The McGill Educational Initiative in Interprofessional Collaboration: Partnerships for patient & family centered practice Margaret Purden, N, Ph.D. David

TheThe McGill Educational Initiative in McGill Educational Initiative in Interprofessional Collaboration: Interprofessional Collaboration:

Partnerships for patient & family Partnerships for patient & family centered practicecentered practice

Margaret Purden, N, Ph.D.Margaret Purden, N, Ph.D.David Fleiszer, M.D.David Fleiszer, M.D.

Hélène Ezer, N, Ph.D.Hélène Ezer, N, Ph.D.Jeffrey Wiseman, M.D., M.Ed.Jeffrey Wiseman, M.D., M.Ed.

Yvonne Steinert, Ph.D.Yvonne Steinert, Ph.D.Bruce Shore, PhDBruce Shore, PhD

Aliki Thomas, OT, PhD (C)Aliki Thomas, OT, PhD (C)Liliane Asseraf Pasin, PT, Ph.D. (C)Liliane Asseraf Pasin, PT, Ph.D. (C)

Kathryn Carnaghan-Sherrard, N, M.Sc.AKathryn Carnaghan-Sherrard, N, M.Sc.ALinda Snell, M.D.Linda Snell, M.D.

Nancy Posel, N, M.EdNancy Posel, N, M.Ed

The McGill Educational Initiative in The McGill Educational Initiative in Interprofessional Collaboration:Interprofessional Collaboration:

Partnerships for Patient & Family-Partnerships for Patient & Family-Centred PracticeCentred Practice

The Who, Why, What & HowThe Who, Why, What & How

Interprofessional Interprofessional Collaboration: Collaboration: Who at McGill?Who at McGill?

Institutional Lead: The Faculty of Medicine Institutional Lead: The Faculty of Medicine

School of MedicineSchool of Medicine

School of Nursing School of Nursing

School of Physical and Occupational School of Physical and Occupational TherapyTherapy

&&

School of Human Communication Disorders School of Human Communication Disorders

Clinical Partners:Clinical Partners:

The McGill University Health CentreThe McGill University Health Centre

The SMBD Jewish General Hospital The SMBD Jewish General Hospital

Interprofessional Interprofessional Education: Education:

Who in Canada?Who in Canada?University of British ColumbiaBuilding Capacity and Fostering System Change Dr. Grant Charles

Calgary Health Region: Creating an Interprofessional Learning Environment through Communities of Practice - Dr. Esther Suter

University of Saskatchewan: Patient Centre Interprofessional Team ExperiencesDr. E.L. Harrison

University of Manitoba: Interprofessional Education for Geriatric CareDr. Ruby Grymonpre


Who in Canada?Who in Canada?

Queen's University: The QUIPPED ProjectDr. Medves

Ontario Council of Universities: Institute of Interprofessional Health Sciences EducationMrs. Marge Harrington

University of Toronto: The SCRIPT ProgramDr. Catharine Whiteside


Who in Canada?Who in Canada?Universite Laval: Le Patient au Coeur de Nos Actions: Mieux se Former Pour Mieux CollaborerDr. André Bilodeau

Dalhousie: Seamless Care: An Interprofessional Education Project for Innovative Team-Based Transition Care Dr. Judith McFetridge-Durdle

Memorial University of Newfoundland: Collaborating for Education and Practice: An Interprofessional Education Strategy for Newfoundland and LabradorDr. Vernon Curran

Interprofessional Education: Interprofessional Education: The WhyThe Why

Complexity of careComplexity of care Rising expectationsRising expectations Professional proliferationProfessional proliferation Students want to know Students want to know Community based careCommunity based care TeamworkTeamwork Interprofessional conflict Interprofessional conflict New models of practice New models of practice Legislation & redefinition of Legislation & redefinition of

professional roles professional roles Effectiveness of interprofessional Effectiveness of interprofessional

practicepractice

Interprofessional Education: Interprofessional Education: The WhyThe Why

Mounting evidence that Collaborative Mounting evidence that Collaborative Practice improves outcomes in a Practice improves outcomes in a number of patient populations studied number of patient populations studied to date.to date.

