Interchangeability in Military Interprofessional Health Care Teams: Lessons Into Collective Self-healing and the Benefits Thereof

Abstract

Introduction Interchangeability—i.e., the capacity to change places with another—is necessary for military interprofessional health care teams (MIHTs) to provide around-the-clock patient care. However, while interchangeability is clearly a necessity for modern health care delivery, it raises uncomfortable questions for civilian health care teams where it is usually labeled as unsafe. This perception surfaces because interchangeability runs counter to some of health care’s cultural beliefs including those around patient ownership and professional scopes of practice. It is, therefore, not surprising that little is known about whether and how some level of interchangeability can be harnessed to improve the productivity of health care teams overall. In this article, we explore the notion of interchangeability in the particular context of MIHTs given that these health care teams are familiar with it. This exploration will offer insights into how interchangeability could maximize civilian health care teams’ capacity to adapt. Materials and Methods We conducted a secondary analysis of interview data as an analytic expansion: “the kind of study in which the researcher makes further use of a primary data set in order to ask new or emerging questions that derive from having conducted the original analysis but were not envisioned within the original scope of the primary study aims”. Within our secondary analysis approach, we used thematic analysis as our analytical tool to describe (1) what interchangeability looks like in MIHT teams, (2) how it is fostered in MIHTs, and (3) how it is enacted in MIHTs. Results Interchangeability was realized in MIHTs when individual team members adapted to take on roles and/or tasks that were not clearly niched in their specific areas of expertise but instead drew on the broad foundation of their clinical skill set. Cross-training and distributed leadership were ways in which MIHT members described how interchangeability was fostered. Furthermore, five features of working within MIHT teams were identified as key conditions to enact interchangeability: knowing your team members; being able to work with what/who you have; actively seeking others’ expertise; situating your role within the broader picture of the mission; and maintaining a learning/teaching mindset. Conclusions Interchangeability can be understood through the theoretical lens of Swarm Intelligence and more specifically, the principle of collective self-healing—which is the ability of collectives to continue to successfully perform despite disruption, challenges, or the loss of a team member. Our findings highlight how MIHTs have adopted interchangeability in a wide array of contexts to realize collective self-healing. Despite the discomfort it provokes, we suggest that interchangeability could be a powerful asset to civilian health care teams.

Building Resilient Healthcare Teams: Insights from Analogy to the Social Biology of Ants, Honey Bees and Other Social Insects

“…Overall, we found that teams that value the ability to: a) to read each other's cues and miscues, b) to step aside when others had the necessary skills, even if outside their scope, c) to deviate from protocols, and d) to foster cross-training adopted an attitude of openness towards plasticity. This attitude allowed them to shift their debriefing conversations from judging what went wrong when they swapped tasks to considering how to best leverage plasticity for success [32]. In our view, team strategies that value a built-in capacity for plasticity, as espoused by the sociobiology analogy will be better situated to navigate the safety and resilience trade-off.…”