Challenges to Navigating Pregnancy and Parenthood for Physician Parents: a Framework Analysis of Qualitative Data.

BACKGROUND: Some gender-based disparities in medicine may relate to pregnancy and parenthood. An understanding of the challenges faced by pregnant physicians and physician parents is needed to design policies and interventions to reduce these disparities. OBJECTIVE: Our objective was to characterize work-related barriers related to pregnancy and parenthood described by physicians. DESIGN: We performed framework analysis of qualitative data collected through individual, semi-structured interviews between May and October 2018. Data related to pregnancy or parenthood were organized chronologically to understand barriers throughout the process of pregnancy, planning a parental leave, taking a parental leave, returning from parental leave, and parenting as a physician. PARTICIPANTS: Physician faculty members of all genders, including parents and non-parents, from a single department at a large academic medical school in Canada were invited to participate in a department-wide study broadly exploring gender equity. APPROACH: Thematic analysis guided by constructivism. KEY RESULTS: Twenty-eight physicians were interviewed (7.2% of eligible physicians), including 22 women and 6 men, of which 18 were parents (15 mothers and 3 fathers). Common barriers included a lack of systems-level guidelines for pregnancy and parental leave, inconsistent workplace accommodations for pregnant physicians, a lack of guidance and support for planning parental leaves, and difficulties obtaining clinical coverage for parental leave. Without systems-level guidance, participants had to individually navigate challenges and resolve these difficulties, including negotiating with their leadership for benefits. This led to stress, wasted time and effort, and raised questions about fairness within the department. CONCLUSIONS: Physician parents face unique challenges navigating institutional policies as well as planning and taking parental leave. Systems-level interventions such as policies for pregnancy, parental leave, and return to work are needed to address barriers experienced by physician parents.

Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System.

BACKGROUND: The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. INTERVENTION: The Medical Emergency-Pandemic Operations Command (MEOC)-a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada-partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. METHODS: In this manuscript, we describe MEOC's Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan's structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. KEY RESULTS: From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March-May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. CONCLUSIONS: MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.

The effect of white coats and gender on medical students' perceptions of physicians.

BACKGROUND: Despite the fact that medical schools spend a considerable effort to rate clinical instructors, there is limited evidence regarding the effect of physical characteristics on instructor ratings. White coats have been shown to alter patients' perceptions of physicians although it has not been determined if preceptors who wear white coats are rated differently than their colleagues. METHODS: Second year medical students were administered a questionnaire with four clinical scenarios depicting medical errors accompanied by a picture of a physician of different sexes and ethnicities. The packages were randomized so that the physicians depicted either had or did not have a white coat. RESULTS: White coats did not alter the perception of physicians' ratings by medical students although sex and ethnicity/case were associated with the perception of trustworthiness, physician management, competence, professionalism and the perception of medical error. CONCLUSIONS: Physical characteristics may alter students' ratings of physicians.

Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle.

BACKGROUND: Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience. METHODS: This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples. RESULTS: Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision. CONCLUSIONS: The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.

Closing the empathy gap towards equitable outcomes: gender equity in the medical workforce.

BACKGROUND: Empathy failures lead to equity failures. Women and men physicians experience work differently. Men physicians, however, may be unaware how these differences impact their colleagues. This constitutes an empathy gap; empathy gaps are associated with harm to outgroups. In our previous published work, we found that men had divergent views from women about the experiences of women relating to gender equity; senior men differed most from junior women. Since men physicians hold disproportionately more leadership roles than women, this empathy gap warrants exploration and remediation. ANALYSIS: Gender, age, motivation and power each seems to influence our empathic tendencies. Empathy, however, is not a static trait. Empathy can be developed and displayed by individuals through their thoughts, words and actions. Leaders can also influence culture by enshrining an empathic disposition in our social and organisation structures. CONCLUSIONS: We outline methods to increase our empathic capacities as individuals and organisations through perspective-taking, perspective-giving and verbal commitments to institutional empathy. In doing so, we challenge all medical leaders to herald an empathic transformation of our medical culture in pursuit of a more equitable and pluralistic workplace for all groups of people.

