December 7, 2004

Leaders’ Forum on Interdisciplinary Collaboration In

Primary Health Care

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Canadians Expect…

• Access to services 24 hours a day/seven days a week;

• Services delivered in community non-hospital settings;

• More emphasis on prevention and health promotion; and

• Better continuity of care and chronic disease management.

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Canadian Coalition on Enhancing Preventative Practices of Health Professionals

Health Professional Organizations all on the same page…

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EICP Objectives

• To develop a set of Guiding Principles and a Framework to enhance interdisciplinary collaboration in Primary Health Care (PHC);

• To have the Principles and Framework broadly supported by PHC practitioners, as evidenced through ratification by the national organizations; and

• To support the national organizations and other stakeholders in the implementation of the Principles and Framework.

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Initiative Commitments

•INCLUSIVE•INDEPENDENT•TRANSPARENT •ACCESSIBLE

• RESPECTFUL• EVIDENCE-BASED• RESPONSIBLE• FLEXIBLE

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Project Life Cycle

Established office Engage staff Finalize Research,

Communication, Change Management and Evaluation Plan

Finalize Work Plan Final contract

negotiations

Development of P & FW

Review, Validation, and Testing

Finalization of P & FW

Development of Implementation Strategy, tools and workshops

Adoption of P & FW Launch Event

Evaluation Report Final Project Report Office shut down

Gathering background/ context information

Research reports Group Consultations Regional Workshops Barrier/Enabling

Task Force Groups Stakeholder

Workshop

Development & Implementation

ResearchInitiation & Planning Closure

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A Framework That Fits

Changes in Primary Health Care

Research Communication Evaluation

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Individual Providers &

Health ServiceOrganizations

Policy Context

Public Health &

Social Context

Individuals & Families

Conceptual Framework

Definition, objectives,examples in Canada, cost-effectiveness, impact on patient/client outcomes.

PHC structures, providers’ payment

mechanisms, liability and regulatory frameworks,

PHC reform.

Attitudes and perceptions, quality of life, job satisfaction,

continuing education, operational issues.

Population health, public access to PHC

services, public perception of IDC and

PHC.

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EICP Communications

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Evaluation Framework

EVALUATION FACTORS: (to be agreed on)Outcomes Achievement • Progress on immediate, intermediate

outcomes• Cost effectiveness• Unintended outcomesProject Performance • Management and financial performance Success Factors (from project charter)• Inclusiveness, independent• Transparent, respectful• Evidence based, responsible• Appropriateness, relevance

Engage Stakeholders

Design Evaluation

Component

Develop Instruments

Gather Credible Evidence

Justify Conclusions

Ensure Useand Share

Lessons Learned

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Change Commitment CurveVIII. Internalization

VII. Institutionalization

VI. Adoption

V. Installation

IV. Positive Perception

III. Understand the Change

II. Awareness of Change

I. Contact

Unawareness

Confusion

NegativePerception

Decision not to Attempt/

Support Installation

Change Aborted After

Initial Utilization

Change Aborted After

Extensive Utilization

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Research Reports

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Enhancing Interdisciplinary Collaboration in Primary Health Care in

Canada• Successful collaboration has the following

characteristics:• Client focus and evidence based;

• Shared vision;

• Trust and mutual support;

• Effective communication and learning; and

• Clear roles and responsibilities.

• Successful models depend on• A supportive organizational structure; and

• The interpersonal traits of team members.

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Providers and Organization ReportAttitudes and Perceptions of IDC

• Personal motivation and commitment are critical;• Practicing collaboratively can lead to higher work

satisfaction;• Inter-professional tensions can develop from a lack

of understanding of the professional identity of others;

• Team effectiveness is enhanced when discrepancies in status and power are minimized; and

• Grassroots involvement in the planning of collaborative initiatives has resulted in successful outcomes.

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Providers and Organization Report:Organizational Factors

• Co-location is preferable, virtual networks show some success;

• ‘Team’ approach requires structured learning activities;

• Face to face Communication is critical in the start-up phase;

• Electronic health records are vital; and• ‘Measuring’ collaboration is critical to

accountability.

