Transforming Acute Care: The Role of Accountable Care Units in Strengthening Interprofessional Collaboration

Introduction

Interprofessional collaboration in acute care settings faces a range of well-documented challenges. These barriers are grounded in different professional routines, hierarchical structures, time limitations, communication gaps, and organizational complexities, which often lead to fragmented care and increased risks for errors and omissions. However, Accountable Care Units (ACUs), as conceptualized and supported by 1Unit, present a promising model to address these challenges, fostering a more unified, patient-centered approach to care delivery.

Challenges to Effective Interprofessional Collaboration in Acute Care

1. Professional Differences, Hierarchies and Power Imbalances

Differences in routines, roles, and professional identities can hinder effective collaboration. Studies highlight that each profession brings distinct perspectives to patient care, leading to varied approaches, potential misunderstandings and misunderstandings in roles and responsibilities (Baxter and Brumfitt, 2008, Duner, 2013, Matziou et al., 2014). Hierarchies can make collaboration difficult (Reeves et al., 2009), particularly if nurses and other allied health professionals may feel that their insights are undervalued, especially when physicians lead discussions and decision-making processes (Matziou et al., 2014). When team members do not fully comprehend the contributions of others, they may inadvertently overstep or withdraw, resulting in "boundary infringements" (Reeves et al., 2011) or result in power imbalances and frustrations between professions (Rahayu et al., 2021).

These issues can escalate into conflicts, particularly in acute care settings where time-sensitive decisions amplify misunderstandings and power imbalances (Folkman et al., 2019). These challenges foster environments where some team members may feel disempowered, resulting in unidirectional communication and limited input from non-physician team members.

2. Time Constraints

Acute care settings are typically high-pressure environments where time is scarce. As observed in multiple studies, limited time for interprofessional meetings restricts the flow of communication and often prioritizes medical issues at the expense of holistic care perspectives (Reeves et al., 2009, Zwarenstein et al., 2013). When communication becomes hurried or one-sided, essential care insights may be missed, increasing the potential for errors (Matziou et al., 2014).

3. Institutional and System-Level Barriers 

Institutional structures, such as legal and economic policies, can limit interprofessional collaboration (Fox and Reeves, 2015). Regulations around scope of practice, contractual agreements, and risk management frameworks are often set independently for each profession, creating silos within the system. Additionally, disparities in remuneration across professions can influence how individuals perceive their role within the team, sometimes fostering resentment and reinforcing hierarchies (Fox and Reeves, 2015).

4. Health Information Technology (HIT) and Communication Limitations 

While HIT can enhance efficiency, it also brings unintended consequences. Electronic messaging, for example, may replace face-to-face communication, which is essential for building interprofessional rapport. HIT systems are not always designed with interprofessional collaboration in mind, and they may inadvertently alter workflows or communication practices, impacting interpersonal relationships (Melby and Hellesø, 2014, Ash et al., 2007).

Influencing Factors for Successful Collaboration

To mitigate these challenges, several key factors can facilitate interprofessional collaboration in acute care:

1. Culture of Caring, Respect and Mutual Understanding

A culture of caring involves mutual respect and a shared commitment to patient-centered care. When team members care not only for patients but also for each other, they foster a collaborative environment that builds trust and inclusivity. Wei et al. (2020) demonstrate that a culture of caring improves job satisfaction, teamwork, and patient outcomes. Professionals should show respect for one another, build interpersonal connections, and understand and accept the roles, skills, and responsibilities of other disciplines (Wei et al., 2020, Chung et al., 2012). A shared mutual understanding of roles, responsibilities, and caring supports acceptance and respect for one another and can lead to a reduction in hierarchies (Homeyer et al., 2018).

2. Clear Communication and Shared Decision-Making 

Effective communication is the cornerstone of interprofessional teamwork, ensuring that team members feel comfortable voicing their concerns and perspectives (Wei et al., 2020). It promotes coordinated interprofessional collaborative practice that helps to identify and address problems. Open structured communication frameworks enable shared decision-making, harnessing diverse professional expertise in patient care plans (Fox and Reeves, 2015, Rahayu et al., 2021).