Transforming Intractable Policy Conflicts: A Qualitative Study Examining the Novel Application of Facilitated Discourse (Track Two Diplomacy) to Community Water Fluoridation in Calgary, Canada.

Governments face challenges in resolving complex health and social policy conflicts, such as the community water fluoridation (CWF) impasse in Calgary. Track Two diplomacy, informal dialogues facilitated by an impartial third party, is proposed to address these issues amid epistemic conflict and declining public trust in fellow citizens, science, and government. This study examined Track Two diplomacy's application in Calgary's CWF policy conflict. Collaborating with policymakers and community partners, the research team explored a Track Two-CWF process and conducted 21 semi-structured interviews with policymakers, scholars, practitioners, observers, and civil society representatives. Data interpretation explored contextual factors, conflict transformation potential, and design features for a Track Two process. A conflict map revealed factors contributing to impasse: the polarizing nature of a binary policy question on fluoridation; disciplinary silos; failed public engagement; societal populism; societal lack of disposition to dialogue; individual factors (adverse impact of conflict on stakeholders, adherence to extreme positions, issue fatigue, apathy, and lack of humility); together with policy-making factors (perceived lack of leadership, lack of forum to dialogue, polarization and silos). Participants suggested reframing the issue as nonbinary, involving a skilled facilitator, convening academics, and considering multiple dialogue tracks for a Track Two process. The first theory of change would focus on personal attitudes, relationships, and culture. Participants expressed cautious optimism about Track Two diplomacy's potential. Track Two diplomacy offers a promising approach to reframe intractable public health policy conflicts by moving stakeholders from adversarial positions to jointly assessing and solving problems. Further empirical evidence is needed to test the suggested process.

Identifying leadership in medical trainees: evaluation of a competency-based approach.

BACKGROUND: As medical professional roles diversify, it is essential to understand what makes effective medical leaders. This study develops and validates a medical leadership competency framework that can be used to develop and evaluate leaders across all levels of medical organisations. METHOD: In Phase One, the authors derived desired leadership traits and behaviours in the medical context from a panel of subject matter experts (SMEs). Traits and behaviours were then combined into multifaceted competencies which were ranked and further refined through evaluation with additional SMEs. In Phase Two, the final seven competencies were evaluated with 181 medical trainees and 167 supervisors between 2017 and 2018 to determine the validity of rapid-form and long-form leadership assessments of medical trainees. Self and supervisor reports of the seven competencies were compared with validated trait and leadership behaviour measures as well as clinical performance evaluations. RESULTS: The final seven leadership competencies were: Ethical and Social Responsibility, Civility, Self-Leadership, Team Management, Vision and Strategy, Creativity and Innovation, and Communication and Interpersonal Influence. Results demonstrate initial validity for rapid-form and long-form leadership evaluations; however, perceptions of good leadership may differ between trainees and supervisors. Further, negative leadership behaviours (eg, incivility) are generally not punished by supervisors and some positive leadership behaviours (eg, ethical leadership) were associated with poor leadership and clinical performance evaluations by supervisors. Supervisor perceptions of leadership were significantly driven by trainee scores on social boldness (a facet of extraversion). CONCLUSIONS: A multicompetency framework effectively evaluates leadership in medicine. To more effectively reinforcepositive leadership behaviours and discourage negative leadership behaviours in medical students and resident physicians, we recommend that medical educators:: (1) Use validated frameworks to build leadership curriculum and evaluations. (2) Use short-term and long-term assessment tools. (3) Teach assessors how to evaluate leaders and encourage positive leadership behaviours early in training.

We need to work differently in a crisis: peer-professional leadership to redesign physicians' work.

