Office of Interprofessional Education and Practice Integrating Health Sciences Across the Continuum Advancements in Interprofessional Education C. Schroder,

Office of Interprofessional Education and Practice Integrating Health Sciences Across the Continuum

Advancements in Advancements in Interprofessional EducationInterprofessional Education

C. Schroder, A. Aiken

Health Sciences Education Rounds

March 6, 2008

Office of Interprofessional Education and Practice

Overview of presentation•Language & definitions

•Linking education and practice

•Proposed benefits

•Historical context

•Theories grounding IP education and practice

•Implications for Queen’s


LanguageSUFFIXES

““Professional”, “Disciplinary”Professional”, “Disciplinary”

Discipline = subject that is taught, field of study

Profession = a calling requiring specialized knowledge and often long and intensive academic preparation

… the use of “ProfessionalProfessional” makes it clear that individuals from different health professions are

included


LanguagePREFIXES

““Multi”, “Inter”, “Trans”Multi”, “Inter”, “Trans”

Multi = partners working independently or in parallel towards a purpose

Inter = partners from different domains work collaboratively towards a common purpose

Trans = role blurring/doing tasks outside normal professional role OR IP teams functioning at high level of synergy


Interprofessional Education (IPE)

DEFINITION

““occasions when two or more occasions when two or more professions learn with, from and professions learn with, from and about each other to improve about each other to improve collaboration and the quality of care”collaboration and the quality of care”

(CAIPE, modified)(CAIPE, modified)

Interprofessional Education

UNI MULTI INTER

(separate) (in parallel) (between)

Evolves toward integration of all components of “with, from and about” into learning experience.

Continuum of learning


Interprofessional Care (IPC)

DEFINITION

““The provision of comprehensive The provision of comprehensive health services to patients by health services to patients by multiple HCPs who are trained to multiple HCPs who are trained to work collaboratively to deliver the work collaboratively to deliver the best quality of care in every health best quality of care in every health care setting.” care setting.” (Summit Document, 2006)(Summit Document, 2006)


Linking IPE and IPCInterprofessional Education for Collaborative Patient-Centred Practice (IECPCP) Framework (D’Amour & Oandasan, 2004)

Two linked circles (“2 CD” model)

1.Education – factors that affect HCP learner’s capacity to become a competent collaborative practitioner

2.Practice – processes and factors that affect patient care outcomes in collaborative practice settings


Linking IPE and IPC

Distinction in the framework between the two fields “provides an opportunity for stakeholders like the government, licensing bodies, hospital and academic institutional leaders, educators, learners, health professionals, and the public, to examine the factors that influence specific outcomes of both fields while acknowledging their interdependence”.


Proposed Benefits IPE & IPC•Improved patient care/outcomes/satisfaction

•More efficient work/practice environment

•Better health care resource utilization

•Reduction in clinical error

•Improved provider satisfaction

•Reduction in staff shortages


IPE: Effects on professional practice and health care outcomes

Scott Reeves et al. 2007 Cochrane review

•Update to 1999 review

•6 studies: 4 RCT, 2 CBA

•4 positive outcomes: ER culture, patient satisfaction, collaborative team behavior, clinical error rate; management care delivered to domestic violence victims; mental HP competencies related to deliver patient care

• 2 mixed (positive & neutral), 2 no impact


IPE: Effects on professional practice and health care outcomes

CONCLUSIONS

•6 studies compared to none in 1999

•Some positive outcomes but not possible to draw generalisable inferences because of small numbers, heterogeneity of interventions, methodological limitations

•Need more rigorous studies that include data collection strategies that provide insight into how IPE affects changes in health care processes and patient outcomes


IPE: Historical Perspective

INTERNATIONAL CONTEXT

World Health OrganizationWorld Health Organization

19731973 Expert Committee reviewing medical education

•IP and traditional programs complementary

1978 1978 IPE entrenched in WHO strategy to promote “Health for All by the year 2000”



INTERNATIONAL CONTEXT

United KingdomUnited Kingdom

1970’s1970’s IPE initiatives developed in response to emphasis on community care and development collaborative models of delivery

