All right, well, thank you everybody who's here for coming this morning to hear us speak and being up early and being wide awake, I hope. And hopefully you'll stay that way until the end. So I was invited to speak about how do you educate a team, best practices for interprofessional education. So those of you, almost everybody here, I think I probably had some kind of a relationship with in some way. I don't mean it like that. I mean professional relationship. Just know that my whole career has been really devoted to interprofessional education and really trying to raise the bar for those of us in critical care who are not physicians. And really trying to integrate into a multi or interprofessional educational platform has been a lifelong ambition of mine. We're not there yet, but we certainly are better. It is always, of course, important to remember that intensive care is a complex, dynamic place. It requires complex, dynamic education that involves all of our teams so that we are all raising to a higher level and that we are all communicating together scientifically, professionally, and moving forward. That requires a collaborative mindset. And a collaborative mindset really does require that all participants on the team, all participants on an equal playing field, that it's egalitarian, that it's collaborative. And that's what we're all striving for. All of us are striving for that, and we're doing a really great work in all of our institutions to achieve that in our practice. That really brings forward the inherent value of each team member. And if you've attended any sessions about recruitment and retention, I had a session on Saturday where I talked about the inherent value for your team member really is one of the most important retention strategies, that if we're valued, if we feel our words have value, if we feel that we can communicate effectively, that our staff want to stay, that it's not just about money, not just about hours, but it's about value and feeling valued. So first key, interprofessional education is about greater communication between health care professionals, and that provides for higher level of patient care. So I want to make sure that we appreciate that simply employing a team-based structure in a critical care unit does not ensure improved patient outcomes. So we can say that we are using a team structure, but we really have to make a commitment. So I want to just mention a commitment that I think is very similar to how we operate. We have a quarterback. That's our leader, and that's our physician. And the physician drives the game, takes the players, organizes them together in order to move forward to a win. And we're the offense. The team is the offense, and the defense, of course, is everything that's happening with the patient that we need to overcome. And by the way, I'd be very remiss if I didn't say 49ers won, because we're in San Francisco. So I like to just start with the idea and the understanding that talking about multidisciplinary and interprofessional or multiprofessional, those are two different things. So when a physician says multidisciplinary, they mean cardiology, pulmonology, endocrinology, nephrology. You get my point. Interprofessional says everyone who is working together to improve care for patients. So that includes everybody on the team. And actually, language is really important, because I think my physician colleagues that I work with would see saying multidisciplinary is very inclusive. But I don't hear it that way. I hear, because I've been around for 45 years, I hear that that's about the disciplines in medicine and not the professions. So really important for us to appreciate that we have one discipline. That one discipline is health care, is critical care. And that we have many professionals with one goal, the care and the safety for our patients. And that is the overarching perspective. That's the really important perspective when we talk about interprofessional education. So I want you to ask yourself, honestly, does expertise, diversity, so nurses, PharmDs, dentists, dieticians, physicians, the status difference based on your initials, and the temporary membership on the team. We come and go. We have this patient today. We have a different patient tomorrow. Our attendings are one week, and then they're off somewhere else. Does this facilitate or hinder your team effectiveness? And what is it that we can harness to actually enhance patient care and improved outcomes? So I think one thing we've ascertained, that we want to change our language from exclusive to inclusive. And I think that can be very beneficial for us. And that's my second key. Now, keys to successful interprofessional education. So I don't want to say that anymore, so I'm going to say IPE, which is what it's called in the literature and the evidence, IPE. Key is to facilitate trust and value through collaborative communication, all the members of the team, between all the different professions, and to build a high performance, highly reliable team. That's how the 49ers won, that's how the World Cup is won, and that's how we need to win. So again, it's collaborative, it's experimental, innovative, egalitarian. And it involves a lot of different types of learning. Real time, right now, point of care learning, learning in a classroom, learning at a conference, learning virtually, learning while you're having wine together and cheese, and professional health care cultures. We know, because our cultures in health care, our physician culture, our nursing culture, our APP culture, et cetera, et cetera, all those cultures complicate equitable education. But I am here to challenge you that equitable education should raise everyone's bar. Everyone's bar. And we should never, ever, ever work to lower the bar to be inclusive. We want to raise the bar to be inclusive, and we want to earn the inclusivity. Because that's so critically and profoundly important. Well, this is a lot of change, but it achieves so many things. Achieves actually a better health care force that works together to improve outcomes for patients and improves morale. People don't feel disenfranchised and disempowered, and they want to come to work. They feel like their words have value. Better sharing of our resources and our education, all