WHO_HRH_HPN_10.3_eng

8/13/2019 WHO_HRH_HPN_10.3_eng

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Framework for Action on Interprofessional Education & Collaborative Practice (WHO/HRH/HPN/10.3)

This pub lication is produced by the Health Professions Network Nursing and Midwifery Ofce w ithin the Department of Human

Resources for Health.

This publication is available on the Internet at: http://www.who.int/hrh/nursing_midwifer y/en/

Copies may be requested from:

World Health Organization, Department of Human Resources for Health, CH-1211 Geneva 27, Switzerland

World Health Organization 2010

All rights reserved. Publications of the Wor ld Health Organization can be obta ined from WHO Press, Wor ld Health Organization,

20 Avenue Appia, 1211 Geneva 27, Switzerland (tel : +41 22 791 3264; fax : +41 22 791 4857; E-mail : [email protected]). Requests

for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be

addressed to WHO Press, at the above address (fax : +41 22 791 4806; E-mail : [email protected]).

The designations employed and the presentation of the mater ial in this publication do not imply the expression of any opinion

whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its

authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines

for which there may not yet be full agreement.

The mention of specic companies or of certain manufacturers products does not imply that they are endorsed or recommended

by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted,

the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication.

However, the published materia l is being distributed without warrant y of any kind, either expressed or implied. The responsibil ity for

the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages

arising from its use.

Edited by : Diana Hopkins, Freelance Editor, Geneva Switzerland

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Cover design: S&B Graphic Design, Switzerland, www.sbgraphic.ch (illustration Eric Scheurer)


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Contents

Acknowledgements ........................................................................................................................ 6

Key messages ..................................................................................................................................7

Executive summary ......................................................................................................................... 9

The case for interprofessional education and

collaborative practice for global health .....................................................................................10

Moving forward with integrated health and education policies ......................................10

A call to action .....................................................................................................................................11

Learning together to work together for better health................................................................... 12

The need for interprofessional collaboration ..........................................................................14

Interprofessional education and collaborative practice

for improved health outcomes .....................................................................................................18

The role of health and education systems ................................................................................20

A culture shift in health-care delivery ........................................................................................22

Moving forward ............................................................................................................................ 23

Interprofessional education: achieving a collaborative

practice-ready health workforce .................................................................................................24

Collaborative practice: achieving optimal health-services ................................................28

Health and education systems: achieving improved health outcomes ........................31

Conclusion ..................................................................................................................................... 36

Contextualize .......................................................................................................................................38

Commit ...................................................................................................................................................39

Champion ............................................................................................................................................. 40

References..................................................................................................................................... 42


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Annexes ........................................................................................................................................ 46

ANNEX1 Membership of the WHO Study Group on

Interprofessional Education and Collaborative Practice ......................................................47

ANNEX2 Partnering organizations ............................................................................................ 48

ANNEX3 Methodology ...................................................................................................................53

ANNEX 4 Public announcement on the creation of the WHO Study Group

on Interprofessional Education and Collaborative Practice ................................................56

ANNEX 5 Key recommendations from the 1988 WHO Study Group

on Multiprofessional Education for Health Personnel technical report .........................58

ANNEX6 Summary chart of research evidence from systematic reviews

on Interprofessional Education (IPE) .......................................................................................... 60

ANNEX7 Summary chart of research evidence from select systematic

reviews related to collaborative practice ...................................................................................61

ANNEX8 Summary chart of select international collaborative

practice case studies .........................................................................................................................62

Tables

Table 1. Actions to advance interprofessional education

for improved health outcomes ......................................................................................................27

Table 2. Actions to advance collaborative practice

for improved health outcomes ......................................................................................................30

Table 3. Actions to support interprofessional education

and collaborative practice at the system-level ........................................................................35

Table 4. Summary of identified mechanisms that shape

interprofessional education and collaborative practice ......................................................38

Figures

Figure 1. Health and education systems ..................................................................................9

Figure 2. Interprofessional education .....................................................................................12

Figure 3. Collaborative practice .................................................................................................12

Figure 4. Types of learners who received interprofessional

education at the respondents insitutions ................................................................................16

Figure 5. Providers of staff training on interprofessional education............................17

Figure 6. Health and education systems ................................................................................18

Figure 7. Examples of mechanisms that shape interprofessional

education at the practice level ......................................................................................................23Figure 8. Examples of mechanisms that shape collaboration

at the practice level ..........................................................................................................................29

Figure 9. Examples of influences that affect interprofessional

education and collaborative practice at the system level ...................................................32

Figure 10. Implementation of integrated health workforce strategies .......................39


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TeFramework or Action on Interproessional Education and Collaborative Practiceis he

produc o he WHO Sudy Group on Inerproessional Educaion and Collaboraive

Pracice (see Annex 1 or a complee lis o members). Te Framework was prepared

under he leadership o John HV Gilber and Jean Yan, wih suppor rom a secrearia

led by Seven J Hoffman.

Preparaion o background papers and projec repors was led by: Marilyn Hammick

(lead auhor, Glossary and IPE Working Group epor), Seven J Hoffman (co-auhor,

IPE Inernaional Scan), Lesley Hughes (co-auhor, IPE Saff Developmen Paper),Debra Humphris (lead auhor, SLSS Working Group epor), Sharon Mickan (co-

auhor, CP Case Sudies), Monica Moran (co-auhor, IPE Learning Oucomes Paper),

Louise Nasmih (lead auhor, CP Working Group epor and CP Case Sudies), Sylvia

odger (lead auhor, IPE Inernaional Scan), Madeline Schmit (co-auhor, IPE Saff

Developmen Paper) and Jill Tislehwaie (co-auhor, IPE Learning Oucomes Paper).

Significan conribuions were also made

by Peer Baker, Hugh Barr, David Dickson,

Wendy Horne, Yuichi Ishikawa, Susanne

Lindqvis, Eser Mogensen, aie Mpou, Bev

Ann Murray and Joleen irendi. Considerablesuppor was provided by he Canadian

Inerproessional Healh Collaboraive.

Adminisraive and echnical suppor

was provided by Virgie Largado-Ferri and

Alexandra Harris. Layou and graphics were

designed by Susanna Gilber.

Te main wriers were Andrea Buron,

Marilyn Hammick and Seven J Hoffman.

Acknowledgements

I

nterprofessional

education... is an

opportunity to not

only change the way that

we think about educating

future health workers, but

is an opportunity to step

back and reconsider the

traditional means of health-

care delivery. I think that

what were talking about

is not just a change ineducational practices, but

a change in the culture of

medicine and health-care.

Student Leader


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Te World Healh Organizaion*(WHO) and is parners recognize

inerproessional collaboraion

in educaion and pracice as an

innovaive sraegy ha will play

an imporan role in miigaing he

global healh workorce crisis.

Inerproessional educaion occurs*

when sudens rom wo or more

proessions learn abou, rom and

wih each oher o enable effecivecollaboraion and improve healh

oucomes.

Inerproessional educaion is*

a necessary sep in preparing a

collaboraive pracice-ready

healh workorce ha is beter

prepared o respond o local healh

needs.

A collaboraive pracice-ready*

healh worker is someone whohas learned how o work in an

inerproessional eam and is

compeen o do so.

Collaboraive pracice happens*

when muliple healh workers rom

differen proessional backgrounds

work ogeher wih paiens,

amilies, carers and communiies o

deliver he highes qualiy o care.

I allows healh workers o engageany individual whose skills can help

achieve local healh goals.

Afer almos 50 years o enquiry,*

he World Healh Organizaion and

is parners acknowledge ha here

is sufficien evidence o indicae

ha effecive inerproessional

educaion enables effecive

collaboraive pracice.

Collaboraive pracice srenghens*healh sysems and improves healh

oucomes.

