chose the careers we are in. We are motivated by our clients and passionate about seeing them improve in their health and skills. Interdisciplinary teamwork requires great selflessness and focus for the well-being of the client we are collaborating with. I am personally hopeful that this would never be a barrier for members of this Community. I further hope that those of us in the Community can motivate others to find their altruism if this is a barrier for a partner you collaborate with.
For those interested in learning more about how to engage in interdisciplinary teamwork, including the barriers and strategies to overcome those barriers, consider the free webinar offered through ASHA for 0.2 CEUs. Additionally, a free e-text book has been published by ASHA on engaging in interprofessional education and collaboration, which can be found through their website.
This post has identified several barriers that limit interdisciplinary teamwork across facilities, but there may be more that we have not discussed. In your experience, what other barriers have you identified that prevent interdisciplinary teamwork?
Resources:
Rogers, M. & Nunez, L. (June, 2013). From my perspective: How do we make interprofessional collaboration happen? The ASHA Leader, 18, 7-8.
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