**6. Identity and relationship building**

### **6.1 Professional identity and contributions to interdisciplinary research in the ED**

Professional identity was discussed among the participants as it relates to the work they are doing and that needs to be done. Participants describe themselves as social workers, nurses, researchers, and physicians. They describe how their prior training and experiences help them effectively function in their current capacity. For instance, a participant who currently functions as a researcher describes formally working as a therapist and "dealing with a lot of clients seeking services for mental health needs." He acknowledges that mental health disorders are prevalent

among those with substance abuse disorders. The same participant bridges the science of social work with the service provided. He states, "we know the research. We know what people need. We know certain things don't work. So, let's try to get involved in that."

The participant's perspective highlights the extent to which discipline-specific training informs knowledge and the conceptualization of one's role in the care delivery process, and within teams. These views are directly related to their value and contributions to an interdisciplinary approach to opioid addiction treatment. As a social worker, he understands how and where he fits into the spectrum of service delivery and treatment. Other participants in the field of social work share similar views. They have a "deep concern for not only understanding but solving issues that affect the most vulnerable. I try to do that through research, through understanding and through interventions." Another participant also in the field of social work adds that she "provides the best services possible to our consumers by being able to connect them with resources, housing, medication, case management therapy and everything." In general, social workers seem to have a genuine sense of service for those in need.

Interestingly, one participant who is a physician by training identifies as a physician only at work and endorses a different view of health care or special populations elsewhere. She states, "I don't really feel like that's my identity outside of work. I'll be like, oh, I work at a hospital, but as a physician at work, I guess, I have mixed opinions." She further highlights the characteristics of taking a non-traditional role as a physician by explaining, "I think of myself more as like an implementer, operation person and trying to take the tools and the knowledge of research and put that into practice, and trying to build a connection between research and what actually happens in real life." She understands that she can use her position as a physician to influence the desired change. She states that "there is a lot of opportunity for leadership and what I consider the right thing to do." She further explains that as a physician she cannot be the solution, but instead part of the solution, reiterating the importance of an interdisciplinary team approach.

### **7. Building effective organizational relationships in the ED**

Building organizational relationships across disciplines has proven to be challenging on two fronts. First, individuals do not always know how to effectively build relationships across professions or disciplines. The importance of building relationships is not always fostered or even emphasized in medical school, for example. One participant explains, "I don't think we're given a lot of tools to understand how to build relationships. And then when you go to medical school it is very much a competitive thing as opposed to a collaborative thing. And I think that's changing slowly overtime, but it's one that the admission process seeks out to identify. I think you are studying with a baseline of students who tend to be like the gunner student in the class whose studying at four in the morning as opposed to building relationships."

Second, building relationships takes a significant amount of time. Even when a relationship is established with key figures, those individuals have to be willing to support new ideas. As the above participant notes, staff "wanted to do this [team building] three or four years ago, but I didn't know the pharmacy director. I didn't know people. To be like, hey, don't you think this would be cool? I think right now it's working and I think we're right at the point where I could give a lecture and the receptive 33% audience member says they're going to call me next time they have a case. And they called me the next time they had a case and we treated and they saw the miracle that happened when you actually treat substance abuse." Building

#### *Building Interdisciplinary Teams in Emergency Care to Respond to National Emergencies… DOI: http://dx.doi.org/10.5772/intechopen.99206*

relationships may be easy for some but challenging for others. In health care, workers are interdependent. Having the emotional intelligence to navigate different personalities can be as important as having the medical knowledge to save lives.

Another participant further explains that even after relationships are built, the relationships must be continuously nurtured. Individuals must build credibility among their colleagues, especially among those who are more resistant to changing the way they work. The presenters explain that "effective leadership can help build effective collaborations through influence and expert guidance." But it takes time to develop the leadership necessary to influence relationships. At the ED, building effective organizational relationships requires leaders who cultivate relationships over time and by gradually gaining buy-in from employees. "It is a trickle-down effect from top manager's leadership to direct service providers" and rely on this and other networks to improve their work. One presenter stated that "social networks are important for implementation, because these ties are conduits for information, for expertise, for social influence. A lot of different implementation strategies leverage these social networks. We try to find an opinion leader and have them exert their influence within an organization or a champion." One participant illustrates how their team is already doing this.

