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Leading Change Collaboratively: Enhancing Interprofessional Practice
and Patient-Centred Care
National Health Leadership Conference June 10, 2013
Collaborative Leadership Initiative
• Background
• Overview
• Evaluation
– Outcomes
– Critical Success Factors
• Next Steps
• Parting Thoughts
Background
• Interprofessional Practice (IPP) has positive impacts on the health care system and those in it
• Health care professionals working in teams does not necessarily ensure collaborative practice
• With this in mind the Collaborative Leadership Initiative (CLI) was developed and piloted at St. Joseph’s Care Group (SJCG), Thunder Bay, ON
Interprofessional Practice
Occurs when practitioners from two
or more professions work together with a
common purpose, commitment and mutual respect
(World Health Organization, 2010)
CLI Overview – Purpose
For clinical teams to discover "the best of
what is" around interprofessional
practice and create opportunities to
enable it to occur more frequently
Goals
CLI Goals
Improve team
function & processes
Improve patient-
centred care
Improve staff satisfaction
Achieve project
sustainability
Participants
• Three clinical teams:
– Acquired Brain Injury
– Adult and Older Adult Rehabilitation
– Day Hospital
• All teams consisted of six or more professions, and included the manager
Clinical Team Sessions
• Each team, including the manager, participated in three sessions, facilitated by the project leads
• Sessions were
– Three hours in length
– Occurred over 3-5 months
– Designed and delivered using Appreciative Inquiry and emergent change methodology
Appreciative Inquiry (AI)
Is a group process that inquires into, identifies, and further develops the best of ‘what is’ in
organizations in order to create a better future
(Preskill & Tzavaras Catsambas, 2006)
Appreciative Inquiry
• Purposely positive / generative
• Builds on past successes
• Grass roots and top down
• Highly participative
• Nurtures a positive inner dialogue
• Stimulates vision and creativity
• Accelerates change (Cooperrider et al, 2008)
Appreciative Inquiry – 4 D Model
Discover
Dream
Design
Destiny
(Preskill & Tzavaras Catsambas, 2006)
Emergent Change Theory
• Change that unfolds in an apparently spontaneous and unplanned way
• Flexible and adaptive to re-navigate
• Usually a grass roots change
(Collaborative Change Leadership Faculty, 2009)
Overview – Clinical Team Sessions
Session 1
Reflected on IPP at its
best
Session 2
Envisioned ways to
enhance IPP
Session 3
Designed goals and action
plans based on emerging themes
Post-sessions
Teams collaboratively led meaningful and sustainable
change
IPP – Interprofessional Practice
Evaluation
• Qualitative data collection was completed six months
following the final facilitated session, and consisted of:
– Team interviews
– Paired interviews
– Managers’ interview
– Individual anonymous questionnaire
• Design – considered if there was a difference as well as
how the difference had been achieved
Evaluation
All teams led change collaboratively, developing and implementing goals that enhanced
interprofessional practice while achieving the project goals to:
Improve team function & processes
Improve patient-centred care
Improve staff satisfaction
Achieve project sustainability
Outcomes
Improved patient-centred care
– Enhanced patient and family involvement in care plans and program development
– Follow-up clinic created
– Interprofessional documentation developed
– Patient pamphlets revised
– Improved environment
“The follow-up clinic is allowing us to see clients that we normally
wouldn’t be able to... the ones that live out of the region.”
Outcomes
Improved team function, processes and engagement
– Increased trust, pride, collaboration, communication and understanding of roles and responsibilities
– Employee orientation revised
– Team norms established
– Daily huddles created
“The CLI has been incredibly valuable in supporting team growth and development, with a closer, more respectful team; with improved
communication, client care has greatly improved. We now have more skills to further develop as a team and continue to improve.”
Outcomes
Improved staff satisfaction
• Increased:
– Morale
– Respect
– Pride
– Excitement
– Energy
“The CLI enhances job satisfaction, flow of programs, client care… you
feel like you want to come to work… you make positive changes.”
