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Can we achieve Interprofessional
Collaboration?
Learning from St. Joseph’s Health Centre
Michael Heffer, RPh, BScPhm, MHSc.
What is Interprofessional
Collaboration?
McMaster IPC Research Group
What is Interprofessional
Collaboration?
St. Joseph’s Health Centre adds:
• IPC is intentional
• Supported by learning with, from and
about one another to leverage
individual and team capacity
* St. Joseph’s Health Centre
•
IPC Expected Outcomes
• Increased access to healthcare for
patients
• Improved outcomes for patients with
chronic diseases
• Less tension and conflict among
caregivers
• Better use of clinical resources
(healthcare professionals)
Structure/Enablers
Required for IPC
• Government support / Legislation
• Senior Leadership support within your
own hospital
• Complimentary IPE structure in place
• Change leaders within hospitals
and universities
Government Support for
IPC
Provincial initiatives
1st
• Ministry of Health and Long Term
Care (MOHLTC) created IPC
Steering Committee 2006
Government Support for
IPC
Provincial initiatives
2nd:
• Joint initiative between MOHLTC and
MTCU (Ministry of Training, Colleges
and Universities)
• Health Force Ontario 2006.
• Mandate: Funding for IPC programs
since Oct 2008
Government Support for
IPC
Provincial initiatives
3rd
• MOHLTC approached Health Professions
Regulatory Advisory Council (HPRAC)
• Bill 179
Expanded scope of practice for 12
professions
Inter-College Collaboration
Government Support for
IPC Federal Level IPC Initiatives
• Health Canada funds the CIHC
Canadian Interprofessional Health Collaborative
• Fall 2008 created IPC Working Group
• Published:
National IPC Competency Framework Feb 2010
IPE Support for IPC
To Facilitate Adoption of IPC
“There must be a seamless integration between the education system preparing the workforce and the health care system that employs it.”
* Final report: IPC Strategic Implementation Committee May 2010
IPC Think Pair Share
• Question: What activities are
happening or need to happen in our
education system to graduate
students ready for IPC?
• Task: Pair up with a colleague at
your table
Discuss /generate ideas
IPE Support for IPC
MOHLTC and MTCU*
• Financial support to the six Ont. Academic Health Science Centres
• Dedicated resources to promote the development of an interprofessional curriculum.
• PIPER at McMaster
Program for Interprofessional Practice, Education and Research
* MTCU: Ministry of Training, Colleges and Universities
Senior Leadership
Support Within Hospitals Important for:
• Establishing IPC reporting structures that have accountability
• Supporting IPC awareness initiatives that influence culture change /acceptance
• Agreeing to devote resources to improvement initiatives that support IPC
• All the above: helps establish credibility with staff
Senior Leadership
Support Within Hospitals Why should Senior Leaders support IPC?
• Improved outcomes for patients = optimal patient care = decreased LOS (length of stay)
• Less tension and conflict = staff satisfaction
= lower staff turnover
= improved recruitment (great reputation)
• Better use of clinical resources
= improved efficiency of team
= lower cost per case compared to peer hospitals
Senior Leadership
Support Within Hospitals Existing Structure at SJHC
• IPAC Interprofessional Advisory Committee
• Interprofessional Point of Care Teams
• IPC listed as a Strategic Priority for 2011-2014 Objectives
• Portfolios: Director of Interprofessional Practice
Director of Interprofessional Education
• Change Leaders: Professional Practice Leaders
Education Coordinators
Professional Clinical Coordinators
IPC Change Leaders
Development of our Change Leaders
• Regarded as IPC project champions
• Added skill set: Change management methodology
Quality improvement methodology
• Collaboration with centre of IPE UofT
• ehpic program
• Collaborative Change Leadership Program
Team Coaching
Project
• Enhancing
Interprofessional
Practice
Resource
Manual for Team Coaches
Roadmap for Co-Creating IPC Models of Care
• A Roadmap for Co-Creating Interprofessional Models of Care
• Available at http://www.stjoe.on.ca/education/resources.php)
IPC Core Competencies
• Trust & Respect
• Knowledge of other Professional Roles
• Appreciating Difference & Conflict Resolution
• Willingness to Share Power
• Shared Decision Making
CIHC addition:
• Focus on patient-centered care
Finding Opportunities for
IPC
Creating IPC Initiatives
• Brainstorming sessions
• Looking at existing patient care teams
Areas for improvement?
• Look at patient care populations that may benefit from a collaborative team approach – groups at high risk?
IPC Think Pair Share
Question: What areas of hospital practice can you think of that might benefit from a more collaborative approach to patient care?
• Task: Pair up with a colleague at your table
Discuss/generate ideas
The AIR Team
Experience
The Assertive Interprofessional Respiratory Team
• The Care Providers
– Registered Nurse
– Registered Pharmacist
– Registered Respiratory Therapist
• The Care Context
– St. Joseph’s Health Centre – Emergency Dept (ED)
• The Patient Population
– Patients with a respiratory-related health issue
Guideline for Co-Creating
Interprofessional Models of Care
IPC Models of Care Step 1: Intraprofessional Reflection
Example Questions:
• What is my profession’s traditional role within this type of setting?
• What does my profession have in terms of knowledge, skill and judgement that can be used to enhance care for this type of patient?
• How much am I personally prepared to negotiate my professional boundaries?
