IPE Nuts and Bolts: Development, Implementation and

Evaluation of Sustainable Interprofessional Programming

IPE

Introduction to IPE

Here are my ideas about introduction to IPE/IPCP and Collaborative Practice – SCK

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Definitions

Interprofessional Education occurs when two or more professions learn about, from and with each other to improve collaboration and the quality of care. Collaborative Clinical Education promotes the active participation of students, educators, and workers in teaching relevant cross-disciplinary person-centered care. Center for the Advancement of Interprofessional Education (2002)

Interprofessional Practice

Multiple health workers from different professional backgrounds providing comprehensive health services working with patients, their families, caregivers and communities to deliver the highest quality of care across settings.

Framework for Action on Interprofessional Education & Collaborative Practice WHO, 2010.

Interprofessional Collaboration“… the process of developing and maintaining effective working relationships with learners, practitioners, patients/clients/families and communities to enable optimal health outcomes. Elements of collaboration include respect, trust, shared decision-making, and partnerships.”

Canadian Interprofessional Health Collaborative, 2010

Why IPE? Why Now?Since 1999 the Institute of Medicine (IOM) has urged the practice of IP team-based care to prevent medical errors. In 2013 the Journal of Patient Safety reported that between 210,000 and 440,000 patients each year suffer some type of preventable harm when receiving hospital care. If the Centers for Disease Control were to include preventable medical errors as a category, these conclusions would make it the third leading cause of death in America. James, J. T. (2013) . A new, evidence-based estimate of patient harms associated with hospital care. JPS, 9(3), 122-128.

• Integration of primary, behavioral and oral care (PCMH; ACA)

• Demographic Changes, e. g. aging population; chronic health conditions• Increase in dual diagnoses• Technological advances;

saving lives• Patient Safety & Quality

agenda• Workforce pressures and gaps• Healthcare and payment

reforms

Interprofessionality is not• Learners hearing a lecture about or by another profession• Reporting out following interdisciplinary activities (e. g. service

learning; poster sessions)• Co-location without intentional collaboration (e. g. events;

simulation lab)• Talking about rather than with other professions/clients

What others

do

Core Competencieshttp://www.aacn.nche.edu/education-resources/ipecreport.pdf

Social workers: • Articulate their roles and

responsibilities as well as accurately and fairly represent the qualifications and obligations of colleagues from other disciplines

• Demonstrate a variety of approaches to achieve desired outcomes

• Acknowledge professional strengths that enhance the interdisciplinary team process and contribute to positive client outcomes

• Identify and seek common ground with your interdisciplinary colleagues

IPEC Core Competencies:Roles & Responsibilities: Know one’s own role and those of team membersEthics & Values: Recognize and respect the unique cultures, values, roles/responsibilities and expertise of other health professionsTeamwork: Integrate knowledge and experience of other professions to inform effective/ethical decisionsCommunication: Listen actively, encourage ideas and opinions; express knowledge and opinions to team members with confidence, clarity, and respect, and work to ensure common understanding.

Change is Hard

Implementation

• Give specific examples of “how” each of us have offered our IPE courses

• Provide details to help a participant who may not have developed an IPE course before

• Convey the message - there is no cookie cutter approach

No “One Size Fits All”• Promote ideas that are meaningful to

your faculty & identify common goals • Form an Inclusive coalition of faculty,

students, staff & community partners• Create a common vision, clear

message, and attainable goals • Walk the Talk – reach out to

colleagues• Begin with small successes and build

on them• Remove obstacles & sidestep barriers• Sustain momentum – establish a

domino effect• Anchor change (Adapted from Kotter, 8-Step Change Model)

Teaching and Learning Opportunities

Core Curriculum IPEC Event Series CLARION Competition

IPE Student-led Clinics Global IPE Learning IPE and the Arts

More OpportunitiesSimulation Symposia IP Courses

Student –led Research Shared Field Experience Service Learning

ACA impact: http://youtu.be/6JAEKmNFTyA; Shared rotation: http://youtu.be/2zkQ0f3sluk

Tools & Methods

• Handout (see slide #16)• Facilitation• TeamSTEPPS

Tools - Handout• Shared didactics – integrated curriculum; required &

elective courses; designed & implemented by IP faculty• Shared assignments – case study presentations;

literature reviews; posters• Shadowing – other professions; community workers;

patients• IP Case conferences – intentionally designed with actual

clients/patients; Clarion Root Cause analysis• Reflective journaling with prompts – use in field

placements; activities; ethnographies• Shared field placements – IP placements• Service learning – deliberately designed IPSL• IP Scholarship & research – mini-grants; IP research

Group Exercise Idea• Which of the teaching and learning tools fits

your IPE goals for the coming year• Break into small groups with facilitator to

teach process and methods for activity• Come back into large group and share

FacilitationIP facilitators are:• Responsive to students as they interact with

one another, surface ideas, and ask questions.• Encourage reflection, circumspection, and

critical thinking• Guide group process and draw out the natural

elements of group dynamics• Comfortable with different views and indeed,

solicit them• Patient, agile, process-oriented yet able to

manage conflict

Facilitation Goals• Orient learners to goals of the session• Prompt learners to discuss their observations • Encourage a non-judgmental environment• Make interprofessional learning explicit (e. g. let’s

get the [discipline] view of client’s needs)• Inquire about what is missing and where might

we find it?• Capture teachable moments• Prompt self-reflection • Encourage closure and final case/topic

determinations

Role Modeling• Role model collaborative competencies in

everyday practice• Share your own process – what were your

misperceptions of other professions• Orient learners to interprofessional principles

and values• Facilitate introductions• Clarify your role and have learners identify

theirs

Facilitation Video Exercise

What is TeamSTEPPS™• A teamwork system designed for

healthcare professionals and workers. • Developed by Department of Defense's in

collaboration with the Agency for Healthcare Research and Quality (AHRQ).

