Redefining Teamwork with Interprofessional Education and Practice: The Academic and Clinical Realities

1
Redefining Teamwork with Interprofessional
Education and PracticeThe Academic and Clinical
Realities

• Ruby Grymonpre, PharmD
• Professor, Faculty of Pharmacy
• IPE Coordinator, UofM
• January 11, 2012

2
Session Outline

• By the end of this presentation, you will be able
  to
• Describe the drivers for interprofessional
  education collaborative practice (IPEP)
• Define key terms related to IPEP
• Outline the systems approach being used in
  Manitoba to implement IPEP
• Articulate the key goals and actions for WRHA and
  UofM with respect to IPEP

3
Health and Wellness of Individuals

• 55 of Canadians suffer 1 or
• more chronic conditions
• 89 of deaths each year
• due to chronic disease
• Chronic disease costs over 100 billion in Canada
  
• Prevention and management of chronic disease in
  individuals has become health care priority

http//www.ocdpa.on.ca/docs/OCDPA_EconomicCosts.pd
f accessed May 27, 2010 http//www.queensu.ca/s
ps/publications/press/intros_tocs/EmergingApproach
es_Intro.pdf accessed May 27, 2010
4
Health and Well-being

• Health is a state of complete physical, mental
  and social well-being and not merely the absence
  of disease or infirmity
• (World Health Organization, 1948)

5
The problem

• Dependent on expensive new technologies
• Hospital is central
• Provider-centred patients come to us

6
The problem

• emergency room overcrowding
• difficult access to the necessary care
• poor record on patient safety
• long wait times
• inconsistent quality
• high costs with poor outcomes

7
The problem

• Health professions have evolved in parallel with
  very different traditions for education and
  clinical service
• Professionals have poor understanding of
  expertise and scope of practice of colleagues
• Reimbursement systems have fostered competition
  over collaboration between disciplines

8
The problem
Health Human Resource Crisis

• estimated worldwide shortage of almost 4.3
  million health workers
• aging workforce
• poor working conditions
• job dissatisfaction

http//www.who.int/hrh/professionals/en/
Accessed Jan 11, 2012
9

• Interprofessional
• Education

• Collaborative Person Centred Practice

IPEP
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Wheres the evidence for IPEP?

• Increased access to health care
• Improved outcomes for people with chronic
  diseases
• Less tension and conflict among caregivers
• Better use of clinical resources
• Easier recruitment of caregivers
• Lower rates of staff turnover

Canadian Health Services Research Foundation.
Teamwork in Healthcare Promoting Effective
Teamwork in Healthcare in Canada. Ottawa, ON
CHSRF 2006. http//www.chsrf.ca/SearchResults.asp
x?searchTeamwork20in20health20care Accessed
January 11, 2012 Lemieux-Charles L, et al. What
do we know about health care team effectiveness?
Med Care Res Rev 200663(3)263300
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Cochrane Review (2008)

• 4 of 6 studies found that IPE resulted in
• improved working culture in ED and patient
  satisfaction
• decreased errors in ED
• improved management of the care delivered to
  domestic violence victims
• improved knowledge and skills of professionals
  providing care to mental health patients
• 2 of these 4 studies found mixed results
• 2 of 6 studies found that IPE had little to no
  effect

Reeves S et al. IPE Effects on professional
practice and health care outcomes. Cochrane
Database of Systematic Reviews 2008, Issue 1.
Art. No. CD002213. DOI 10.1002/14651858.CD002213
.pub2.
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WHO statement

• After almost 50 years of enquiry, the World
  Health Organization and its partners acknowledge
  that there is sufficient evidence to indicate
  that effective interprofessional education
  enables effective collaborative practice.
• Collaborative practice strengthens health
  systems and improves health outcomes.
• Framework for Action on Interprofessional
  Education and Collaborative Practice, 2010
• http//whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_
  eng.pdf
• p 7 accessed January 11, 2012

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WHO Statement

• Once students understand how to work
  interprofessionally, they are ready to enter the
  workplace as a member of the collaborative
  practice team. This is a key step in moving
  health systems from fragmentation to a position
  of strength.

http//whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_
eng.pdf p 10
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Sydney Interprofessional Declaration

• All users of health and human services shall be
  entitled to fully integrated, interprofessional
  collaborative health and human services.
• All health and human services work to create and
  strengthen a culture that promotes the delivery
  of contextual opportunities for interprofessional
  learning and collaborative team training.
  Interprofessional education and training for
  collaborative practice should be a core element
  of continuing professional development.
• Health worker education and training prior to
  practice shall contain significant core
  elements/learning domains of interprofessional
  education. These core elements/learning domains
  shall contain practical experiences, for example
  simulation. These core elements/learning domains
  for interprofessional education will be formally
  assessed.
• Between ATBH5 and ATBH6 the global
  interprofessional community will undertake to
  develop a globally agreed upon set of definitions
  and descriptions that capture interprofessional
  education, learning, practice and care.
• The global interprofessional community will work
  with the World Health Organization to implement
  the Framework for Action on Interprofessional
  Education and Collaborative Practice.

