Learning About from and With Each Other

February 12, 2014

CHANNELS Project: Learning Objectives

1. TEAMWORK & COLLABORATIVE PRACTICEPromote positive teamwork skills (TeamSTEPPS)Understand roles & responsibilities of team members

2. CULTURAL AWARENESS & IDENTITYImpact of assumptions, beliefs & biasesAwareness of power inequities and disparities

3. CULTURAL KNOWLEDGEAwareness of culturally appropriate resources & skillsKnowledge that one is not an expert in another culture

4. HEALTH LITERACY & COMMUNICATIONUse of active listening & linguistically appropriate resourcesIntegration of CHOWs as critical team members

Definitions

Interprofessional Education occurs when two or more professions learn about, from and with each other to improve collaboration and the quality of care.

Collaborative Practice promotes the active participation of relevant cross-disciplinary professions in patient-centered care.

FunctionInterprofessional knowledge and skills promote capacities to

understand the roles of other health providers and implement the workings of teams - regardless of team make-up - with the

person’s best interests at the center of care.

Emergency Care

Operating Theater

Community Health Environments

Mental Health Settings

WHY IPE IS IMPORTANT?

To advance the Triple Aim of improving population health, enhancing patient quality care and controlling costs

To close the gap between health education and practice settings by aligning their needs and interests

Institute of Medicine

The Institute of Medicine’s (IOM) seminal study of preventable medical errors estimated as many as 98,000 people die every year at a cost of $29 billion. If the Centers for Disease Control were to include preventable medical errors as a category, these conclusions would make it the sixth leading cause of death in America. Deaths/Mortality, 2005, National Center for Health Care Statistics at the Centers for Disease Control, viewed at http://www.cdc.gov/nchs/fastats/deaths.htm.

http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_Sue_Sheridan/Sue_Sheridan-400-300.html

IPE – Guiding Principles

Values/Ethics for Interprofessional Practice Roles/Responsibilities for

Collaborative Practice Interprofessional Communication Interprofessional Teamwork and

Team-based Care Collaborative Leadership Patient-Centeredness

Values & Ethics

• Patients and populations are at the center

• Cultural and individual diversity is acknowledged and honored

• Expertise of other health professions is known and respected

IOM 6 Aims for Improving Health Care

• Safety: avoid injuries to patients from the care that is intended to help them

• Effective use of scientific evidence to serve all patients • Patient-centered care that is respectful of and responsive

to patient preferences, needs and values, and ensuring that patient values guide all clinical decisions

• Timeliness and reduction of potentially harmful delays• Efficiency and avoidance of waste of equipment, supplies,

and human resources • Equitable care that does not vary in quality because of

person characteristics such as age, gender, ethnicity, geographic location and socioeconomic status

NASW Ethics• Service aimed to help people in need and address social

problems• Competent use of best knowledge and skills for within

scope of practice• Dignity and worth of the person aimed at client self-

determination and empowerment• Integrity to act honestly and effectively according to the

mission and values of the profession• Importance of human relationship that makes effective

and efficient use of engagement in the helping process• Social Justice focused on equitable access and quality of

service for all people regardless of age, gender, race, ethnicity, and socioeconomics

Patient-centeredness

• Invite patients into healthcare decision-making

• Provide information & context to empower patients

Providers

• Disseminate information to inform individuals, families & populations

• Advocate for quality primary prevention & meeting the needs of the underserved

Public Health

• Capacity to think critically & have perspectives honored

• Make informed decisions with health team

Patients

ATTITIDESRespect for patient knowledgeValue patient as team memberTrust in each other & the teamTrust in system of care

ACTIONSInvite patient into care communicationFacilitate empowering practiceCommunicate openly; Listen activelyRespond effectivelyEvaluate efficacy

Roles & Responsibilities

• Communicate roles and responsibilities

• Engage diverse healthcare professionals in healthcare development to meet patients’ needs

• Optimize complementary abilities of all team members to patient care

Community health outreach workers (CHOWs) •Deliver health care services to underserved populations•Are trusted members of their communities •Provide vital links between health systems and communities.1

http://www.maine.gov/dhhs/oma/MulticulturalResource/health.html 1 Whitley et al (2006). Measuring return on investment of outreach by community health workers. J of Health Care for the Poor and Underserved, 17, 6-15.

CHOW Roles & responsibilities• Offer culturally/linguistically relevant health education•Mediate between community members and services providers•Provide case management and systems navigation• Offer medical interpretation•Assist with health insurance enrollment•Provide community-based health promotion & prevention activities•Conduct surveys, collect community and health related data•Contribute information on community needs and •needed resources.

CHOWs: Community Health Outreach Workers

Communication

• Communicate respectfully and appropriately in all situations

• Listen actively• Encourage ideas and opinions

of all team members • Recognize differences in

experience, expertise, culture, and status that may affect communication

• Facilitate conflict resolution to enhance interprofessional working relationships

Collaborative Leadership

• Value contributions of all health team and family/community members

• Facilitate contributions of all team members

• Build support for working together

• Apply leadership practices that support collaborative and effective team practice

Teams & Teamwork

• Collaborate to deliver patient-centered, community-based care

• Develop shared principles of care

• Integrate knowledge and experience of other professions to inform care decisions

• Respect patients’ perspectives and community values that inform care preferences

TeamSTEPPS Skills

SHARED VISION & PHILOSOPHY• SHARED MENTAL MODELCOMMUNICATION• SBAR• TEAM SKILLS: BRIEF, HUDDLE, DEBRIEF• CUS• TEACHBACK (HEALTH LITERACY TOOL)• CHECKBACK

Shared Mental ModelThe perception of, understanding of, or

knowledge about a situation or process that is shared among team members through

communication."Teams that perform well hold shared mental models."

(Rouse, Cannon-Bowers, and Salas 1992)

SBAR

Introduce Situation Background Assessment Recommendation

Brief

Who is on the team?Agree on Goals

Roles & Responsibilities

Understood

Plan of CareAvailability

Access Resources

Huddle

Problem-solvingReview situation Discuss new &

emerging events

Anticipate outcomes & possibilities

Assign resourcesExpress Concerns

DebriefCommunicate clearly

about eventGo over detailsWere roles &

responsibilities understood?

What went wellWhat should change

Can we improve?

Continuous Communication

CUS• I am Concerned• I am Uncomfortable• There is a Safety issue

Teachback• Confirmation of

understanding• Opportunity to correct

miscommunication• Comprehensive:“Tell me in

your own words…”

Checkbackhttp://www.youtube.com/watch?v=AKtNLP8jQ7s

CASE EXAMPLE

What are the risks in this scenario?• What communication was missed?• How would an interpreter or community

health worker improve safety, quality and outcome?

• Describe an alternative scenario.

Interprofessional Collaborative Practice

“Health care delivered by well-functioning coordinated teams leads to better patient and family outcomes, more efficient health care services, and higher levels of satisfaction among health care providers. We all share the vision of a U.S. health care system that engages patients, families, and communities in collaborative, team-based care.”

Dr. Mary K. Wakefield, HRSA

WHY IT MATTERS