Mapping Interdisciplinary Role Ownership Over Actionable Practices Identified From the Bereaved Family Survey.

Abstract

Purpose: To determine the feasibility of mapping interdisciplinary role ownership over actionable practices identified from qualitative comments in the Veterans Affairs Bereaved Family Survey (BFS).

Methods: We polled two providers from each of 14 disciplines as to whether an actionable practice that improved end-of-life care quality sits within their scope of practice. We grouped practices by having the greatest, middle, and fewest number of disciplines that claimed role ownership and then characterized what roles were shared.

Major findings: Medicine, nursing, social work, and occupational therapy claimed role ownership of the greatest number of practices among the 14 disciplines. Chaplaincy and the allied health disciplines had a comparatively more limited range of role ownership of practices. Practices with the greatest number of professionals claiming role ownership were general professional behaviors that do not require specialized training (e.g., being easy to talk to). Practices with the middle number of role ownership required clinical specialization (e.g., offering non-pharmacological interventions to reduce agitation). Practices with the fewest number of disciplines required a narrower skill set (e.g., signing the death certificate in a timely manner) or administrative authority to perform (e.g., providing adequate nursing staff).

Conclusions: This project demonstrated the feasibility of mapping BFS actionable practices across disciplines. A larger sample and rigorous statistical analysis are required for application at a health care system level. Understanding role ownership can then guide efforts relating to role ownership and role sharing for end-of-life quality improvement activities.