Interprofessional Care:Building on Collaborative Teams

Mandy LoweFaculty Lead, IPE Preceptorship & FacilitationOffice of Interprofessional EducationUniversity of TorontoInterprofessional Education LeaderToronto Rehabilitation InstituteLowe.mandy@torontorehab.on.ca

1

Objectives

• Define teams and collaboration • Recognize the importance of team

collaboration• Consider individual and team-based strategies

to enhance collaboration

2

What is team?

A collection of individuals who: • are interdependent in their tasks• share responsibilities for outcomes• are seen by others as an intact social entity

embedded in one or more larger social system• manage their relationships across

organizational bordersOandasan et al. (2006)

Ehpic course, June 20093

What is interprofessional collaboration (IPC)?

“…an interprofessional process of communication and decision-making that enables the separate and shared knowledge and skills …to synergistically influence the… care provided”

Way , Jones & Busing (2000)

4

What does Interprofessional Education (IPE) Mean?

• Members (or students) of two or more professions associated with health or social care, engaged in learning with, from and about each other

(Geissler, 2002)

5

6

It is believed by many that if we train competentcollaborative practitioners, more collaborative practice settings will be developed over time… Hence practice is linked with education. p. 12, D’Amour & Oandasan (2005)

Capacity to Collaborate

Ehpic course, June 2009

7

8

Drivers for IPE and IPC International

− Research and programs – e.g. UK, USA National

− Health Canada – Romanow, 2002 Provincial/Local

− Health Force Ontario’s Interprofessional Health Education Innovation Funds 2007 and 2008

− “Regulation of Health Professions in Ontario: New Directions” (HPRAC, 2006 and 2008)

− U of T – Office of IPE - research, practice, curricula Enhance care

− Collaborative Practice improves outcomes in specific populations

Teamwork Positively Impacts Outcomes

• Improved Outcomes in specific populations– Neonatal ICU, STD screening, geriatrics, fractured hips

(Zwarenstein et al., 2005) – Stroke Functional Outcome (Strasser et al., 2008)

• Improved Patient Safety– SBAR Communication Tool (Velji et al., 2008)– Fewer deaths when in ‘true’ team (West, 2006)

9

Teamwork Positively Impacts Outcomes

• Improved Cost Efficiency (D’Amour, 2005)

• Improved Health Professional Satisfaction (Cohen & Bailey, 1997)

• Leads to a Healthy Workplace(Shamian & El-Jaradali, 2007)

www.cihc.cawww.chsrf.ca – Promoting effective teamwork in

healthcare in Canada

10

Discussion

• Think about a time when you were part of or observed a highly collaborative team.

• What do you think made such successful collaboration possible?

11

12

7 Essential Elements for Collaboration Way , Jones & Busing (2000)

Ehpic course, June 2009

What elements define team collaboration in pediatric rehabilitation?

• Communication – open, clear, regular, jargon free • Decision making – shared, effective problem solving

strategies• Goal setting – shared, clear, prioritized, regularly evaluated• Organization – coordination of planning (e.g. single plan of

care), structure, resources• Team process – evaluation, mutual respect and role

understanding• Parent involvement – critical team members

Nijhuis et al, 2007

13

How can team collaboration be fostered?

14

Three Key Questions for Collaborative Teams

1. What is the goal of our team?

2. How will our team communicate? How will our teamwork be coordinated?

3. How will our team repeatedly review what we are trying to achieve and how effective we are?– Balance of task/content (the ‘what’) and

process (the ‘how’)Adapted from Aston West OD

& Schmidt, 2006

15

16

17

1. What is the goal of our team?

• Shared goal and vision• All team members are clear about roles• Roles reviewed regularly to ensure satisfaction

and optimal use• Opportunities for team members to get to

know each other to find out what contributions team members can make

Government of Ontario, Family Health Team Guide to Collaborative Team Practice (2005)

18

19

20

2. How will our team communicate and coordinate?

• Strategies may include:– Team members meet regularly– Members involved in planning for activities in which they

will be involved– There is an effective decision-making method – Issues are confronted and problems resolved as they arise– There is a process for identifying/clarifying role overlap – Role of leader is understood by team members – Leader encourages active participation of all team

members

Government of Ontario, Family Health Team Guide to Collaborative Team Practice (2005)

21

22

3. How will our team repeatedly review what we are trying to achieve and how effective we are?

• Accomplishments and achievements are celebrated

• There is an evaluation process for follow-up, to ensure goals are being met

• Team process is reviewedGovernment of Ontario, Family Health Team Guide to Collaborative

Team Practice (2005)

23

Team FunctionHigh performance requires

BALANCETASK PROCESS

Task – what is done and the problems associated with completion

Process- How the team functions –how the task is accomplished, what happens between the members, the way decisions are made

PROCESS affects OUTCOME

Ehpic course, June 2009

Health Professional Collaborator Competencies

KNOWLEDGE*roles of other health professionals

SKILLS*communicating with others*reflecting upon my role and others

ATTITUDES*mutual respect*willingness to collaborate*openness to trust

25

Oandasan & Reeves (2005)

Ehpic course, June 2009

Collaboration: What can you do?