our experiences. Better understanding of our roles and our work intensity and our anxiety. It has to be introduced so early in training. It needs to be introduced in pharmacy school. It needs to be introduced in medical school. It needs to be introduced in nursing school. Before you become an APP, you should already have had exposure to these methodologies of IPE. And it really helps us to assure that the needs are met for all. The WHO, the Interprofessional Education Collaborative Expert Panels, they're all reminding us that we have to build these collaborative models or otherwise we're going to fail. So the collaborative model, many of us say we do it, but do we actually do it? And it's really important, again, to really examine what it is we're doing and how we can change that. To have a shared vision, to have good communication, to value all the roles and to understand them. I did not go to medical school, but I'm pretty smart. I have a lot to offer. I know I'm not the person that is writing my name on that final line that makes the decision that might affect the life and death of the patient, but I am an integral part of the team. My PharmD is an integral part of the team. Together, we explore all those facets. So I'm going to read this. This is from Manthouse, who published it in 2011, but I just thought it was so brilliant. He said, interdisciplinary rounds are the foundation of critical care. Stakes of the discussion, the decisions are high, but there's ample time to build team skills and empowerment. I mistakenly, in his first role as a unit director in critical care, I mistakenly treated other team members as reporters. There to provide me with a list of information so I could make most of the decisions. While this, he calls immature modus operandi, might be expected from a just graduate trainee eager to assert his new skills and directive discretion, it simultaneously disrespects and fails to leverage the talents and energies of teammates. So I think this is such an important statement because we're making steps to be inclusive on our rounds and to include our colleagues, but we also want to recognize the methodology and our language is very important in terms of approving and proving that team value. So I think it's always important to just look at fabulous quotes, and you can see them there. I really probably don't have time to read them, but I do want to say that I love many ideas grow better when transplanted into another mind than the one where they sprang up. I thought that was such a brilliant way to look at it. So why do we need education, interprofessional? Because that builds a team that communicates well with each other, that helps to merge our observations, bring all those puzzle pieces together, utilizing different expertise and valuing the different expertise and decision-making responsibilities. So every member of your clinical team can contribute by embracing teamwork as a core value. Right now for most of us, we still are working in silos. We talk about my patient, my nurses, my unit, my doctors. I'm here to recognize the value of other team members' contributions. I'm a physician. What can they really teach me? What can the nurse teach me? What can the PharmD teach me? I'm a physician. What nurses say? Why is a doctor teaching in a nursing course? Why not? You have a physician who wants to be part of your team and wants to improve your knowledge? How fantastic and fabulous. But mostly, it's really about fear of judgment and loss of safety. What if I say something dumb or something wrong? How am I going to be judged? How is that going to affect me? And it also is what kind of supports the idea of the us-versus-them approach. So health professionals overall feel unsafe. 55% of staff feel – only 55% of staff feel comfortable to speak up when they perceive a problem with patient care. Sense of psychological safety mirrors professional hierarchy, the culture hierarchy. 1,400 health professionals from 23 neonatal ICUs said that they saw that significance felt greater safety, but not 100%. And nurses felt safer than respiratory therapists, but they all reported that they did not speak up about concerns because they fear blame, retaliation, punishment, and belittling responses. 50% of nurses actually report that their input is not well-received in their intensive care units. So is this the environment you work in, live in? Is this the environment that you wish to build? And do you suffer from FOSO? Okay, FOSO, fear of speaking out. That's my term. I don't think anybody else knows that. So there's wonderful tools to actually evaluate team psychological safety. This is just one of them. This is probably the most used one. Use a simple Likert scale for your team to actually anonymously reply so that you can evaluate whether or not your team is in the best position. I'm happy to share that with you. If you want to take a picture, I saw you did. I'll share it with you. So our goal, of course, is to create psychological safety. And one of the best ways we can do that is through interprofessional education, where we are leveling the playing field. That helps us to agree to share our failures, talk about our mistakes. It's an opportunity to learn and grow, to ask for help, and to ask freely and give help when asked, embrace expertise among many versus a single hero mentality. I thought that was such a brilliant statement, the expertise of all rather than hero mentality. To encourage and express gratitude, which reinforces team members' sense of self, and to ask powerful open-ended questions and then actively listen to the response and value the response. So creating a safety zone, it's the leader who sets the tone. So by the way, the quarterback. And the quarterback is going to be the physician. And everybody values the quarterback. And they set the tone. They set the tone of the informal group dynamics, of valuing all the team members, of trust and respect, of use of practice fields, supportive organizational context. They set the tone. So last night at 1 o'clock in the morning, I also have a roommate, I said, do you remember what movie it is where they said, you set the tone? And she'd be like, what are you talking about? I'm asleep. But I remembered that it wasn't a movie, it was ER. And in ER, when the main nurse