Module 1: Welcome & Program

Overview

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Acknowledgements

On behalf of the EnHANCE Ontario Project Partners, we would like to extend our appreciation to all of the individuals who have generously dedicated time to participating in brainstorming, planning, writing, reviewing, and editing the drafts of the resources. A wide range of stakeholders have contributed from their areas of expertise and experience, including college and university educators, service providers, organizational leaders and researchers. The iterative approach used to develop the education programs was critical to ensuring that these resources would meet the needs of the intended user.

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Client Stories

The Client Stories have been adapted and modified by the EnHANCE Ontario project. They were originally published through the Canadian Collaborative Mental Health Initiative: Curran, V., Ungar, T., Pauzé, E. (2006). Strengthening Collaboration through Interprofessional Education: A Resource for Collaborative Mental Health Care Educators. Mississauga, ON: Canadian Collaborative Mental Health Initiative; February 2006. Available at: www.ccmhi.ca

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Adaptation of Tools

The EnHANCE Ontario Education Programs have been published in Word and PowerPoint formats to permit for the adaptation of these materials for different educational timeframes, processes, contexts and learners. In the interest of sharing resources and preventing the duplication of work, the project provides permission to individuals to modify the materials, to change the formatting, to use only certain sections, and to add or delete content to suit their needs. Individuals may photocopy, modify and distribute these materials for their use provided that proper attribution is given to the source.

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Welcome!

Welcome to the EnHANCE Ontario Education Program for Healthcare Students

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What is EnHANCE?

“EnHANCE Ontario was a multi-partner project with a vision of leading the development of inter-organizational partnerships and enhancing capacity for the delivery of collaborative and interprofessional care for people seeking access to services across primary care, mental health and addictions organizations in Ontario.”

Funded by HealthForceOntario Interprofessional Care/Education Fund

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Program Objectives

The overall objectives of the EnHANCE Education Program include: Examining ways providers can work together to enhance

services for clients with complex mental health and addiction needs seeking access to services across MH&A and primary care settings

Exploring ways organizations can collaborate to enhance services for clients with complex mental health and addiction needs seeking access to services across MH&A and primary care settings

Reviewing elements of interprofessional collaboration and inter-organizational partnerships

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Meet Stan

Stan is a 43 year old Caucasian male with chronic schizophrenia. He has had multiple admissions for his illness and is well known to the hospital and community team. His mother, who had been his primary care giver, moved into a retirement home 5 years ago and has become more removed from his care.

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Stan’s Story

When well, Stan is pleasant with a good sense of humour. Everyone likes him. When ill, Stan can be threatening and people quickly become afraid.

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Stan’s Story (cont’d)

Stan has not been taking his medications. The pharmacist left a message at the Psychiatrist’s office

The community health nurse noticed Stan was becoming more suspicious and hostile

Stan’s mother reported that she thought Stan was becoming ill. What should she do?

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Stan’s Story (cont’d)

Stan was brought by police to emergency. Stan refused bloodwork and became belligerent. Stan’s mother asked the nurses to check his blood sugar. They told her this would happen on the ward.

Stan’s mother came in the next day and found him listless and “out of it”. His blood sugar was checked and found to be dangerously high. He was transferred to a medical ward for stabilization.

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Why EnHANCE?

Working together• Decreased competition• Decreased duplication• Less chance of “falling through the cracks” and

blaming others• Recognizes the skills and expertise of others

For clients – working together increases the chances that their needs will be met by the right provider at the right time

For providers – working in an environment that supports their personal and professional needs

For the system – creating new and sustainable solutions

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The Program

Goal: How do I become a better inter-organizational collaborator?

Modules consist of theory, learning activities and in-depth case studies

Evaluation methods – Is there a test?

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Module 2: Introduction to IPC

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What is Interprofessional Collaboration (IPC)?

IPC occurs when health disciplines come together around client care issues, whereby decision-making happens within the group, and a transformation occurs.

Client is the focus.

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Why IPE?

