Interprofessional Collaborative Practice: The whole is greater than the sum of the parts Prof Sarah...
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Interprofessional Collaborative Practice: The whole is greater than the sum of the parts Prof Sarah Strasser Associate Vice President Academics & Interprofessional
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
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Vast Remote Sparsely populated Indigenous Chronic health issues
Large disease burden Tropical - desert The Northern Territory
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Interprofessional collaborative practice Prof. Sarah
Strasser
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In, by and for Northern Ontario Northern Ontario Southern
Ontario Sioux Lookout
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27-30 October 2014 Uluru, Northern Territory, Australia Latest
Muster information is available at www.flinders.edu.au/muster2014
[email protected] 27 30 October
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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
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Interprofessional Collaboration (IPC) A.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) B.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) C.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)
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Competency Domains Canadian Framework:
Patient/Client/Family/Community-Centered Care Role Clarification
Interprofessional Communication Team Functioning Collaborative
Leadership IP Conflict Resolution
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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
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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).
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Examples of application of a competency or other framework
Capacity building Strategic planning Educational planning and
implementation Team/Self assessment Organizational changes
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Interprofessional Communication Patient & Family Focused
Care Team Function Collaborative Leadership Conflict Resolution
Role Clarification Interprofessional Collaboration NEW GRADUATE
EARLY PRACTITIONER EXPERIENCED PRACTIIONER Simple Complicated
Complex Immersion Exposure Mastery Attitudinal Change Capacity
building & strategic planning
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Education
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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
Team / Self assessment
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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
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Care of the elderly: Coach team 48/5
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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
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Interprofessional Communication Patient & Family Focused
Care Team Function Collaborative Leadership Conflict Resolution
Role Clarification Interprofessional Collaboration NEW GRADUATE
EARLY PRACTITIONER EXPERIENCED PRACTIIONER Simple Complicated
Complex Immersion Exposure Mastery Attitudinal Change Coach
team
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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
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Virtual Intensive Care Unit
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HSN Helicopter pad
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Interprofessional Communication Patient & Family Focused
Care Team Function Collaborative Leadership Conflict Resolution
Role Clarification Interprofessional Collaboration NEW GRADUATE
EARLY PRACTITIONER EXPERIENCED PRACTIIONER Simple Complicated
Complex Immersion Exposure Mastery Attitudinal Change Virtual
ICU
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HSN Simulation Lab: Anaesthetic Boot Camp
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Beyond clinical care Quality Improvement Patient safety Health
Care Management (allocation of resources) quality based
funding/procedures (QBF/QBP)
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Organizational Excellence training Quality Improvement
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Interprofessional Communication Patient & Family Focused
Care Team Function Collaborative Leadership Conflict Resolution
Role Clarification Interprofessional Collaboration NEW GRADUATE
EARLY PRACTITIONER EXPERIENCED PRACTIIONER Simple Complicated
Complex Immersion Exposure Mastery Attitudinal Change OE
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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. Adjusted for: Patient complexity
Quality of health care delivered QBP Equation = Price X Volume
5
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QBPs Addressed in the NE LHIN Clinical Services Review
1.Medical I.CHF II.COPD III.Stroke 2.Surgical I.Cataracts II.Total
Joints Replacement ( Knee and Hip) III.Hip Fractures (2014/15)
IV.Vascular Surgery 3.Outpatient I.Endoscopy II.Chemotherapy 9
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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
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Interprofessional Communication Patient & Family Focused
Care Team Function Collaborative Leadership Conflict Resolution
Role Clarification Interprofessional Collaboration NEW GRADUATE
EARLY PRACTITIONER EXPERIENCED PRACTIIONER Simple Complicated
Complex Immersion Exposure Mastery Attitudinal Change QBF
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Risk of team working - knotworking Engestrom 1999
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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
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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
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If you dont control the money you dont 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
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Call to action
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Health care in NZ in 2012 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 baby- boomer generation of health care providers. D. Gorman
2014
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Jaws of death NZ: D. Gorman 2014
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NZIER (2005) NZ Population Projections by Age Cohort (Assuming
medium population growth) 0 50,000 100,000 150,000 200,000 250,000
300,000 350,000 400,000 0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89
90+ 200120112021 D. Gorman 2014
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Towards a sustainable and fit-for-purpose NZ health system 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 D. Gorman 2014
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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.
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Putting the I back in team.
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The alternative lens PATIENT- CENTRED COLLABORATIVE PRACTICE
SOCIAL CAPITAL RHETORIC (FRAMING) NEGOTIATING PRIORITIES
PERSPECTIVE TAKING ADDRESSING CONFLICT RELATION- SHIP BUILDING G.
Regehr
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Differing forms of interprofessional work networking
coordination collaboration teamwork Integration &
interdependence S. Reeves