Caregiver-Driven Program Boosts Clinical Performance by Diffusing Interprofessional Tensions

Several critical elements must be in place for caregiver teams to achieve peak performance: trust, psychological safety, empathy and mutual respect, to name but a few. To address the common pitfalls that can compromise these core tenets, Cleveland Clinic created a novel program aimed at helping its clinical teams achieve and sustain a collaborative, high-impact culture.

Designed to help caregivers overcome inherent assumptions that can lead to suboptimal patient care and interprofessional tension, Building Optimal Outcomes by Strengthening Team Trust (BOOST) has continued to grow through the contributions of Cecile Foshee, PhD, Director of Cleveland Clinic’s Office of Interprofessional Learning, and her team. The program has already guided scores of clinical teams toward a healthier, more connected future.

“Interpersonal conflict, assumptions, unclear roles and limited time to work through problems can prevent teams from functioning at the highest level. We are often told not to sweat the small stuff, but the reality is that when tensions are left unaddressed, even small issues can compromise team functioning, caregiver engagement, and ultimately, patient care,” explains Dr. Foshee, a board-certified coach. “Through BOOST, we support teams in building trusting relationships, uniting around shared goals and fostering a culture of mutual learning that promotes personal accountability.”

BOOST is facilitated by Cleveland Clinic caregivers who have been certified as High-Impact Engagement Team Coaches. Trained to help program participants achieve their potential, the coaches use tangible data about the current and desired states of each team to help them focus on what matters most. The insights gained from the coaching sessions inform the curriculum, which is customized to address each team’s unique needs.

Sparking change

The neonatal intensive care unit (NICU) at Hillcrest Hospital is one of many Cleveland Clinic teams that have turned to BOOST for guidance. Nursing Director Diane Cleary, MSN, CMSRN, NE-BC, says the program has helped her caregivers develop stronger interpersonal connections and enhance their ability to function as a cohesive team.

“Before participating in BOOST, many of our decisions were driven by individual agendas,” she explains. “The program has enabled us to work more closely with one another by implementing changes designed to build trust, encourage more productive conversations and support caregiver well-being.”

Among the most significant changes that BOOST inspired was the creation of a group email and chat channel that have helped the team communicate more cohesively, Cleary says. In addition, the unit has implemented group rounds, which have increased transparency and led to more meaningful discussions about patient care.

“We’ve continued to see evidence of improved teamwork and collaboration through positive patient feedback and improved, positive employee engagement,” she says.

The NICU team, which includes nurses, physicians, respiratory therapists, occupational therapists, social workers and pharmacists, also instituted an expectation of responsibilities to help each discipline achieve accountability.

“By encouraging every caregiver to own his or her part in the change process, our team has been able to move new projects and ideas forward at a much faster, more efficient pace,” adds Cleary.

Increasing caregiver satisfaction

Cleveland Clinic Children’s Hospital for Rehabilitation also sought support from BOOST to improve the way its caregivers were communicating across disciplines.

“We wanted to build a more cohesive team by cultivating trust and open communication between caregivers,” explains Team Lead and Inpatient Rehabilitation Social Worker Maureen Giardina, LISW, MSSA. “In the past, meetings often ran too long and were sometimes filled with high emotions. We needed a constructive way to have difficult conversations, and that’s exactly what BOOST provided.”

Since participating in the program, Giardina says the hospital’s inpatient teams now follow formal meeting guidelines, which have made “an enormous difference” in caregiver morale. Each meeting begins with positive shoutouts and words of recognition, and team members are assigned roles (e.g., notetaker, timekeeper and peacekeeper) designed to keep the team focused and intercept any challenging behaviors.

“When you work with people day in and day out over the course of years, relationship challenges naturally arise, but programs like this one can give caregivers the tools they need to talk about hard things and solve conflicts constructively,” Giardina says.

Spreading positivity

Dr. Foshee says BOOST participants report increased caregiver engagement, better psychological safety and an improved ability to act on their team’s shared vision and goals – all while performing their best work.

“The program has proven especially effective in high-stakes, multidisciplinary environments like NICUs and rehabilitation units, making it a replicable model for healthcare systems seeking to build resilient, high-performing teams,” she notes. By focusing on the resolution of interpersonal tensions that can hinder patient care, hospitals can equip their caregivers with the tools needed to have productive conversations that strengthen team cohesion.”