Dr Alison Machin - October 2015
Email: alison.machin@northumbria.ac.uk
Twitter: @DrAlisonMachin
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To provide an overview of IPE at Northumbria
University
To present a research study undertaken to
explore students’ assessment content as
outcomes of their IPE experience
To present a second research study which
focused on facilitators of IPE and our identified
implications for developing and supporting them
To reflect on our key challenges in maintaining a
high quality student experience
To conclude with key opportunities for
maximising students’ IPE experience
16 year history of delivering IPE within
mainstream programmes
 Initial model was one module in each year
nursing (all fields), midwifery, physiotherapy,
occupational therapy, Operating Department
Practice and Social Work. Lots of lessons learned
including the need for clear leadership
 2003 Director of IPE appointed, full time,
Principal Lecturer
 1st key development in 2006 brought together
the suite of pre-registration health programmes
in a single curriculum framework
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Core philosophy: Recognising similarity, valuing
difference
A focus on Core, Common, Collaborative
competency development (Barr et al 2005)
Two cross programme modules in each year – some
programmes with 2 intakes, around 1200 students/
year
Learning and teaching strategy combined uniprofessional, multi-professional and
interprofessional approaches within the same
module.
This helped students to develop their own
professional identity whilst at the same time to
understand where professional skills sets are
common across professions and to learn how to work
together.
 Foundations
of Learning and Collaborative
Working
 Core skills for professional practice
 Developing
skills of collaborative working
 Development of core skills of professional
practice
 Core
skills for professional practice –
transition
 Collaborative Working for Service
Improvement
To provide a critical appraisal of:
 a) the rationale for inter-professional,
patient/ client/ service user focused health
and social care delivery.
 b) the underpinning evidence base for
providing an inter-professional service in a
specific practice area and/or patient/
client/ service user group in relation to
safety and service improvement.
 c) the factors influencing the ongoing
improvement and delivery of an interprofessional service in a specific practice
area and/or patient/ client/ service user
group.
“an incident or lived experience arising
during contact with health, social care
and education services which causes
distress or harm (physical, emotional,
psychological) to service users and their
families”.
(Machin and Jones 2014)
 undertake
a service improvement project
related to their practice experience
 present their project, in the form of an
electronic poster, to their IPL group,
academic marker, and service user and/or
practitioner, who gave formative feedback to
the students through Q&A/discussion
 submit an A4, hard copy of their poster with
a bullet point reflective annotation based on
feedback received during assessment and
their experience in the IPL service
improvement process
Warren (2007)
holistic model of
involvement
consultation
Information
S.U.
Weekly House Meetings
Participation
Achieve task
Information sharing and involvement
forum for service users and staff
Legislation and policy
GSCC Code of Conduct
Build team
Develop
individuals
empowerment
HOW
•Plsek (2000) Complex Adaptive
Systems
Wright et al (2006) whole systems
approach
•Capra (2002) Structures, Processes,
Patterns
• empowerment
• Kirby et al (2003) benefits
to S.U. And organisation
•The
Children
Now
Participation Charter (2006)
Results
•Regular meetings
•Service user involvement in
process development
•Minutes used to feed into staff
meetings
• consultation
act
study
• information
SERVICE USER
INVOLVEMENT
Overall
organisational
culture and
policies
plan
Evaluation
Honey and Mumford (2004)
prospective approach to learning
Leish (1997) action centred leadership
do
• participation
Service user
culture
Staff culture
Sphere of
professional
influence
Carmel Peters – Social Work Student
Midwifery project to raise awareness of the IP
team in a maternity department about the
maternity information in other languages freely
available on the web. Added to a local care-plan
checklist of things to consider in an initial
assessment
 Nursing student - Local implementation of national
guidance on timely dispensing of medication –
stickers on notes, information for patients, posters
etc all already available, but the local
implementation improved the service user
experience in that local setting
 Physiotherapy student’s implementation of a
“traffic light” system on white board by the
patient’s bedside indicating to the wider team the
patient’s mobility level
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 What
are the service user experiences that
trigger students' choice of service improvement
project;
 What were the project ideas students devised
to address identified areas for improvement in
their practice learning context;
 How do students' perceive their key learning
from the experience and its relevance for their
qualified practice?
 Interpretive
paradigm/ qualitative design
(Blaikie 2007)
 Content Analysis (Krippindorf 2004)
 Framework for analysis: Unit of
analysis/meaning unit/condensation/
abstraction analysis (Granneheim and
Lundman 2004)
 Descriptive Statistics
 150
students (total cohort = 420)
 Learning disability nursing (LDN) (n = 2)
 Midwifery (MW) (n = 12);
 Mental health nursing (MHN) (n = 9);
 Children's nursing (CN) (n = 12);
 Adult nursing (AN) (n = 50);
 Social work (SW) (n = 25);
 Physiotherapy (PT) (n = 20);
 Occupational therapy (OT) (n = 20).
