Interprofessional Collaborative
Practice:
The whole is greater than
the sum of the parts
Prof Sarah Strasser
Associate Vice President
Academics & Interprofessional Practice
Health Science North
Academic Health Centre for NOSM
The Northern
Territory
• Vast
• Remote
• Sparsely populated
• Indigenous
• Chronic health issues
• Large disease burden
• Tropical - desert
Interprofessional collaborative
practice
Prof. Sarah Strasser
Northern Ontario
• Sioux Lookout
Southern Ontario
In, by and for Northern Ontario
27 – 30 October
27-30 October 2014
Uluru, Northern Territory, Australia
Latest Muster information is available at
www.flinders.edu.au/muster2014
muster2014@flinders.edu.au
Interprofessional Collaborative Practice:
The whole is greater than
the sum of the parts
“A partnership between a team of health professionals and a
client in a participatory, collaborative and coordinated approach
to shared decision-making around health issues”
(Orchard et al., 2005).
• There is a set of competencies that describe the desired collaborative
practitioner at a team level.
• The knowledge, skills, and attitudes that shape interprofessional
practice are reflected in the competency framework which can be
applied in different situations.
• There is a sub-set of competencies that strives to put the “I” back in
TEAM and challenges individuals to take responsibility for their
collaborative practice skills.
Thanks to Lesley Bainbridge for sharing
Interprofessional Collaboration (IPC)
A.
B.
C.
An interprofessional process of communication and decision making that enables the
separate and shared knowledge and skills of health care providers to synergistically influence
the patient care provided. (Way et al, 2000)
Occurs when multiple health care providers from different professional backgrounds provide
comprehensive services by working with patients, their families, carers and communities to
deliver the highest quality of care across settings. (WHO Framework for Action on IPE & CP,
2010)
A partnership between a team of health care providers and a client in a participatory,
collaborative and coordinated approach to shared decision making around health and social
issues. (CIHC Framework)
D.
Interprofessional collaboration is a process through which clients and providers
can examine different aspects of a problem and constructively explore their
differences, searching for solutions that go well beyond their own vision of what
is possible. (Gray, 1989)
E.
Interprofessional collaboration implies interdependence among clients and providers,
constructive handling of differences, joint ownership of decisions and collective
responsibility for outcomes. (Hartman et al, 1999)
Canadian Framework:






Patient/Client/Family/Community-Centered Care
Role Clarification
Interprofessional Communication
Team Functioning
Collaborative Leadership
IP Conflict Resolution
Competency Domains
An Example
• Domain: Interprofessional Conflict Resolution
• COMPETENCY STATEMENT: Learners/practitioners actively engages self &
others including the client/patient/family, in positively & constructively
addressing disagreements as they arise.
• DESCRIPTORS: To support interprofessional collaborative, team members
consistently address conflict in a constructive manner by:
–
–
–
–
–
–
Valuing the potential positive nature of conflict
Recognizing the potential for conflict to occur & taking constructive steps to address it
Knowing & understanding strategies to deal with conflict
Setting guidelines for addressing disagreements
Establishing a safe environment in which to express diverse opinions
Developing a level of consensus among those with differing views; allowing all
members to feel their viewpoints have been heard no matter what the outcome
Competency framework considerations
Background considerations:
– Quality improvement
– Simple through
complex
– Context of practice
Rather than focusing on
demonstrated behaviours
to determine competence,
the framework relies on
the ability to integrate
knowledge, skills, attitudes,
and values in arriving at
judgments.
Five characteristics
• complexity (the dynamic
organization of components);
• additive (application of
knowledge, skills, attitudes to
formulate judgments)
• integrated (diversity of
individual resources);
• developmental (over the
lifespan); and
• evolutionary (within a given
context; actualization creates
new understandings).
Examples of application of a
competency or other framework
•
•
•
•
•
Capacity building
Strategic planning
Educational planning and implementation
Team/Self assessment
Organizational changes
Capacity building & strategic planning
Mastery
Immersion
Exposure
Role Clarification
Complicated
Simple
NEW GRADUATE
Collaborative Leadership
Interprofessional
Collaboration
EARLY PRACTITIONER
Attitudinal Change
EXPERIENCED
PRACTIIONER
Complex
Education
Team / Self assessment
• I. Role Clarification
• Learners/practitioners understand their own role and the roles of
those in other professions, and use this knowledge appropriately to
establish and achieve patient/client/family and community goals.
