Organisational

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Organisational Financial Barriers to IPLD
cultural lag

• Hazel Colyer, Director of IPE
• November 2006

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Aims

• to demonstrate how IPLD has been embedded within
  the organisation since 2001
• to discuss the organisational financial context
• to highlight the phenomenon of cultural lag and
  evaluate its effects.

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The Professions

• Adult Nursing
• Mental Health Nursing
• Diagnostic Radiography
• Occupational Therapy
• Social Work

• Midwifery
• Child Nursing
• Operating Department Practice
• Speech Language Therapy (2007)

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The Pre-registration IPL Programme

• A pre-registration programme providing
  professional education to registration for 8
  groups
• Single programme management structure within
  Faculty of HSC
• Project-managed development 2002 -2004, alongside
  DH funded project.
• NOW THE ONLY SHOW IN TOWN!

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Postgraduate Programmes

• PgDip/MA Social Work
• PgDip Speech Language Therapy
• Within a postgraduate framework and sharing 2
  modules with all other programmes

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Structure of Pre-reg IPL

• Whole Programme approach - one programme, eight
  pathways,
• Two academic levels aligned Diploma and Degree
  students studying together
• Two intakes a year for some professions
  September and February
• Delivered on 2 sites Canterbury and Chatham
• Practice fully integrated accredited learning
  also takes place in the workplace

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Programme Philosophy

• to produce unique professionals who are
  collaborative practitioners, able to work
  interprofessionally
• to embrace a single curriculum framework that
  includes common, interprofessional and profession
  specific content
• to provide an interprofessional perspective on
  all aspects of the curriculum where possible
• to embed practice learning in all awards

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The Interprofessional Curriculum

• Is the spine ribs of the programme
• Defined and agreed by all professions following a
  content analysis of QAA Subject/Academic
  Benchmarks (2001)
• An integral part of all pathway curricula, NOT an
  add on.

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Common IP Learning

• Skills for Professional Learning (Yr 1)
• Psychosocial Perspectives on Health Human
  Interaction Communication (Yr 1)
• Person Centred Care Interprofessional Practice
  (Yr 1)
• Evidence Based Practice (Yr 2)
• The Impact of Policy on Practice (Yr 2)
• Collaborative Practice (Yr 3)
• Independent Study (Yr 3)

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Organisational Financial Barriers

• Ostensibly none
• Director of IPE at FMT level with organisational
  development role a budget
• All programmes are within IP Frameworks pre-,
  post-registration postgraduate

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Organisational Financial Barriers

• Faculty has a departmental structure but
  programmes are cross-faculty, creating
  constructive tension between Heads of Departments
  programme directors ( me!)
• In the process of moving towards DRAM of funding,
  but at faculty level
• Professions involved are (those that are)
  commissioned

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Cultural Lag the battle for hearts and minds

• Enthusiasts have been joined by many of those who
  were positively disposed but waiting to see
• Negatively disposed and resistant remain so
• - large, complex programme is harder to engage
  with
  - constant change, staff are unconvinced
  that IPE is permanent
  - heavy workloads in HE

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Characteristics

• Use of language and behaviours that reveal
• anxiety and disaffection
• defensiveness
• anger and hostility
• retreat into comfort zone

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Evidence

• E-survey of staff attitudes to the IPL programme
  during 2005/06, sent out 3 times at different
  points in the year
• 63/178 responses (35), representative of the
  professional profile
• 56/62 agreed or strongly agreed that the IPL
  programme is of benefit to health social care
• 46/61 agreed or strongly agreed that the IPL
  Programme is of benefit to their specific area of
  professional practice
• BIT OF A POINTLESS EXERCISE?

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Until you read the free text responses!

• More than 90 of staff elaborated
• Much useful information about structures and
  resources plus
• Evidence of cultural lag
• Quotations from respondents, mainly in
  agree/strongly agree categories.
• Demonstrate beliefs and opinions about self and
  others

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Cultural lag?(benefit health social care)

• The IPL programme will only be successful if
  those involved in the provision of education also
  adopt the underlying philosophies of IPL
• Students I come into contact with are deeply
  unimpressed and do not see the benefits of
  forced integration
• Why should the HSC professions fall into line
  with an economic/rational model that offers very
  limited evidence of efficacy?

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Cultural lag?(benefit health social care)

• Benefit to health and social care could just as
  easily arise from individual professions pursuing
  profession-specific programmes
• There isnt a box that says not sure
• Have not been persuaded so far
• It is a fallacy that people who learn together
  will work together

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Cultural lag?(benefit specific prof practice)

• There still seems to be quite a lot of staff who
  are firmly ensconced in their professional silos
• Some non-nurse academics say very disparaging
  things about student nurses e.g. they are not as
  intelligent as AHPs.
• We should not try too hard to force IPL where
  it genuinely does not fit

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Cultural lag?(additional comments)

• Many staff members do not really subscribe to the
  ethos of IPL
• It feels as though the pathway that shouts
  loudest is accommodated in procedures
• IPL requires a change in culture in the practice
  setting (and in the university to some extent)
• I have been concerned about elements of
  disrespectfulness from colleagues

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Cultural lag?(additional comments)

• Not everyone is committed to interprofessional
  training
• We demonstrate some of the same territorial
  behaviour that is seen in practice as
  detrimental to the patient. Perhaps our behaviour
  is detrimental to the student
• The mantra of IPL takes precedence over specific
  parts of the programme
• Staff in the faculty need to understand it (IPL)
  I know they dont all.

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Some tentative conclusions

• Even when organisational and financial barriers
  are minimised it is hard to implement IPL
  programmes successfully
• Professional identity is embedded in the psyche
  of the groups and makes inter-group relations
  problematic. Loyalty to ones own group seems
  paramount
• The psycho-social transition to belonging in the
  new world of IPLD needs to be recognised and
  accounted for