BACKGROUND: Understanding physician leadership is critical during pandemics and other health crises when formal organisational leaders may be unable to respond expeditiously. This study examined how physician leaders managed to quickly design a new model for acute-care physicians' work, adopted across four large hospitals in a public health authority in Canada during the COVID-19 pandemic. METHODS: The research employed a qualitative case study methodology, with inductive analysis of interview transcripts and documents. Shortly after a physician work model redesign, we interviewed key informants: the physician leaders and others who participated in or supported the model's development. Participants were chosen based on their leadership role and through snowballing. All those who were approached agreed to participate. RESULTS: A process model describes leadership actions during four phases of work model development (priming, early planning, readying for operations and transition). These actions were: (1) recognising the threat, (2) committing to action, (3) forming and organising, (4) building and relying on relationships, (5) developing supporting processes and (6) designing functions and structure. We offer three additional contributions to knowledge about leadership in a time of crisis: (1) leveraging peer-professional leadership to initiate, formalise and organise change processes, (2) designing a new work model on existing and emerging evidence and (3) building and relying on relationships to unify various actors. CONCLUSIONS: The model of peer-professional leadership can deepen understanding of how to lead professionals. Our findings could assist peer-professional and organisational leaders to encourage quick redesign of professionals' work in response to new phases of the COVID-19 pandemic or other crises.

Perceptions of effective leadership in a medical school context.

BACKGROUND: There have been calls for the development of leadership attributes in healthcare practitioners through leadership development programs. However, understanding how leadership is conceptualized is needed to assure effective participant-centred leadership development programs. The purpose of this study was to elucidate how the construct of leadership is conceptualized by multiple stakeholder groups associated with medical school leadership programs. METHODS: We conducted a total of 77 semi-structured interviews with six major demographic groups: Trainees (n = 16), Mid-Level University Leaders (n = 10), Clinician Leaders (n = 17), Senior University Leaders (n = 10), Medical Scientists (n = 12), and Senior Leaders, external to the University (n = 12) to address the research question. RESULTS: Content analyses revealed that the leaders were expected to create a compelling vision and a foster a motivating culture within the organization. Integrity and a sense of passion about leading were viewed as being principal characteristics of a leader. The twin skills of technical competence and communication were endorsed as most important for a leader. Finally, leaders are expected to be accountable for outcomes. CONCLUSION: Medical school leadership training programs should strive to incorporate these characteristics, given their broad appeal to diverse interest groups.

Association of Physician Characteristics With Perceptions and Experiences of Gender Equity in an Academic Internal Medicine Department.

Importance: The persistence of inequities that disadvantage women physicians remains empirically underexplained. Understanding the cultural factors that are associated with disparities in harassment, discrimination, remuneration, and career trajectory are critical to addressing inequities. Objectives: To explore how physicians perceive the climate for women physicians and compare perceptions and experiences of gender inequity among physicians based on characteristics including gender, faculty status, parental status, and years in practice. Design, Setting, and Participants: This sequential, explanatory, mixed-methods qualitative study used the Culture Conducive to Women's Academic Success (CCWAS; range 45-225, with higher scores indicating better perceived culture toward women), followed by individual semistructured interviews with physicians at the Department of Medicine of the University of Calgary. All 389 physician members of the Department of Medicine, including academic and clinical physicians and those of any gender, were invited to participate in the survey and interview phases. Main Outcomes and Measures: The culture within the department for women physicians was assessed using the CCWAS score. Scores were compared between respondents' gender and years in practice. Interviews with physicians were used to further explore findings from the CCWAS and to understand experiences and perceptions of gender disparities. Results: A total of 169 of 389 physicians completed the survey (response rate, 43.4%; 102 [59.9%] women; 65 [38.9%] men; and 2 [1.2%] who did not disclose gender); 28 participants (7.2%) elected to participate in an interview (22 [78.6%] women; 6 [21.4%] men). Women physicians perceived the culture of the department toward women as significantly worse than men physicians (median [interquartile range] CCWAS score, 137.0 [118.0-155.0] vs 164.5 [154.0-183.4]; P < .001). Physicians with more than 15 years in practice perceived the culture toward women as significantly more favorable than physicians with 15 years or less in practice (median [interquartile range] CCWAS score, 157.0 [138.8-181.3] vs 147.0 [127.5-164.3]; P = .02). Qualitative data demonstrated that experiences of junior women (ie, physicians who graduated medical school after 1996, when an equal number of men and women in medical school was achieved in Canada) and perceptions of senior men (ie, those who graduated before 1996) were most different; junior women reported high rates of discrimination and harassment, while senior men perceived that the Department of Medicine had achieved gender equity. Conclusions and Relevance: In this study, senior men physicians' perceptions of gender equity were different from lived experiences of gender inequity reported by junior women physicians. This demographic mismatch between perceptions and experiences of gender equity in medicine may explain the lack of action by leaders and decision-makers in medicine to mitigate disparities.

