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Student name
Capella University
NHS 6008
Professor Name
April 12, 2026
NURS FPX 4005 Assessment 2: Interview and Interdisciplinary Issue Identification
The interdisciplinary collaboration is now a vital part of contemporary healthcare since intricate patient needs tend to demand knowledge and skills from various fields cooperating towards a common setup (Warren and Warren, 2023). As a baccalaureate-prepared nurse, having the skillset for how to determine what problems are inherent in the system, how to structure a solution as a team effort, and then how to make sure the solution will work is essential in improving patient and system outcomes. This process begins with such an evaluation when an interview with a health care professional is performed to explore real-life problems related to communication, workflow, or coordination that exist in a given organization.
Interview Summary
The nursing leader interviewed was an employee of a 200-bed community hospital that provided community, urban, and suburban-based acute medical surgical care, obstetric, and outpatient specialty clinic. It has a diverse adult and older population that has a wide range of chronic and acute illnesses; recent developments regarding service usage include a large number of inpatients turning over and a rising pressure on outpatients’ follow-up. During the interview, the participant described a variety of stressors to the operation, especially the lack of discharge coordination between nursing, case management, and outpatient, which creates delays in discharge and can even result in readmission (Cadel et al., 2022). These pressures were put into perspective within a system where changes in staffing and conflicting priorities make smooth communication and/or transitions of care challenging.
The interviewee mentioned being a nurse manager in two inpatient units of the medical-surgical unit, with duties that include: managing the nursing staff, communication with the case manager and physician, and quality indicators like LOS and readmission. Explaining organizational issues, the interviewee indicated that breaking down of communication between various disciplines (discharge plans, lack of knowledge of out-hospital visits, etc.) were the problems associated with the working process, leading to an increase in nursing loads and decreasing patient satisfaction and continuity of the treatment. Girnius et al. (2024) suggested that leadership had already made a number of changes, such as short interdisciplinary huddles, ad hoc electronic reminders, and specific staff education, but these were not successful at a whole-school level as they were only partial changes, due to poor engagement and not standardized processes. Two themes emerged: culture—general positive attitude towards teamwork, though inconsistencies noted between different departments working together to participate in any formal interdisciplinary team activity; leadership support, and the use of formal tools for communication was important for success based on past interdisciplinary team experience. Since there is a broad spectrum of information that could be collected to be analyzed afterwards, broad questions, reflective probing, and active listening were the methods used to facilitate the interview.
Issue Identification
The biggest issues discussed during the interview are the coordination of the discharges; the interface between nursing staff, case managers, doctors, and outpatient service providers is not effective. It is also interdisciplinary in nature as successful discharge planning requires working together amongst different departments to carry out the processes, joint decision making, and information sharing in a timely manner to ensure patients make a safe transition. Therefore, an interdisciplinary approach is important as no one department has all the information or the authority to maximize discharge, and the individual departments’ experience (such as education or case management led by individual nurses) did not achieve lasting improvement (Tseng et al., 2025). The interviewee’s statements on the lack of communication, lack of appropriate workflow, and lack of consistency of discharge involvement from day to day indicate that this is an inter-disciplinary problem that needs to be solved through teamwork and collaboration.
Change Theories That Could Lead to an Interdisciplinary Solution
Two dynamic models for change – Lewin’s Change Theory and Kotter’s 8-Step Change Model – can be applied as a strategy to facilitate an interdisciplinary intervention to improve discharge coordination. The Lewin model has emphasized three phases: unfreezing, changing, and refreezing, all of which are quite natural in helping the team-based practice change: bring stakeholders to understand the need for change, implement new behaviours in the team, and consolidate the communication process between disciplines. The model developed by Kotter builds on this, with much emphasis on steps, such as ‘creating a sense of urgency’, ‘forming a guiding coalition’, ‘creating a vision’, ‘communicating a vision’, and ’empowering action’, that were echoed in the collective leadership and the coordinated effort that is necessary in multi-disciplinary teams. Both theories encourage a planned approach towards communication, planned common ownership, and slow implementation of new workflows – all critical to overcome the breakdowns in communication as voiced in the interview. The peer-reviewed literature is full of reports that these models are effective in a medical setting, especially if the change to be implemented entails the coordination of activities between the members of different professions (Persson et al., 2022).
