Interprofessional Care: Building on Collaborative Teams

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Interprofessional CareBuilding on Collaborative
Teams

• Mandy Lowe
• Faculty Lead, IPE Preceptorship Facilitation
• Office of Interprofessional Education
• University of Toronto
• Interprofessional Education Leader
• Toronto Rehabilitation Institute
• Lowe.mandy_at_torontorehab.on.ca

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Objectives

• Define teams and collaboration
• Recognize the importance of team collaboration
• Consider individual and team-based strategies to
  enhance collaboration

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What is team?

• A collection of individuals who
• are interdependent in their tasks
• share responsibilities for outcomes
• are seen by others as an intact social entity
  embedded in one or more larger social system
• manage their relationships across organizational
  borders
• Oandasan et al. (2006)

Ehpic course, June 2009
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What is interprofessional collaboration (IPC)?

• an interprofessional process of communication
  and decision-making that enables the separate and
  shared knowledge and skills to synergistically
  influence the care provided
• Way , Jones Busing (2000)

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What does Interprofessional Education (IPE) Mean?

• Members (or students) of two or more professions
  associated with health or social care, engaged in
  learning with, from and about each other
• (Geissler, 2002)

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Capacity to Collaborate

It is believed by many that if we train
competent collaborative practitioners, more
collaborative practice settings will be
developed over time Hence practice is linked
with education. p. 12, DAmour Oandasan
(2005)
Ehpic course, June 2009
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Drivers for IPE and IPC

• International
• Research and programs e.g. UK, USA
• National
• Health Canada Romanow, 2002
• Provincial/Local
• Health Force Ontarios Interprofessional Health
  Education Innovation Funds 2007 and 2008
• Regulation of Health Professions in Ontario New
  Directions (HPRAC, 2006 and 2008)
• U of T Office of IPE - research, practice,
  curricula
• Enhance care
• Collaborative Practice improves outcomes in
  specific populations

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Teamwork Positively Impacts Outcomes

• Improved Outcomes in specific populations
• Neonatal ICU, STD screening, geriatrics,
  fractured hips (Zwarenstein et al., 2005)
• Stroke Functional Outcome (Strasser et al., 2008)
• Improved Patient Safety
• SBAR Communication Tool (Velji et al., 2008)
• Fewer deaths when in true team (West, 2006)

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Teamwork Positively Impacts Outcomes

• Improved Cost Efficiency (DAmour, 2005)
• Improved Health Professional Satisfaction (Cohen
  Bailey, 1997)
• Leads to a Healthy Workplace(Shamian
  El-Jaradali, 2007)
• www.cihc.ca
• www.chsrf.ca Promoting effective teamwork
  in healthcare in Canada

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Discussion

• Think about a time when you were part of or
  observed a highly collaborative team.
• What do you think made such successful
  collaboration possible?

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7 Essential Elements for Collaboration Way ,
Jones Busing (2000)
Power Hierarchy
Conflict Resolution
Ehpic course, June 2009
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What elements define team collaboration in
pediatric rehabilitation?

• Communication open, clear, regular, jargon free
  
• Decision making shared, effective problem
  solving strategies
• Goal setting shared, clear, prioritized,
  regularly evaluated
• Organization coordination of planning (e.g.
  single plan of care), structure, resources
• Team process evaluation, mutual respect and
  role understanding
• Parent involvement critical team members
• Nijhuis et al, 2007

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How can team collaboration be fostered?
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Three Key Questions for Collaborative Teams

• What is the goal of our team?
• How will our team communicate? How will our
  teamwork be coordinated?
• How will our team repeatedly review what we are
  trying to achieve and how effective we are?
• Balance of task/content (the what) and process
  (the how)
• Adapted from Aston West OD
• Schmidt, 2006

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1. What is the goal of our team?

• Shared goal and vision
• All team members are clear about roles
• Roles reviewed regularly to ensure satisfaction
  and optimal use
• Opportunities for team members to get to know
  each other to find out what contributions team
  members can make
• Government of Ontario, Family Health Team Guide
  to Collaborative Team Practice (2005)

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2. How will our team communicate and coordinate?

• Strategies may include
• Team members meet regularly
• Members involved in planning for activities in
  which they will be involved
• There is an effective decision-making method
• Issues are confronted and problems resolved as
  they arise
• There is a process for identifying/clarifying
  role overlap
• Role of leader is understood by team members
• Leader encourages active participation of all
  team members
• Government of Ontario, Family Health Team Guide
  to Collaborative Team Practice (2005)

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3. How will our team repeatedly review what we
are trying to achieve and how effective we are?

• Accomplishments and achievements are celebrated
• There is an evaluation process for follow-up, to
  ensure goals are being met
• Team process is reviewed
• Government of Ontario, Family Health Team Guide
  to Collaborative Team Practice (2005)

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Team Function

• High performance requires BALANCE

PROCESS
TASK
Process- How the team functions how the task is
accomplished, what happens between the members,
the way decisions are made
Task what is done and the problems associated
with completion
PROCESS affects OUTCOME
Ehpic course, June 2009
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Health Professional Collaborator Competencies

• KNOWLEDGE
• roles of other health professionals
• SKILLS
• communicating with others
• reflecting upon my role and others
• ATTITUDES
• mutual respect
• willingness to collaborate
• openness to trust

Oandasan Reeves (2005)
Ehpic course, June 2009
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Collaboration What can you do?