Inegraed healh and educaion*policies can promoe effecive

inerproessional educaion and


A range o mechanisms shape*

effecive inerproessional

educaion and collaboraive

pracice. Tese include:

supporive managemen pracices-

ideniy ing and supporing-

championshe resolve o change he culure-

and atiudes o healh workers

a wil lingness o updae, renew and-

revise exising curricula

appropriae legislaion-

ha eliminaes barriers o

collaboraive pracice

Mechanisms ha shape*


collaboraive pracice are no hesame in all healh sysems. Healh

policy-makers should uilize

he mechanisms ha are mos

applicable and appropriae o heir

own local or regional conex.

Healh leaders who choose*

o conexualize, commi and

champion inerproessional


pracice posiion heir healhsysem o aciliae achievemen

o he healh-relaed Millennium

Developmen Goals (MDGs).

Te* Framework or Action on

Interproessional Education and

Collaborative Practice provides

policy-makers wih ideas on how

o implemen inerproessional


pracice wihin heir currenconex.

Key messages


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Executive

summary

Improved

healthoutcomes

Health & education systems

Local context

Present &future

health

workforce

Optimal

health

services

Collaborative

practiceCollaborative

practice-ready

Interprofessional

education

Localhealthneeds

Strengthened

health system

Fragmented

health system

health

workforce

A a ime when he world is acing a

shorage o healh workers, policy-

makers are looking or innovaive

sraegies ha can help hem develop

policy and programmes o bolser heglobal healh workorce. Te Framework

or Action on Interproessional Education

and Collaborative Practice highlighs

he curren saus o inerproessional

collaboraion around he world, idenifies

he mechanisms ha shape successul

collaboraive eamwork and oulines a

series o acion iems ha policy-makers

can apply wihin heir local healh sysem

(Figure 1). Te goal o he Framework is

o provide sraegies and ideas ha willhelp healh policy-makers implemen he

elemens o inerproessional educaion

and collaboraive pracice ha wi ll be

mos beneficial in heir own jurisdicion.

9

Figure 1. Health and education systems


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The case for interprofessional

education and collaborative

practice for global health

Te Framework or Action onInterproessional Education and

Collaborative Practicerecognizes ha

many healh sysems hroughou he

world are ragmened and sruggling o

manage unme healh needs. Presen

and uure healh workorce are asked

wih providing healh-serv ices in he

ace o increasingly complex healh

issues. Evidence shows ha as hese

healh workers move hrough hesysem, opporuniies or hem o gain

inerproessional experience help hem

learn he skills needed o become par o

he collaboraive pracice-ready healh

workorce.

A collaboraive pracice-ready

workorce is a specific way o describing

healh workers who have received

effecive raining in inerproessional

educaion. Inerproessional educaionoccurs when sudens

rom wo or more

proessions learn

abou, rom and

wih each oher

o enable effecive

collaboraion and

improve healh

oucomes. Once

sudens undersandhow o work

inerproessionally,

hey are ready o

ener he workplace

as a member o

he collaboraive

pracice eam.

Tis is a key

sep in moving healh sysems rom

ragmenaion o a posiion o srengh.

Inerproessional healh-care eams

undersand how o opimize he ski lls o

heir members, share case managemen

and provide beter healh-serviceso paiens and he communiy. Te

resuling srenghened healh sysem

leads o improved healh oucomes.

Moving forward with

integrated health and

education policies

Te healh and educaion sysems muswork ogeher o coordinae healh

workorce sraegies. I healh workorce

planning and policymaking are

inegraed, inerproessional educaion

and collaboraive pracice can be ully

suppored.

A number o mechanisms shape how

inerproessional educaion is developed

and delivered. In his Framework,

examples o some o hese mechanismshave been divided ino

wo hemes: educaor

mechanisms (i.e.

academic saff

raining, champions,

insiuional

suppor, managerial

commimen, learning

oucomes) and

curricular mechanisms

(i.e. logisics

and scheduling,

programme conen,

compulsory

atendance, shared

objecives, adul

learning principles,

conexual learning,

The faculty

development

interprofessional

education program was

an expanding (mind and

soul) experience for me

to interact with otherhealth workers in various

health professionsan

opportunity to share with

like-minded people in other

professions who value

interprofessional education

and are committed to

bringing it about.

Educator


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1111

assessmen). By considering hese

mechanisms in he local conex, policy-

makers can deermine which o he

accompanying acions would lead o

sronger inerproessional educaion in

heir jurisdicion.Likewise, here are mechanisms

ha shape how collaboraive pracice is

inroduced and execued. Examples o

hese mechanisms have been divided

ino hree hemes: insiuional suppor

mechanisms (i.e. governance models,

srucured proocols, shared operaing

resources, personnel policies, supporive

managemen pracices); working culure

mechanisms (i.e. communicaionssraegies, conflic resoluion policies,

shared decision-making processes);

and environmenal mechanisms (i.e.

buil environmen, acil iies, space

design). Once a collaboraive pracice-

ready healh workorce is in place, hese

mechanisms will help hem deermine

he acions hey migh ake o suppor


Te healh and educaion sysems

also have mechanisms hrough which

healh-services are delivered and paiens

are proeced. Tis Framework idenifies

examples o healh-services delivery

mechanisms (i.e. capial planning,

remuneraion models, financing,

commissioning, unding sreams) and

paien saey mechanisms (i.e. risk

managemen, accrediaion, regulaion,

proessional regisraion).

A call to action

I is imporan ha policy-makers review

his Framework hrough a global lens.

Every healh sysem is differen and new

policies and sraegies ha fi wih andaddress heir local challenges and needs

mus be inroduced. Tis Framework

is no inended o be prescripive nor

provide a lis o recommendaions or

required acions. aher i is inended

o provide policy-makers wih ideas

on how o contextualizeheir exising

healh sysem, commito implemening

principles o inerproessional educaion

and collaboraive pracice, and championhe benefis o inerproessional

collaboraion wih heir regional

parners, educaors and healh workers.

Inerproessional educaion and

collaboraive pracice can play a

significan role in miigaing many o

he challenges aced by healh sysems

around he world. Te acion iems

idenified in his Framework can help

jurisdicions and regions move orwardowards srenghened healh sysems,

and ulimaely, improved healh

oucomes. Tis Framework is a call

or acion o policy-makers, decision-

makers, educaors, healh workers,

communiy leaders and global healh

advocaes o ake acion and move

owards embedding inerproessional

educaion and collaboraive pracice in

all o he services hey deliver.


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Te need o srenghen healh sysems

based on he principles o primary

healh-care has become one o he

mos urgen challenges or policy-

makers, healh workers, managers

and communiy members around he

world. Human resources or healh are

in crisis. Te worldwide shorage o 4.3

mill ion healh workers has unanimously

been recognized as a criical barrier o

achieving he healh-relaed Millennium

Developmen Goals (1,2). In 2006, he

59h World Healh Assembly responded

o he human resources or healh crisis

by adoping resoluion WH A59.23

which called or a rapid scaling-up o

healh workorce producion hrough

various sraegies including he use

o innovaive approaches o eaching

in indusrialized and developing

counries (3).

Governmens around he world

are looking or innovaive, sysem-

ransorming soluions ha will

ensure he appropriae supply, mix and

disribuion o he healh workorce. One

o he mos promising soluions can be

ound in inerproessional collaboraion.

Learning together to

work together forbetter health

Present & future

health

workforce

Collaborative

practice-ready

health

workforce

Interprofessional

education

Collaborative

practice-ready

health

workforce

Optimal

health

services

Collaborative

practice

Figure 2. Interprofessional education

Figure 3. Collaborative practice


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A greaer undersanding o how hissraegy can be implemened will help

WHO Member Saes build more flexible

healh workorces ha enable local

healh needs o be me while maximizing

limied resources.

