Advances in Health Sciences Education

, Volume 21, Issue 4, pp 735–748 | Cite as

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

  • Elise ParadisEmail author
  • Myles Leslie
  • Michael A. Gropper


Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs’ educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians’ de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers’ contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians’ time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed.


Ward rounds Critical care Interprofessional relations Medical education-graduate Patient centered care 



This research was funded by the Gordon and Betty Moore Foundation. The authors wish to acknowledge the contributions of Niall Byrne, Ph.D., Simon Kitto, Ph.D., Mandy Pipher, and Scott Reeves, Ph.D.

Compliance with ethical standards

Conflict of interest



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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoCanada
  2. 2.Department of Anesthesia, Faculty of MedicineUniversity of TorontoTorontoCanada
  3. 3.The Wilson CentreTorontoCanada
  4. 4.Armstrong Institute for Patient Safety and QualityJohns Hopkins MedicineBaltimoreUSA
  5. 5.Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoUSA

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