Five Professions, One Huddle and Nobody in Charge: Building an Interprofessional Discharge Team Where People Speak Up, With Evidence From Team Training and Psychological Safety
[Student Name]
University of Phoenix
DNP/730: Organizational and Systems Leadership
Week 7 Assignment
[Instructor Name]
[Date]
The team and scenario are composites written for a model paper.
The afternoon discharge huddle brings together a charge nurse, a hospitalist, a case manager, a physical therapist and a pharmacist for ten minutes to identify tomorrow's discharges. On 5 East, the huddle runs smoothly: people challenge each other's assumptions, and plans change. On 5 West, the hospitalist speaks, others nod and the list often proves wrong the next morning. This paper examines the teams' dynamics and plans team development.
Observing the Huddles
I observed five huddles on each unit. In the 5 East room, the charge nurse asked the hospitalist directly whether a patient was truly ready, and the therapist said a patient was not safe for home. On 5 West, nurses rarely spoke; when a case manager mentioned that a family could not pick up until evening, the hospitalist moved on. Afterward, two 5 West nurses told me they had doubts about two patients but did not say so.
Psychological Safety
Edmondson (1999) studied work teams in a manufacturing company and found that where members felt free to take interpersonal risks, teams engaged more in learning behavior, such as seeking feedback, asking questions and talking through errors, with those learning-oriented teams performing better. Team leader coaching and context support contributed to psychological safety.
Applying Psychological Safety
The difference between the huddles is psychological safety. On 5 East, members risk disagreement; on 5 West, they stay silent, and the team loses information that would make the discharge list accurate. Hierarchy between physicians and others, and 5 West's low trust in leadership, suppress speaking up.
The 5 West huddle had all the right people and all the right information; the information just never left the nurses' heads.
Does Team Training Help?
Salas et al. (2008), in a meta-analysis of team training interventions, found moderate positive relationships between team training and cognitive, affective, process and performance outcomes. Effects depended on training content, team membership stability and team size. Weaver et al. (2014), synthesizing health care team training studies, found that simulation and classroom-based team training can improve teamwork processes such as communication and coordination and that implementation has been associated with improvements in patient safety outcomes, with larger effects for bundled interventions that included tools and organizational changes.
Why 5 West Is Different
Psychological safety grows from experience. On 5 West, staff remember a charge nurse who was reprimanded after questioning a discharge that later went badly. That memory, not the current hospitalist, silences nurses today. Rebuilding safety requires leaders to respond to speaking up with thanks, especially when the concern turns out to be unnecessary.
A Bundled Approach
In line with the synthesis (Weaver et al., 2014), team development for the huddle will be bundled: brief training, a structured huddle tool and organizational supports.
Why Training Alone Is Not Enough
A training session without changes to the huddle's structure would teach skills that the room's dynamics would suppress. Weaver et al. (2014) found larger effects when training was bundled with tools and organizational changes, which is why the script and leader coaching are part of the plan.
Training
A 45-minute session for huddle members from both units will practice structured speaking up, using a two-challenge rule, and closed-loop communication, with short role-plays of huddle scenarios. Training content focuses on the specific behaviors the huddle needs, consistent with Salas et al. (2008) finding that content moderates effectiveness.
A Structured Tool
A one-page huddle script asks each profession in turn a fixed question for each potential discharge: the physician, is the patient medically ready; the nurse, is the patient and family ready; therapy, is the patient safe for the planned destination; case management, is the destination ready; pharmacy, are medications ready. A structured turn gives every member a voice and reduces reliance on individual courage.
Leader Behavior
What leaders do after someone speaks up decides whether others will.
Edmondson (1999) found that leader coaching supported psychological safety. The hospitalist and charge nurse co-lead the huddle and will model inviting input: "What am I missing?" I will coach 5 West's hospitalist champion on this behavior and on thanking members who raise concerns, even when the concern proves unfounded.
Team Size
Salas et al. (2008) found that team size moderated training effects. The huddle has five core members; adding observers or trainees makes speaking up harder. Visitors will be limited to one at a time, and the huddle will stay at five members plus a patient advocate when needed.
Stable Membership
Salas et al. (2008) found that team membership stability moderated training effects. Hospitalist schedules rotate weekly. We will assign the same case manager and therapist to each unit for three months and encourage hospitalists to attend the same unit's huddle all week.
Hierarchy and Speaking Up
In many hospitals, nurses hesitate to question physicians. On 5 West, the hospitalist spoke first at every huddle, which set the tone. The structured tool changes the order: the nurse speaks first about patient and family readiness. Changing who speaks first is a small structural change that shifts power in the room.
Conflict as a Resource
Healthy teams disagree. On 5 East, disagreement about a patient's readiness led the team to delay one discharge and speed another, improving both decisions. The goal on 5 West is not harmony but productive disagreement, surfaced in the huddle rather than in the hallway afterward.
Including the Patient's Voice
The structured tool includes a line for the patient's and family's stated plans, gathered by the nurse earlier in the day. A patient who says her daughter cannot come until evening changes the plan; including that voice prevents morning plans that fail on logistics.
Debriefs
Once a week, the huddle will spend two extra minutes asking what went well and what did not with yesterday's list. Brief debriefs build learning behavior into routine work and give quieter members a structured moment to speak.
Measuring Team Function
Measures include the accuracy of the huddle list, meaning the percentage of identified patients discharged the next day, observed speaking-up behavior using a simple count of contributions by profession and a short psychological safety survey.
Early Results
After three weeks with the script on 5 West, nurses contributed at every huddle, and list accuracy rose from 58% to 74%. Two nurses said the script made it easier to raise doubts because speaking was expected rather than volunteered, and the hospitalist said the list was finally worth trusting when he arrived on the unit the next morning to begin rounds.
Conclusion
The same huddle succeeds on 5 East and falters on 5 West because of differences in psychological safety, which support or suppress the learning behavior that makes the discharge list accurate. Evidence from team training and health care team training syntheses supports a bundled approach of focused training, a structured huddle tool, leader coaching and stable membership.
References
Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999
Salas, E., DiazGranados, D., Klein, C., Burke, C. S., Stagl, K. C., Goodwin, G. F., & Halpin, S. M. (2008). Does team training improve team performance? A meta-analysis. Human Factors, 50(6), 903-933. https://doi.org/10.1518/001872008X375009
Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: A narrative synthesis of the literature. BMJ Quality and Safety, 23(5), 359-372. https://doi.org/10.1136/bmjqs-2013-001848
How this DNP 730 Week 7 example is structured
The DNP/730 Week 7 work usually turns to team dynamics and interprofessional leadership. This paper observes a real team, diagnoses its dynamics with evidence and plans specific interventions to strengthen teamwork across professions. Students search this week as DNP 730 Week 7, DNP730 Wk 7 or DNP/730 Wk 7; all three are the same assignment.
DNP/730 Week 7 questions, answered
What does DNP/730 Week 7 usually ask for?
Many sections ask students to analyze team dynamics and interprofessional collaboration and to plan leadership actions that improve teamwork.
What is psychological safety?
Members' common sense that they can ask a question, admit an error or voice a worry without being embarrassed or punished, a condition that supports team learning and performance.
Does team training work in health care?
Evidence suggests that team training improves teamwork processes and has been associated with better patient safety outcomes, with larger effects when training is bundled with tools and organizational supports.
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