For healh workers o collaborae

effecively and improve healh oucomes,

wo or more rom differen proessional

backgrounds mus firs be provided wih

opporuniies o learn abou, rom andwih each oher. Tis interproessional

educationis essenial o he developmen

o a collaboraive pracice-ready

healh workorce, one in which saff

work ogeher o provide comprehensive

services in a wide range o healh-care

setings. I is wihin hese setings wherehe greaes srides owards srenghened

healh sysems can be made.

Policy-makers and hose who suppor

his innovaive approach o human

resources or healh planning can

use his Framework o move owards

opimal healh-services and beter healh

oucomes by:

examining heir local conex*

o deermine heir needs andcapabiliies

commiting o building*

inerproessional collaboraion ino

new and exising programmes

championing successul iniiaives*

and eams.

Key concepts

Health worker is a wholly inclusive term which refers to all people engaged in actions whose

primary intent is to enhance health. Included in this definition are those who promote and

preserve health, those who diagnose and treat disease, health management and support workers,

professionals with discrete/unique areas of competence, whether regulated or non-regulated,

conventional or complementary (1).

Interprofessional education occurs when two or more professions learn about, from and witheach other to enable effective collaboration and improve health outcomes.

Professional is an all-encompassing term that includes individuals with the knowledge*

and/or skills to contribute to the physical, mental and social well-being of a community.

Collaborative practice in health-care occurs when multiple health workers 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.

Practice includes both clinical and non-clinical health-related work, such as diagnosis,*

treatment, surveillance, health communications, management and sanitation engineering.

Health and education systemsconsist of all the organizations, people and actions whose

primary intent is to promote, restore or maintain health and facilitate learning, respectively. They

include efforts to influence the determinants of health, direct health-improving activities, andlearning opportunities at any stage of a health workers career (4748).

Health is a state of complete physical, mental and social well-being and not merely the*

absence of disease or infirmity (World Health Organization, 1948) (49).

Education is any formal or informal process that promotes learning which is any*

improvement in behaviour, information, knowledge, understanding, attitude, values or skills

(United Nations Educational, Scientific and Cultural Organization, 1997) (50).


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Te Framework or Action on Inter-

proessional Education and Collaborative

Practice provides a unique opporuniy

or all levels in he healh and educaion

sysems o reflec on how hey migh be-

er uilize inerproessional educaionand collaboraive pracice sraegies o

srenghen healh sysem perormance

and improve healh oucomes (Figures

2,3).

The need for interprofessional

collaboration

Healh policy-makers have

shifed heir ocus

rom radiional

delivery mehods o

innovaive sraegies

ha will srenghen

he healh workorce

or uure generaions

(47).

Alhough hereis a grea deal o

ineres in moving

inerproessional

collaboraion

orward, he desire

o engage in his ype

o long-erm planning

is ofen sidelined by urgen crises such

as epidemics o HI V/AIDS and/or

uberculosis, spiralling healh-care coss,naural disasers, ageing populaions, and

oher global healh issues. Forunaely,

many policy-makers are recognizing

ha a srong, flexible and collaboraive

healh workorce is one o he bes ways

o conron hese highly complex healh

challenges. In recen years, a number o

local, naional and regional associaions

and academic cenres o excellence

have been launched, demonsraing he

growing momenum or inerproessional

collaboraion.


collaboraive pracice can posiivelyconribue o some o he worlds mos

urgen healh challenges. For example:

Family and community health

Maernal and child healh are essenial

o he overall well-being o a counry.

Every day 1500 women worldwide die

rom complicaions in pregnancy

or childbirh. Healh

workers who are ableo joinly ideniy

he key srenghs o

each member o he

healh-care eam and

use hose srenghs o

manage he complex

healh issues o

he enire birhing

amily, will play a

key role in reducinghese alarming and

prevenable saisics.

HIV/AIDS,

tuberculosis

and malaria

Te deecion, reamen

and prevenion o global diseases, such

as HIV/AIDS, uberculosis and malaria,

requires he collaboraion o every ypeo worker wihin he healh sysem.

Inerproessional eams ha have he

experise and resources o ailor heir

response o he local environmen will

be criical o he success o disease

managemen programmes, educaion

and awareness.

Building a regional

network to support

interprofessional

collaboration not only

ensured there was no

competition for funding

between projects, it

also made it possible

for all interprofessional

projects to share best

practices, challenges and

opportunities.

Regional Health Leader


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Health action in crisis

In siuaions o humaniarian crisis

and conflic, a well-planned emergency

response is essenial. o overcome waer,

ood and medical supply gaps, healh

workers mus have he knowledge andskil ls o mobilize whaever resources and

experise are available wihin he healh

sysem and he broader communiy.

Inerproessional educaion provides

healh workers wih he kind o skills

needed o coordinae he delivery o care

when emergency siuaions ar ise.

Health security

Epidemics and pandemics place suddenand inense demands on he healh

sysem. Individuals who regularly work

on a collaboraive pracice eam can

enhance a regions capaciy o respond o

healh securiy issues such as oubreaks

o avian influenza. In he even o a

global epidemic or naural disaser,

collaboraion among healh workers is

he only way o manage he crisis.

Non-communicable diseases

and mental health

Inerproessional eams are ofen able

o provide a more comprehensive

approach o prevening and managing

chronic condiions such as demenia,

malnuriion and ashma. Tese

condiions are complex and ofen require

a collaboraive response.

Health systems and services


collaboraive pracice maximize he

srenghs and skil ls o healh workers,

enabling hem o uncion a he highes

capaciy. Wih a curren shorage o 4.3

mill ion healh workers, innovaions o

his naure will become more and more

necessary o manage he srain placed on

healh sysems.

Te Framework or Action on

Interproessional Education and

Collaborative Practiceliss a range o

pracice- and sysem-level mechanismsha can help policy-makers

implemen and susain progress

in inerproessional collaboraion.

ecognizing ha healh and educaion

sysems should reflec local needs and

aspiraions, his Framework has been

designed o help decision-makers

worldwide apply key mechanisms and

acions according o he needs o heir

unique jurisdicions. Tis Framework

provides inernaionally relevan ideas

or healh policy-makers o consider and

adap as appropriae.

Team-based learning at Jimma University, Ethiopia

Since 1990, Jimma University has placed 20 to 30 final year students in medicine, nursing,

pharmacy, laboratory science and environmental health in district health centres. Students

deliver services ranging from nutrition promotion to primary care and basic laboratory services

while becoming familiar with regional health centres and other students from a wide range of

disciplines (51).

WHO/DRT/Martel


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International environmental scan

of interprofessional education practices

To capture current interprofessional activities at a global level, the WHO Study Group on

Interprofessional Education and Collaborative Practice conducted an international environmental

scan between February and May 2008. The aim of this scan was to:

Determine the current status of interprofessional education globally*

Identify best practices*

Illuminate examples of successes, barriers and enabling factors in interprofessional education.*

A total of 396 respondents, representing 42 countries from each of the six WHO regions, provided

insight about their respective interprofessional education programmes. These individuals represent

various fields including practice (14.1 per cent), administration (10.6 per cent), education (50.4 per

cent) and research (11.6 per cent).

Results indicate that interprofessional education takes place in many different countries and health-

care settings across a range of income categories.

*

It involves students from a broad range ofdisciplines including allied health, medicine, midwifery, nursing and social work.

For most respondents, interprofessional education was compulsory. Student engagement occurs

mainly at the undergraduate level, with a relatively even distribution among undergraduate years.

Students are

typically assessed

in group situations

(46.9 per cent in

developed and

36.8 per cent

in developing

countries), followed

by individual

assignments,

written tests and

other methods.

Although

interprofessional

education is

normally delivered

face-to-face,

information

technology is

emerging asanother valuable

option.

* Te counries o he respondens were caegorized according o he World Banks Income Classificaion Scheme.