http//www.cihc.ca/files/The20Sydney20Interprofe
ssional20Declaration.pdf
15
Health Canada

• Building on Values The Future of Health Care in
  Canada
• the direction of our health care system must be
  shaped around health needs of individual
  patients, their families and communities. -
  CPCP -
• If health care providers are expected to work
  together and share expertise in a team
  environment, it makes sense that their education
  and training should prepare them for this type of
  working arrangement. - IPE
• November 2002, Commissioner Roy J. Romanow, Q.C.
• http//www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/rom
  anow_e.html
• Accessed January 12, 201

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Health Canada HHR Strategy

• Health Human Resource Planningensuring we have
  enough of the right types of health-care
  providers to meet the needs of Canadians
• Recruitment and Retentionencouraging more people
  to enter the health-care field and improving
  working conditions to keep them there and
• Interprofessional Education for Collaborative
  Patient-Centred Practice IE(CP)2 changing the
  way we educate health providers so Canadians will
  have better and faster access to the health-care
  provider they need when they need it, ultimately
  boosting the satisfaction of both patients and
  health-care providers.
• http//www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/ind
  ex_e.html
• Accessed January 12, 2012

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Reality check in Manitoba

• there appears to be no active program of
  interprofessional learning at that centre
  University of Manitoba.
• Cook D. Models of Interdisciplinary Learning
  Report to Health Canada. February, 2004 page 25

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Total of 20 Health Canada funded projects across
Canada
1
1
1
2
1
3
1
3
7
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IPE Offices/Initiatives in Canada

• Ontario
• Canadore College
• Centennial College
• Confederation College
• George Brown College
• Humber Institute of Technology Advanced
  Learning McMaster University
• Michener Institute for Applied Health Sciences
• Niagara IP Health Education Institute
• Northern Ontario School of Medicine
• Queens University
• Ryerson University
• University of Toronto
• University of Western Ontario
• Nova Scotia
• Dalhousie

• Alberta
• University of Alberta
• Saskatchewan
• University of Saskatchewan
• Quebec
• McGill University
• University of Sherbrooke
• Manitoba
• University of Manitoba
• British Columbia
• University of British Columbia
• University of Victoria
• Vancouver Community College
• Newfoundland
• Memorial University

20
Accreditation of Interprofessional Health
Education (AIPHE)

• Accreditation Council of Canadian Physiotherapy
  Academic Programs
• Canadian Association of Occupational Therapists
• Canadian Council for Accreditation of Pharmacy
  Programs
• Canadian Association of Schools of Nursing
• Canadian Association of Schools of Social Work
• Committee on Accreditation of Canadian Medical
  Schools
• Royal College of Physicians and Surgeons of
  Canada
• College of Family Physicians of Canada

21
Accreditation of Interprofessional Health
Education (AIPHE)

• Phase I 2007- 2009

• Phase II 2010-2011

http//www.afmc.ca/aiphe-afiss/documents/AIPHE_Pri
nciples_and_Implementation_Guide_EN.pdf
22
National Health Sciences Students Association
(NaHSSA)

• The National Health Sciences Students
  Association strives to promote collaborative
  patient-centred practice and teamwork through
  interprofessional education in order to respond
  to the evolving health care needs of Canadians.
• MaHSSA
• http//www.nahssa.ca Accessed January 11, 2012

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The systems shake
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Manitoba Health Care System

• Manitoba Health oversees provincial health care
  system and sets broad policy direction
• RHAs responsible for assessing/prioritizing
  needs, goals and coordinating health services
• 11 RHAs in Manitoba
• WRHA responsible for health services for 60 of
  1.2 million MB residents
• WRHA encompasess over 200 programs, services,
  facilities
• includes 9 acute long term care centres, 16
  community health offices and 39 personal care
  homes
• 36 regional program teams

25
Post-Secondary Education in Manitoba

• Advanced Education Literacy
• Council of Post Secondary Education oversees
  allocation of funds to the province's seven
  public post-secondary institutions
• University of Manitoba
• 27,000 students

• 13 Academic Units
• Clinical Health Psychology
• Dentistry
• Dental Hygiene
• Human Ecology
• Kinesiology Rec Management
• Social Work
• Medicine
• Nursing
• Occupational Therapy
• Pharmacy
• Physical Therapy
• Physician Assistants
• Respiratory Therapy

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Manitoba Health
Council of Post Secondary Education
University of Manitoba
Winnipeg Regional Health Authority
COLLABORATIVE PERSON CENTRED CARE
UofM IPE INITIATIVE
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UofM IPE Initiative

• Mission
• To graduate health professionals prepared to
  manage and adapt processes in interprofessional
  (IP) teams necessary to achieve person- and
  family- centred health and wellness outcomes.
  This will be achieved through innovative learning
  opportunities for students to learn about, with,
  and from each other at the University of Manitoba
• Vision
• Improved health and well-being for Manitobans by
  building a culture of interprofessional education
  and practice.