• Provides attitudes, knowledge and skills for improving patient safety and quality within health and health-related settings.

• Informed by evidence-based research aimed at improving communication and teamwork skills among healthcare professionals and workers.

"Your spoken word, your courage to challenge, your will to engage in teamwork, and your determination to ensure no harm can all be pivotal in determining if a patient lives or dies.“ Sue Sheridan

http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_Sue_Sheridan/Sue_Sheridan-400-300.html

A Shared Mental Model Is...

The perception of, understanding of, or knowledge about a situation or process that is

shared among team members through communication.

"Teams that perform well hold shared mental models." (Rouse, Cannon-Bowers, and Salas 1992)

ISBAR

Introduce Situation Background Assessment Recommendation

A Shared Mental Model for Communication

Patient • Sally Hinton is a 55 year old single women who lives on her own, receives

MaineCare and SSI disability. She previously worked for 30 years as a school bus driver and continues to do volunteer work in the schools.

• Sally was discharged a week ago after 2 days in the hospital being worked up for angina. Her diagnoses include insulin dependent diabetes, obesity, depression, and hydradenitis suppurativa (i.e., the development of cysts in the breasts, arm pits, neck and groin which require occasional draining). She takes nine different medications.

• During a routine office visit today Sally seems uncharacteristically disoriented. She denies using alcohol or other intoxicating substances. You ask if she’s taking her medication appropriately to which she replies that she thinks so. When you ask to see her medications she tells you that they are stored in their vials in a kitchen drawer. She cannot however tell you which medications she takes, when she takes them or their dosages.

• Sally also describes two falling incidents that occurred last week during the night. Although nothing was apparently broken, she shows you large bruises on her hip and forearm. She also has an open injury on her shin that she says is painful and not healing properly.

• What are your thoughts about Sally’s health and well-being?• Describe how you would use ISBAR when transferring or referring Sally’s care.

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Briefs, Huddles & Debriefs

Brief

Who is on the team?Agree on Goals

Roles & Responsibilities Understood

Plan of CareAvailability

Access Resources

Huddle

Problem-solvingReview situation Discuss new &

emerging events

Anticipate outcomes & possibilities

Assign resourcesExpress Concerns

DebriefCommunicate clearly

about eventGo over detailsWere roles &

responsibilities understood?

What went wellWhat should change

Can we improve?

Check-Back Is when Practitioners…

Racial & Ethnic Disparities• IOM’s Unequal Treatment

highlighted evidence of racial and ethnic disparities in health care

• Language barriers are less well documented

• The root causes of patient safety events for non-English speaking patients in are: (1) poor communication and (2) insufficient use of qualified medical interpreters and cultural navigators

http://www.youtube.com/watch?v=ABn0sE1aiGo

Case Study

Mr. Morales is a 45-year-old car mechanic with type 2 diabetes. He was born in Mexico, speaks English as a second language, and has an eighth grade education. He just learned that he must transition to insulin therapy to manage his illness. His attempts at weight loss were challenged by desire to show appreciation for his wife and mother’s cooking. His PCP sent him to a dietician, who in turn provided him with an 1800 calorie-count diet plan. Written materials given to Mr. Morales were not helpful because he does not read English. He has also heard that insulin causes blindness and is thus fearful of starting this new medication delivery method. For now Mr. Morales chooses to use Mexican remedies such as prickly pear, offered by his mother.

Risks in Translation• Not using a professional interpreter or

community health worker– Using family members or hospital/clinic staff

as interpreters – “Getting by” with provider’s or patient’s poor

language skills– Interpreter only present for part of the

encounter

Community Health Outreach WorkersCommunity health outreach workers (CHOWs): trusted members of their communities who provide vital links between health systems and communities and play critical roles on the health team.

• Culturally relevant health education

• Mediate between community members and services providers

• Case management, systems navigation & insurance enrollment

• Medical interpretation• Health promotion • Conduct surveys, collect

community and health related data.

• Contribute information on community needs and needed resources.

• Educate health professions Whitley et al (2006). Measuring return on investment of outreach by community health workers. J of Health Care for the Poor and Underserved, 17, 6-15.

Teach-Back Is…• Confirmation of understanding• Opportunity to correct miscommunication• Comprehensive– “Tell me in your own words how you will take

this medicine when you get home…”

Equipping Patients & Families• Quality care is a team effort • Patients and families can

improve their care by taking active roles in the process

• Invite patients to ask questions, and evaluate their option

• Be culturally responsive to patients

• Encourage shared decision-making in their health care

• The AHRQ Web site ―www.ahrq.gov/questionsaretheanswer/

Questions Your Patients Should Ask

What is the test for?When will I get the results?Why do I need this treatment?Are there any alternatives?What are the possible complications?Which hospital is best for my needs?How do you spell the name of that drug?Are there any side effects?

3 Things

Write down 3 things that you take away from today’s teaching and learning time together.

Share one with the rest of the group.