1987 1987 Centre for the Advancement of Interprofessional Education (CAIPE) founded



CANADIAN CONTEXT – NationalNational

20012001 Caring for Medicare: Sustaining a Quality System (Fyke)

20022002 Study on the State of the Health Care System in Canada (Kirby)

20022002 The Commission on the Future of Health Care (Romanow)




“if health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement”

(Romanow)




20032003 First Minister’s Accord on Health Care Renewal

20032003 Interprofessional Education for Collaborative Patient-Centred Practice (IEPCPC)

•National Expert Committee

•20+ million dollars in funding through Health Canada

•QUIPPED

•EFPPEC

•Canadian Interprofessional Health Collaborative (CIHC)



IECPCP Outcomes by March 31, 2008IECPCP Outcomes by March 31, 2008

•Increased understanding of IP collaborative practice

•Improved sharing of best practices

•Increased use well functioning IP teams

•Increased access to appropriate provider at appropriate time

•Decreased wait times in critical areas of health care system



CANADIAN CONTEXT – OntarioOntario

20062006 Summit on Advancing IP Education and Practice

• Priorities and actions within health care and education systems to ensure ready access to quality health care services and protect sustainability of system and its workforce



CANADIAN CONTEXT - OntarioOntario

“We know that IP collaboration is key to providing the best in patient care. That means we need to ensure our health and human services students gain the knowledge and skills they need through IPE that begins at the earliest stages of their schooling. This is why Ontario has made IPE and IPC a cornerstone of their new health human resources plan. A cornerstone that will support health providers and patient for years to come.” (Dr. Joshua Tepper , ADM MOHLTC)




2006 2006 Funding through MOHLTC and MTCU for IPE, Mentorship, Leadership, Preceptorship and Coaching Fund

•Mentoring MD/APN Dyads in PC

•Seed funding Mental Health

•Seed funding Ontario Collaborative

•AHSC infrastructure funding- OIPEP




20072007 Blueprint for Advancing IP Care in Ontario (MP)

20072007 Combined funding MOHLTC/MTCU – ICEF

• The Southeastern Interprofessional Collaborative Learning Environment (SEIPCLE)

• The Ontario Collaborative

• Mentoring IP Primary Health Care Teams in Collaborative Palliative Care Practice

• Centre for Interprofessional Mental Health Education and Care

• Primary Care Consulting Program (ID)


Theories relevant to IPE & IPC

Scott Reeves et al. 2007 Scoping Review

•Funded by QUIPPED and Calgary Health Region’s IECPCP project

•Identified & described 35 theories in literatures currently applied to IPE/C

•Identified & presented 33 additional theories with potential to inform IPE/C not as yet employed in IP context


Theories used in IP literature

Perspectives:Perspectives:

1. Social psychology (12)

2. Sociology (7)

3. Adult learning (4)

4. Systems (5)

5. Psychodynamic (3)

6. Organizational (3)


Theories used in IP literature: examples

Social psychologySocial psychology

• Contact theory (Allport)

SociologySociology

• Discourse, surveillance theories (Foucault)

Adult LearningAdult Learning

• Reflective learning (Schön)

• Experiential learning (Kolb)


Theories used in IP literature: examples

SystemsSystems

• Complexity theory (Cooper)

PsychodynamicPsychodynamic

• Social defence (Menzies)

OrganizationalOrganizational

• Organizational learning (Argyris & Schön)


Theories suggested as relevant

Focus:Focus:

1. Individual (9)

2. Team/group (13)

3. Organizational/system (11)


Theories suggested as relevant: examples

IndividualIndividual

• Active learning

Team/groupTeam/group

• Collaborative/cooperative learning

Organizational/systemOrganizational/system

• Unfreeze – Change – Refreeze


IPE: Key questions to address

What?

When?

How?

Where?