Especially the discharge coordination issue, because they provide systematic ways to provide resistance, involve staff, and implement new communication in the different departments. Lewin’s unfreeze, change, and refreeze model might help organizations to appreciate that they have a problem with the lack of aligned communication leading to poor patient outcomes, and the change stage to implement system- or interdisciplinary discharge huddles or standardized communication can be provided. Kotter’s steps are also useful for leaders to turn others into champions for the new approach and to ingrain the new behaviours by rewarding behaviour, training others, and enabling feedback loops (Zomorodi et al., 2024). The interviewee noted the issue of inconsistent participation and lack of standardization in processes, which directly refers to the two theories – cultural, behavioral, and organizational determinants in order to understand and improve case discharges for effective interventions. In addition, the mentioned sources are current, evidence-based, and published in reputable, peer-reviewed healthcare journals (meaning that the theoretical components that they use to address the problem in question are both valid and balanced with current best practice).
Leadership Strategies That Could Lead to an Interdisciplinary Solution
Among various types of leadership styles, one of the most effective ways of creating interdisciplinary cooperation and ensuring the process of organizational change is transformational leadership. Transformational leaders can inspire and motivate staff members in the following ways: Provide the staff members with a shared vision, empower those staff members as well, and allow for the free sharing of information between staff members. Central to emotional intelligence and effective leadership are the qualities of building relationships, trust, and psychological safety, which are essential to nurses, physicians, case managers, and other allied health professionals on the frontlines to open up in their problem-solving and decision-making. The available evidence reveals that transformational leadership provides a lot of cohesion to the team, effectiveness of communication, and willingness to change, which makes it particularly relevant when addressing multi-departmental and complicated issues (Singh et al., 2024). If the transformational leaders offer behaviours that are inclusive, the interdisciplinary ways of working and the new working processes in communication should lead them to be involved in this process and contribute their input.
The lack of involvement and disconnect in communication highlighted in this interviewee’s answer shows the applicability of the concept of transformational leadership to the issue of discharge. Perhaps a transformational leader can foster a collective vision of interdisciplinary rounds in consistent discharge planning, encourage staff to ensure they are regularly completing these rounds, and help the staff develop a common way to communicate (e.g., formal handoff) with each other. This leadership approach would help to eliminate silos and ensure that all disciplines feel trusted and accountable to drive optimization of discharge outcomes, as exists in the departmentalized areas. Furthermore, the literature cited with respect to transformational leadership in the health care environment is current, peer-reviewed, and has a good reputation (validity and reliability) of improving the nature of health care, quality of care, and interdisciplinary collaboration.
Collaboration Approaches for Interdisciplinary Teams
Benefits of evidence-based collaboration strategies like Situation, Background, Assessment, Recommendation (SBAR) communication, interdisciplinary rounds, and TeamSTEPPS can prove to be a lifesaver in situations involving improved communication and coordination across health care teams. Interactions with key patient information in an SBAR (Situation, Background, Assessment, and Recommendation) format can help reduce ambiguities and give each of the disciplines that may be needed to make the decision the same information. Nurses, doctors, case managers, and allied health personnel are able to huddle and attend interdisciplinary rounds on a regular basis and face-to-face to coordinate the goals, discuss the discharge plans, and anticipate the needs for patients. TeamSTEPPS is an evidence-based teamwork system that involves training to utilize common instruments and response behaviors to enhance communication, mutual support, and understanding among various departments to work together. The current literature shows that practices and electronic health records (EHR) implementation lead to fewer errors, efficiency, and improved patient outcomes, particularly in scenarios where three or more professionals are involved in providing care across the continuum, such as during transitions of care.
The strategies that have been outlined in the interviews that will help to address the discharge coordination issue are direct solutions, as they have ensured dependable strategies to provide real-time information and expectations of all team members. To prevent miscommunication when it comes to preparing for discharge or follow-up care, standardization of nursing and case management changes could be done based on SBAR. The interdisciplinary rounds would make it possible to involve various specialties on a regular basis, and the interdisciplinary communication, which would end up with delays and work overload, would be eliminated. Implementation of the team strategies of TeamSTEPPS (checkbacks, briefs, and cross-monitoring) would develop a sense of accountability and ownership of the discharge process by the department.
