PromotingInterprofessionalCollaborativeCare
AmyV.Blue,PhDProfessorandAssociateDeanforEducationalAffairsCollegeofPublicHealthandHealthProfessionsAssociateVicePresidentforInterprofessionalEducation– UFHealth
SessionObjectives
• Discussinterprofessionaleducationandcollaborativecarepracticeconcepts
• Applytoolstopromoteinterprofessionalcollaborativecare
• Advocatethevalueofinterprofessionalcollaborativecare
WhyTeamsinHealthcare
BasedonIOMestimates,1jumbojet(270persons)crashingeveryday
InterprofessionalCollaborativePractice
Happenswhenmultiplehealthworkersfromdifferentprofessionalbackgroundsworktogetherwithpatients,families,careersandcommunitiestodeliverthehighestqualityofcare.
(WHO2010)
InterprofessionalCollaboration
Effectiveinterprofessionalcollaborationpromotestheactiveparticipationofeachdisciplineinpatientcare,wherealldisciplinesareworkingtogetherandfullyengagingpatientsandthosewhosupportthem,andleadershipontheteamadaptsbasedonpatientneeds.”
(RobertWood Johnson Foundation2015)
InterprofessionalEducation
“Interprofessionaleducationoccurswhentwoormoreprofessionslearnabout,fromandwith eachothertoimprovecollaborationandthequalityofcare.“
(WHO2010)
IPECCompetencies
May 2011
GuidingPrinciples
• Patient/familycentered(patient-centered)• Community/populationoriented• Relationshipfocused• Processoriented• Linkedtolearningactivities,educationalstrategies,andbehavioralassessmentsdevelopmentallyappropriate
GuidingPrinciples
• Abletobeintegratedacrosslearningcontinuum
• Sensitivetosystemscontext/applicableacrosspracticesettings
• Applicableacrossprofessions• Statedinlanguagecommon/meaningfulacrossprofessions
• Outcomedriven
CompetencyDomains
IPEinAccreditationStandards
• AccreditationCouncilforPharmacyEducation• AccreditationCouncilforPhysicalTherapyEducation
• AccreditationReviewCommissiononEducationforthePhysicianAssistant
• CommissiononCollegiateNursingEducation• CouncilonDentalAccreditation• LiaisonCommitteeonMedicalEducation
DoesIPCMakeaDifference?
• Froma2013Cochranereview(15studies):– 7studiesreportedpositiveoutcomes– 4studiesreportedmixedoutcomes– 4studiesreportedIPEinterventionshadnoimpactonpracticeorpatientcare
(Reevesetal2013)
TeamworkTraining
• Well-likedbytrainees• Improveslearningandtransferstothejob• Improvesorganizationaloutcomes– Safetyclimate,lengthofstay,turnover,jobsatisfaction
• Trueeffectforreducedpatientmortality,improvedpatienthealthandsatisfaction
(Salas2015)
LearningAbout,FromandWith
• Studentslearnmorefromeachother(thanusas“teachers”)
• Ourroleasteachersistocreate thelearningcontext,facilitate interaction,promotereflection
• Contentisthevehicleforlearningcollaborativeprocessskills
IPEInClinicalSettings
• Rolemodellingcollaborativecareimperative• Promotelearnerstointeractwithotherprofessionalsinanintentionalmanner
• Debriefwithlearnerstopromotereflection:– Howdidworkingwith…..helpyourpatientcare?–Whatotherprofessionsmightwewanttoinvolveinthecareofthispatient?
WhatisaTeam
• Twoormoreindividualswithahighdegreeofinterdependencegearedtowardtheachievementofagoalorthecompletionofatask.
• Teamsmakedecisions,solveproblems,providesupport,accomplishmissions,andplantheirwork.
WhatisTeamwork
• Itistheactions,events andbehaviors,cognition, feelings takentoaccomplishateamgoal.
• Itisabout…– …taskwork skills(i.e.,owntask).– …teamwork skills(i.e.,howtoworktogether).– …building andmaintaining both.
TeamsinHealthcare
• Healthcareprofessionalsbecomemembersofmanydifferenthealthcareteams.
• Theseteamsmaynotbeabletohaveasmuchtimetogetherasisideal.
• Therefore,eachprofessionalmustunderstandtheimportanceofteamsandhowtobeaneffectiveteammembertoallowtheteamtoworkwell.
EffectiveTeams:
�Membershaveacleargoalandarecommittedtothegoal
�Membershaveclearroles�Theyachievedecisionsthroughconsensus�Eachmemberfeelsempoweredtoact,speakup,offerideas
EffectiveTeams:
�Thereisdiversityamongteammembers�Membershaveeffectiveinterpersonalskills�Thereisperiodicself-assessment�Thereissharedleadershipoftheteam
ATeamworkFramework
22
OutcomesofTeamCompetencies
• Knowledge– SharedMentalModel
• Attitudes– MutualTrust– TeamOrientation
• Performance– Adaptability– Accuracy– Productivity– Efficiency– Safety
TeamStructures
• Thinkabouttheteamstructure(s)inyoursetting– Coreteam(patientcareproviders)– Contingencyteams(forspecificevents)– Coordinatingteams(daytodaymanagement)– Ancillaryandsupportservices(clinical,IT,
housekeeping,etc.)– Administration
Communication
“Theprocessbywhichinformationisclearlyandaccuratelyexchangedbetweentwoormoreteammembersintheprescribedmannerandwithproperterminologyandtheabilitytoclarifyoracknowledgethereceiptofinformation.”(Cannon-Bowers,etal1995)
SBAR….
