Improving patient safety

This case study illustrates how multiple healthcare disciplines can work together to meet a patient’s needs. The idea is to integrate the patient within a network of medical and healthcare professionals who assist her in her recovery. Studies show that seamless interaction between the various disciplines increases the quality of patient care and patient safety while also reducing costs. With many healthcare services increasingly being provided on an outpatient basis – that is, without an overnight stay in hospital – a holistic, interdisciplinary approach to care is becoming more and more important.

Exemplary teamwork

In practice, however, integrated and well-coordinated patient care is far from being the rule. Overwork, poor coordination and staff shortages all hamper interdisciplinary cooperation. For patients, the processes involved often appear confused and inconsistent. Sick individuals are concerned solely with their own health, not with how health might be defined according to different professions.

“Treatment is teamwork and should be delivered in a patient-centred way,” says ETH professor Jörg Goldhahn. He works at the Institute of Translational Medicine, which aims to take research findings from bench to bedside – in other words, from the laboratory research setting into clinical practice. Goldhahn also serves as Director of Studies for the Bachelor of Human Medicine at ETH Zurich, which was launched in 2017. The team responsible for this ETH Bachelor’s programme developed a new training module that focuses on interprofessional collaboration from the patient’s perspective. They created the module in a joint project with Kantonsspital Uri, the nursing college Berner Bildungszentrum Pflege and the coordinators of pharmacy-related degree programmes at ETH. “It’s modelled on the kind of teamwork that is common in engineering; we took this tried-and-tested approach and applied it to the healthcare sector,” says Goldhahn.

This joint module gives medical, pharmacy and nursing students an insight into the expertise and working methods of other healthcare disciplines and shows them the roles and responsibilities these professions have in patient care. “By bringing together medical, pharmacy and nursing students on the same course, we encourage them to learn from and about each other. It helps them see how important it is to view the various aspects of patient care not in isolation, but from an integrated, patient-centred perspective,” says Claudia Schlegel. As Co-Leader of Training and Transfer at the Berner Bildungszentrum Pflege, she played a key role in designing the interprofessional course as a member of the ETH Bachelor of Human Medicine project team.

A doctor’s education should be based on what they will need in the future, says Goldhahn: “Working in interprofessional teams will be even more common than it is today. We want students of medicine to prepare for that environment early on.” The course is taught to ETH medical students in their fifth semester over 12 afternoon sessions.

First-hand experience

Real-life situations form the basis for this interprofessional training. As well as experiencing births together with midwifery students, the medical students develop drug therapies with pharmacy students and learn how doctors and nurses can work together to develop patient treatment plans. The course also includes sessions at Kantonsspital Uri and at GP practices. The point of these visits is for students to see for themselves what collaboration means under real-life conditions and to observe the practical challenges that medical professionals face at the interfaces and during handovers.

At the Bern and Aarau nursing colleges, medical students practice how to draw up a patient discharge plan together with nursing students and simulated patients – that is, people trained to play a specific patient role which allows students to practice their communication and consultation skills. This activity helps the students see things from the perspective of other professions and from that of the patient. They also learn to express their opinions within an interprofessional team in such a way that their observations and considerations are incorporated in the final decision on which treatment to recommend for a patient.

The optimal dose

The joint modules for Bachelor’s students in Human Medicine and Master’s students in Pharmacy are based on the same premise. Doctors and pharmacists are both members of the medical profession and have specialist knowledge of medicines, so it makes sense for both sides to attempt to understand and appreciate each other’s expertise. Doctors tend to look at how a drug can be applied to treat a specific disease in the

human body, while pharmacists tend to focus on the active ingredients a medicinal product contains. “We show students how interprofessional communication between doctors and pharmacists can help identify the optimal dose, and how to avoid undesirable side-effects or risky interactions when combining several drugs,” says Elvan Kut. A lecturer and programme coordinator on the ETH Master’s programme in pharmacy, Kut also works as a pharmacist in Zurich.

When it comes to drug therapy, patient safety is a vital part of the treatment process. That’s why medical, pharmacy and nursing students all take this subject together – because valuable feedback on therapy is equally likely to come from nurses and physiotherapists. This feedback is particularly helpful in the case of complex or chronic complaints such as cardiovascular disease, cancer, dementia, chronic respiratory disease and diabetes, all of which cannot be completely cured and require repeated treatment. In order to avoid errors in a patient’s course of treatment, it is vital that all the clinicians involved feel able to express their concerns if they notice something is wrong. However, this willingness to speak up requires a high degree of trust between different professions and is sometimes hampered in practice by interpersonal issues or organisational hierarchies.

Communication challenges

In some cases, circumstances can make it hard to address sensitive aspects of a patient’s treatment, as Abinaa Senthilrajan knows all too well. She completed her Bachelor’s degree in Human Medicine at ETH this year and is now studying medicine in Lugano. One of her cases involved a supermarket employee who was so badly affected by Covid-19 that doctors had to put her in an induced coma for two weeks. She struggled to wake from the coma and continues to suffer from long Covid today. Interprofessional collaboration on her case ran smoothly despite the disruption caused by the pandemic, but understanding the patient’s wishes and concerns proved to be difficult. Her knowledge of German was extremely basic, and her daughter was unable to visit as often as necessary due to the pandemic restrictions. “Communication is a vital factor and forms the basis of any successful medical treatment,” says Senthilrajan.

“What we’ve seen so far suggests that students have no difficulty in adopting the perspective of patients and healthcare professions and developing an interdisciplinary understanding of patient care,” says Schlegel. “They see that all medical and healthcare professions work for the benefit of patients, even though they use different methods to achieve this.”