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CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Assessing the Evidence for Interprofessional Education
6th APA-PHS Conference 2008, Kuala LumpurJohn H.V.Gilbert Ph.D., FCAHSPrincipal & Professor Emeritus, College of Health Disciplines, UBCProject Lead, CIHC
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
IPE At A Glance
•World Health Organization
•1978 Alma Ata Declaration • •1988 Learning Together to
Work Together in Health••2008 Framework for Action on
Interprofessional Education and Collaborative Practice
•
Significant Signposts
1995 The Quality in AustraliaHealthcare Study (Australia)
2000 To Err is Human (IOM, USA) 2001 The Bristol Inquiry (UK)
2003 Health Professions Education– A Bridge to Quality (IoM, USA)
2004 The Adverse Events Study(Canada)
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
The Definition
•Interprofessional Education (IPE) occurs when two or more professions learn with, from and about each other in order to improve collaboration and the quality of care. (CAIPE, 2002)
•(see the Canadian Interprofessional Health Collaborative’s (CIHC) Statement on the Definition and Principles of IPE: http://www.cihc.ca/resources-files/CIHCStatement_IPE_Final.pdf )
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
IPE is TO and FOR, a diverse cast of characters
4
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
2008 The Health Care Workforce Challenge
•“Anything that is labour intensive in a labour saving world becomes prohibitively expensive”
•
• (The late US Senator, Daniel Patrick Moynihan)
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Problems Facing Healthcare Policymakers
• Increasing shortages of health providers specialties• Disparities in access to healthcare services• Unequal incentives and pay structures for health
providers • Expanding scopes of practice (forcing curricula and
competency changes)• New and emerging health professions• Consumer expectations & demands• Cost
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
What have policymakers learned?
• Increasing the number of students in health professional schools does not solve the problem
• Training should be on the basis of population need not population ratio
• Innovative new ways are needed to change the way health services are delivered and the ways in which providers interact with each other
• IPE is one solution = one process to teach students and practitioners how to effectively work across professional boundaries
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Benefits of IPE
• Reduces wait times• Addresses challenges in chronic disease management• Improves workplace safety & job satisfaction• Improves organization of care, (ie, referrals between
professions)• Builds efficient work patterns• Maximizes existing processes• Improves documentation (ie, guidelines, protocols, etc.)• Evidence makes the best case for IPE
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
The Evidence
• IPE enables students and practitioners to learn the knowledge and skills necessary to work collaboratively.
• IPE enhances practice, improves the delivery of services and may also have a positive impact on patient care.
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Benefits for Students
• Many universities and colleges now offer IPE courses and practica to health and human service students.
• Most studies report that students enjoy their interprofessional experiences.
• Curricula changes enhance the ability of universities and college to offer these experiences.
•
• For more information on student engagement in IPE, the National Health Sciences Students’ Association at www.nahssa.ca is a national student-run organization with active chapters across Canada.
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Antecedents to Patient-Centred Collaboration
• Inherent Factors• Interpersonal differences e.g. age, gender, culture• Fear of change e.g. place, time, persons• Stereotypic rivalry e.g. me, him/her, them• Power, income and status e.g. salary vs. fee-for-service• Language e.g. gender, profession, social class, jargon• External Factors• Models of practice e.g. medicine, nursing, social work• Management structures e.g. acute care, community• Management priorities e.g. money, space, people
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
IPE Curricula: Learning Together
• Use the definition intelligently: A/W/F• Use the entire practice curricula • Ensure:
– the sum > the parts u– NOT another silo – NOT 3:30 – 4:30 on Friday.
– Nota Bene: IPE is NOT about the personal pronoun
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
The Collaborative Model
• IPE is a means to an end • IPE provides a microcosm of collaborative practice• IPE is a demonstration of the art of the possible• IPE recognizes that competition is never wholly absent
from professional and interprofessional education• IPE recognizes a reality:
Rivalry introduced from relationships in the world of work are examined as part of the learning experience.
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Moving Collaboration to the Practice Setting
• All settings in which health care teams already function– Primary health care– Chronic disease management– Rehabilitation
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Big Challenges
• No internationally agreed on definition of IPE, ergo– Different audiences have differing interpretations– No precise & measurable curricula, ergo– No agreed set of competencies
• Lack of methodologies to test a definition of IPE• Limited quantitative data on effectiveness
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Meeting the Challenges
• Adopt a global definition of IPE that encompasses every health and human service discipline. Leave no room for multiple interpretations
• Adopt a common set of goals that every discipline can adhere to
• Adopt one set of core competencies, regardless of discipline and geographic location
• Foster & build a strong research program
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Today’s Lessons, Tomorrow’s Solutions
• Governments must recognize the importance of implementing meaningful interprofessional policies
• Courses and projects specific to IPE should be offered in the workplace
• Quality improvement approaches should be implemented to support IPE in enhancing practice, delivery of services and patient care
• Practicing professionals should mentor students on IPE, and students should share their IPE knowledge with mentors
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Future Directions
• Reports of IPE should: • Clearly articulate precise details of the program under
evaluation and a clear discussion of methodological limitations (e.g. sampling, detection bias)
• Provide specific information about the educational processes employed within an IPE program, and provide both quantitative and qualitative data to describe the outcomes of those processes
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Future Directions
• The IPE research community should:• Develop methodologies to improve the generalisability of
their studies (ie, examining opportunities to combine existing data sets from single sites)
• Build mechanisms to foster multi-site and multi-institutional longitudinal studies
• Construct knowledge dissemination strategies to ensure (and assure) the translation of results into effective teaching and learning experiences
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
IPE
• Is generally well received by participants• Can enable students and practitioners to learn the knowledge
and skills necessary for collaborative working• Can enhance practice, improve the delivery of services and
make a positive impact on care• Can be effectively delivered in a variety of clinical settings. • AND• The use of quality improvement approaches such as
Continuous Quality Improvement or Total Quality Management can support IPE in enhancing practice, delivery of services and patient care
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
Key Ingredients for Success
• One size does not fit all• Assign resources• Change curricula • Create collaborative learning environments • Modify structures to support collaboration• Embed in educational and health care systems• Engage the wider community in IPE
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
A Major Lesson Learned
• Commit to sustain:• The only cash flow is an institution’s cash flow• Build on what exists:
– Create collaborative platforms for IPE across post-secondary institutions that facilitate curricular change and interaction
– Identify and champion existing IP teams inside health care to develop innovative Collaborative Learning Environments
– Promote & support student-led Collaborative IPE Initiatives
CIHC is a 5-year initiative funded by Health Canada www.cihc.ca
A special thanks to my colleagues for their great work on the synthesis report …
• Scott Reeves, St Michael’s Hospital, Li Ka Shing Knowledge Institute, University of Toronto
• Joanne Goldman, St Michael’s Hospital, Li Ka Shing Knowledge Institute, University of Toronto
• Brenda Sawatzky-Girling, Canadian Interprofessional Health Collaborative
• Andrea Burton, Canadian Interprofessional Health Collaborative