Other

6.7%Speech Pathologists

4.7%

Social Workers

9.3%

Psychologists

5.9%

Podiatrists

1.6%

Physiotherapists

10.1%

Physicians Assistants

2.2%

Pharmacists

7.7%

Occupational

Therapists, 8.9%

Nutritionists/Dietitians

5.7%

Nurses/Midwives

16%

Doctors/Physicians10.2%

Audiologists

2.2% Community

Health Workers

4.3%

Figure 4. Types of learners who received interprofessional education at the

respondents insitutions


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17

Internationally, preparing staff to deliver interprofessional education is uncommon.

Courses are usually short and variable in nature and interprofessional education activities

are not yet systematically delivered. In addition, routine evaluation of interprofessional

educations impact on health outcomes and service delivery are rare.

Despite this, respondents reported that they had experienced

many educational and health policy benefits from

implementing interprofessional education. For example:

Educational benefits

Students have real world experience and insight*

Staff from a range of professions provide input into*

programme development

Students learn about the work of other practitioners*

Health policy benefits

Improved workplace practices and productivity*

Improved patient outcomes*Raised staff morale*

Improved patient safety*

Better access to health-care*

Significant effort is still required to ensure interprofessional

initiatives are developed, delivered and evaluated in keeping

with internationally recognized best practice.

Therapists/Health

Professionals

12.3%

Pedagological Staff

7.2%

Consultants/Facilitators

7.2%

Teams of Professionals

3.6%

Self-Taught

1.4%

Clinical Directors/Teachers

7.2%

Other Staff/

Workplace Learning

8.7%

No one

8.7%

IPE Committees/

Teaching Teams

18.8%

University Faculty/Staff

24.6%

Figure 5. Providers of staff training on interprofessional education

The 42 countriesrepresented by the

respondents

Armenia, Australia, Bahamas, Belgium, Canada,

Cape Verde, Central African Republic, China,

Croatia, Denmark, Djibouti, Egypt, Germany,

Ghana, Greece, Guinea, India, Iran (Islamic

Republic of), Iraq, Ireland, Japan, Jordan,

Malaysia, Malta, Mexico, Nepal, New Zealand,

Norway, Pakistan, Papua New Guinea, Poland,

Portugal, Republic of Moldova, Saudi Arabia,Singapore, South Africa, Sweden, Thailand,

United Arab Emirates, United Kingdom, United

States of America, Uruguay.


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Improvedhealth

outcomes

Health & education systems

Local context

Present &

future

health

workforce

Optimal

health

services

Collaborative

practice

Collaborativepractice-ready

Interprofessional

education

Local

healthneeds

Strengthenedhealth system

Fragmented

health system

health

workforce

Interprofessional education

and collaborative practice for

improved health outcomes

Afer almos 50 years o inquiry, hereis now sufficien evidence o indicae

ha inerproessional educaion enables

effecive collaboraive pracice which

in urn opimizes healh-services,

srenghens healh sysems and

improves healh oucomes (Figure 6)

(621). In boh acue and primary care

setings, paiens repor higher levels o

saisacion, beter accepance o care

and improved healh oucomes ollowingreamen by a collaboraive eam (22).

esearch evidence has shown a

number o resuls:

Collaboraive pracice can improve:*

access o and coordinaion o-

healh-services

appropriae use o specialis-

clinical resources

healh oucomes or people wih-

chronic diseases

paien care and saey-

(2325).

Collaboraive pracice can*

decrease:

oal paien complicaions-

lengh o hospial say-ension and conflic among-

caregivers

saff urnover-

hospial admissions-

clinical error raes-

moraliy raes (1820, 22,23,-

2629).

In communiy menal healh*

setings collaboraive pracice can:

increase paien and carer-saisacion

promoe greaer accepance o-

reamen

reduce duraion o reamen-

reduce cos o care-

reduce incidence o suicide (17,21)-

increase reamen or psychiaric-

disorders (30)

reduce oupaien v isis (30).-

18

Figure 6. Health and education systems


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19

erminally and chronically*

ill paiens who receive eam-

based care in heir homes:

are more saisfied wih heir care-

repor ewer clinic visis-presen wih ewer sympoms-

repor improved overall healh-

(24,31).

Healh sysems can benefi rom*

he inroducion o collaboraive

pracice which has reduced he

cos o:

seting up and implemening-

primary healh-care eams or

elderly paiens wih chronicillnesses (31)

redundan medical esing and he-

associaed coss (32)

implemening mulidisciplinar y-

sraegies or he managemen o

hear ailure paiens (19)

implemening oal pareneral-

nuriion eams wihin he

hospial seting (18).*

Tis evidence clearly demonsraeshe need or a collaboraive pracice-

ready healh workorce, which may

include healh workers rom regulaed

and non-regulaed proessions such as

communiy healh workers, economiss,

healh inormaicians, nurses, managers,

* Summary chars o research evidence rom sysemaicreviews relaed o inerproessional educaion andcollaboraive pracice can be ound in Annexes 6

and 7 respecively. Te Canadian InerproessionalHealh Collaboraive has also recenly prepared anevidence synhesis or policy-makers on he effecs oinerproessional educaion, including 181 sudies rom19742005, ha can be accessed a htp://www.cihc.ca/resources-files/he_evidence_or_ipe_july2008.pd

Cross-sectoral interprofessional

collaboration during health crises

In 2005, northern Pakistan experienced a severe earthquake resulting in thousands of injuries.

Relief efforts were particularly challenging in isolated mountain communities. A wound clinic

was eventually opened within a partially constructed hotel, but had no source of water, making

infection control extremely difficult. One of the volunteer health workers took the initiative to

locate a trained plumber who was able to provide the clinic with a constant source of clean waterwithin 48 hours. In this situation, seeking expertise outside of the conventional health-care team

ensured earthquake victims were able to receive quality health-services in spite of the difficult

circumstances (52). This is a common occurrence in emergency situations where collaboration

across sectors can be essential to improving health outcomes (48).

Jean-MarcGiboux

Any project thatencompasses

different specialties

or jurisdictions needs

to coordinate activities

to achieve the greatest

effectiveness. This is

particularly the case with

emergency situations.

It is in that capacity that

interprofessional teams mayhave the greatest impact on

a public health emergency.

The increased coordination

and smoother functioning

will facilitate a more efficient

and effective response, as

well as delivering assistance

more quickly to those in

need.

National Chief PublicHealth Officer


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20

social workers

and veerinarians.

Cross-secoral

inerproessional

collaboraion

beween healhand relaed secors

is also imporan

because i helps

achieve he broader

deerminans o healh such as

beter housing, clean waer, ood securiy,

educaion and a violence-ree sociey.

Inerproessional educaion can occur

during pre- and pos-qualiying educaion

in a variey o clinical setings (e.g. basicraining programmes, pos-graduae

programmes, coninuing proessional

developmen and learning or qualiy

service improvemen). Inerproessional

educaion is generally well-received by

paricipans who develop communicaion

skills, urher heir abiliies o criically

reflec, and learn o appreciae he

challenges and benefis o working

in eams. Effecive inerproessional

educaion osers respec among he

healh proessions, eliminaes harmul

sereoypes, and evokes a paien-cenred

ehic in pracice (8).

Many healh workers already pracice

in eams and acively communicae

wih colleagues. W hile coordinaion

and cooperaion lay he oundaion or

collaboraion, hey are no he same

as collaboraive pracice, which akes

cooperaion one sep urher by engaging

a collaboraive pracice-ready healh

workorce, poised o ake on complex

or emergen problems and solve hem

ogeher. Tese healh

workers know how

o collaborae wih

colleagues rom oher

proessions, have

he skil ls o pu heirinerproessional

knowledge ino acion

and do so wih respec

or he values and belies

o heir colleagues. Tey can

inerac, negoiae and joinly work wih

healh workers rom any background.


collaboraive pracice are no panaceas

or every challenge he healh sysemmay ace. However, when appropriaely

applied, hey can equip healh workers

wih he skills and knowledge hey need

o mee he challenges o he increasingly

complex global healh sysem.