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Public Health and the Social Context for Interdisciplinary Collaboration Report

• Chronic diseases is threatening the sustainability of the Canadian health system;

• Only 50–60 per cent of patients with chronic diseases are receiving appropriate evidence-based interventions;

• Integrated, interdisciplinary teams of PHC providers resulting in improved outcomes; and

• The highest health status in the world and the highest quality of care should be the vision for a redesigned primary health care system.

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Canadian Policy Context Report: Interdisciplinary Collaboration in Primary

Health Care

• Regulatory silos exist, which require legislative action for change to move forward;

• Role and boundary blurring between providers may have potential implications for liability concerns;

• Resource allocation and payment methods remain a major part of collaboration and primary health care reform; and

• IDC requires governments to make necessary financial commitment, and providers who are willing to switch to publicly financed positions.

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Canadian Policy Context Report: Interdisciplinary Collaboration in Primary

Health Care• Health care professional associations need to

have a unified ‘voice’ to counter pressures about pharmaceutical expansion and wait list concerns and support interdisciplinary collaboration.

• Future funding of interdisciplinary collaborative primary health care teams will likely require the creation of intermediary organizations between providers and governments/health authorities.

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Common Themes in Reports

Principles of IDC:• Trust and respect• Communication soft

skills• Visionary leadership• Team approach• 24/7 access• Health

promotion/population health approach

Framework Elements:• Organizational

structure (diverse models)

• Funding aspects• Electronic health

records• Liability and

regulatory issues• Health human

resources

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Leaders’ Forum Objectives• Provide an opportunity for Board members to

learn and share perspectives on the EICP Initiative;

• Update, discuss and rework the EICP Principles and Framework with Board members;

• Discuss the Root Causes and Critical Actions Required to Achieving Interdisciplinary Collaboration in Primary Health Care; and

• Review the Principles and Framework ratification process and the challenges required to develop commitment.

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Expectations

My principal objective for this session is…

________________________________________________________________________________________________

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All I Really Needed to Know – I Learned in Kindergarten

• Share everything• Play fair• Don’t hit• Put things back• Say sorry when you

hurt someone• Clean up your own

mess • Flush

• When you go out in the world, watch out for traffic, hold hands and stick together

R. Fulghum

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Introductions at your Tables

• Your name• Practice/

professional/work setting

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Review of the Principles and Framework for Interdisciplinary Collaboration in

Primary Health Care

Two rounds of conversation

• Round # 1–– Interdisciplinary Collaboration Principles

• Report Back• Round # 2— Framework

Elements• Report Back• Synthesizing what we heard

– after lunch

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Reviewing the Principles of Interdisciplinary Collaboration

Round # 11. Based on the research, your experience and

what you heard today, what stands out for you in the Principles of Interdisciplinary Collaboration?

2. What do you like and what concerns you?

3. What one or two modifications would your table group suggest? – add, delete, or change.

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Reviewing the Framework for Interdisciplinary Collaboration

Round # 21. Based on the research, your experience and

what you heard today, what stands out for you in the Framework Elements of Interdisciplinary Collaboration?

2. What do you like and what concerns you?

3. What one or two modifications would your table group suggest? – add, delete, or change.

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Synthesizing our Conversations

Does this synthesis reflect your discussions this morning?

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Selected Framework Elements

• Funding

• Liability

• Regulations

• Health records

• Health human resources

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Moving Towards the Future of Interdisciplinary Collaboration in Primary

Health Care

• What are the underlying root causes associated with your groups framework element?

• For each framework element identify up to 6 – 8 root causes and indicate their importance (I/VI)

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What You Will Return with to the Group Session

DESCRIPTION OF THE UNDERLYING CAUSES, OF THE FRAMEWORK ELEMENTS

I/VI

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How to think about the work…

Lack of funding Poorly prioritized budgets

Privacy legislation Inconsistency across jurisdictions

Challenge Root Cause

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Moving Towards the Future of Interdisciplinary Collaboration in Primary

Health Care

What are the critical actions required to overcome the challenges associated with your groups framework element?

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What You Will Return with to the Group Session

DESCRIPTION OF THE CRITICAL ACTIONS REQUIRED…

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Moving Towards the Future

What do you need to move the Principles and Framework forward in

your community?

What can EICP do to help?

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