What is it?Interprofessional Education is…."occasions when two or more professions learn with, from and

about each other to improve collaboration and the quality of care”

Why is it important?Collaborative Patient-Centred Practice…"is designed to promote the active participation of each discipline

in patient care. It enhances patient- and family-centred goals and values, provides mechanisms for continuous communication among caregivers, optimizes staff participation in clinical decision making within and across disciplines and fosters respect for disciplinary contributions of all professionals”

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Patient Safety

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National Institute of Medicine’s comprehensive report on patient safety entitled To Err is Human, released in 2000

In 2004, the Canadian Adverse Events Study was released.

70,000 preventable adverse events (est.) each year in Canada.

Canadian Interprofessional Health Collaborative (CIHC)

Competencies developed and released in 2010• Role Clarification• Team Functioning• Patient/Client/Family/Community-Centred

Care• Collaborative Leadership• Interprofessional Communication• Interprofessional Conflict Resolution

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Inter-Organizational IPC

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Currently 3 systems spanning physical health, mental health and addictions

Gaps and duplications

The Goal

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All providers work together on behalf of the client

The client is in the centre

Module 3: Communities of Practice

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Activity: Communities of Practice

Who will be on your team? Where does the client fit in? Are there others missing? How can you include them?

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Module 4: Partnership vs. Collaboration

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Inter-Organizational Partnership vs. Inter-Organizational IPC

Partnership: Two or more organizations agree to formally

or informally work together to provide services to a population of individuals

Collaboration: IPC at the provider level when the service

providers are working together across organizations

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Benefits of Inter-Organizational IPC

Take a moment to individually list all the benefits of inter-organizational IPC….

Now let’s brainstorm as a group – did we generate more?

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Client-Centred Care

Promotes participation of each healthcare discipline

Enhances client and family-centred goals Provides mechanisms for continuous

communication Optimizes staff participation in clinical

decision making Fosters respect for contributions made by all

professionals Function as a service team for the client

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Client-Centred Care (cont’d)

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Module 5: Knotworking Teams

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Knotworking

Knotworking describes a type of collaboration within and between organizations.

From the perspective of the client – the healthcare team should change to meet their needs

The knotworking team forms up around the client to meet his/her needs

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Knotworking Teams

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PhysicianNurseSocial WorkerPharmacist

PhysicianSocial WorkerDietitian

SpecialistNurse PractitionerOccupational TherapistSocial Worker

PhysicianPharmacistSocial WorkerDietitianNurseDischarge Planner

Knotworking in Action

In your group, list the many teams you have been part of – formally and informally during your training

Where are the examples of knotworking? Where are the opportunities for teams to

form?

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Module 6: Types of Teams and

Features of Partnerships

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Types of Teams

Multi-disciplinary – several professions working side by side, independently or in parallel. Decisions are made autonomously

Inter-disciplinary – several professions working together in an integrated fashion, drawing on the expertise of one another to solve complex problems

Trans-disciplinary – several professions working together, consensus seeking behaviour is intentional, client is active in decision making

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Continuum of Autonomy

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Features of Partnerships to Consider

Types of services performed by each of the partnering organizations

Professional and organizational cultures of the partnering organizations

Degree of autonomy versus team collaboration practiced by the healthcare providers

Size and complexity of the partners

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Features of Partnerships to Consider (cont’d)

Number of partners Amount of funding available to support

collaborative work Physical distance between partnering

organizations Number of each type of provider within each

partnering organization

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What Features Have You Experienced?

What features of organizational support have you experienced that enhance collaboration?

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Features of Successful Partnerships

Organizational structures to guide the integration of service delivery, support collaboration and maintain accountability

A single point of entry for clients through an interdisciplinary case management approach

Organized provider networks to enhance access and provide seamless care

Financial incentives to promote prevention, rehabilitation and service integration

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Types of Partnerships

Partnership: A formal, typically long term, agreement between organizations where each has specific obligations and makes specific contributions

Affiliation: A formal relationship that comprises cooperative efforts between universities, colleges and/or service providers to affect the academic interchange of faculty and students, and academic and research information

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Types of Partnerships (cont’d)

Service Agreement: A formal relationship between a client and the provider of a service or product.

Secondment: An arrangement to temporarily “loan” an employee to another organization or department without any change to the employment relationship

Strategic Alliance: A formal relationship where organizations come together to plan, operate or evaluate shared services

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Principles Forming the Foundations of Success

Core values are necessary to help people with day-to-day decision-making….People need “guiding stars” to navigate and make decisions day to day. But core values are only helpful if they can be translated into concrete behaviours.

