Sandrijn M. van Schaik, MD, PhD, of the University of California San Francisco discusses her research as a Macy Faculty Scholar to examine communication between health care professionals.
Macy: What are you working on as a Macy Faculty Scholar and why it is important?
van Schaik: There is a lot of interest in interprofessional teamwork as a concept, but we don’t know how best to implement it based on evidence. There’s data showing that, when teams function well, patient care improves. But what exactly does it mean to function well as a team? In practice, for example, teamwork can easily fall apart because different health care professionals don’t know how to talk to each other.
The goal of my research project is to develop guidelines for health professions students and practicing professionals that will help them communicate effectively with each other around patient care, particularly when giving and receiving feedback about performance.
Why are you focused on feedback in particular?
If you look at the World Health Organization’s definition of interprofessional education, it is “when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.” I think we’re making headway with the “about” and “with,” but we’re not focused enough on the “from.”
There are a lot of unspoken, deep-seated barriers among the different health professions—we all bring prejudices and preconceptions to our interactions with each other that inhibit our communication. And this is particularly true when we’re giving each other feedback. I see this every day in my own work. For example, as a pediatrician, I meet frequently with parents and social workers, and I would benefit from hearing from my social work colleagues about my performance in those meetings. Do I communicate effectively? Could I explain things more clearly? Do I listen? Do I put parents at ease? How do I compare to other physicians that they’ve observed in similar meetings? But I don’t get that type of feedback because the social workers don’t feel comfortable sharing these types of opinions with physicians. We’re missing an opportunity to help each other perform better.
So my research will try to get at some of these things. I want to identify and label some of the communications traps that health care teams typically fall into so that we learn to avoid them. I’ll do this by seeking anonymous feedback among team members—both students and practicing professionals—and then sharing that feedback and gauging reactions to it. I’m expecting to find out what makes feedback more or less readily accepted. Do we rate feedback from certain professions more highly than others? Are there ways of delivering feedback that make it easier to accept?
What is your ultimate goal? What do you hope to change with this project?
What I’m really shooting for is opening up conversations and changing the culture of health care. We need to start listening to each other and get away from the idea that conversations can only take place in one direction, originating with the physician. All people on a health care team need to feel empowered to make themselves heard. We just don’t have that culture right now because we have traditionally focused health care on medicine—on the curing of illness and disease—and that model has made the physician the leader of the conversation.
But we’re gradually beginning to think about health care differently now. We’re beginning to realize that health care shouldn’t necessarily be about curing disease. In some cases, it’s more about helping someone live pain-free or helping them live well with chronic disease. The doctor isn’t necessarily the leader of those conversations; in some case it should be the social worker or the nurse. Moving in this direction has huge consequences, not only for improving patient care, but also for the economics of health care—having the physician and curative medicine at center is a very expensive approach to health care.
By and large, we’re still far away from that reality, but things are shifting and we need to change how we train health professions students so they are prepared to practice in this new environment and work effectively in teams.
What motivates you personally to take on this project?
I went to medical school in the Netherlands and that colored everything I’ve learned since. As part of my training, long before I ever saw a patient as a medical student, we all had to spend three months in a different health care role. I worked as a nursing assistant. It was an eye opening experience and gave me a different perspective on the health professionals around me. I think it gave me a little bit of humbleness and helped me see that perhaps what I do is, in some ways, easy compared to what other health care professionals do. It helped me develop respect and appreciation for our various roles and it has enabled me to have a lot of deep conversations with other health professionals whose voices aren’t always heard, but who have a lot to offer.