The role of health and

education systems

egional issues, unme healh needs and

local background influence how healh

and educaion sysems are organized

around he world. No wo conexs

are exacly he same, ye all share six

common building blocks. Collaboraive

pracice can be seen in each o he six

building blocks o he healh sysems:

1. healh workorce

2. service delivery3. medical producs, vaccines and

echnologies

4. healh sysems financing

5. healh inormaion sysem

6. leadership and governance (32)

Critical reflection on collaborative practice

Several primary health-care clinics in Denmark maintain records on the services that each of its

health workers provide to facilitate reflection, open discussion and improvement among its staff

in how they work collaboratively. This process facilitates the sharing of best practices and fosters a

team spirit (53).

Having a personal

relationship with

the team members

helped to build trust among

us, and colleagues that trust

each other are much more

inclined to seek collaboration.

Rural health worker


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21

Because o he unique naure o each

healh region, collaboraive pracice

sraegies mus be considered according

o local needs and challenges. In

some regions, his may mean ha

collaboraive, eam-based approaches

o care are driven by effors o promoe

paien saey (34,35), maximize limied

healh resources, move care rom acue

o primary care setings or encourage

greaer inegraed working (36,37).

In ohers, he ocus may be on human

resource benefis such as increased

healh worker job saisacion or greaer

role clariy or healh workers when

working in eams (22).

egardless o he conex in which

policy-makers choose o inroduce

collaboraive pracice, research evidence

and experience have demonsraed ha

a eam-based approach o healh-care

delivery maximizes he srenghs and

skil ls o each conribuing healh worker.

Tis enhances he efficiency o eams

hrough reduced service duplicaion,

more requen and appropriae reerral

paterns, greaer coninuiy and

coordinaion o care and collaboraive

decision-making wih paiens (22).

I can also assis in recruimen and

reenion o healh workers (29) and

possibly help miigae healh workorce

migraion.

Health workforce satisfaction

and well-being

Health workers in Australian and English primary care teams have reported high levels of well-

being. They share problems and support each other and the resulting cooperation buffers

individuals from negative workplace interactions (5456).

Family health teams in Brazil

In Brazil, the reform of the national constitution in the late 1980s saw the establishment of the

Sistema Unificado e Descentralizado de Sade (SUDS, unified and decentralized health system).

This led to the creation of Family Health Teams, which are comprised of a doctor, two nurses

and community health workers. The teams are responsible for monitoring a specific number of

families living in defined geographical areas for a range of health needs (57). Twenty years after

the establishment of the Unified Health System (SUS) and 15 years after the implementation of

the Family Health Team programme, more than 88 million Brazilians are followed by 28,000 Family

Health Teams and 16,000 Family Oral Health Teams (57). In 2006, the National Primary Health-care

Policy reaffirmed the commitment of the Brazilian government to the expansion and consolidationof the Health-care Network in SUS on the basis of a broad base of Family Health Teams linked to

the population (58).

JWHO/photobyALMASYP.


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22

A culture shift in health-care

delivery

One o he benefis o implemening


collaboraive pracice is ha hese

sraegies change he way healh workers

inerac wih one anoher o deliver care.

Boh sraegies are abou people: he

healh leaders and policy-makers who

srive o ensure here are no barriers o

implemening collaboraive pracice

wihin insiuions; he healh workers

who provide services; he educaors who

provide he necessary

raining o healh

workers; and mos

imporanly, he

individuals and

communiies who

rely on he service.

By shifing he way

healh workers hink

abou and inerac

wih one anoher,

he culure o he working environmen

and atiudes o he workorce will

change, improving he working

experience o saff and benefiing he

communiy as a whole.

Inernaionally, inerproessionaleducaion and collaboraive pracice

are now considered credible sraegies

ha can help miigae he global healh

workorce cr isis. Te growing evidence

and research base coninues o ideniy

inerproessional collaboraion as

beneficial o healh workers, sysems

and communiies. In order o move

inerproessional educaion

and collaboraivepracice orward, his

Framework oulines

he mechanisms ha

policy-makers and civil

sociey leaders can

use o begin making

he shif o sysem-

wide inerproessional

collaboraion.

It made me more

aware of how important

the process of change

is. Teams can benefit

patients if they are working

well. If the team is not

working well it can also

affect the patient. It also

makes me more aware of

how I will want to practice

in the future.

- Pharmacy Student


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Achieving inerproessional educaion

and collaboraive pracice requires

a review and assessmen o he

mechanisms ha shape boh. For

his Framework, a number o keymechanisms were idenified rom a

review o he research lieraure, resuls

o an inernaional environmenal

scan o inerproessional educaion

pracices, counry case sudies and

he experise o key inormans. Tese

mechanisms have been organized ino

broad hemes and grouped ino hree

secions: 1) inerproessional educaion,

2) collaboraive pracice, and 3) healhand educaion sysems. For each

secion, possible acion iems have been

idenified ha healh policy-makers

can implemen in heir local conex.

However, while he mechanisms and

acions have been assigned under hebroad caegories o inerproessional

educaion and collaboraive pracice,

here is a grea degree o overlap, and

many o he mechanisms influence

boh secions (Figure 7). As hese

sraegies are inroduced and expanded,


collaboraive pracice will become more

embedded, srenghening healh sysems

and improving healh oucomes.

Moving

forward

Figure 7. Examples of mechanisms that shape interprofessional education at the practice level

Present & future

health

workforce

Collaborative

practice-ready

health

workforce

Staff training

Champions

Institutionalsupport

Assessment

Learningoutcomes

Logistics &scheduling

Programme

content

Compulsory

attendanceContextual

learning

Adult learningprinciples

Sharedobjectives

Interprofessional

education

Managerialcommitment

EDUCATOR MECHANISMS

CURRICULAR MECHANISMS

Learningmethods

23


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24

Interprofessional education:

achieving a collaborative

practice-ready health

workforce

Inerproessional educaion is shaped

by mechanisms ha can be broadly

classified ino hose driven by:saff responsible or developing,*

delivering, unding and managing

inerproessional educaion

he inerproessional curricula.*

Educatormechanisms. Developing

inerproessional educaion curricula is

a complex process, and may involve saff

rom differen aculies, work setings and

locaions. Susaining inerproessionaleducaion can be equally complex and

requires:

supporive insiuional policies*

and managerial commimen (38)

good communicaion among*

paricipans

enhusiasm or he work being done*

a shared vision and undersanding*

o he benefis o inroducing a new

curriculuma champion who is responsible or*

coordinaing educaion aciviies

and ideniy ing barriers o progress

(39).

Careul preparaion o insrucors or

heir roles in developing, delivering and

evaluaing inerproessional educaion is

Te erm educaor includes all insrucors, rainers,aculy, precepors, lecurers and aciliaors who work

wih in any educ aion or heal h-ca re insi uion, as wel l ashe individuals who suppor hem.

also imporan (10,14,40,41). For mos

educaors, eaching sudens how o

learn abou, rom and wih each oher

is a new and challenging experience.

For inerproessional educaion o be

successully embedded in curricula and

raining packages, he early experiences

o saff mus be posiive. Tis will ensure

coninued involvemen and a willingnesso urher develop he curriculum based

on suden eedback.

Curricular mechanisms. Healh-care

and educaion around he world are

provided by differen ypes o educaors

and healh workers who offer a range

o services a differen imes and

locaions. Tis adds a significan layer

o coordinaion or inerproessional

educaors and curriculum developers.

Evidence has shown ha making

atendance compulsory and developing

flexible scheduling can preven logisical

challenges rom becoming a barr ier o

effecive inerproessional collaboraion.

esearch indicaes ha

inerproessional educaion is more

effecive when:

principles o adul learning are used* (e.g. problem-based learning and

acion learning ses)

learning mehods reflec he real*

world pracice experiences o

sudens (39)

ineracion occurs beween*

sudens.