UNITS OF COMPETENCY

KEY ELEMENTS OF COMPETENCIES FOR HEALTH CARE PROFESSIONALS

Medicine Nursing Physiotherapy Occupational Therapy

ProfessionalIncluding health

advocate

Deliver highest quality of care with integrity, honesty and compassionExhibit appropriate personal and interpersonal professional behavioursPractise medicine ethically consistent with obligations of a physician

Advocates for clients or the client's designated representatives, when the client is unable to advocate for self

Supports professional efforts in nursing to achieve a healthier society

Reports situations which are potentially unsafe for clients and health team members

Demonstrate professional integrity and a commitment to the well-being of all clientsModels professional practice incorporating service delivery, education, research and managementAddress issues of client and provider safety in all aspects of practice

Maintain essential competencies of practice and act with professional integrityPractice within scope of professional and personal limitations Adhere to the code of ethics and take action to report unsafe, unethical or incompetent occupational therapy practice

Expert

Demonstrate diagnostic and therapeutic skills for ethical and effective patient care Access and apply relevant information to clinical practice Demonstrate effective consultation services with respect to patient care, education and legal opinions

Utilizes knowledge and expertise in health promotion, disease prevention and epidemiology to provide information to a range of stakeholders

Evaluates the effectiveness of nursing interventions, including learning plans, by comparing actual outcomes to anticipated outcomes

Makes a physiotherapy diagnosis applying theory and practice

Demonstrate an integration of occupational therapy skills with current theory and relevant supporting scientific knowledgeDemonstrate awareness of socio-cultural and economic environment of jurisdiction of practice

Scholar

Develop, implement and monitor a personal continuing education strategy Critically appraise sources of medical informationFacilitate learning of patients, house staff/students and other health professionalsContribute to development of new knowledge

Uses evidence-based knowledge from nursing, health sciences and related disciplines to select and individualize nursing interventions

Critically appraises research evidence and applies relevant findings to the care of clients

Seeks opportunities for professional growth which enhance competence.

Incorporate service delivery, education, research and managementEvaluate the effectiveness of overall service and make appropriate adjustmentsGuide human resources involved in the delivery of physiotherapy services including volunteers, students and paid personnelCollects quantitative and qualitative data relevant to client's perceived needs and to physiotherapy practice

Demonstrate sound clinical and professional judgement consistent with accepted models of practiceEngage in reflection and evaluation and integrate findings into practiceDemonstrate responsible decision-makingFormulate, articulate and demonstrate sound clinical reasoning

Manager

Utilize resources effectively to balance patient care, learning needs and outside activitiesAllocate finite health care resources wiselyWork effectively and efficiently in a health care organizationUtilize information technology to optimize patient care, life-long learning and other activities

Provides direction to unregulated care providers, evaluates clients' responses to care provided by UCPs and contributes to the performance evaluation of UCPs

Exercises acountability for decisions which are delegated to others.

Participates in analyzing, developing, implementing and evaluating nursing practice and policy in the workplace

Use available physical, material and financial resources as required for safe and cost-effective physiotherapy practiceImplement the physiotherapist's role and physiotherapy services with an understanding of the comprehensive health system

Utilize and/or refer to reasonable and appropriate resources to support client needsUnderstands and negotiates roles and responsibilities appropriate to the occupational therapy service with clients and stakeholders

Communicator

Establish therapeutic relationship with patients/familiesObtain and synthesize relevant history from patients/families/communities and listen effectivelyDiscuss appropriate information with patients/families and the health care team

Employs a range and variety of communication skills appropriate to various clients

Selects appropriate media and learning strategies to meet client learning needs

Selects methods of communication which are appropriate to client circumstances and needs

Facilitate informed client decision makingRespect the client's health service needs and goals before other factorsRecord and provide appropriate access to accurate information about the client and servicesMaintain client confidentiality

Maintain a professional relationship in all communicationsUse client-centred principles in the communication processDemonstrate timely and effective communicationMaintain confidentiality and security in the management of information

Collaborator

Consult effectively with other physicians and health care professionals

Contribute effectively to other interdisciplinary team activities

Collaborates with clients to develop a plan of care

Collaboraties with other health related sectors to achieve client health outcomes

Collaborates as a member of an interdisciplinary health team

Communicate effectively with clients, relevant others and colleaguesDemonstrate effective collaboration and interdisciplinary teamwork

Identify and communicate with key individuals, organizations and groups Respect and consider the information and opinions of clients and colleagues

IPE involves collaboration in the learning process to:

– Socialize professionals in working together, in shared problem solving and decision making towards enhancing the benefit for patients, and other recipients of services

– Develop mutual understanding and respect for the contributions of various disciplines

– Instill the requisite competencies for collaborative practice (communication, negotiation, etc.)