*Isn't that kind of what we are doing? I mean how we have built a relationship with two leaders in the ED, a physician and a head nurse who are very involved in the ED and very passionate about this topic. It kind of helped us get in so we could build relationships with other nurses and physicians. They see us when we are going on Sundays. They say, hey you guys are here again, let me get some people for you. So, kind of just making ourselves present there so they get more comfortable knowing that we are there because we care about this topic. And then I'm sure they'll want to see us later and we can present it to them. I think we kind of started that and can continue building on it. "Building organizational relationships will facilitate the overall implementation of MAT. Over time, these relationships will be instrumental in influencing not only ED practitioners, but will have a greater influence at the organizational level."*

### **8. Discussion**

The opioid epidemic poses several challenges for health professionals and health service delivery systems. The current study sought to understand the team process necessary for researchers to be more effective in tackling this wicked problem. From a systems perspective, the opioid epidemic can be ameliorated through a number of approaches that require high-level coordination and execution among teams. These include changing the way opioids are prescribed, how substance abuse is defined and treated, how collaborations across disciplines take place, the composition and effectiveness of healthcare teams, understanding professional identity, and building organizational relationships to improve collaboration and health outcomes (see **Table 2**). These are the themes identified in this study, but also consistent with the National Institute on Drug Abuse (NIDA) priorities to combat the opioid epidemic [12], as well as the NIDA's three-prong approach—reducing prescriptions, enhancing access to treatment and preventing overdoses—to address this epidemic [13]. Inherent in these priorities are interdisciplinary team approaches to effectively responding to the opioid epidemic.

The team-building activities undertaken in this study supported the key aspects of the cultural exchange framework, and are aligned with evidence informed approaches. These were 1) accessibility to one another; 2) a sense of mutual respect;


#### **Table 2.**

*Themes and strategies.*

3) creation of a shared language; and 4) willingness to compromise/accommodate the needs of others [8]. These activities increased access for all team members to discuss a variety of issues related to ED responses to the opioid epidemic. Team leaders created a sense of mutual respect across disciplines, and activities promoted the co-creation of language to define challenges and solutions for the ED to diagnose and treat OUD. The structured problem-solving activities, as well as the scholarly presentations and consensus group, allowed members to compromise with each other and accommodate new information to lead an effective interdisciplinary collaboration.

Member interactions ranged from building personal connection, sharing world views, to professional and scientifically focused detailing of strategies to break down the problems into different components. These team interactions helped identify barriers and facilitators to using the Science of Team Science framework. For instance, it was clear that physicians, nurses and social workers have and bring unique knowledge and competencies to the team (intrapersonal) that could either disconnect or expand the team knowledge. Yet, communication, connection, and shared knowledge among team members improved greatly with exposure to the team building activities (interpersonal).

#### **8.1 Limitations**

We should note limitations of the present study. The study used a small sample of researchers from different disciplines to obtain a deep understanding of how team building may enhance problem solving. Although derived from a small sample, the qualitative data were not intended to be representative of interdisciplinary teams, or researchers in ED systems. However, the themes that emerged from this work are consistent with concerns in the field [12, 13]. Furthermore, the comprehensive and multimethod approach to data collection used in this study is consistent with other research in behavioral health [14, 15]. Our results did not provide information about concrete outcomes, but rather to team building process generally, as intended. The physical environment was a barrier to team building – traveling in a large metropolis reduces interactions. The societal and political norms were however not evident. Participants discussed them in terms of hospital

*Building Interdisciplinary Teams in Emergency Care to Respond to National Emergencies… DOI: http://dx.doi.org/10.5772/intechopen.99206*

policies that prevented new medications from being included in prescribing schedules. Finally, technological issues were important in improving connection. Using video communication and presentations as well as text messaging reinforced the initiative. Future studies can build on our results and address these limitations by examining how each of the team building strategies we implemented influence the quality of decision making and effectiveness of problem-solving abilities of the team, and ultimately opioid use disorder treatment practices.