Assessment posters and reflections were analysed
in relation to each of the research questions
 Once all service improvement triggers and ideas
were analysed by professional group they were
categorised by frequency of category recurrence
(with percentages) was collated within and across
the professionals groups. This facilitated some
cross group, cross theme analysis drawing on the
elements of qualitative comparative analysis
(Berg-Schlosser, 2009)
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 There
were no distinguishable differences
between professional groups reflected in
their learning experiences, possibly due
to the interprofessional small group
nature of the student shared learning
journey, therefore no attempt was made
to quantify the recurrence of key learning
points.
Service users disempowered by care environment
and/or routine
 Unmet need due to gap in service/resources
 Lack of information causing service user/carer
anxiety
 Poorly facilitated transition between
services/settings
 Poor/inconsistent interprofessional/interagency
communication resulting in misunderstanding
and anxiety
 Lack of understanding of professional roles
 Duplication of professional roles causing
confusion

Improve interprofessional communication and
teamwork
 Improvements in written information available
 Interprofessional education initiatives
 Adapting the therapeutic environment/routine to
improve outcomes
 Creating “products” to complement service provision
 Support groups & anxiety management initiatives
 Implementing existing care protocols
 Systems to improve access to services
 New quality monitoring/audit systems
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 Students'
service improvement IPL
can largely be divided into two
domains —
 knowledge development and
personal and professional
development in relation to:
 themselves
(intrapersonal learning)
 their relationships with others
(interprofessional learning).
 Intrapersonal
knowledge gained clearly
reflected the taught component of the module:
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“Neglect of a simple task can have a wide negative
impact on patients‘ and relatives' psychological safety”.
[AN21]
 Interprofessional
knowledge gained included
better role awareness:
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“I feel I learned a lot from my buddy group … about
different professional roles in the health service, the
work they're responsible for, difficulties they face,
policy drivers and systems they work in, research used
and tools they use for assessment, planning and storage
of data” [SW 20]
 It
was clear that the experience had influenced
students' personal growth and professional
development:
 “Service
improvement involving
interprofessional groups and clients is a
complex and crucial subject that I will
continue to study and implement throughout
my career” [CN9]
 This
included a perceived increase in their selfconfidence as change agents in an
interprofessional context:
 “I
feel better equipped to go into practice
and challenge the poor practice of other
professionals” [CN7]
 Some
students suggested they had developed
an ability to give and receive
interprofessional feedback, acknowledging
the importance of mutual trust:
 “Working
with my interprofessional buddy
group enabled me to evaluate my own
opinions and nursing practice by receiving
constructive feedback to learn from
positive and negative experiences” [AN41]
 Engaging
positively in interprofessional
service improvement learning as a student is
an important rehearsal for life as a qualified
practitioner.
 It can help students to develop an ability to
challenge unsafe practice elegantly, thereby
acting as advocates for the people in their
care.
 Universities can play a key support role by
working collaboratively with service
organisations; role modelling effective
interprofessional working;
 Evaluation
of the module showed 97% of 227
respondents would recommend IP service
improvement learning
 The research, our experiences and other
student evaluations have helped us to
continuously improve the IPL experiences
within the curriculum, making more use of
authentic, practice focused, student led small
group IPL
 One key challenge that continued to be
identified through student module evaluations
and NSS qualitative feedback was that the
facilitator had a key influence on the student
experience
 We wanted to explore this in more depth as the
issue persisted despite us running staff
development sessions
 Research
question: How do university
educators in an IPL delivery team
perceive the knowledge and skills needed
for their role adequacy as IPL facilitators?
Research Process
RESEARCH METHODOLOGY/DESIGN
•IPL facilitation is an interactive
process in which learning takes
places for all involved
•This fits with symbolic
interactionist theory (Mead 1934).
•Grounded theory methodology
(Glaser and Strauss 1967)
•Constant comparative analysis
used (sampling, data collection and
data analysis occur concurrently
until data saturation is reached).
•Ethical approval granted
•Informed by researchers’
theoretical sensitivity (Glaser
1978)
SAMPLING
•An email questionaire was sent
to all IPL educators involved in
the modules (n=30) and
included questions such as
experience as an educator,
professional background,
involvement in IPL modules.
•25 responses to questionnaire
received and answers were
transposed onto a sampling
matrix.
