Developing leadership in rural interprofessional palliative care teams

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  • Developing leadership in rural interprofessional palliativecare teams

    PIPPA HALL1,2, LYNDA WEAVER1, RICHARD HANDFIELD-JONES2, &

    MARYSE BOUVETTE1

    1SCO Health Service, Ottawa, and 2Department of Family Medicine, University of Ottawa, Ottawa,

    Ontario, Canada

    AbstractThis project brought together community-based practitioners and academics to develop and deliverinterventions designed to enhance the leadership abilities of the designated leaders of seven rural/smalltown-based palliative care teams. Members of these community-based teams have already gainedrecognition for their teams leadership and service delivery in their communities. All of the teams hadworked closely with most members of the academic team prior to this project. The team membersparticipated in a needs assessment exercise developed by the Sisters of Charity of Ottawa HealthService and University of Ottawa academic team. Results of the needs assessment identified leadershipqualities that had contributed to their success, as well as their needs to further enhance their individualleadership qualities. The team effort, however, was the most important factor contributing to thesuccess of their work. The interventions developed to address the identified needs had to be adaptedcreatively through the collaborative efforts of both the community and academic teams. Theeducational interventions facilitated the integration of learning at the individual and community levelinto the busy work schedules of primary health care providers.

    Keywords: Leadership, interprofessional practice, palliative care, education

    Introduction

    In 1994, Ontario implemented an educational initiative to improve palliative care services

    across the province. The Sisters of Charity of Ottawa (SCO) Health Services Palliative Care

    Program (which is affiliated with the University of Ottawa as a teaching site), was given the

    mandate for these educational initiatives for an area of Eastern Ontario from Deep River to

    the Quebec border. This region is commonly referred to as the Champlain District. The

    Province of Ontario recently regionalized health care management; this district is now

    served by the Champlain Local Health Integrated Network (LHIN). The mandate

    included the development of a consultation resource for health care professionals and

    informal caregivers (called the Pain and Symptom Management Team) and a mandate for

    physician palliative care education. Palliative care requires interprofessional collaborative

    teamwork in order to deliver the best quality of care to terminally ill patients and their

    families (Canadian Hospice Palliative Care Association [CHPCA], 2002). In rural areas,

    Correspondence: Pippa Hall, MD, CCFP, MEd, FCFP, Program Director, Palliative Medicine Residency Program, SCO Health

    Service, Ottawa, Associate Professor, Department of Family Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N

    8H5, Canada. Tel: 1 613 562 4262 ext 4014. Fax: 1 613 562 6371. E-mail: phall@scohs.on.ca

    Journal of Interprofessional Care,

    June 2008; 22(S1): 73 79

    ISSN 1356-1820 print/ISSN 1469-9567 online 2008 Informa Healthcare USA, Inc.DOI: 10.1080/13561820802028337

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  • few resources exist to develop teams providing only palliative care, and the primary health

    care providers must learn the knowledge, skills and attitudes necessary to provide high

    quality palliative care. This includes learning to collaborate and integrate these approaches

    into their busy primary care practices. Through a series of innovative community-based

    initiatives, strong relationships were formed between the rural communities and the SCO

    Health Service Palliative Care Program, which resulted in outcomes to improve the care of

    the terminally ill in those communities (Hall et al., 1999; Hall 2001).

    An important outcome of this ongoing work together was the development of

    identifiable health care provider teams in eight rural communities. In 2000, the SCO

    Health Service Palliative Care Educational Team shifted their strategy from educators to

    facilitators; they began to facilitate these rural teams to enable them to be the drivers for

    their local educational initiatives, called Community Educational Projects (CEPs). Each

    team identified the needs of its community, established goals and objectives, developed an

    education intervention that suited their local community, and then implemented and

    evaluated it. These projects resulted in innovative and successful community-based

    projects, which have continued to evolve since 2000. In addition, the team members were

    recognized as local experts and leaders for palliative care in their communities, becoming

    advocates for the care of the terminally ill through involvement with committees and social

    action groups.

    The CEP teams formed naturally from among the complementary health care providers in

    their various roles working in their communities. However, leadership of the teams had

    never been formally examined. Though there had not been any significant problems with

    leadership, it occurred to the SCO Health Service Palliative Care Educational Team that

    defining possible leadership models and enhancing leadership abilities would be helpful for

    the teams to work effectively and to continue influencing their communities.

    This project was conducted as part of a national multi-centred project called Issues of

    Quality and Continuing Professional Development: Maintenance of Competence (or

    CPDiQ), as described elsewhere in this supplement. Funded by Health Canada, this project

    fostered a network of faculty members interested in interprofessional health education

    across the 16 Canadian medical schools. This paper describes project at the University of

    Ottawa, designed to explore leadership in the CEP teams, including finding ways to enhance

    the skills of those in leadership roles.

    Methods and activities

    The principal goal of the Ottawa CPDiQ project was to develop and deliver interventions

    designed to enhance the leadership abilities of the designated leaders in the CEP teams. This

    was to be achieved by conducting a needs assessment on leadership issues to determine their

    experience with interprofessional team work, to explore their perceptions of their roles as

    leaders, and to assess what kinds of leadership skills they believed needed to be developed.

    The subsequent objective would be to develop appropriate educational interventions. The

    project had three phases:

    (1) Needs assessment

    The eight CEP teams were invited to participate in the Needs Assessment. Focus groups

    were held in 20042005 with each of the seven CEP teams who agreed. Notes were taken at

    the focus group sessions, and reviewed with group before the session ended. The data was

    then merged and content-analyzed for common themes and issues.

    74 P. Hall et al.

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  • (2) Goals and objective development

    Based on the results of the focus group, suggested educational goals and objectives were

    developed by the project team, in 2005.

    (3) Intervention delivery

    A menu of educational options to achieve the goals and objectives was developed by the

    project team. The results of the needs assessment, the goals and objectives and the

    educational options were then presented to all the CEP teams via videoconference in the fall

    of 2005.

    Outcomes and results

    Seven of the eight CEP teams participated in all three phases. The number of participants in

    each focus group varied, based on the membership of the team, ranging from a minimum of

    two (nurse-doctor dyad) to six (two physicians, nurse, pharmacist, long-term care

    representative, spiritual care professional). Other teams also included representation from

    recreational therapists, occupational therapists, physiotherapists, health care administrators,

    home care case managers and representatives from nursing agencies. The non-participating

    team had completed their earlier project by 2005, presented their results, and several team

    members had moved away before this new project had started.

    The content analyses of the focus group data led to a clear identification of the successes

    and challenges experienced by the teams, and some needs for educational interventions by

    team members.

    The specific factors contributing to the success of their CEP teams included:

    (1) There was no specific Team Leader, but different leaders for different tasks,

    according to the demands of the task. Generally, leadership was shared.

    (2) Though there was no single leader, an administrative coordinator with paid protected

    time was considered essential. This person was responsible for coordinating the

    teams activities, including organizing team meetings (e.g., scheduling, agendas,

    minutes), insuring important ta