Coordination

Quality

Collaboration

Safety

Communication

Interprofessional Learning

Meeting at the Crossroads of Care

Small Group Activity 1

How do you define teamwork?

1. Where did you learn about how to be a team member?

2. What skills are needed to build collaborative team-based practice?

3. What are the barriers to working as a team?

What does collaborative learning & practice look like in your institution?

Interprofessional collaboration promotes the achievement of goals that cannot be reached when

individual professions learn or act on their own

Definitions

Interprofessional Education occurs when two or more professions learn about, from and with each other to improve collaboration and the quality of care.

Collaborative Practice promotes the active participation of relevant cross-disciplinary professions in patient-centered care.

Interprofessionality is not• Simply sharing electronic health records• Sole profession teams (neurologist, pulmonologist, radiologist)• Learners hearing a talk about another profession• Reporting out at interdisciplinary team meetings• Co-location without intentional collaboration• Decision-making without client/patient input

WHAT STUDENTS TELL US

FunctionInterprofessional knowledge and skills promote capacities to

understand the roles of other health providers and implement the workings of teams - regardless of team make-up - with the

person’s best interests at the center of care.

Emergency Care

Operating Theater

Community Health Environments

Mental Health Settings

Institute of Medicine

The Institute of Medicine’s (IOM) seminal study of preventable medical errors estimated as many as 98,000 people die every year at a cost of $29 billion. If the Centers for Disease Control were to include preventable medical errors as a category, these conclusions would make it the sixth leading cause of death in America. Deaths/Mortality, 2005, National Center for Health Care Statistics at the Centers for Disease Control, viewed at http://www.cdc.gov/nchs/fastats/deaths.htm.

http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_Sue_Sheridan/Sue_Sheridan-400-300.html

BIG Picture

IPE – Guiding Principleshttp://www.aacn.nche.edu/education-resources/IPECReport.pdf

World Health Organization

Canadian Interprofessional

Health Collaborative

U. S. Interprofessional

Expert Panel

Institute of Medicine

IOM 6 Aims for Improving Health Care

• Safety: avoid injuries to patients from the care that is intended to help them

• Effective use of scientific evidence to serve all patients • Patient-centered care that is respectful of and responsive

to patient preferences, needs and values, and ensuring that patient values guide all clinical decisions

• Timeliness and reduction of potentially harmful delays• Efficiency and avoidance of waste of equipment, supplies,

and human resources • Equitable care that does not vary in quality because of

person characteristics such as age, gender, ethnicity, geographic location and socioeconomic status

IPE – Guiding Principles

Values/Ethics for Interprofessional Practice Roles/Responsibilities for

Collaborative Practice Interprofessional Communication Interprofessional Teamwork and

Team-based Care Collaborative Leadership Patient-Centeredness

Roles & Responsibilities

• Communicate roles & responsibilities

• Engage with others to meet the needs of the people & populations served.

• Use complementary skills of all team members to optimize care.

Values & Ethics• Place the interests of patients and populations at the center of health care. • Respect unique cultural values and perspectives of

individuals, populations, and health professionals.

The D-P family is, like many Maine families, struggling to make do despite full-time employment. Mr. D-P suffers with severe knee pain. Mrs. D-P is anxious to return to work but hasn’t been able to as both of her children have special needs. Her son has numerous health concerns as well as development delays and behavioral issues that have made it difficult for him to attend traditional day care.

Communication• Use respectful and

appropriate communication in all situations

• Listen actively and encourage ideas and opinions of all team members

• Become knowledgeable about the cultures in your system & in the community

Teams & Teamwork

• Work with others to deliver patient-centered, community-responsive care.

• Integrate knowledge and experience of other professions to inform effective clinical, ethical, and systems-based decisions.

While most recognize the value of collaboration and teamwork they also note many barriers beginning with different definitions of team; lack of systems integration; few policies supporting team practices; and physical separation.

Collaborative Leadership

• Strong leaders value contributions of all health team members’ and also those of the patient, family, and community.

• Leaders facilitate contributions from all team members and build support for working together.

Purposeful Leadership

Consists of purposive efforts to address social determinants of health which negatively impact people and change specific existing conditions, policies and practices on behalf or with a client group, community, or population.

Oandasan, 2014

Person-Centeredness

• Respect for complementary expertise

• Value for clients/patients as a vital members of the team

• Trust in each other & in the team

• Value for clients’ perspectives and needs

• Connection & Compassion• Commitment to shared

decision-making process

Person/Patient-Centeredness

Clinical Providers

Invite & empower people to engage

with choices & adhere to prescribed treatment protocols, life style changes and medication regimens.

Public HealthProvide tools to inform & engage

consumers in health decision-making, self-

management, and health advocacy

Persons/Patients Capacity to

think critically & make informed and shared decisions in

collaboration with health care teams

Qualities of Patient-CenterednessAttitudeso Respect for complementary expertise o Value for patients as a vital members of the teamo Trust in each other & in the teamo Connection & Compassion

Actionso Explicitly invite patients to be part of the health care teamo Introduce patients to empowering practice & facilitate skillso Communicate openly, listen actively & respond effectively o Engage patients in care planning & collaborate decision-making o Consider utilization of an ongoing evaluation process

Modified from: Orchard, C, Shaw, L, & Culliton, S. Client-Centred Collaborative Care: From the patients’ perspective. Journal of Interprofessional Care 2011.