•9 participants were selected
based on the matrix , enabling
theoretical sampling
DATA ANALYSIS
•Interviews were
transcribed verbatim,
•Line by line open coding
was used becoming
increasingly axial and
theoretical as the study
progressed (Strauss and
Corbin 1990)
•Data Categories were
generated by grouping
emerging themes and a
core linking category
identified.
DATA COLLECTION
•Digitally recorded,
individual, Semistructured interviews
•Broad interview guide
used which evolved over
time to allow for follow
up of emerging
categories and
theoretical propositions
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“It is important that you go into the session with a
positive perspective.. I often use a light hearted
approach pick up the vibe from the students, (p 6).
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“Facilitator needs to be aware of what is going on in the
classroom, they need to be inclusive and involve
everyone so no one sits on the side line..." (p 3).
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"I think leadership style is important, you change your
style depending on the situation, it is linked to
emotional intelligence and being aware of self.." (p5).
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"You do need extra knowledge about how groups work to
be able to get them going in class for the benefit of all
students... it's like a social event.. it's about social skills
development" (p 8)
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"I check the register before the session... I make sure I
have examples from each group to include them in
discussions.. if you not aware of this it can make them
feel isolated and you les credible.." (p1)
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“I think it is important to know the group you are going
into, acknowledge which professionals will be in the
session so that you develop a good rapport with the
students from the outset..” (p 4)
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"If you get a group that underperforms it is often due to
a lack of team work, leadership and communication [by
the facilitator]... not about the (professional)
knowledge they have…" (p 5).
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“Most of my experience of IPL has been in the clinical
environment where I facilitated education and training
with mixed professional groups.. so I am able to use
examples .. the idea of facilitating IPL does not phase me”
(p2).
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“Sometimes I use personal examples of my own from my 20
years in health care to try to incorporate different
perspectives…” (p1).
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“It’s good to bring in personal experiences when you have
not got the professional background but I have is a lot of
experience in teaching methods and facilitation of groups…
I did feel out of my depth at the start but feel much more
comfortable with IPL now” (p3).
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“ it’s about openness, honesty and being prepared
to listen, valuing everyone and acknowledging
them as individuals…” (p1).
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"It’s about appreciating people as individuals rather
than just their profession.." (p5).
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"there is often a heavier contingent towards one
group so you need to be mindful of including
everyone in the discussion...it is so important that
students leave the room with the right idea and not
embed negative stereotypes...." (p6).
Many of the skills identified were in keeping with the
IPL literature and in our workshops however emphasis
on their importance differed between participants
 Data showed that participants’ experience as an
educator and/or a professional did not necessarily
equate to confidence and skills in an IPL context.
However this perception varied amongst individual
participants
 Of significance in our analysis was the strength of
comparability of participants’ perceptions of the skills
needed for IPL facilitation and the skills widely
acknowledged as needed for effective transformational
leadership.
 The grounded theory generated, although propositional,
suggests that the social process underpinning IPL
facilitation in the setting studied “Transformational
Interprofessional Learning Leadership”.
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“Individualized Consideration – the
degree to which the leader attends to each
follower's needs, empathises, supports,
encourages, values
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Creating and Sustaining
Group Culture through
Transformational IPL
Leadership
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Readiness for IPL
facilitation
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Drawing on past
IPL/IPW experiences
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Role modelling an
interprofessional
approach
Intellectual Stimulation
– the degree to
which the leader challenges assumptions, takes
risks and solicits followers' ideas. For such a
leader, learning is a value and unexpected
situations are seen as opportunities to learn.
Inspirational Motivation
– the degree to
which the leader articulates a vision that is
appealing and inspiring to followers.
Communication skills that make the vision
understandable, precise, powerful and
engaging.
Idealized Influence
– Provides a role
model for high ethical behaviour, instils pride,
gains respect and trust”.
 To
account for variation in perception we
are planning an individualised staff
development approach using for example:
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 We
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IPL leadership coaching
Peer shadowing to facilitate IPL role modelling
IPL focused action learning style opportunities for
reflective learning (individual & team)
are planning further research:
To test our propositional grounded theory which links
IPL skills to leadership skills, in a wider range of
settings and with different professional groups
To study the impact of staff development activities on
individuals’ IPL practice and the quality of the student
IPL experience.
Complexities
of systems to
support L&T in university and in
practice learning settings
Constantly changing staff base
Managing student expectations
Convincing others of its value
Sustaining developments and
enthusiasm
Increasingly
integrated health and
social care systems across the UK
Increasingly robust international
research evidence base for the
efficacy of IPL
 Widespread international
community of IPL practice
Thank you for listening!
Any Questions?
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DOI: 10.1016/j.nedt.2014.05.001
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