Conclusion
The interview revealed that a lack of communication and coordination within and between different disciplines is one of the biggest issues for successful discharge planning and quality outcomes in patients. Identifying the problem aids the need for a team-based, evidence-based intervention that would benefit from the right model change and effective leadership. Utilizing the Lewin Change Theory and transformational leadership can move the staff toward long-term change, while SBAR, interdisciplinary rounds, and TeamSTEPPS are in place for the staff to communicate and/or work together.
References
Alharbi, M. F. (2025). Does electronic health record implementation enhance hospital efficiency and patient outcomes? A comprehensive systematic review. SAGE Open, 15(3), 0. https://doi.org/10.1177/21582440251359791
Bakewell, F. (2024). Medical silos, social identity, and duty of care: A call for health leaders to improve transitions of care. Healthcare Management Forum, 38(2), 148–151. https://doi.org/10.1177/08404704241290689
Cadel, L., Sandercock, J., Marcinow, M., Guilcher, S. J. T., & Kuluski, K. (2022). A qualitative study exploring hospital-based team dynamics in discharge planning for patients experiencing delayed care transitions in Ontario, Canada. BioMed Central BMC Health Services Research, 22(1), e1472. https://doi.org/10.1186/s12913-022-08807-4
Girnius, A., Snyder, C., Czarny, H., Minges, T., Stacey, M., Supinski, T., Crowe, J., Strong, J., Josephs, S. A., & Zafar, M. A. (2024). Preoperative multidisciplinary team huddle improves communication and safety for unscheduled cesarean deliveries: A system redesign using improvement science. Anesthesia & Analgesia, 139(6), 1199–1209. https://doi.org/10.1213/ane.0000000000006905
Persson, M. H., Søndergaard, J., Mogensen, C. B., Skjøt-Arkil, H., & Andersen, P. T. (2022). Healthcare professionals’ experiences and attitudes to care coordination across health sectors: An interview study. BioMed Central BMC Geriatrics, 22(1), e509. https://doi.org/10.1186/s12877-022-03200-6
Singh, S., Miller, E., & Closser, S. (2024). Nurturing transformative local structures of multisectoral collaboration for primary health care: qualitative insights from select states in India. BMC Health Services Research, 24(1), e634. https://doi.org/10.1186/s12913-024-11002-2
Tseng, Y.-C., Chang, N.-T., Liu, S. H.-Y., Gau, B.-S., Liu, T.-C., & Lou, M.-F. (2025). Effects on health outcomes following a nurse-led hearing loss management intervention designed for older adults: A randomized controlled trial. International Journal of Nursing Studies, 166(1). https://doi.org/10.1016/j.ijnurstu.2025.105050
Warren, J., & Warren, J. (2023). The case for understanding interdisciplinary relationships in health care. Ochsner Journal, 23(2), 94–97. https://doi.org/10.31486/toj.22.0111
Zomorodi, M., Lisa, Ciarrocca, K., Neal, M., & Rodgers, P. (2024). Step by step: Utilizing Kotter’s model to design and implement a strategic plan for institutionalizing interprofessional education and practice. Journal of Interprofessional Education & Practice, 37(1). https://doi.org/10.1016/j.xjep.2024.100720
FAQs
What are the objectives of NURS FPX 4005 Assessment 2?
It requires you to do an interview in order to uncover an interdisciplinary problem in healthcare as well as solutions to that problem.
Why should interdisciplinary collaboration be encouraged in healthcare settings?
Interdisciplinary collaboration will help healthcare providers interact effectively and offer quality services to their clients.
What types of issues can be identified through interviewing healthcare professionals?
Common issues include communication barriers, patient safety concerns, workflow inefficiencies, and staffing challenges.
Why would interviewing healthcare professionals be beneficial for nursing students?
Interviewing with professionals in the healthcare industry will be helpful for students who are pursuing nursing, as they can gain information on the problems faced by a health care organization.
Why is it necessary to identify an interdisciplinary problem?
The significance of doing so includes the need to understand health care issues and how collaboration can be promoted.