Change

Workplace Learning“People don’t learn by looking in the mirror. They learn by talking with people who have different points of view.” Ronald Heifetz (1995)

Definition: Bi-Culturalism

Dual Identities• Shared vision and

common goals for health and health practice

• Respect for Distinctions between professions and value for the differential roles played by members of the team

Bi-Cultural Competencies• Knowledge of Roles &

Responsibilities • Communication• Collaborative Teamwork• Shared Values & Ethics

Culture Change

• A process of institutional-systems socialization (Ideas, language, values, & attitudes )

• Common vision and mission statements

• Preferred workplace/clinical practices

• Common definitions of health & principles of health care delivery

Step 1: Promote ideas that are meaningful to the workplace & set common goalsStep 2: Form an Inclusive Coalition and invite meaningful changeStep 3: Create a Common Vision for achievable changeStep 4: Walk the Talk – reach out to colleaguesStep 5: Appreciate small successes and build on themStep 6: Remove obstacles & sidestep barriersStep 7: Sustain momentum – establish a domino effectStep 8: Anchor change in the workplace

“We meet monthly to discuss successes and needed changes, which allows us to know what others value and how they see their roles as educators. Such knowledge allows us to be expansive and inclusive in our own disciplines.”

“The more we work together the more apparent it becomes that we face tremendously challenging health care issues that can only be solved through collaboration and teamwork. There is momentum to our interprofessional efforts that appears unstoppable.”

Learning from Pat’s Story

Caring

IP Collaboration

CommunicationRelationship

Mutual Support

Patient Safety

Respect

Patricia Chalmers, 31Patricia (Pat) Chalmers is a 31-year-old woman who prides herself on self-sufficiency and resourcefulness. She works part-time as a bookkeeper and gets paid to take care of her aging grandmother with whom she lives. Pat describes herself as having been a caretaker since adolescence. It is therefore difficult for her to acknowledge her own needs or to seek others for help. Pat is tired of people commenting on her weight, diet, and need to exercise. She avoids health care as much as possible because she knows she’ll be told to lose weight or be blamed for “being fat” (her words). “I know what risks I face” she says. “But I’ve tried everything and nothing works. I’ve accepted my size and would like others to respect that.”Pat found herself in the ED with a broken ankle several months ago. The break was significant enough to require surgery. Labs revealed elevated glucose levels and surgery was put off until further tests could be done to determine whether Pat might have diabetes. When asked about this possibility, Pat reacted strongly. “I don’t have the time or money for diabetes,” she explained.

Huddle1. What do we know about Pat?2. What professions might be important to Pat’s team?3. What can we learn from other professions to improve the

quality of Pat’s care?

Social Work & Behavioral Health Primary Care Oral Health

Nursing Support Staff Rehabilitation

The Nexus

The next step forward is to increase the link between future healthcare employers and campus-based

interprofessional educational initiatives.

Shared Learning Environments

Shared Assignments & Didactics

6 Week Shared Placements

Cross-professional

preceptorships

Common Client/Patient

Panel

Clinical-Public Health-

Systems Health

“One of the best parts of this interaction for me was the ability to learn and share with one another. I was able to share my strengths as a student and learn to appreciate the strengths of student pharmacists. “

“We have the same goal: to provide excellent patient care, but we approach this goal from very different perspectives.”

“Because we know each other better, our interactions come easier and smoother when it comes to patient care… we feel comfortable to chime in and the visits became integrated in an organic way.”

Shared Learning:The Strategic Advantage

“Investment in IPE makes health professions programs more competitive within the university”

• Increased understanding of other departments and programs (internal education)

• Leads to understanding of the value-added by collaboration (e. g. shared programming in common curriculum)

• Opportunities for large interdisciplinary grants (HRSA)

• Enhances recruitment by distinguishing program options from other similarly designed institutions

• Opportunities for joint appointments and creative hires

• Support for Scholarly productivity and successful faculty reappointment/tenure

Institutional Benefits• Enhances the reputation of educational

institutions by creating a niche and showing currency with health reform

• Increases potential for collaboration between previously siloed programs and reduces costs to the institution

• Increases opportunities for service learning and community partnerships

• Attracts vibrant and innovative faculty• Attracts interest of external funders• Prepares students for workplace hires

Communicating IPE MessagesIf you have IPE programming:– Include IPE in recruitment materials– Work to get internal and external press– Find champions outside of IPE– Publish– Include IPE in your annual performance report– Give Deans regular outcome-driven reports– Give Deans “good news” to be shared– Meet with Dean/Leadership about IPE return on investment

(ROI)

Communicating IPE Messages

If you are not yet engaged but are working to develop IPE:– Make sure to create clear vision and mission statements

and IPE principles– Involve leadership early– Invite national IPE educators to campus– Gather literature and exemplars from other

similar institutions– Provide evidence of ROI– Have patience and don’t give up – Changing culture is a

process

Thank you

Shelley Cohen Konrad PhD, LCSWUniversity of New England

Director Interprofessional Education CollaborativeAssociate Professor, School of Social Work