Effecive inerproessional educaion

relies on curricula ha link learning

aciviies, expeced oucomes and an

Staff training for interprofessional education

An interprofessional preceptor development course for East Carolina Universitys Rural Health

Training Program in the United States of America consisted of four three-hour sessions over

four months. Educators learned how to increase student comfort with the interprofessional

curriculum and one another. Content included regular meetings to discuss shared cases and

provide feedback (59).


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25

assessmen o wha has been learned

(42). I is imporan o remember ha

expeced oucomes will be influenced

by he sudens physical and social

environmen as well as heir level o

educaion. Well-consruced learningoucomes assume sudens need o

know: wha o do (i.e. knowledge); how

o apply heir knowledge (i.e. skills);

and when o apply heir skills wihin

an appropriae ehical ramework

using ha knowledge (i.e. atiudes and

behaviour).

Interprofessional education offersstudents real-world experience

In 1996, Linkping University in Sweden implemented an extensive commitment to interprofessional

education for all health science students. Up to 12 weeks of the curriculum for all students is

devoted to interprofessional education (60). A part of this commitment was the launch of the first

interprofessional student training ward at the Faculty of Health Sciences at Linkping University (61).

A similar training program has been offered at the nearby Karolinska Institutet since 1998, where a

two week mandatory interprofessional course for medical, nursing, physiotherapy and occupational

therapy students is delivered on a training ward. Five to seven students work in teams to plan and

organize patient care while their supervisors act as coaches. At the end of every shift the student

teams reflect on their learning experience with their supervisors (62).

Interprofessional curriculum development and delivery

At Tribhuvan Universitys Maharajgunj Nursing Campus in Nepal, the curricula on newborn care was

updated at a workshop that included nursing and medical faculty. Participants worked together to

identify essential components of a new curriculum. They found that the nursing faculty were more

knowledgeable and skilled in areas like essential newborn care while the medical faculty were more

knowledgeable and skilled in advanced care (63).

At Christian Medical College in Vellore, India, nursing students are taught about interprofessional

teamwork and the role of interpersonal relationships when communicating with patients and

colleagues. They learn about different ways to improve collaboration, including strengthening referralservices. (64).

The New Generation Project at the University of Southampton is at the forefront of making common

learning across the health-care practices a reality. The project comprises a team of educationalists and

researchers who have created and are developing a new syllabus that brings the distinct health-care

professions closer together through common understanding, mutual respect and communication

(65).

Mandatory interprofessional education

In Sweden, the Centres for Clinical Education Project conducted evaluations of a two week

interprofessional course for medical, nursing, physiotherapy and occupational therapy students.Evaluators noted that in making the interprofessional clinical course mandatory, there was greater

contact among faculty, staff and students who expressed an interest in having these interactions

continue (66).

WHO/P.V

irot


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26

Tese oucomes may be seen in he

ollowing examples grouped under he

inerproessional learning domains.

1. eamwork:

being able o be boh eam leader-

and eam memberknowing he barriers o eamwork-

2. oles and responsibiliies:

undersanding ones own roles,-

responsibiliies and experise,

and hose o oher ypes o healh

workers

3. Communicaion:

expressing ones opinions-

compeenly o colleagues

lisening o eam members-

4. Learning and criical reflecion:

reflecing criically on ones own-

relaionship wihin a eam

ranserring inerproessional-

learning o he work seting

5. elaionship wih, and recognizing

he needs o, he paien:

working collabora ively in he bes-

ineress o he paien

engaging wih paiens, heir-

amil ies, carers and communiies

as parners in care managemen

6. Ehical pracice:

undersanding he sereoypical-

views o oher healh workers held

by sel and ohers

acknowledging ha each healh-

workers views are equally val id

and imporan

Inerproessional educaion provides

learners wih he raining hey need

o become par o he collaboraivepracice-ready healh workorce. Once

healh workers are ready o pracice

collaboraively, addiional mechanisms

and acions can help shape heir

experience (able 1). In developing

collaboraive pracice, healh sysem

planners and healh educaors mus

engage in discussions abou how hey can

help learners ransiion rom educaion

o he workplace.

We welcome

white brothers

and sisters

who are working together

to improve the health ofour people. We will go

out with you we will

guide and support you

we will introduce you

to the community. You

will find that each of our

communities share a sense

of humor we hang on to

it we are a resilient people

and we welcome working

together on this journey

towards interprofessional

collaboration.

Aboriginal Community

Leader


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27

Table 1. Actions to advance interprofessional education for improved health outcomes

ACTION PARTICIPANTS LEVEL OF ENGAGEMENT EXAMPLES POTENTIAL OUTCOMES

1. Agree to a common vision and purpose

for interprofessional education with

key stakeholders across all faculties and

organizations

Decision-makers

Policy-makers

Health facility directors and

managersEducation leaders

Educators

Health workers

CONTEXTUALIZE

Vision: Whether students are in the

classroom or participating in practice

education, interprofessional educationwill be encouraged and collaborative

practice principles upheld

All health-worker education is

directed by an interprofessional

vision and purpose

2. Develop interprofessional education

curricula according to principles of good

educational practice

Curriculum developers

Educators

Education leaders

Researchers

CONTEXTUALIZE

Link with local researchers to

understand how best practices in

interprofessional education can be

applied to their local context

Develop curricula based on existing

resources and local needs

An interprofessional education

framework that is specific to

the local region and takes into

account culture, geography,

history, challenges, etc.

Engagement of numerous

community layers, such as health

workers, researchers and facilities

3. Provide organizational support and

adequate financial and time allocations for:

the development and delivery of


staff training in interprofessional

education


managers

Education leaders

COMMIT

Set aside a regular time for

interprofessional champions, staff and

others to meet

Provide incentives for staff to

participate in interprofessional

education

A collaborative practice-ready

health workforce

Improved workplace health and

satisfaction for health workers

4. Introduce interprofessional education

into health worker training programmes:

all pre-qualifying programmes

appropriate post-graduate and continuing

professional development programmeslearning for quality service improvement

Government leaders

Policy-makers

Education leaders

Educators

Curricula developers


managers

COMMIT

Introduce new system-wide curricula

Manage senior health worker resistance

to re-education

A collaborative practice-ready

health workforce

Interprofessional education and

collaborative practice embedded

into health-system delivery

5. Ensure staff responsible for developing,

delivering and evaluating interprofessional

education are competent in this task, have

expertise consistent with the nature of the

planned interprofessional education and have

the support of an interprofessional education

champion

Educators

Education leaders

COMMIT

Provide educators and training staff

with opportunities to discuss shared

challenges and successes

Provide resources for educators and

staff

Focus on continuous improvement

using appropriate evaluation tools

Strengthened education with

a focus on interprofessional


practice

6. Ensure the commitment tointerprofessional education by leaders in

education institutions and all associated

practice and work settings

Education leadersHealth facility directors and

managers

CHAMPIONAllow educators, clinical supervisors

and staff to share positive

interprofessional experiences with their

supervisors and leaders

Improved attitudes toward otherhealth professions

Improved communication among

health workers


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28

Collaborative practice:

achieving optimal health-

services

Collaboraive pracice works bes wheni is organized around he needs o he

populaion being served and akes ino

accoun he way in which local healh-

care is delivered. A populaion-based or

needs-based approach is necessary when

deermining he bes way o inroduce

new inerproessional conceps. W hile

a collaboraive pracice-ready healh

workorce is an essenial mechanism

owards shaping he effecivenesso collaboraive pracice, by isel i

wil l no guaranee he provision o

opimal healh-services (Figure 8).

Oher pracice-level mechanisms,

such as insiuional suppors, working

culure and environmen can enable he

effeciveness o collaboraive pracice

(able 2).

Institutional supports. Insiuional

mechanisms can shape he way a eam

o people work collaboraively, creaing

synergy insead o ragmenaion (43).