IPE: What, when, how, where?

Core Competencies for IPCCore Competencies for IPCKnowledgeKnowledge

• Roles, responsibilities

Skills/BehavioursSkills/Behaviours

• Communication, Reflection, Cooperation, Conflict Management

AttitudesAttitudes

• Mutual respect, trust, willingness to collaborate


IPE: What, when, how, where?

1. Pre-licensure, post-licensure

2. Mandatory, elective

3. Content & IP objectives together or IP objectives alone

4. Explicit, implicit

5. Classroom, Simulation, Practice setting


IPE: Barriers, Challenges, Opportunities

MACROMACRO Level - National/Political Organizational

Need for senior management and government political support

• Accreditation, regulatory, and licensing bodies

• University funding: flexibility of finances and HHR

• Professional associations - liability

• Compensation for educators/clinicians


Queen’s Enablers

MACROMACRO Level - National/Political Organizational

• Government support: IECPCP, Blueprint, MOHLTC/MTCU

• QUIPPED, 5 ICEF grants, OIPEP

• Primary care reform (FHT)

• Organizations: CIHC, NaHSSA, Ontario Collaborative

• Provincial work groups developing core competencies & curriculum, accreditation



MESOMESO Level – University/Medical Organization

Administrative challenges for learners and faculty that affect teaching environment and role of local leaders

• Scheduling: e.g. timing of IPE approach (early, late)

• Logistical obstacles: inequality number of learners; divergent learning/assessment styles; different curricular periods; limited resources; space; considered an add-on; lack of administrative support; lack of value


Queen’s Enablers

MESOMESO Level – University/Medical Organization

• FHS (Medicine, Nursing, Rehabilitation)

• QUIPPED initiatives (learner, faculty) - momentum

• OIPEP funded until March 2009

• Adoption OIPEP vision statement at FHS Faculty Board – administrator support, leadership

• OIPEP management and steering committee – broad stakeholder group - address logistical obstacles



MICROMICRO Level – Learner/Faculty

• Attitudinal/behavioural: hidden curriculum

• Stereotypes

• Learning environment – individual, cooperative

• Professional readiness for IPE


Queen’s Enablers

MICROMICRO Level – Learner/Faculty

• Student advocates – readiness

• Faculty champions

• Faculty development – IPTL

• Model collaborative teams

• Learning environment – CEC, IP placements, simulation – hospital, community, local, regional


Implications for Queen’s

• Need to sustain momentum created by QUIPPED – initiatives, faculty development

• Maintain infrastructure support for OIPEP to ensure its Vision is realized

• All health professional schools promote and support Interprofessional Education (IPE).

• Common IPE competencies have been identified for medicine, nursing and rehabilitation therapy.

• IPE is integrated throughout the core curriculum .• All students have opportunities each year to participate in IPE

activities through simulations, the Clinical Education Centre, or in clinical settings.”



• Develop a IPE framework for Queen’s FHS that considers barriers, theories, and links education with practice

• Develop variety of IPE opportunities including classroom, CEC, simulation lab, placements for learners

• Develop variety of IPE opportunities for faculty specific to interests and education roles

• Support/develop IP teams in all settings to model IPC

• Highlight “value” of IPE – space, student stipends, awards, faculty promotion, scholarship



• Support for Queen’s IPE leaders (students, patients, faculty) to continue their provincial & national involvement on work groups, OC, CIHC, AHSC, NaHSSA

• Mandate to contribute to the literature, share “lessons learned”, disseminate “best practices”

Documents

Office of Interprofessional Education and Practice Integrating Health Sciences Across the Continuum Advancements in Interprofessional Education C. Schroder,