Collaborative Practice in Critical Care Settings: A Workbook
By Scott Reeves, Janet Alexanian, Deborah Kendall-Gallagher, Todd Dorman, Simon Kitto
1st Edition, London, Routledge, 2018
138 pages, eBook £17,50, ISBN9781351798662
Reviewed by Dr Andreas Xyrichis, King’s College London
It is a rare pleasure to be reviewing a book that delivers exactly on what it promises. In a classic Reeves fashion, this book offers an accessible yet astute analysis of the key issues hindering and fostering collaborative practice in critical care settings; and, importantly, evidence-based tools and advice on how to improve on this fundamental element of delivering critical care services. It is a book that I enjoyed reading, and one that I will definitely be revisiting in many years to come.
This Workbook is designed around a series of assessment, implementation and evaluation activities for professionals, managers, educationalists and researchers working in critical care settings. Uniquely, it looks both at collaboration between professionals, and between professionals and patients or family members. The discussion and activities presented are based on extensive empirical research in critical care settings in different countries. This is rare for a book of this nature but so important to ensure what is presented takes into account the everyday reality of professionals, patients and family members in critical care units.
The book consists of seven chapters and no less than 12 appendices full of tools, templates and plenty of guidance on delivering and evaluating interprofessional collaborative activities. The book sets of with an Introduction, setting the scene for the discussion and contextualising the material presented in current theory and practice, as well as the international literature. Throughout, the book draws on the PROC framework developed by Reeves et al. (2010), which raises awareness of the Processual, Relational, Organisational and Contextual factors that can influence collaborative practice.
Chapter One builds on an extensive literature review to advance four central themes that are key to developing and sustaining differing forms of collaboration: building an infrastructure to support sustainable improvement, understanding how local context impacts collaboration, creating psychologically safe environments, and giving patients and their families a voice. Key and up-to-date literature is introduced and skilfully synthesised to both make the point for the benefits of improved collaboration, as well as the many issues that can impede collaboration in everyday practice.
In Chapter Two, the authors dive straight into presenting the overall approach to developing activities that enhance the nature of collaboration between healthcare providers in critical care settings. Three iterative sets of activities are examined around: assessment, intervention and evaluation. First, assessment activities aim to gain a deeper understanding of interprofessional dynamics and identify issues that can contribute to patient harm. Focus is placed on interviews and observations, with advice on selecting staff (sampling), interview/observation technique and interpretation of results (analysis). I really liked the example analysis matrixes included on perception of roles, triangulation of perspectives on roles, membership of the critical care team, and application of the PROC framework. This is such a helpful approach to analysing interprofessional practice within and beyond critical care settings. Second, interventions responding to the findings of the first exercise are discussed. Here, the authors focus on the Interprofessional Collaboration Workshop as a kind of interprofessional education activity. Advice on the content, learning outcomes as well as facilitation of the workshop is offered. Third, we find advice on the evaluation of the interventions at different levels including attitudes, perceptions and collaborative behaviour.
Chapters Three, Four and Five unpack and expand on the overall approach offering detail and practical advice. Chapter Three has a specific focus on patient and/or family involvement, drawing insights from the authoring team’s extensive ethnographic work. Chapter Four is really the heart of this book, as it comprehensively suggests different ways to help staff improve collaborative practices with each other and with patients or families. A range of activities are suggested, each mapped to the PROC framework and designed to respond to known challenges around collaboration. Examples include Processual interventions such as family conferences and checklists; Relational, such as simulation and Schwartz Rounds©; Organisational, such as pathways and family visitation policies; and Contextual, although this last dimension of the framework tends to be outside the influence of clinical teams.
In Chapter Five, there is solid guidance on how to generate robust evidence to understand the effects of the various interventions and activities. Here, we find discussion on the nature of evaluation, its importance and types of evidence one might seek to generate. Other important evaluation issues covered include developing focussed questions, choosing the right quantitative or qualitative design, ethical issues, stakeholder involvement, dissemination and change management.
Finally, Chapter 6 brings the various threads of the book together and sets out a view for the future of collaborative practice in critical care settings. The team issues a call for feedback, testing and further development of the resources presented -to which I hope many will respond. The 12 Appendices included are especially helpful and include tried and tested tools developed over the years through the team’s extensive research work. I especially like Appendix 12, which includes a selective bibliography of the key readings around this field helpfully grouped under key topics.
My only criticism is that, as a fellow critical care ethnographer, I often found myself wanting more detail and discussion especially around critical, theoretical and methodological aspects of doing research in this kind of environment. In fairness, there are a lot of suggested readings throughout and the team’s own publications do delve into some of these issues in greater depth. However, the success of this book is that it is written and presented in true collaborative spirit: addressed to different audiences, it draws from a range of professional and lay perspectives without privileging one over the other.
This is a much-anticipated book which will appeal and be enjoyed by critical care clinicians and scholars alike.