Interprofessional Education for Collaborative PatientCentred Practice: The Curricular Challenges to

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Interprofessional Education for Collaborative
Patient-Centred PracticeThe Curricular
Challenges to Making a Difference

• John H.V.Gilbert, Ph.D. Principal
• College of Health Disciplines
• University of British Columbia
• Canada
• inBC
• June Forum, 2006 Vancouver
• Transforming Healthcare Interprofessional
  Education Collaborative Patient-Centred
  Practice

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Health Care A collaboration, not a competition
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Building to Improve Health in Canada Some
Historic Landmarks

• Lalonde 1974 health more than health care, many
  determinants are in environment and behaviour
• WHO, Alma Ata 1978 international commitment to
  a population health model, reducing disparities
• Epp 1986 Achieving Health for All, a nod to
  Alma Ata and an extension of Lalonde
• CIAR 1990s Why Are Some People Healthy and
  Others Not (the population health paradigm
  explored)
• National Forum on Health 1997 applying
  population health to health policy
• Building on Values Nov. 2002 The Future of
  Health Care in Canada

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Rhetoric and Reality Challenges Within the
Health Care System

• Talk wellness model, health promotion
• Walk money flows to high tech and acute care
• Talk accountability and performance
• Walk unconditional funding, poor information
  systems, inadequate evaluation
• Talk integration, coordination, collaboration,
  teams
• Walk professional rivalries, lingering
  fragmentation, boundaries, political battles
  educational fiefdoms

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Vision Reality An Example

• Primary Health Care in Canada is negotiated, not
  mandated
• Vision Provinces attempt to create incentives to
  encourage move to new models
• Reality incentives for the status quo are often
  greater than incentives for change post
  secondary education largely ignored
• Result status quo remains lucrative and PHC
  viewed as a voluntary transition and post
  secondary education remains unchanged
• HOWEVER Many PHC projects have done good things
  but few are examples of a fully integrated PHC
  model, that includes post secondary education
• See Primary Health Care Transition Fund,
  Summary of Initiatives, Health Canada, 2005.

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Vision, rhetoric realityWhy Their Congruence
Matters

• Conventional approaches to health care and health
  care education fail many people with diverse and
  complex needs
• At-risk populations are especially vulnerable
• People with chronic diseases
• The frail elderly
• People with linked social, economic, and health
  problems
• The failure of prevention harms people and costs
  billions of dollars
• The goal to produce a healthy population is not
  achieved

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The Interprofessional Promise

• Greatest potential of IPE is to help reduce
  disparities
• More holistic and comprehensive care
• Superior management of complicated cases
• People with multi-dimensional needs
• Frail elderly
• People with chronic diseases
• People with mental health disorders
• Better use of professional skills

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The Problem Ahead

• Changing a college curriculum is like moving a
  graveyard - you never know how many friends the
  dead have until you try to move them.
• (Variously attributed to either Calvin Coolidge
  or Woodrow Wilson)

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Using the Wrong Word Four Descriptions of
Interdisciplinary Education

• Drawing on two or more disciplines in a single
  course or program.
• A course or instructional program involving
  concepts, knowledge, or faculty from several
  disciplines.
• Concerning the cooperation of several
  disciplines, e.g. physicists with medical
  practitioners and others.
• A group of professional specialists with
  expertise in different resources that collaborate
  to develop and evaluate management alternatives.

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Using the Right word The Definition of
Interprofessional Education

• Occasions when two or more professions learn
  with, from and about each other to improve
  collaboration and the quality of care.
• (Centre for the Advancement of Interprofessional
  Education, (UK) rev. 2002)

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Curricular Reform Getting the right words and
the words right
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The CLAIM for IPE

• When two or more professions learn with, from
  and about each other they significantly improve
  collaboration and the quality of care.

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The Skeptics view of IPE

• There is no difference in collaboration to
  improve quality of care provided by health
  human service professionals who are educated at
  the pre-licensure level to learn with, from and
  about each other, as compared with those
  professionals who are not so educated.

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Its All In The Words

• WITH, FROM, ABOUT
• Contact theory? (Allport, 1954)
• COLLABORATION
• Social Identity theory? (Tajfel, 1978, 1981)
• QUALITY OF CARE
• Donabedian? (1988)

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What do we mean by WITH, FROM, ABOUT?

• Take a health problem e.g. obesity and bring
  together students from six or seven health
  disciplines to engage in a unique learning
  dialogue.
• With Students learn with each other, about
  obesity, in a variety of paradigms, e.g.,
  problem and/or case based learning.
• From Students learn from each other, about the
  knowledge base and practices that each profession
  brings to the problem of obesity.
• About Students learn to integrate what they have
  learned about each others knowledge base and
  practices related to obesity, into a coordinated
  plan to improve quality of care of the obese
  person.
• Learning Outcome The interprofessional whole is
  greater than the sum of the disciplinary parts

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One Description of Collaborative Practice

• An interprofessional process for communication
  and decision making that enables the separate and
  shared knowledge and skills of care providers to
  synergistically influence the client/patient care
  provided.
• (Way, Jones Busing, 2000). Used in the
  definition guides, In-BC Evaluation Framework
  my italics)

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A Testable Definition for Collaboration?

• For Example - take. Members of a group/team of
  diverse professionals who are each educated and
  trained to assess different aspects of a health
  problem, e.g. obesity.
• Apply. A theory informed, model which allows the
  group/team
• to explore, analyze and summate each members
  different professional assessments which leads
  the group/team to
• a search for, and development of, a coordinated
  plan
• that goes significantly (plt .001?) beyond each
  members own professional aspect of what is
  possible in providing the best quality of care
  for the problem of obesity.

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Probing for Changes in Quality of Care

• Structure. Attributes of the settings in which
  care for obesity occurs, e.g.
• Facilities, equipment and money number and
  qualifications of personnel, and of
  organizational structure.
• Process. What is done in giving and receiving
  care for obesity, e.g.
• The patients activities in seeking care and
  carrying it out.
• The practitioners activity in making a diagnosis
  and recommending or implementing treatment,
  across the spectrum of health and human services
• Outcome. The effects of care on the health status
  of patients with obesity, e.g.
• Improvements in the patients knowledge.
• Significant changes in the patients behaviour.
• The degree of the patients satisfaction with
  care.
• After the work of Donabedian

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The Real Barriers to IP Practice?

• Inherent e.g.
• 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 e.g.
• models of practice e.g. medicine, nursing, social
  work
• management structures e.g. acute care, community
• management priorities e.g. money, space, people

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Thank you to my colleagues

• at UBC
• in InBC
• at Health Canada Nursing Directorate
• the Ministry of Health B.C
• the Ministry of Advanced Education, B.C
• around the world
• all of whom contributed to this presentation
• www.health-disciplines.ubc.ca
• john.gilbert_at_ubc.ca