Operating principles of a partnership need to be articulated and understood by all members of the healthcare team – including the client.

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Provider-Level Principles

EICP principles:

1. Client centredness2. Population health approach3. Best possible care and services4. Access5. Trust and respect6. Effective communication

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Module 7: Types of Partnerships

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Inter-Organizational Partnership Framework

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Green Light Partnerships

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Case conferencing Develop a program proposal

for new joint service Discussion of resources

being spent to meet a community need for services

Education (e.g., staff development; joint conference for IPE)

Informal networks/committees/interest groups

Joint advocacy plan

Joint discussion of a health problem or need

Networking events Research collaborations Service planning Service resolution tables

(e.g., placing clients with complex needs, if organizations are already part of a informal partnership or network)

Yellow Light Partnerships

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Co-location (e.g., shared office space/program space if short-term)

Development of an IPE framework agreement

Feasibility analyses Funding arrangement

covered in Multi-Sectoral Service Accountability Agreement (MSAA), Health Services Accountability Agreements (HSAA) or LHIN agreements

Interventions with common clients

Joint discussion of a program response

Medium term resource transfer

Pilot program, or pilot phase of a program

Policy development Secondment of staff or staff

sharing (short to medium term)

Service networks (e.g., primary purpose of information sharing, planning)

Sharing common client information

Submitting a proposal to funders

Red Light Partnerships

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Co-located services Coordinated access (needs

agreement to specify obligations of parties, e.g., referral process)

Evaluation (e.g., how, what, when)

Funding (e.g., how, who, what for?)

Implementation of advocacy strategy

Mandated partnership/relationship

Research collaborations Resource commitments

(e.g., human, financial, equipment, other)

Secondment agreement (e.g., outline payment, supervision, liability)

Shared administration (e.g., back office: information technology, accounting, human resources)

Shared care (e.g., needs agreement on staff responsibilities, risk)

Shared client service responsibilities

Signing and implementing of IPE programs

Student involvement(e.g., placements, internships, practicum)

Reasons to Partner

• Challenges accessing services for clients• Gaining access to specialized services• Requiring additional resources to better

serve clients• Requiring services provided in other

languages• Requiring services for a specialized

population• Providing better continuity of care

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Reasons to Partner (cont’d)

• Gaining access to and sharing of client information

• Gaining access to specialized diagnostic or treatment services

• Wanting to explore an issue or problem• Looking for opportunities• Forming interest groups/committees• Believing that collaboration is a better

approach than current risks

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Module 8: Stereotypes and Generalizations

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Stereotypes and Generalizations

Stereotypes – predictive generalizations about people and situations

When do we use them and why? When are they helpful? When are they problematic?

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Module 9: Inter-Organizational

Teams and Geography

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Inter-Organizational teams

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Geography

May need to learn to communicate via communications technology

May need to manage workflow using technology

May need to work with people you have never met

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Communications Technology

Email Fax Conference calls Video-conferencing Webinars Online forums

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Workflow

The administrative processes that the client engages with as they interact and move from provider to provider within organizations

May be managed with technology Strict legal, policy and ethical guidelines

around the collection and use of client data

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Module 10: Traditional vs.

Knotworking Teams

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Traditional vs. Knotworking Teams

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Need to understand roles, responsibilities and team functioning

What Can Healthcare Providers Do?

Share information – observations, clients’ stories and feedback, community liaison experiences

Share personal care provision challenges Set time aside to reflect as a team on what’s

working and what isn’t

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Meet Your Community

A key element of service provision involves knowing what services are available to your clients within their own community and how to access them.

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Module 11: Inter-Organizational IPC

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Organizational Culture

Institutional or “corporate” culture can affect how teams function inter-organizationally

What are some examples of organizational cultural characteristics?

How can dysfunctional organizational power dynamics affect IPC?

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Competencies for Inter-Organizational IPC

Two identified competencies that must be present for success:• Responsiveness – the perception that team

members are willing and able to follow up on requests and needs of other team members

• Facilitation – the ability of team members to direct work, problems and concerns through proper channels to ensure appropriate completion or resolution

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Thank you!

Thank you for participating in the EnHANCE Ontario Education Program for Healthcare Students

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