• Describes own role and that of others
– Never
– Rarely
– Sometimes
– Almost Always
– Does Not Apply
One size does not fit all:
IP team needs to fit the purpose
Comprehensive patient centred care on a
consistent basis (same team):
Rural practice
Palliative Care
Cancer Care
Stroke Care
Care of the elderly – COACH Team
Care of the elderly: Coach team 48/5
48/5 for >65
•
•
•
•
•
Bowel & bladder Management
Cognitive functioning
Functional mobility
Medication management (+ pain)
Nutrition & hydration
“many things wrong, all at once”
Dr Janet McElhaney
Mastery
Immersion
Exposure
Role Clarification
Complicated
Simple
NEW GRADUATE
Collaborative Leadership
Interprofessional
Collaboration
EARLY PRACTITIONER
Attitudinal Change
Complex
EXPERIENCED
PRACTIIONER
Coach team
Intermittent IP team – pockets of
care/education & training
• Operating theatre
• Out patient clinics – based on a scenario:
pain, diabetes, bariatric surgery
• Technology enabled – Virtual ICU,
telehealth
• Simulation Lab
Virtual Intensive Care Unit
HSN Helicopter pad
Immersion
Exposure
Role Clarification
Complicated
Simple
NEW GRADUATE
Collaborative Leadership
Virtual ICU
Interprofessional
Collaboration
EARLY PRACTITIONER
Attitudinal Change
Mastery
EXPERIENCED
PRACTIIONER
Complex
HSN Simulation Lab:
Anaesthetic Boot Camp
Beyond clinical care
• Quality Improvement
• Patient safety
• Health Care Management (allocation of
resources) – quality based
funding/procedures (QBF/QBP)
Organizational Excellence training Quality
Improvement
OE
Collaborative Leadership
Exposure
Role Clarification
Complicated
Simple
NEW GRADUATE
Attitudinal Change
Immersion
EARLY PRACTITIONER
Interprofessional
Collaboration
EXPERIENCED
PRACTIIONER
Complex
Mastery
Quality Based Funding/Procedure
• Health Service Providers will be reimbursed for the types
and volumes of patients they treat, using rates based on
efficiency and best practices that are adjusted for each
procedure.
QBP Equation = Price X Volume
• Adjusted for:
– Patient complexity
– Quality of health care delivered
5
QBPs Addressed in the NE LHIN Clinical
Services Review
1. Medical
I.
II.
III.
CHF
COPD
Stroke
2. Surgical
I.
II.
III.
IV.
Cataracts
Total Joints Replacement ( Knee and Hip)
Hip Fractures (2014/15)
Vascular Surgery
3. Outpatient
I.
II.
Endoscopy
Chemotherapy
9
QBP – Hip Fractures
HUB Hospital (4)
Smaller Hospital (21)
For most part all hip fractures
will be done at HUB
(except Parry Sound as they
do total joints)
Transfer from the Emergency
to the Operating Room goal
is within 48 hours
After Acute Hospital stay for
fracture is complete, patient
will be transferred to home
hospitals for inpatient rehab.
If they do total joints, they
must do hip fractures!
Transfer from the Emergency
to the Operating Room goal is
within 48 hours
After Acute Hospital stay for
fracture is complete, patient
will be transferred to home
hospitals for inpatient rehab - with telemedicine support
from HUB rehab outreach.
18
Exposure
Collaborative Leadership
Immersion
Role Clarification
EARLY PRACTITIONER
Interprofessional
Collaboration
Complicated
Simple
NEW GRADUATE
Attitudinal Change
EXPERIENCED
PRACTIIONER
QBF
Mastery
Complex
Risk of team working - knotworking
Engestrom 1999
Organizational support:
access to resources (time & money),
senior management commitment
Improved quality of team work: teamwork:
• Organizational rewards for improvements in work
practices
• Encourage use of innovation & implementation of
change
• High support for team innovation
• Support to implement team changes
Xychris & Lowton 2008
No hard evidence of patient outcomes
(other than patient safety)
• Lack of consensus, focus & vision
• Lack of consistent funding & short funding
cycles
• Lack of leadership & succession planning
• Lack of incentives/ perverse funding/ ‘work
arounds’
• Not all positive outcomes
“If you don’t control the money you
don’t control anything”
•
•
•
•
•
•
•
•
•
•
IP Competencies/capabilities & supervision
IP communication & trust
Physician & patient engagement
Clinical Leadership & governance
Regulations & organizational support
Scaling up/ UHC/ transprofessional care
Health literacy
PCM & End of life care
Context, complexity & costs
Team changes, space and EMRs
Call to action
Health care in NZ in 2012
D. Gorman 2014
• Challenges:
– Focal deficiencies and
shortfalls;
– Falling productivity;
– Unsustainable reliance
on immigrant health
workers;
– Costs of health care
growing faster than
national wealth;
• Challenges:
– Ageing of the
community and growing
demand for health care;
and
– Ageing of the
community and
retirement of the ‘babyboomer’ generation of
health care providers.
Jaws of death NZ:
D. Gorman 2014
NZIER (2005)
NZ Population Projections by Age Cohort
(Assuming medium population growth)
D. Gorman 2014
400,000
2001
2011
2021
350,000
300,000
250,000
200,000
150,000
100,000
50,000
90+
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
0
Towards a sustainable and fit-for-purpose
NZ health system
D. Gorman 2014
• A shared care record.
• A new way of funding services and of rewarding
providers and consumers.
• A diversified and fit for purpose community based
health workforce that works as much as is possible at
the “top end of their licence.”
• Genuine patient-directed and centred care
– Advanced care planning
Rogue physicians
• Health is too diverse to have one person making
decisions any more, in fact negative when one is
left alone:
Canada, Globe & Mail 2014:
Reports solo physician renders vaccines ineffective
by mixing them, for over 20 years.
Putting the “I” back in team.
SOCIAL
CAPITAL
RELATION-
RHETORIC
SHIP
BUILDING
(FRAMING)
PATIENTCENTRED
COLLABORATIVE
PRACTICE
ADDRESSING
NEGOTIATING
PRIORITIES
CONFLICT
PERSPECTIVE
TAKING
The alternative lens
G. Regehr
Differing forms of
interprofessional work
networking
coordination
collaboration
teamwork
S. Reeves
Integration & interdependence
Thank You