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(No Transcript)
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WRHA Professional Advisory Committee

• Senior patient care committee reporting to CEO
  and Board with representation from nursing,
  allied health, and medical leadership
• Focus is on collaborative practice, scope of
  practice and evidence informed practice
• In 2009, action plan developed to advance
  interprofessional education and practice within
  the region

30
WRHA Collaborative Care

• http//www.wrha.mb.ca/professionals/collaborativec
  are/

31
What is Interprofessional Education?

• ..occurs when two or more professions learn
  about, from and with each other to enable
  effective collaboration and improve health
  outcomes
• Professional is an all-encompassing term that
  includes individuals with the knowledge and/or
  skills to contribute to the physical, mental and
  social well-being of a community.

Framework for Action on Interprofessional
Education and Collaborative Practice, 2010
http//whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_
eng.pdf p 13 accessed Jan 12, 2012
32
What does IPE look like?

• An educational approach
• Requires interaction
• Something must be exchanged that changes how they
  perceive themselves and others
• Changes must positively affect clinical practice

http//www.afmc.ca/aiphe-afiss/documents/AIPHE_Pri
nciples_and_Implementation_Guide_EN.pdf
33
What does IPE not look like?

• It is not
• a collective of learners from different
  professions sitting in the same room listening to
  the same lecture
• - or -
• learners from one profession sharing knowledge
  with one or more other professions in a one way
  exchange

http//www.afmc.ca/aiphe-afiss/documents/AIPHE_Pri
nciples_and_Implementation_Guide_EN.pdf
34
Terminology

• Uni professional occasions when professionals
  or students from one profession learn together
• Multi professional occasions when two or more
  professions learn side by side but in parallel
  (minimal interaction)
• Inter professional occasions when two or more
  professionals learn about, with, and from each
  other to improve collaboration and the quality of
  care
• Trans professional occasions in real practice
  where professional boundaries have been crossed
  or merged

Carpenter J, Dickinson H Interprofessional
Education and Training. Policy Press. Great
Britain. 2008. p.3
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What does collaboration look like?
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The 3 Cs

• Communication the imparting or interchange of
  thoughts, opinions, or information
• Cooperation parallel activities among
  individuals or organizations that associate
  informally to accomplish their common goals

Denise L, Collaboration vs C-Three. Innovating
1999(Spring) 7(3)
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Collaboration

• ...is the process of shared creation two or
  more individuals with complementary skills
  interacting to create a shared understanding that
  none had previously possessed or could have come
  to on their own. Collaboration creates a shared
  meaning about a process, a product, or an event.
  In this sense, there is nothing routine about it.
  Something is there that wasnt there before.

Michael Schrage, Shared Minds, NY Random House,
1990, p. 140
38
Canadian Interprofessional Health Collaborative
(CIHC) www.cihc.ca/resources/publications
39
Here Now Getting it Wrong - The Problem with
Words
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Whats in a name?
Individual
Family
Recipient
Consumer
Patient
Service user
Expert by experience
Person
Customer
Client
Participant
Caregiver
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Whats in a name?
Rotation
Practicum
Fieldwork placement
Service Learning
Experiential learning
Community project
Clinical placement
Cooperative learning
Clerkship
Structured practical experience
Internship
Externship
Community placement
Practice education
42
UofM IPE Curriculum Blueprint

• Guide and monitor implementation of IPE
• a balance of competencies are addressed through
  a students university education
• learning occurs along a continuum
• by graduation, learning around all competencies
  has been accomplished
• To ensure IPE
• strategic, transparent, uses common terminology
• explicitly states/addresses 1 learning
  objective
• is assessed (students) and evaluated (session)

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The University of Manitoba IPE Curriculum
Blueprint
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Understanding Roles and Responsibilities

• Exposure
• Knowledge
• Articulate your professional role in the care of
  individuals
• Articulate the roles and scopes of practice of
  other members of the IP team and identify areas
  of responsibility overlap
• Attitudes
• Reflect on personal values/beliefs regarding
  scopes of practice and role overlap

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Understanding Roles and Responsibilities

• Immersion
• Skills/Behaviours
• During an IP shared care planning session
  negotiate responsibilities/actions based on role
  constraints, overlap, and discipline-specific
  legal/ethical practice standards.

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Understanding Roles and Responsibilities

• Mastery
• Has sufficient confidence in and knowledge of
• ones own discipline to work effectively with
  others in order to optimize person centred care
• others professions to work effectively with
  others in order to optimize outcomes for
  individuals

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Curriculum Overload
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Guiding Principles

• We value interprofessional education (IPE) and
  foster its existence where and when two or more
  professions are involved.
• We value IPE that is integrated in University of
  Manitoba curricula and foster its development
  through
• We value IPE in which its uniqueness is a well
  understood identity within the university culture
  through
• We value a common understanding of IPE among all
  faculty, in which
• We value evaluation of and scholarship in UofM
  IPE Initiative in which

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Questions?
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