At the hospital’s monthly interdisciplinary meeting, a lively discussion takes place: Is there an optimal pathway for patients who present to the emergency department with chronic abdominal pain? One by one, representatives from emergency medicine, general surgery, gastroenterology, pain management, radiology, nursing, and hospital administration make recommendations. At one point, a debate arises as to whether patients might be more appropriate for disposition to an observation unit versus the inpatient ward, and it becomes clear no consensus can be reached. Someone makes the suggestion that all patients be monitored in the observation unit for the first 24 hours, asserting that this is “what’s best for the patient.” Without further objection, the team’s focus shifts to the topic of multimodal pain management. The issue of final disposition remains unresolved.
Explore This IssueACEP Now: Vol 40 – No 08 – August 2021
This sort of group dynamic is familiar to many of us working in complex health care environments. Claims that a favored approach is what’s best for the patient may be made in good faith but often have the effect of shutting down further discussion and silencing dissent. To understand why this phrase is so pernicious, it helps to understand the purpose of interdisciplinary dialogue in the first place. When physicians, nurses, and administrators with different perspectives and diverging interests come together, opinions as to what’s best for the patient should vary. The goal, then, is not to perfectly align opinions and agendas to reach consensus but to balance them and emerge with an informed, actionable outcome. That said, how does one go about making interdisciplinary discussions more productive? Is there a way to use “what’s best for the patient” not as a bludgeon but as a rallying call?
Table 1: Key Features of Productive and Nonproductive Discussion
What does this accomplish?
|A balance of inquiry and advocacy
|Strong advocacy without sufficient inquiry
Strategies for Productive Conversations
Much ink has been spilled on this topic, but for clinician leaders, we suggest leveraging many of the same skills that we employ in taking a patient’s medical history.1–3 Practice open-ended inquiry, focus on the “how” and “why,” search out facts and missing information, promote inquiry, test assumptions, seek alternate explanations, and avoid judgmental or conclusory statements. Leaders should promote an environment of psychological safety by allowing all participants to speak up, encouraging and applauding dissent, and identifying when differences in status or seniority interfere with debate (see Table 1). A healthy debate should focus on the thought processes, assumptions, and underlying data—rather than opinions—that team members used to arrive at their conclusions.