character tried to commit suicide and the ER staff was falling apart, the chief physician said to Mark Green, the ED doctor, the unit is looking to you, Mark. You set the tone. So you set the tone. My physician colleagues, my APPs, the bedside nurses, the PharmDs, we set the tone. But we rely on the quarterback because the quarterback calls the plan. And that's really important. So let me just give you a few little tips about getting started informal and bedside. So you can see I animated them, but I'm bringing them all up at once. Strong leaders can, but they do not need to dominate team discourse. Consensual leadership actually promotes and provides psychological safety, which in turn promotes positive transactive memories. We work together all the time. We know what you want. We know what you expect. And we can do it on our own. I recommend something that I think is profoundly important, really changes the way staff sees their work, to debrief difficult patients at the end of the week. And really to try to do at the end of a shift, if you can, where you take 10 minutes to discuss and support all of our colleagues. Right now, we are all suffering. We are all overburdened. We are all understaffed and highly acute. But when a human being dies under our care, we've got to have a few minutes to debrief and to do that together. Because the gift that person who passes under our care gives us is a way to do better next time. But if we don't debrief, we never learn. And if we don't debrief, we don't value each other in the way that we all need right now. We're all suffering. And we need that support. I think that if you run M&Ms or discussions about mortality and morbidity, maybe not in the traditional sense, but all of the team should be involved. That shouldn't be held in a secret room. All the team needs to be involved. Daily rounds where all opinions are included and valued, and individuals speak in no particular order. And they're not reporters, but they are sharing what their concerns are. And then daily education bites in the ICU with nurses, RTs, physicians, PharmD, therapists, residents, dietician, everybody presenting a small point, something that they had to study to talk about a patient's aspect. Oh, this patient has stiff man syndrome. We didn't really know much about that. Well, here's what we need to be doing pharmacologically for that patient. All involved, little times taken up, and loads and loads of value. Have a senior staff nurse who I assigned her a topic to report. And she said, I was nervous that first time you assigned me the topic, but it really changed how I view myself and my contribution. And we have med students that rotate through, and we assign them with an SICU senior staff nurse. And he said, I spent a day in the SICU being precepted by a senior staff nurse. Totally opened my eyes. I had no idea how meaningful and difficult each day is. And my mother was a nurse, and I still didn't know that. And simple bedside tools, just really eliciting an observation of others, promoting that team culture of shared inquiry, innovation, genuine interest in what folks are saying, and in the growth of our colleagues, acknowledge that errors are part of being human. And that errors are the gift that help us change. They're not for punishment, but to help us change. Because we don't grow from our success. We only grow from our mistakes. And by the way, we have decades, if not centuries, of embedded cultural hierarchy to overcome. So it's not something that's going to come easily. But we're going to try to do that. So very important, again, a wonderful statement from Benthouse, but I think I probably, what, two minutes left? You're fine. Oh, I am? You have five minutes. Oh, my goodness. I'm so happy. I'm talking very New York fast. So again, I really, this is such a fantastic article from Benthouse. I would encourage everyone to read it. But he just talks about it's really, really important to have all of our teammates be well-trained and to be able to distinguish substantive versus irrelevant signals. Learn how to administer multitude of daily evidence-based therapies and to do it automatically without oversight and reteaching. So many of us who are nurses and many of our physician colleagues and certainly our PharmDs know that we've had tremendous oversight from JCH. I'm not saying that there wasn't reason to be concerned, but that oversight has really affected outcomes. We need to band together as a team to say our critical care nurses actually can titrate appropriately and should be able to do so. So a more formalized learning system, more formalized approach, exposure to new resident orientation. So every profession should be on that first day of new resident orientation. We should have invited lecture series. All professions are invited and they're all committed to sending a fair number of attendees. So we're all in a room together hearing the same thing, learning the same thing, maybe hearing it in a different way, applying it in a different way, but we're hearing the same information. A journal club with articles that affect team practice. And by the way, probably to do that with a wine and cheese outing, right? At my hospital in the emergency department, we have Thirsty Thursdays. Now I don't think at Thirsty Thursday they do anything but retrieve their thirst. But it is really quite important to say we can do scientific social gatherings, all of us together, and bond, create trust, build relationships, and a collaborative model where we know each other outside of work and where we've learned how to trust each other. And then, of course, the most fantastic, Fundamentals Portal, the CRT Academy, which is held in Alabama and in Cincinnati every year and just is a fabulous multi-professional workshop. ENLS, ACLS, but by the way, in person. They need to be in person because if it's virtual, we're not connecting in the same way. We're not developing that collaborative model in the same way. And then, of course, utilizing simulation scenarios every time we can with all pertinent team members so we really learn a lot, we debrief, we communicate, we make change. And the heart of that sharing reciprocal model is that everyone has stuff they can learn from others and everyone has things they can help others with. You get some