Trends in the Proportion of Female Speakers at Medical Conferences in the United States and in Canada, 2007 to 2017.

Importance: Gender equity is a prominent issue in the medical profession. Representation of female physicians at academic meetings has been identified as an important component of gender equity; however, this topic has not been systematically assessed. Objective: To determine the trend during the last decade in the proportion of speakers who were women at major academic medical conferences held in Canada and in the United States. Design, Setting, and Participants: A cross-sectional analysis was conducted examining the gender of speakers listed in meeting programs of medical conferences held in Canada and in the United States in 2007 and from 2013 through 2017. Eligible conferences were identified using a sensitive search strategy, and a previously validated tool was used to analyze each meeting speaker list and to assign a proportion of female speakers. Conferences held in English language, hosted in Canada or the United States, and targeted to a physician audience with 100 or more attendees were included. The comparison group was active physicians in Canada and in the United States. Main Outcomes and Measures: The mean of the proportion of female speakers at each conference per year. Results: In total, 181 conferences with 701 individual meetings were analyzed, including 100 medical and 81 surgical specialty conferences. The proportion of women ranged from 0% to 82.6% of all speakers. The mean (SD) proportion of female conference speakers for all meetings analyzed significantly increased from 24.6% (14.6%) for 40 meetings in 2007 to 34.1% (15.1%) for 181 meetings in 2017 (P < .001). The mean proportion of female speakers at medical specialty conferences was 9.8% higher (SE, 1.9%; P < .001) than the mean proportion of female speakers at surgical specialty conferences for all years analyzed. The mean proportion of female speakers at conferences was similar to the mean proportion of active female physicians across all specialties in the United States and in Canada for all years analyzed. Conclusions and Relevance: Although our findings indicate that the proportion of female speakers at medical conferences increased during the last decade, women continue to be underrepresented. Speaker invitation and selection at conferences represent important opportunities to influence gender equity within medicine.

Barriers and enablers to academic health leadership.

Purpose This study sought to identify the barriers and enablers to leadership enactment in academic health-care settings. Design/methodology/approach Semi-structured interviews ( n = 77) with programme stakeholders (medical school trainees, university leaders, clinical leaders, medical scientists and directors external to the medical school) were conducted, and the responses content-analysed. Findings Both contextual and individual factors were identified as playing a role in affecting academic health leadership enactment that has an impact on programme development, success and maintenance. Contextual factors included sufficient resources allocated to the programme, opportunities for learners to practise leadership skills, a competent team around the leader once that person is in place, clear expectations for the leader and a culture that fosters open communication. Contextual barriers included highly bureaucratic structures, fear-of-failure and non-trusting cultures and inappropriate performance systems. Programmes were advised to select participants based on self-awareness, strong communication skills and an innovative thinking style. Filling specific knowledge and skill gaps, particularly for those not trained in medical school, was viewed as essential. Ineffective decision-making styles and tendencies to get involved in day-to-day activities were barriers to the development of academic health leaders. Originality/value Programmes designed to develop academic health-care leaders will be most effective if they develop leadership at all levels; ensure that the organisation's culture, structure and processes reinforce positive leadership practices; and recognise the critical role of teams in supporting its leaders.