• Aframeworkforteammemberstoeffectivelycommunicateinformationtooneanother:– Situation―Whatisgoingonwiththepatient?– Background―Whatistheclinicalbackgroundorcontext?
– Assessment―WhatdoIthinktheproblemis?– Recommendation/Request―WhatwouldIrecommend?WhatdoIneedfromyou?
Check-BackinCommunication
LeadingTeams
Twotypesofleaders:– Designated– Thepersonassignedtoleadandorganizeadesignatedcoreteam,establishcleargoals,andfacilitateopencommunicationandteamworkamongteammembers.
– Situational– Anyteammemberwhohastheskillstomanagethesituationathand.
TeamLeaders
• Organizetheteam• Articulatecleargoals• Makedecisionsthroughcollectiveinputofmembers
• Empowermemberstospeakupandchallenge,whenappropriate
• Activelypromoteandfacilitategoodteamwork
• Areskillfulatconflictresolution
TeamLeaders
• FormingthePlan– “Briefs”–Whoisonteam,goals,rolesofmembers,plan
• MonitoringandModifyingthePlan–“Huddles”– “Touchbase”meetingstoregainawarenessofsituationandmodifyplanasneeded
• ReviewingtheTeam’sPerformance–“Debrief”– Toimproveteamworkandoutcomes;– whatwentwell,couldbeimproved
SituationMonitoring
Processofactivelyscanning behaviorsandactionstoassesselementsofthesituationorenvironment– Fostersmutualrespectandteamaccountability– Providessafetynetforteamandpatient– Includescross-monitoring
SharedMentalModels
• Theperceptionof,understandingof,orknowledgeaboutasituationorprocessthatissharedamongteammembersthroughcommunication
SharedMentalModels
• Leadtomutualunderstandingofsituation• Leadtomoreeffectivecommunication• Enableback-upbehaviors• Helpensureunderstandingofeachother’srolesand
howtheyinterplay• Enablebetterpredictionandanticipationofteam
needs• Createcommonalityofeffortandpurpose
WhatDoYouSee?
MutualSupport
Mutualsupportistheessenceofteamwork– Protectsteammembersfromworkoverloadsituationsthatmayreduceeffectivenessandincreasetheriskoferror
TaskAssistance
Teammembersfosteraclimateinwhichitisexpectedthatassistancewillbeactivelysought andoffered asamethodforreducingtheoccurrenceoferror.
MutualSupport:CUSWords
PleaseUseCUSWordsbutonly whenappropriate!
ReviewofObjectives
• Discussinterprofessionaleducationandcollaborativecarepracticeconcepts
• Applytoolstopromoteinterprofessionalcollaborativecare
• Advocatethevalueofinterprofessionalcollaborativecare
References• WHO.FrameworkforAction(Feb.2010):http://www.who.int/hrh/resources/framework_action/en/• RobertWood Johnson Foundation. Lessons fromtheField:PromisingInterprofessional Collaboration Practices.
2015.Availableat:http://www.rwjf.org/content/dam/farm/reports/reports/2015/rwjf418568• InstituteofMedicine.ToErrisHuman.Washington,DC:NationalAcademyPress.2000.• http://susannahfox.com/2013/02/22/a-jumbo-jet-a-day-who-said-it/• Interprofessional EducationCollaborative ExpertPanel.(2011).Corecompetenciesforinterprofessional
collaborativepractice:Reportofanexpertpanel.WashingtonD.C.:InterprofessionalEducationCollaborative.• ReevesS,PerrierL,GoldmanJ,FreethD,ZwarensteinM.Interprofessional education:effectsonprofessional
practiceandhealthcareoutcomes(update).CochraneDatabaseofSystematicReviews2013, Issue3.SalasE.CanTeamTrainingSaveLifes?CriticalConnections: Feb/March2015.http://www.sccm.org/Communications/Critical-Connections/Archives/Pages/Can-Team-Training-Save-Lives.aspx
• SalasE,ShufferML,ThayerAL,BedwellWL,LazzaraEH.Understandingandimproving teamworkinorganizations:ascientifically basedpracticalguide.HumanResourceManagement2014.DOI:10.1002/hrm.21628
• TeamSTEPPS.http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html• Cannon-Bowers JA,TannenbaumSI,SalasE,etal.Definingcompetenciesandestablishingteamtraining
requirements.InGuzzoRA,SalasE,andassociates, eds.Teameffectiveness anddecision-making inorganizations.SanFrancisco:Jossey-Bass; 1995.p.333.