Geriatrics, ER care for abused Geriatrics, ER care for abused women, STD screening, Adult women, STD screening, Adult immunization, fractured hips & immunization, fractured hips & neonatal ICU care, depression care, neonatal ICU care, depression care, and in simplifying medicationsand in simplifying medications

(Zwarenstein et. al. 2004)(Zwarenstein et. al. 2004)

StudyStudy Source Source InterventionInterventionA randomized clinical trial of A randomized clinical trial of outpatient geriatric outpatient geriatric evaluation and evaluation and managementmanagement

Boult et al.Boult et al. J Am J Am Geriatr SocGeriatr Soc 2001;49:351-9.2001;49:351-9.

Comprehensive Comprehensive assessment followed by assessment followed by interdisciplinary primary interdisciplinary primary care.care.

An evaluation of a system-An evaluation of a system-change training model to change training model to improve emergency improve emergency department response to department response to battered women.battered women.

Campbell et al. Campbell et al. Acad Emerg MedAcad Emerg Med 2001;8:131-82001;8:131-8

Team participated in 2 Team participated in 2 day didactic training day didactic training and team planning and team planning exercise.exercise.

Can differences in Can differences in management processes management processes explain different outcomes explain different outcomes between stroke unit and between stroke unit and stroke-team care?stroke-team care?

Evans et al. Evans et al. LancetLancet, 358 , 358 (9293), 11-10-(9293), 11-10-2001, 1586 – 2001, 1586 – 15921592

Stroke unit, no specific Stroke unit, no specific interventions to interventions to encourage collaboration encourage collaboration of team.of team.

Interdisciplinary inpatient Interdisciplinary inpatient care for elderly people with care for elderly people with hip fracture: A randomized hip fracture: A randomized controlled trial.controlled trial.

Naglie et al. Naglie et al. CMAJCMAJ 2002;167:25-32.2002;167:25-32.

Interdisciplinary rounds Interdisciplinary rounds to discuss each patient to discuss each patient twice weekly. twice weekly.

Systematic Review of Recent Systematic Review of Recent Trials of Effective Collaboration Trials of Effective Collaboration

InterventionsInterventions

StudyStudy Source Source InterventionInterventionReduced mortality in Reduced mortality in treating acutely sick, frail treating acutely sick, frail older patients in a geriatric older patients in a geriatric evaluation and evaluation and management unit (GEMU). management unit (GEMU). A prospective randomized A prospective randomized trial. trial.

Saltvedt et al. Saltvedt et al. J J Am Geriatr SocAm Geriatr Soc 2002;50:792-8.2002;50:792-8.

GEMU, the treatment GEMU, the treatment strategy emphasized strategy emphasized interdisciplinary interdisciplinary assessment of all relevant assessment of all relevant disorders, prevention of disorders, prevention of complications and complications and iatrogenic conditions, early iatrogenic conditions, early mobilization/rehabilitation, mobilization/rehabilitation, and comprehensive and comprehensive discharge planning. discharge planning.

Effect of a clinical practice Effect of a clinical practice improvement intervention improvement intervention on Chlamydia screening on Chlamydia screening among adolescent girls.among adolescent girls.

Shafer et al. Shafer et al. JAMAJAMA 2002;288:2846-2002;288:2846-5252

Audit and feedback, Audit and feedback, barrier identification, barrier identification, team building and team building and meetings, iterative meetings, iterative approach.approach.

Cluster randomized Cluster randomized controlled trial of an controlled trial of an educational outreach visit educational outreach visit to improve influenza and to improve influenza and pneumococcal pneumococcal immunization rates in immunization rates in primary care.primary care.

Siriwardena et Siriwardena et al.al. Br J Gen PractBr J Gen Pract 2002;52:735-402002;52:735-40

Academic detailing to Academic detailing to team in each practice team in each practice to promote to promote immunization, immunization, combined with audit combined with audit and feedback. Control and feedback. Control group received audit group received audit and feedback only.and feedback only.


InterventionsInterventions


InterventionsInterventionsStudyStudy Source Source InterventionIntervention

Reducing medication Reducing medication regimen complexity: A regimen complexity: A controlled trial.controlled trial.

Muir et al. J Muir et al. J Gen Gen Intern MedIntern Med 2001;16:77-822001;16:77-82

For intervention patients, a For intervention patients, a medication grid was created medication grid was created that displayed all of the that displayed all of the patients’ medicines and the patients’ medicines and the times of administrations for 1 times of administrations for 1 week. This grid was delivered week. This grid was delivered to the admitting resident soon to the admitting resident soon after admission. Information after admission. Information transfer intervention.transfer intervention.