Saff paricipaing in collaboraive

pracice need clear governance models,

srucured proocols and shared

operaing procedures. Tey need o know

ha managemen suppors eamwork

and believes in sharing he responsibiliyor healh-care service delivery among

eam members. Adequae ime and

space is needed or inerproessional

Delivery of interprofessional education using

information communication technologies

In the virtual learning environment, students from different health professional groups

gain an understanding of the roles and responsibilities of each member of the health-care team. Experiences from the Universitas 21 global consortium of universities show

that information communication technology can be used to help break down established

stereotypes and promote equal partnership in patient care (67).

Effective communication strategies

At a psychiatry hospital in Tamilnadu, India, a mental health team works interprofessionally to

deliver patient care. In this setting clinical rounds are done together, allowing all professions

to be engaged in the decision-making process. Individuals from this team have emphasized

that their success is largely due to a clear understanding of responsibilities, trust between

professions, open and honest communication, and inclusion of the family in patient care (68).

Students views of interprofessional education

At the University of Queensland in Australia, students reported gaining a better

understanding of the need for communication and listening following an interprofessional

workshop about children who have developmental coordination disorders (69).

Structures for shared decision-making

In an urban community health clinic in India, care is managed by a team of health

workers. Each practitioner has a caseload of over 3,000 patients, and physicians provide

weekly support during clinic hours (64).


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Collaborative

practice-ready

health

workforce

Optimal

health

services

Governancemodels

Structuredprotocols

Shared operatingresources

Shared decision-making processes

Supportivemanagement

practices

Facilities

Spacedesign

Personnelpolicies

Collaborative

practice

Communicationsstrategies

Builtenvironment

Conflictresolution

policies

ENVIRONMENTAL MECHANISMS

INSTITUTIONAL SUPPORT MECHANISMS

WORKING CULTURE

MECHANISMS

collaboraion and delivery o care. A

he same ime, personnel policies need

o recognize and suppor collaboraive

pracice and offer air and equiable

remuneraion.

Working culture. Collaboraive pracice

is effecive when here are opporuniies

or shared decision-making and rouine

eam meeings. Tis enables healh

workers o decide on common goals

and paien managemen plans, balance

heir individual and shared asks, and

negoiae shared resources. Srucured

inormaion sysems and processes,

effecive communicaion sraegies,srong conflic resoluion

policies and regular

dialogue among eam

and communiy

members play an

imporan role in esablishing a good

working culure.

Environment. Space design, acil iies

and he buil environmen can

significanly enhance or deracrom collaboraive pracice in an

inerproessional clinic. In some cases,

effecive space design has included

inpu and recommendaions rom

he communiy and paiens, as well

as members o he healh-care eam.

Mos noably, physical space should

no reflec a hierarchy o posiions.

Addiional consideraions could include

developing a shared space o beteraciliae communicaion or

organizing spaces and

rooms in ways ha

eliminae barriers o

effecive collaboraion

(44).The course was

very helpful

in gaining an

understanding of the roles

and perspectives of other

health professions, working

as a team, and developingefficient relationships in the

workplace.

Physiotherapy Student

Figure 8. Examples of mechanisms that shape collaboration at the practice level

29


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30

Table 2. Actions to advance collaborative practice for improved health outcomes

ACTION PARTICIPANTS LEVEL OF ENGAGEMENT

EXAMPLES

POTENTIAL OUTCOMES

1. Structure processes that

promote shared decision-making,

regular communication andcommunity involvement

Health facility managers and

directors

Health workers

CONTEXTUALIZE

Discuss and share ideas for

improved communicationprocesses

Develop a sense of community

through interaction and staff

support

A model of collaborative

practice that recognizes the

principles of shared decision-making and best practice

in communication across

professional boundaries

2. Design a built environment

that promotes, fosters and extends

interprofessional collaborative

practice both within and across

service agencies

Policy-makers


directors

Health workers

Capital planners

Architects/space planners

CONTEXTUALIZE

Relocate and rearrange

equipment to better facilitate

communication flow

Improved communication

channels

Improved satisfaction among

health workers

3. Develop personnel policies thatrecognize and support collaborative

practice and offer fair and equitable

remuneration models

Government


directors

Policy-makers

Regulatory/labour bodies

COMMIT

Review personnel policies

and consider innovative

remuneration and incentive

plans

Improved workplace health and

well-being for workers

Improved working environment

4. Develop a delivery model that

allows adequate time and space for

staff to focus on interprofessional

collaboration and delivery of care


directors

Policy-makers

Health workers

COMMIT

Set aside time for staff to meet

together to discuss cases,

challenges and successes

Provide opportunity for staff

to be involved in development

of new processes and strategicplanning

Improved interaction between

management and staff

Greater cohesion and

communications between

health workers

5. Develop governance models

that establish teamwork and shared

responsibility for health-care service

delivery between team members as

the normative practice


directors

Policy-makers

Government leaders

CHAMPION

Review and update the existing

governance model

Develop a strategic plan for an

interprofessional education and

collaborative practice model

of care

A sustained commitment to

embedding interprofessional

collaboration in the workplace

Updated governance model, job

descriptions, vision, mission and

purpose

Vision and programme aims

In Nepal, a national strategy called Saving Newborn Lives was implemented to address high rates

of newborn mortality. Bringing together nursing and medical faculty, this common goal became

the catalyst for the development of an integrated curriculum and strengthened relationships

between the two professions (56).

Collaborative practice and the built environment

The physical setting for collaborative practice plays an important role in the quality of care

provided by interprofessional teams. For health workers providing services to patients and family

dealing with sensitive health issues such as mental illness or chronic disease, a private, quiet area isessential in order to provide quality, compassionate, patient-centred care (47).


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31

Health and education

systems: achieving improved

health outcomes

Te healh and educaion sysems

mus coordinae heir effors inorder o ensure he uure healh

workorce consiss o appropriaely

qualified saff, posiioned in he righ

place a he righ ime. Insiuions

and individuals working wihin he

healh and educaion sysems can

help oser a supporive climae or

inerproessional collaboraion. In

developing collaboraive pracice, healh

workers and healh educaors musdiscuss how o make he ransiion rom

educaion o he work environmen. Key

principles ha can guide he movemen

owards inerproessional educaion and

collaboraive pracice include conex

relevance, policy inegraion, muli-

level sysem change and collaboraive

leadership. I is also imporan o noe

ha service users, paiens and carers

and amilies are all engaged in he

collaboraive pracice process.

Legislaion is a key mechanism

hrough which healh and educaionsysems are organized, moniored and

managed. Because legislaive changes

can influence how healh workers

are educaed, accredied, regulaed

and remuneraed, legislaion has a

significan impac on he developmen,

implemenaion and susainabiliy

o inerproessional educaion and

WHO/TDR/TLMI

Legislation to support collaborative practice

In 2008, the Government of British Columbia in Canada passed legislation that included a provision

on interprofessional collaboration. Each of the provinces health professional regulatory colleges

are now asked, (k) in the course of performing its duties and exercising its powers under this Act

or other enactments, to promote and enhance the following: (ii) interprofessional collaborative

practice between its registrants and persons practising another health profession (45).

Government mechanisms

shaping interprofessional education in norway

In 1972, the Norwegian Government stated that to prepare students to work across boundaries

and to further interprofessional collaboration, health professional students should be educated

together. In 1995 they recommended that all undergraduate allied health, nursing and social

work programmes include a common core curricula that covered: scientific theory; ethics;

communication and collaboration; and scientific methods and knowledge about the welfare state.

All university colleges adopted the common core. Government encouraged shared studies, but

provided a great degree of flexibility for university colleges that had too few professions or were

located far from potential partner institutions (70).