knowledge, you develop your own, you share it with those from whom you got knowledge, and it becomes a more even relationship. And that's really what we want, a more even relationship. When you're planning multi-professional education, you really have to actually include diverse faculty members. So maybe people, as SDSM has done such a fantastic job of putting different team members together to present from different points of view how we work together in these models. And it's just a fantastic methodology. And really utilizing these active learning methods. So physicians, nurses, all direct care providers understand the role that each of us play. And we're valuing that role that each of us play and that unique contribution to care. And utilizing simulation practice models, technology models in order to build that environment. So by the way, when we say successful inter-professional education and the key to facilitate trust, value, and communication, let's not forget how SCCM was at the forefront of this. So was the American Heart Association with ACLS, SCCM with FCCS, the original FCCS, ENLS, Emergency Neurological Life Support, and SCCM and ACC are two organizations. I attend a fair amount of multi-professional meetings. But SCCM and ACC are the organizations that really are walking the walk. We might need a cane, like I need right now. We might stumble a little bit, but we are really trying to walk that walk. And I just wanted to share with you that this is my first FCCS certificate from 1999 when nurses were not allowed to take FCCS. But I advocated for myself. I drove in a car with four attending physicians to Vanderbilt. We all took the FCCS course together. And it was intimidating, but it certainly gave a lot of value to my career and life here in SCCM because I became the first nurse course director, the first nurse international course director, the first nurse chairperson of FCCS, and the first nurse editor of the FCCS textbook. So I think that's walking the walk, and I'm really grateful. I'm really grateful to SCCM for all that opportunity and for what they're doing for us as a team. Step five is even more formal, and that's really the most important point here is that this actually medical education and other health care education, all programs, we have to talk about how to perform as a team. That it impacts patient outcomes as much or more than the brilliance of any one individual team member. There is no hero. There's a team. And identifying that early on in undergraduate education helps us to understand and learn the values of different professions and disciplines. That's really an important point in the IPE curriculum, and that process should begin for all health students. So whatever venue we're choosing, respiratory therapy, dietician, et cetera, should begin as early as possible in their higher education programs. We want to create a team and teamwork through IPE because, as I said, it creates trust, value. It creates a collaborative model. It also significantly, profoundly, for nursing staff, I can speak for nurses, increases job satisfaction, decreases staff turnover. That in turn reduces health care costs and the building of the team. So developing the next gen of leaders, we've got to teach that strategy. We all have drank the Kool-Aid here. I'm not speaking to people who don't believe this, but we have to teach the strategy to the next generation. We have to model the real behaviors. And all of us are taking a risk. We risk feeling dumb. We risk feeling stupid. We risk not always being the person who has the right answer, but being the leader who embraces others. I was remembering that the early FCCM pin, the early FCCM pin was a tiny Phoenix Rising. And that's really what this is. Collaborative model is the Phoenix Rising. And it's incredible. Out of our cultural hierarchical history, we have a Phoenix Rising where we value our teams, where we say we're going to educate to the highest level possible. We're going to embrace everybody in that educational possibility, but we're going to trust each other. We're never going to humiliate each other. We're going to embrace each other and value each other as we move forward in this fantastic practice. Each member's individual training and excellence, shared learning and collaborative respect coupled with an embedded transactive memory, that means we know how we work together and we know what to do. And it's psychological safety that creates a haven in the complex world of critical care. And by the way, if you're worried about staffing retention and recruitment, let me make sure you appreciate true respect, true value, true voice, shared learning together. You believe that I had the capability and the capacity to appreciate what you're going to teach me, and I believe that you have that capacity to appreciate what I'm going to teach you. Intentional communication, intentional inclusion, a voice at the table, real recognition, continuous and ongoing mentorship, and empowered decision making. This is what nurses are saying they need and want. And to build a strong team, you need to have a team of people that are committed to you. So in summary, interprofessional teams deserve interprofessional education. Intercommunication, professional culture change, leader setting that tone. Every member of the team can contribute by embracing teamwork as a core value, better working environments, better problem solving, bridging the gap between clinical and cultural knowledge, improving patient safety, and being better informed about what's happening to our patient, our patient. So instead of football, I think we should be practicing soccer. Because soccer is much more of a team event. We still have to have a lead. Now I say that's going to be our goalie, right, because our goalie is the one who is setting those ultimate goals and making sure they happen. But it's just a transitional role. And by the way, then you can win the World Cup. Thank you all very much for your attention. I really appreciate your attendance today. And thank you for inviting me to be here at this society. Thank you.

interprofessional education

healthcare collaboration

communication in healthcare

leadership in healthcare

challenges in interprofessional education

promoting interprofessional education