• Knowledge of Roles– Provide opportunities for clarifying your role

(e.g. interview, education, shadow opportunities)

– Request opportunities to clarify team members’ roles

– Orientation for new team members? Or changes in roles over time?

26

27

Collaboration: What can you do?

• Communicate and reflect– Enhance your own collaborative communication

e.g. giving and receiving feedback, conflict resolution, monitor for jargon, etc.

– Invite feedback re: specific collaborative competencies

28

Collaboration: What can you do?“We may look in the same direction, even at the ‘same

lines,’ and not see what our colleague sees.”McKee (2003)

Reflect on your own ways of knowing, e.g.• What assumptions am I making? • Where did I learn these values?• What values orient me?• How might someone whose role is different than

mine look at this?McKee (2003)

30

Collaborative Attitudes: An IDEA • Interact with others whose role differs from my own• Collect Data about others’ roles

– e.g. how others are educated; competencies others possess; the many settings in which they may work

• Expertise - “… open to the views and approaches of their colleagues (and) altering …perceptions via the discussion when appropriate”

• Attention to one’s own professional and personal background, biases, stereotypes and assumptions - including skills in exploring and appreciating others’ approaches

Pecukonis (2008)

31

32

33

34

Objectives

• Define teams and collaboration • Recognize the importance of team

collaboration• Consider individual and team-based strategies

to enhance collaboration

Learning from Teams: Displays• What has enabled your team to collaborate so effectively?• How did your team successfully address challenges to

collaboration?• What was your shared goal as a team? How did you arrive

at this goal?• What approaches/strategies did you find most successful

for coordinating and communicating as a team?• How did you learn and benefit from your collective

experience? How did you repeatedly review your work and experiences?

37

“To talk well and eloquently is a very great art, but that an equally great one is to

know the right moment to stop.”

38

Thank you!

39

References• Aston West, OD. The Aston team performance toolkit (2007). In Jelphs, K &

Dickinson, H (2008) Better Partnership Working: Working in Teams. The Policy Press: UK.

• Cohen, SG & Bailey, DE (1997). What makes teams work: Group effectiveness research from the shop floor to the executive suite. Journal of Management, 23(3):239-290.

• D’Amour, D & Oandasan, I (2005). Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessinal C are, 19(Suppl 1):8-20.

• Government of Ontario (2005). Family Health Teams - Advancing Primary Health Care: Guide to Collaborative Team Practice. Available at: http://www.health.gov.on.ca/transformation/fht/guides/fht_collab_team.pdf

40

References• Lemieux-Charles, L., & McGuire, W. L. (2006). What do we know about

health care team effectiveness? A review of the literature. Medical Care Research and Review, 63(3), 263-300.

• McKee, M. (2003). Excavating our frames of mind: The key to dialogue and collaboration. Social Work, 48(3):401-8.

• Nijhuis, BJG et al. (2007). A review of salient elements defining team collaboration in paediatric rehabilitation. Clinical Rehabilitation, 21:195-211.

• Oandasan et al. (2006) Teamwork in Healthcare: Promoting Effective Teamwork in Healthcare in Canada – Policy Synthesis and Recommendations, CHSRF. Available from www.chsrf.ca

• Oandasan, I & Reeves, S (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal of Interprofessional Education, 19(Suppl 1):21-38.

41

References• Pecukonis E; Doyle O, & Bliss, D.L. (2008). Reducing barriers to

interprofessional training: Promoting interprofessional cultural competence. Journal of Interprofessional Care, 22(4): 417–428.

• Pew-Fetzer Task Force on Advancing Psychosocial Health Education (2000). Health professions education and relationship-centred care. San Francisco, USA: Pew Health Professions Commission and the Fetzer Institute.

• Schmidt, M et al (2006). Outcomes study of a customer relations educational program in dialysis practice. Advances in Chronic Kidney Disease, 13(1):86-92.

• Shamian, J., & El-Jardali, F. (2007). Healthy workplaces for health workers in Canada: knowledge transfer and uptake in policy and practice. Healthcare Papers, 7, 6–25.

• Strasser et al. (2008). Team training and stroke rehabilitation outcomes: A cluster randomized trial. Archives of Physical Medicine in Rehabilitation, 89.

42

References• Velji, K et al. (2008). Effectiveness of an adapted SBAR communication tool

for a rehabilitation setting. Health Care Quarterly, 11:72-9.• Way, D., Jones, L., and Busing N. Implementation strategies: "Collaboration

in primary care -family doctors & nurse practitioners delivering shared care" Discussion paper for the Ontario College of Family Physicians. 1-10. 2000

• West, MA et al. (2006). Reducing patient mortality in hospitals: The role of human resources management. Journal of Organizational Behavior, 27:983-100.

• Zwarenstein M. Reeves S. & Perrier L. (2005). Effectiveness of pre-licensure interprofessonal education and post-licensure collaborative interventions Journal of Interprofessional Care. 19 Supl 1:148-65

43

Websites• www.cihc.ca – Canadian Interprofessional Health

Collaborative

• www.ipe.utoronto.ca – Office of IPE, University of Toronto

• www.chsrf.ca – Canadian Health Services Research Foundation

44