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collaboraive pracice (Figure 9).I can also play an imporan role

in championing inerproessional

collaboraion when governmen agrees o

develop legislaion ha removes barriers

o collaboraive pracice. egulaion is

ofen an imporan par o he legislaive

agenda. As he healh workorce

diversifies, policy-makers mus address

he role ha regulaion could or should

play in recognizing and supporing newand emerging proessions, paricularly

hose ha include a unique mix o skil ls.

Health-services delivery. Te way in

which healh and educaion services are

financed, unded and commissionedcan

influence he success o inerproessional

educaion and collaboraive pracice.

For example, how healh workers are

remuneraed can affec he amoun oime hey spend collaboraing wih one

anoher and demonsraing eamwork

in pracice o sudens. eviewing

how differen workorce remuneraion

models, unding sreams and risk

managemen processes may impac

paien care and suden learning is

Financing is how money is raised, unding is howmoney is spen, and commissioning is he process o

choosing service providers.

Figure 9. Examples of influences that affect interprofessional education and collaborative practice at

the system level

Fragmented

health system

Strengthened

health system

Remunerationmodels

Riskmanagement

Accreditation Regulation

Professionalregistration

Capitalplanning

FinancingCommissioning

Funding

streams

Health &

education

systems

HEALTH SERVICES DELIVERY MECHANISMS

PATIENT SAFETY MECHANISMS

32

WHO/M.Gary


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33

essenial o moving

inerproessional

educaion and


orward. A he same

ime, coordinaingpolicies or healh-

services ha suppor

he developmen and

delivery o inegraed

eam-based services

would:

engage oher*

areas o public

policy such

as social care,educaion,

housing and

jusice

sysemaize inerproessional*

collaboraion in educaion and

healh as a naional sraegic

direcion

aciliae he commissioning o*

healh and educaion services

ha suppor he principles o


Patient safety.

Governance

mechanisms ha

esablish sysem-

wide sandards and

suppor paien saeycan be used o embed

inerproessional

educaion and


wihin he healh-

care sysem. Many

o he governance

mechanisms ha are

enaced hroughou

he world exis oproec paiens and

he communiy. I

regulaion is oo rigid,

processes may become ragmened

and resul in an escalaion o coss

and addiional srain on he healh

sysem. Alernaely, i regulaion is

reasonably flexible, opporuniies o

embed inerproessional educaion

ino pracice increase.

Sustained political commitment

In Japan, the Kobe Municipal Government committed to a collaborative practice model for

maternal and child health to help reduce infant mortality rates. This programme, called The

Supporting Room, provides comprehensive services (prenatal, postpartum and during early

childhood) delivered by staff from different professions in a collaborative setting (71).

Integrated health and education policies

as supportive mechanisms

An explicit change in health policy in England required all universities who train health

professionals to develop and integrate interprofessional education in the classroom and in practice

(6). In Canada, one of the outcomes of the Romanow Commission (72) which reviewed and

advised on a future model for the Canadian health-care system, was the recommendation that

interprofessional education be taken forward with the explicit intention to promote team-based

working (7374).

In Thailand, Khon Kaen University is responding to the worldwide shortage of health workers by

coordinating meetings between community hospitals, administrative organizations and faculty to

develop programmes to support local practitioners and educators (75).

It was an encouraging

feeling to have the

support, camaraderie

and cooperation of

the other students

and preceptors in thecommunity, and it gave

us the opportunity to

experience both learning

and teaching roles with

each other. It helped make

me aware of some of the

misconceptions existing

between professions and

the limitations of our own

profession. Medical Student


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34

In almos every counry here are

legal and regulaory srucures ha

can be boh barriers o and enablers

o inerproessional educaion and

collaboraive pracice. Accrediaion

requiremens or healh cenres and

regisraion crieria or sudens canalso ransorm educaion and pracice

(42). One governmen, or example,

has included a clause in heir healh

legislaion ha requires regulaory

bodies o include inerproessional

educaion as par o heir bylaws

(45). Anoher includes a requiremen

ha communiy members be par

o he selecion panel or suden

admission ino healh proessionaleducaion programmes and, alongside

he proessional bodies ha oversee

healh proessional educaion, srongly

indicaes ha sudens should experience

inerproessional educaion as par o

heir iniial proessional educaion (46

48). By embedding inerproessional

educaion and collaboraive pracice in

legislaion, accrediaion requiremens

and/or regisraion crieria, policy-makers and governmen leaders can

be champions o inerproessional

collaboraion. In response o issues

raised around paien saey in o err

is human, in 2003 he Unied Saes

Insiue o Medicine issued a landmark

repor Health proessions education: a

bridge to qualitywhich emphasized he

need or inerproessional educaion and

collaboraive pracice (able 3).

Interprofessional education and patient safety

In the United States of America, the Institute of Medicine issued a landmark report in 2003

titled, Health Professions Education: A Bridge to Quality(76), which emphasized the need for

interprofessional education and collaborative practice. This publication was a follow-up to two

earlier reports on patient safety, To Err is Human(77) and Crossing the Quality Chasm(78), released

in 1999 and 2001 respectively.

Before this[interprofessional

education] project,

people didnt really see each

other as people. They saw

each other as a doctor or

a nurse and forgot about

the human side. Now, they

go beyond the job title and

communicate with each

other with more respect.

Because of this project,

they see each other as

people now and thats a big

change.

Education Leader

WHO/TDR/Crump


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35

Table 3. Actions to support interprofessional education and collaborative practice at the system-level

ACTION PARTNERSHIPS LEVEL OF ENGAGEMENT

EXAMPLES

POTENTIAL OUTCOMES

1. Build workforce capacity at

national and local levels

Government leaders


directorsEducation leaders

Policy-makers

CONTEXTUALIZE

engage in focused discussions

with partners and health-careleaders

develop short and long

term planning strategies for

recruitment, retention and

education

Short-, medium- and long-term

planning for an interprofessional

workforceClear and defined direction for

human resources for health

planning

2. Create accreditation standards

for health worker education

programmes that include clear

evidence of interprofessional

education

Education leaders

Regulatory bodies

Legislators

Government leaders

Researchers

CONTEXTUALIZE

Review current accreditation

standards and ensure

future standards include


and collaborative practice

componentsEnsure accreditation standards

of all professions include similar

language on interprofessional


practice

Updated accreditation standards

for all professions with a shared

theme of interprofessional


practice

3. Create policy and regulatory

frameworks that support educators

and health workers to promote and

practice collaboratively, including

new and emerging roles and models

of care

Government leaders

Professional associations

Regulatory authorities

Education leaders

Legislators

COMMIT

Encourage legislators to develop

appropriate legislative models to

support collaborative practice

Engage partners and health

workers in discussions around

roles and responsibilities of new

and emerging professions

Legislative and regulatory

frameworks that support

interprofessional education and

collaborative practice

4. Create frameworks and allocate

funding for clear interprofessional

outcomes as part of life long learning

for the health workforce

Professional associations

Regulatory bodies

Government leaders

Government agencies

Education leaders

Legislators

COMMIT

Develop programmes and courses

that suit pre- and post-qualifying

education

Lifelong learning for health

workers to enable them to

become and remain collaborative-

practice ready throughout their

career

5. Create an environment in which

to share best practices from workforce

planning, financing, funding and

remuneration which are supportive

of interprofessional education and

collaborative practice

Government leaders

Researchers

Education leaders


directors

CHAMPION

Host meetings that bring together

regional champions to share

successes and challenges

A coherent funding model for

interprofessional collaboration

Improved communication

between all levels of the health

system

Development of a database of

best practices/evidence


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36

Conclusion

Te World Healh Organizaion

recognizes inerproessional

collaboraion in educaion and pracice

as an innovaive sraegy ha will play an

imporan role in miigaing

he global healh crisis.

Te purpose o he

Framework or Actionon Interproessional

Education and

Collaborative Practice

is o provide policy-

makers wih a broad

undersanding o

how inerproessional

educ

Documents

WHO_HRH_HPN_10.3_eng