IPC Models of Care Step 2: Re-story the Professional
Narrative
1. What are some stereotypes about our
profession?
2. Which activities, practices or roles do we
need to keep?
3. What possible future practice could be
supported by the knowledge, skills and
judgement of our profession
IPC Models of Care Step 3: Establish a Harmonization
Philosophy
Examples of Assumptions:
• Each skill or competency will be considered in
light of what the profession is currently doing,
should be doing or could be doing.
• Decisions will be made with the provincial
College regulators in mind
• Scopes of practice will be optimized for the
purpose of enhancing patient-centered care
Step 4: Analyze
Activities
• Create a list of activities
• Then ask the 3D
questions
– Which of the
professions is
currently doing this?
– Which of the
professions should be
doing this?
– Which of the
professions could be
doing this?
Scope and
Team Optimization • Step 4 Analyze Activities &
Develop Competency Framework
• Negotiating which clinician(s) will be responsible for specific patient care processes leads to team optimization
• Negotiating which clinician(s) will be responsible for specific clinical skills and competencies leads to scope optimization
IPC Think Pair Share
Consider a Diabetes Clinic Team
The team consists of a nurse, physician, dietitian and pharmacist.
Questions:
• Can you think of activities that could be shared to promote team optimization?
• What activities might be negotiated for scope optimization?
• Task: Discuss /generate ideas with a colleague at your table
Guidelines for Co-Creating
Interprofessional Models of Care
Step 8: Evaluate the
System
Evaluation focused on whether the AIR team
Interprofessional model of care would impact
quality of care as evidenced by:
• Key access and flow indicators
• Patient experience of care
Access and Flow
Length of ED Stay
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Av
era
ge
Le
ng
th o
f E
D S
tay
(m
inu
tes
)
Intervention 1319 1542 581
Baseline 1398 1769 592
All Patients Admitted Non-Admitted
226 min (p<0.01)
Patient Experience of Care
Patient Experience of Care by Dimension
0.0
20.0
40.0
60.0
80.0
100.0
Pe
rce
nt
Po
sit
ive
Sc
ore
AIR Team 89.1 80.4 82.4 80.0 81.9 76.6 100.0
Baseline 52.8 54.7 50.0 41.7 77.5 52.1 89.7
Ontario Average 63.5 66.4 63.3 62.4 77.5 64.0 89.6
Emotional
Support
Access &
Coordination
Information &
Education
Physical
Comfort
Respect for
Patient
Preferences
Continuity
and
Transition
Courtesy
p<0.001 p<0.001 p<0.001 p<0.001 p<0.001
Other IPC initiatives at
St. Joseph’s
• Interprofessional Skills Fair
• Interprofessional Orientation
• Scope of Practice Quiz
• Interprofessional Journal Club
• Interprofessional Maze Activity
Interprofessional Skills Fair
Interprofessional Orientation
0% 20% 40% 60% 80% 100%
WHIMIS
Library Services
Interpreter Services
Infection Control
Self Care
Therapeutic Relationships
Documentations
Code White/CPI
Critical Thinking/Time Management
Consent and Capacity
Falls Standard of Care
Least Restraints
DNR order/case examples
Domestic Abuse
Major Mental Illness
End of Life Care, Bereavement, Suffering & Loss
CCAC Services
Pain Assessment & Management
Addictions and Mental Health Consultations
Oxygen Therapy
Pharmacy
I/V Venipuncture
Skin & Wound
Diabetic Monitoring
PICC & Central Lines
Blood Administration & Products
Tubes and Drains
Transcription
Hypodermoclysis
Traches & Suctioning
Epidurals
NG Feeds, Flushes etc.
Chest Tubes
Bladder Scanning
IP
Partially IP
Scope of Practice
Interactive Quiz
Which is NOT a Regulated
Health Profession?
b) Kinesiology
c) Paramedic
d) Traditional Chinese
Medicine
e) Psychology
a) Naturopathy
C
Paramedic
How many of the 13 controlled acts were
authorized to physicians?
a) 10
b) 13
c) 11
d) 12
e) 9
D
12
The Registered Dietician (RD) is responsible for which
of the following re: tube feeding?
a) Determining access & inserting the tube
b) Conducting the assessment to
determine needs, the Formula, and rate
c) Teaching the patient/family to use the
feeding pump
d) Flushing the tube with sterile water
B
Conducting the assessment to determine needs,
the Formula, and rate
Interprofessional Journal
Club
Interprofessional Maze
Activity
Other Initiatives at SJHC
that support IPC
• Interprofessional Orientation
• IPE week
• Interprofessional Skills Fair
• Interprofessional Journal Club
• Scope of Practice Quiz
Interprofessional Collaboration
What do our patients want?
• To be seen not as an OHIP #, not even as a patient but as a person who is valued.
• Health professionals coaching and cheerleading me to improve my health.
• A team working together, communicating the care I want to receive
• Providers who are good at explaining what they are doing as they are doing it
* Focus groups: Report on Implementing IPC in Ontario May 2010
Thank you to partners
& Change Leaders
Mary Kapetanos, Jeff Dionne, Marie Eason-Klatt, Helen
Papakyriacou, Marcia Sivilotti, Chris Ashdown, Lynne Strathern,
Scott Graney, Janice Klutt, Jenny Seah