Economic implications of Economic implications of neonatal intensive care neonatal intensive care unit collaborative quality unit collaborative quality improvement.improvement.

Rogowski et al. Rogowski et al. PediatricsPediatrics 2001;107:23-9.2001;107:23-9.

Multidisciplinary teams doing Multidisciplinary teams doing collaborative quality collaborative quality improvement, reviewing improvement, reviewing performance data, developing performance data, developing shared goals, designing shared goals, designing improvements to their improvements to their practices.practices.

A CQI intervention to A CQI intervention to change the care of change the care of depression: A controlled depression: A controlled study. study.

Solberg et al. Solberg et al. Eff Clin PractEff Clin Pract 2001;4:239-492001;4:239-49

CQI intervention in which CQI intervention in which participants from intervention participants from intervention clinics developed an approach clinics developed an approach to depression care.to depression care.

Interprofessional Patient-Interprofessional Patient-Centred PracticeCentred Practice

The active participation of different The active participation of different professional groups in professional groups in decision decision

makingmaking and delivery of patient and and delivery of patient and family centred care. It is responsive family centred care. It is responsive to patient and family goals, opens to patient and family goals, opens

mechanisms for mechanisms for continuous continuous communicationcommunication and fosters and fosters mutual mutual

respectrespect among professionals” among professionals”

Interprofessional EducationInterprofessional Education

Occasions when two or more Occasions when two or more professionsprofessions

learn from and about each otherlearn from and about each other

to improve collaboration to improve collaboration

and the quality of careand the quality of care

Source: CAIPE (UK Centre for the Advancement of Source: CAIPE (UK Centre for the Advancement of Interprofessional Education), 1997Interprofessional Education), 1997


A new name A new name

An evolving ideaAn evolving idea

The Nature of The Nature of CollaborationCollaboration


Many methods of implementationMany methods of implementation


The “What” at McGill ?The “What” at McGill ? Beliefs /AssumptionsBeliefs /Assumptions

Responsive to needs of patients and families Responsive to needs of patients and families Partnerships between educators and clinicians for Partnerships between educators and clinicians for

IP education and practiceIP education and practice Student involvement in planning and Student involvement in planning and

implementationimplementation Collaboration as an expanded concept Collaboration as an expanded concept Principles of adult learning Principles of adult learning Institutional supportInstitutional support is essential for sustainabilityis essential for sustainability

What are Our Unique What are Our Unique StrengthsStrengths

Students who want to understand the Students who want to understand the roles of other professionalsroles of other professionals

Practitioners across all professions who Practitioners across all professions who are skilled in IPPare skilled in IPP

Support of educational leadersSupport of educational leaders

Well developed Joint Appointment SystemWell developed Joint Appointment System

What are Our ChallengesWhat are Our Challenges

Silo approaches to educationSilo approaches to education

Respecting professional identitiesRespecting professional identities

Logistical considerations Logistical considerations

Mapping across curricula Mapping across curricula

Resistance to change Resistance to change

Bridging learning and practice environmentsBridging learning and practice environments

Maintaining support of educational leadersMaintaining support of educational leaders


The “How” at McGill ?The “How” at McGill ? Promoting commitment and understanding of IPE Promoting commitment and understanding of IPE

and IPP among faculty, clinical teachers & cliniciansand IPP among faculty, clinical teachers & clinicians

Develop and utilize learning resources that Develop and utilize learning resources that facilitate interprofessional education facilitate interprofessional education

Mount a comprehensive program for IPE delivered Mount a comprehensive program for IPE delivered within and across programswithin and across programs

Identify exemplar learning environments that Identify exemplar learning environments that enable and enhance IPE and IPPenable and enhance IPE and IPP

Project TimelineProject Timeline

Interprofessional Education: Interprofessional Education:

The “How” at McGill ?The “How” at McGill ?

1. Need

2. Decision

3. Selection

4. Proposition

5. Examination

6. Negotiation

7. Agreement

8. Development

9. Fine-Tuning

10. Cooperation

11. Growth

12. Broadening

Scheuing (1994), The Power of Strategic Partnering.

The Process

Documents

The McGill Educational Initiative in Interprofessional Collaboration: Partnerships for patient & family centered practice Margaret Purden, N, Ph.D. David