Outcomes
Project sustainability
• Team members:
– Valued IPP
– Expressed a strong interest in and commitment to engage in ongoing quality improvement
– Were empowered and recognized themselves as change leaders
“I think we have more skills and strategies to use now going forward, but
just that awareness of change and the opportunity of change I think is greater
in this group… and you know, the willingness to change... we can look to
be better and ultimately for our clients.”
Critical Success Factors
1. Clear, common team direction – by developing realistic team goals collaboratively
2. Sense of accomplishment – by achieving team goals together
3. Engagement – to create change leaders within and beyond the project
4. Effective change model – Appreciative inquiry and emergent change
5. Facilitators 6. Time to meet
Critical Success Factors
1. Clear, common team direction – by developing realistic team goals collaboratively
“It’s a much stronger process when we can do it as a team, when everybody’s on board, when everybody’s working
towards the same goal”
Critical Success Factors
2. Sense of accomplishment – by achieving team goals together
“I felt it was certainly a ‘team’ effort; working
together to reach goals was very rewarding”
Critical Success Factors
3. Engagement – to create change leaders within and beyond the project
“Attitudes towards change (have improved)…we’re taking better advantage of opportunities that present themselves for change”
Critical Success Factors
4. Effective change model – Appreciative inquiry and emergent change
“…the focus is on the solutions,
not on the issues”
“(AI) recognizes that we’re not approaching change as a
remediation or deficit”
Critical Success Factors
5. Facilitators
“…in the room when everybody was talking and the way the facilitation was happening, it was amazing to see the team work together as this moving
unit… It doesn’t just happen, it needs to be fostered and it needs
to be worked at”
Critical Success Factors
6. Time to meet
“It got everyone together in the same place, at the same time, and
for a single purpose – It created the space in an otherwise
scheduled work day, to reflect and brainstorm something new”
Next Steps – Program Expansion
• 9-12 clinical and non-clinical teams in 2013-14 • Purpose: For teams to enhance collaborative teamwork
and create opportunities to enable it to occur more frequently
• Approach: Appreciative Inquiry and emergent change • Structure: One manager prep session; Three half day
team sessions (including managers), once monthly, over three consecutive months
• Evaluation – Quantitative – Pre/Post (6 months post) staff satisfaction
survey and Bruyѐre Team Self-Assessment Scale – Qualitative – Questionnaire (immediately and 6 months
post)
Parting Thoughts
When looking to lead change, consider the following:
• All staff, regardless of title, have the potential to contribute to and become leaders of change
• The organizational development methodology / change model matters… and will affect success
• Natural facilitators exist within organizations and can be highly effective in advancing change
• Creating the time and opportunity for key stakeholders to collaborate towards change in a meaningful way can improve ownership and sustainability of change
Audacity to imagine helps push the boundaries of possibility
Success will be great if we dare to overcome fear and take a risk
Bertrand Picard
Adora Svitak
Questions…
Thank you
Michelle Addison Professional Practice Leader, Physiotherapy St. Joseph’s Care Group, Thunder Bay, ON
Special Thanks Linda Belcamino, Manger Learning and Professional Practice
Meaghan Sharp, VP Complex Care and Physical Rehabilitation Services & CNO Acquired Brain Injury Program
Adult and Older Adult Rehabilitation Programs Day Hospital Program
Interprofessional Working Group
References Collaborative Change Leadership Faculty, Centre for Interprofessional
Eduction, University of Toronto, 2009.
Cooperrider, D., Whitney, D., Stavros, J. (2008). The Appreciative Inquiry Handbook: For Leaders of Change. Brunswick, OH, USA: Crown Custom Publishing.
Preskill, H. & Tzavaras Catsambas, T. (2006). Reframing Evaluation Through Appreciative Inquiry. Thousand Oaks, CA, USA: Sage Publications
World Health Organization. (2010). Framework for Action on Interprofessional Education & Collaborative Practice. Health Professions Networks Nursing and Midwifery Human Resources for Health. Retrieved March 27, 2012 from http://www.cihc.ca/files/Framework%20for%20Action%20on%20Interprofessional%20Education%20and%20Collaborative%20Practice.pdf