• Knowledge of Roles
• Provide opportunities for clarifying your role
  (e.g. interview, education, shadow opportunities)
• Request opportunities to clarify team members
  roles
• Orientation for new team members? Or changes in
  roles over time?

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Collaboration What can you do?

• Communicate and reflect
• Enhance your own collaborative communication e.g.
  giving and receiving feedback, conflict
  resolution, monitor for jargon, etc.
• Invite feedback re specific collaborative
  competencies

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Collaboration What can you do?

• We may look in the same direction, even at the
  same lines, and not see what our colleague
  sees.
• McKee (2003)
• Reflect on your own ways of knowing, e.g.
• What assumptions am I making?
• Where did I learn these values?
• What values orient me?
• How might someone whose role is different than
  mine look at this?
• McKee (2003)

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Collaborative Attitudes An IDEA

• Interact with others whose role differs from my
  own
• Collect Data about others roles
• e.g. how others are educated competencies others
  possess the many settings in which they may work
• Expertise - open to the views and approaches
  of their colleagues (and) altering perceptions
  via the discussion when appropriate
• Attention to ones own professional and personal
  background, biases, stereotypes and assumptions -
  including skills in exploring and appreciating
  others approaches
• Pecukonis (2008)

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Objectives

• Define teams and collaboration
• Recognize the importance of team collaboration
• Consider individual and team-based strategies to
  enhance collaboration

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Learning from Teams Displays

• What has enabled your team to collaborate so
  effectively?
• How did your team successfully address challenges
  to collaboration?
• What was your shared goal as a team? How did you
  arrive at this goal?
• What approaches/strategies did you find most
  successful for coordinating and communicating as
  a team?
• How did you learn and benefit from your
  collective experience? How did you repeatedly
  review your work and experiences?

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To talk well and eloquently is a very great art,
but that an equally great one is to know the
right moment to stop.
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Thank you!
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References

• Aston West, OD. The Aston team performance
  toolkit (2007). In Jelphs, K Dickinson, H
  (2008) Better Partnership Working Working in
  Teams. The Policy Press UK.
• Cohen, SG Bailey, DE (1997). What makes teams
  work Group effectiveness research from the shop
  floor to the executive suite. Journal of
  Management, 23(3)239-290.
• DAmour, D Oandasan, I (2005).
  Interprofessionality as the field of
  interprofessional practice and interprofessional
  education An emerging concept. Journal of
  Interprofessinal C are, 19(Suppl 1)8-20.
• Government of Ontario (2005). Family Health Teams
  - Advancing Primary Health Care Guide to
  Collaborative Team Practice. Available at
  http//www.health.gov.on.ca/transformation/fht/gui
  des/fht_collab_team.pdf

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References

• Lemieux-Charles, L., McGuire, W. L. (2006).
  What do we know about health care team
  effectiveness? A review of the literature.
  Medical Care Research and Review, 63(3), 263-300.
  
• McKee, M. (2003). Excavating our frames of mind
  The key to dialogue and collaboration. Social
  Work, 48(3)401-8.
• Nijhuis, BJG et al. (2007). A review of salient
  elements defining team collaboration in
  paediatric rehabilitation. Clinical
  Rehabilitation, 21195-211.
• Oandasan et al. (2006) Teamwork in Healthcare
  Promoting Effective Teamwork in Healthcare in
  Canada Policy Synthesis and Recommendations,
  CHSRF. Available from www.chsrf.ca
• Oandasan, I Reeves, S (2005). Key elements for
  interprofessional education. Part 1 The learner,
  the educator and the learning context. Journal of
  Interprofessional Education, 19(Suppl 1)21-38.

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References

• Pecukonis E Doyle O, Bliss, D.L. (2008).
  Reducing barriers to interprofessional training
  Promoting interprofessional cultural competence.
  Journal of Interprofessional Care, 22(4)
  417428.
• Pew-Fetzer Task Force on Advancing Psychosocial
  Health Education (2000). Health professions
  education and relationship-centred care. San
  Francisco, USA Pew Health Professions Commission
  and the Fetzer Institute.
• Schmidt, M et al (2006). Outcomes study of a
  customer relations educational program in
  dialysis practice. Advances in Chronic Kidney
  Disease, 13(1)86-92.
• Shamian, J., El-Jardali, F. (2007). Healthy
  workplaces for health workers in Canada
  knowledge transfer and uptake in policy and
  practice. Healthcare Papers, 7, 625.
• Strasser et al. (2008). Team training and stroke
  rehabilitation outcomes A cluster randomized
  trial. Archives of Physical Medicine in
  Rehabilitation, 89.

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References

• Velji, K et al. (2008). Effectiveness of an
  adapted SBAR communication tool for a
  rehabilitation setting. Health Care Quarterly,
  1172-9.
• Way, D., Jones, L., and Busing N. Implementation
  strategies "Collaboration in primary care
  -family doctors nurse practitioners delivering
  shared care" Discussion paper for the Ontario
  College of Family Physicians. 1-10. 2000
• West, MA et al. (2006). Reducing patient
  mortality in hospitals The role of human
  resources management. Journal of Organizational
  Behavior, 27983-100.
• Zwarenstein M.  Reeves S.  Perrier L.  (2005).
  Effectiveness of pre-licensure interprofessonal
  education and post-licensure collaborative
  interventions Journal of Interprofessional Care.
  19 Supl 1148-65

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Websites

• www.cihc.ca Canadian Interprofessional Health
  Collaborative
• www.ipe.utoronto.ca Office of IPE, University
  of Toronto
• www.chsrf.ca Canadian Health Services Research
  Foundation