An orientation to wellness for new faculty of medicine members: meeting a need in faculty development.

OBJECTIVES: To evaluate the format, content, and effectiveness of a newly developed orientation to wellness workshop, and to explore participants' overall perceptions. METHODS: This was a mixed methods study. Participants consisted of 47 new faculty of medicine members who attended one of the four workshops held between 2011 and 2013. Questionnaires were used to evaluate workshop characteristics (10 survey items; response scale 1=unacceptable to 7=outstanding), intention to change behavior (yes/no), and retrospective pre/post workshop self-efficacy (4 survey items; response scale 1=no confidence to 6=absolute confidence). Mean scores and standard deviations were calculated for the workshop characteristics. Pre/post workshop self-efficacy scores were compared using a Wilcoxon signed-rank test. Participants' written qualitative feedback was coded using an inductive strategy to identify themes. RESULTS: There was strong support for the workshop characteristics with mean scores entirely above 6.00 (N=42). Thirty-one of 34 respondents (91%) expressed intention to change their behavior as a result of participating in the workshop. The post workshop self-efficacy scores (N=38 respondents) increased significantly for all four items (p<0.0001) compared to pre workshop ratings. Participants perceived the key workshop elements as the evidence-based content relevant to academic physicians, incorporation of practical tips and strategies, and an atmosphere conducive to discussion and experience sharing. CONCLUSIONS:   Participants welcomed wellness as a focus of faculty development. Enhancing instruction around wellness has the potential to contribute positively to the professional competency and overall functioning of faculty of medicine members.

Medical applications: a database and characterization of apps in Apple iOS and Android platforms.

BACKGROUND: Medical applications (apps) for smart phones and tablet computers are growing in number and are commonly used in healthcare. In this context, there is a need for a diverse community of app users, medical researchers, and app developers to better understand the app landscape. METHODS: In mid-2012, we undertook an environmental scan and classification of the medical app landscape in the two dominant platforms by searching the medical category of the Apple iTunes and Google Play app download sites. We identified target audiences, functions, costs and content themes using app descriptions and captured these data in a database. We only included apps released or updated between October 1, 2011 and May 31, 2012, with a primary "medical" app store categorization, in English, that contained health or medical content. Our sample of Android apps was limited to the most popular apps in the medical category. RESULTS: Our final sample of Apple iOS (n = 4561) and Android (n = 293) apps illustrate a diverse medical app landscape. The proportion of Apple iOS apps for the public (35%) and for physicians (36%) is similar. Few Apple iOS apps specifically target nurses (3%). Within the Android apps, those targeting the public dominated in our sample (51%). The distribution of app functions is similar in both platforms with reference being the most common function. Most app functions and content themes vary considerably by target audience. Social media apps are more common for patients and the public, while conference apps target physicians. CONCLUSIONS: We characterized existing medical apps and illustrated their diversity in terms of target audience, main functions, cost and healthcare topic. The resulting app database is a resource for app users, app developers and health informatics researchers.

Improving prevention, early recognition and management of acute kidney injury after major surgery: results of a planning meeting with multidisciplinary stakeholders.