3. Strong Leadership and Defined Roles 

Leadership that values input from all team members and clarifies roles can empower professionals to contribute meaningfully and develop a team culture (Verhaegh et al., 2017). Leaders play a crucial role in maintaining open communication channels, promoting mutual respect, and balancing self-governance, co-governance and hierarchical governance with team goals (Folkman et al., 2019). Clear role definitions minimize boundary issues and ensure that every team member understands their contributions to patient care (Verhaegh et al., 2017, Homeyer et al., 2018).

4. Interprofessional Education (IPE) 

Education and training are critical for preparing healthcare professionals to work collaboratively (Wei et al., 2020). IPE helps professionals understand each other's roles and fosters respect, empathy, and trust (Homeyer et al., 2018). Through simulation and team-building exercises, IPE can also equip team members to handle the high-stakes environment of acute care more effectively.

5. Sufficient Resources and Organizational Support 

Adequate time, space, and resources are necessary for professionals to get to know each other, discuss issues, and collaborate effectively (Verhaegh et al., 2017). Regular team meetings, adequate staffing, and financial backing for collaborative initiatives are essential to foster a cohesive team environment (Chung et al., 2012). Moreover, thoughtful implementation of HIT can support rather than hinder interprofessional communication (Melby and Hellesø, 2014).

Accountable Care Units: Addressing Challenges and Leveraging Influencing Factors

Accountable Care Units (ACUs), as conceptualized and supported by 1Unit, present a transformative model to address these interprofessional challenges. The ACU model reorganizes acute care by physically colocating teams and standardizing interdisciplinary rounds, facilitating regular face-to-face communication between team members. The potential of ACUs to resolve common collaboration issues lies in several core elements:

1. Geographic Colocation and Enhanced Communication 

ACUs emphasize the importance of geographic colocation, which reduces communication delays and fosters structured and as-needed, face-to-face interactions. These informal exchanges help to build rapport and trust among team members, helping to break down professional hierarchies and promote a more inclusive environment for collaborative problem-solving.

2. Structured Interdisciplinary Bedside Rounds (SIBR® rounds) 

The SIBR model requires the core team (physician and bedside nurse with patient) and when possible the full care team, including physicians, nurses, pharmacists, and allied health professionals, to participate in patient-centered bedside rounds. These rounds, held at the patient's bedside, encourage shared decision-making and ensure that each discipline's perspective is heard and integrated into the care plan. Closely held information and mis-information is proactively shared forward. SIBR’s structured format minimizes ambiguity in roles and responsibilities, allowing professionals to coordinate care seamlessly and avoid boundary issues.

3. Leadership and Accountability Structures 

ACUs place a strong emphasis on leadership, with designated physician and nursing unit leaders responsible for facilitating collaboration. These leaders advocate for team members, ensuring that communication channels remain open and that each discipline feels valued. Moreover, ACU leadership models often blend self-governance and hierarchical oversight, creating a balance that empowers all professionals while maintaining accountability.

4. Role Clarity and Mutual Respect

ACUs provide clarity regarding roles, which mitigates misunderstandings and boundary conflicts. By fostering respect among team members, ACUs can help reduce professional tensions, allowing team members to focus on patient-centered care rather than competing for authority or recognition.

5. Supportive Organizational Infrastructure 

For ACUs to function effectively, hospitals must commit resources to support this model, including adequate staffing, training, and support for interdisciplinary rounds. Unit leaders utilize unit-level data to monitor and improve unit outcomes and care process fidelity. Unit-to-unit sharing of successful interventions and lessons creates a wider environment of support and learning.

Conclusion: Potential for ACUs to Transform Acute Care Settings

The ACU model provides a framework that directly addresses the multifaceted challenges of interprofessional collaboration in acute care. By colocating teams, standardizing rounds, and prioritizing clear communication and role definition, ACUs mitigate the risks associated with professional hierarchies, time constraints, and fragmented communication. For hospital and physician group leaders, implementing ACUs offers an opportunity to foster a collaborative culture that enhances patient safety, reduces errors, and improves job satisfaction among staff.

Ultimately, the ACU model serves as a testament to the potential of structural innovations in healthcare to promote a culture of shared responsibility, mutual respect, and collective accountability — key components of interprofessional collaboration that are essential for delivering high-quality patient care in acute settings. By investing in and adapting the ACU framework, healthcare leaders can drive lasting improvements in team performance and patient outcomes. To learn more about achievable outcomes explore our results or research studies.

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