PURPOSE OF REVIEW: Acute kidney injury (AKI) is common after major surgery, and is associated with morbidity, mortality, increased length of hospital stay, and high health care costs. Although recent guidelines for AKI provide recommendations for identification of patients at risk, monitoring, diagnosis, and management of AKI, there is lack of understanding to guide successful implementation of these recommendations into clinical practice. SOURCES OF INFORMATION: We held a planning meeting with multidisciplinary stakeholders to identify barriers, facilitators, and strategies to implement recommendations for prevention, early identification, and management of AKI after major surgery. Barriers and facilitators to knowledge use for peri-operative AKI prevention and care were discussed. FINDINGS: Stakeholders identified barriers in knowledge (how to identify high-risk patients, what criteria to use for diagnosis of AKI), attitudes (self-efficacy in preventive care and management of AKI), and behaviors (common use of diuretics, non-steroidal anti-inflammatory drugs, withholding of intravenous fluids, and competing time demands in peri-operative care). Educational, informatics, and organizational interventions were identified by stakeholders as potentially useful elements for future interventions for peri-operative AKI. LIMITATION: Meeting participants were from a single centre. IMPLICATIONS: The information and recommendations obtained from this stakeholder's meeting will be useful to design interventions to improve prevention and early care for AKI after major surgery.

OBJECTIF DE L'ÉTUDE: L'insuffisance rénale aiguë (IRA) est fréquente à la suite d'une chirurgie importante et elle est associée à une morbidité, à une mortalité, à une hospitalisation prolongée et à des coûts élevés liés aux soins de santé. Bien que les lignes directrices récentes concernant l'IRA fournissent des recommandations pour déterminer les patients à risque, de même que pour contrôler, diagnostiquer et prendre en charge l'IRA, la compréhension fait défaut pour mener leur mise en place réussie dans la pratique clinique. SOURCES D'INFORMATION: Nous avons tenu une réunion de planification avec des acteurs pluridisciplinaires afin de cibler les obstacles, les appuis et les stratégies de mise en œuvre des recommandations pour la prévention, l'identification précoce et la prise en charge de l'IRA suite à une chirurgie importante. On a abordé les obstacles et les appuis à l'utilisation des connaissances dans la prévention périopératoire de l'IRA et les soins qui s'y rattachent. RÉSULTATS: Les acteurs ont déterminé les obstacles à la connaissance (comment identifier les patients à risque élevé, le choix de critères diagnostiques pour l'IRA), les attitudes (l'auto-efficacité dans les soins préventifs et la prise en charge de l'IRA), et les comportements (l'usage courant de diurétiques, d'anti-inflammatoires non stéroïdiens, la non-administration de solutés intraveineux, et les contraintes de temps dans les soins périopératoires). Les acteurs ont défini les interventions éducatives, informatiques et organisationnelles comme des éléments potentiellement utiles dans les interventions futures en soins périopératoires pour l'IRA. LIMITES DE L'ÉTUDE: Les participants à la réunion provenaient d'un seul et même centre. IMPACTS: Les informations et recommandations obtenues au cours de la réunion des acteurs seront utiles pour l'élaboration des interventions afin d'améliorer la prévention et les soins précoces relatifs à l'IRA suite à une chirurgie majeure.

Perspective: a business school view of medical interprofessional rounds: transforming rounding groups into rounding teams.

An effective interprofessional medical team can efficiently coordinate health care providers to achieve the collective outcome of improving each patient's health. To determine how current teams function, four groups of business students independently observed interprofessional work rounds on four different internal medicine services in a typical academic hospital and also interviewed the participants. In all instances, caregivers had formed working groups rather than working teams. Participants consistently exhibited parallel interdependence (individuals working alone and assuming their work would be coordinated with other caregivers) rather than reciprocal interdependence (individuals working together to actively coordinate patient care), the hallmark of effective teams. With one exception, the organization was hierarchical, with the senior attending physician possessing the authority. The interns exclusively communicated with the attending physician in one-on-one conversations that excluded all other members of the team. Although nurses and pharmacists were often present, they never contributed their ideas and rarely spoke.The authors draw on these observations to form recommendations for enhancing interprofessional rounding teams. These are to include the bedside nurse, pharmacist, and case manager as team members, begin with a formal team launch that encourages active participation by all team members, use succinct communication protocols, conduct work rounds in a quiet, distraction-free environment, have teams remain together for longer durations, and receive teamwork training and periodic coaching. High-performing businesses have effectively used teams for decades to achieve their goals, and health care professionals should follow this example.