MOIRA STEWART, PhD

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Patient-Centred Care and Teamwork Development
of a Framework

• MOIRA STEWART, PhD
• The Dr. Brian W. Gilbert Canada Research Chair in
  Primary Health Care
• Centre for Studies in Family Medicine
• The University of Western Ontario
• Symposium on patient-centred care in the context
  of teamwork challenges and innovation
• Vibe Hotel
• April 9, 2008

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- Primary Care Teams and Teamwork -
Patient-Centred Clinical Method - Bringing the
two together
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Composition of Primary Care Teams in Canada
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Objective of the Study

• To determine estimates of primaryhealth care
  services for the five professions studied (family
  physicians, nurses, dietitians, pharmacists and
  social workers)

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Methods

• Mail-out survey to a sample of 1000 practitioners
  for each profession (n 5000)
• Using Colleges register data
• Used only those working in Ontario (postal codes)
• Stratified by four health regions of Ontario
  based on LHIN data
• (south east, central, south west, north)

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Total Number of Ontario Providers on College
Registers
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Response Rate on Completed Mailings
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Direct Care Community Providers and
Self-described PHC Providers ()
Number in PHC 453 7941
4255 1271
6293
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Other Professionals in Office/Unit Team I Do
NOT share Patient Care Setting with Others (
Direct Care Community Providers)
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Summary Who do they share patient/client care
within their office/unit?
Dietitians work
? ? Top ? 2nd or 3rd
FPs work
Pharm work
SW work
Nurses work
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Regular Practice to Provide Consultations to
Professionals ( Direct Care Community Providers)
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Type of Consultation ( Direct Care Community
Providers)
Hallway Consults
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Type of Consultation( Direct Care Community
Providers)
Meet with Patient Directly
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New formal models of teams in Ontario
- Family Health Networks - Family Health Teams
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How PC team members work together? What is
teamwork?
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What Makes a Team Work?
Trust
Relationship Bldg Approachability Caring Scope of
practice
ABC Foundations of Teamwork in PHC April 2006
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- Primary Care Teams and Teamwork -
Patient-Centred Clinical Method - Bringing the
two together
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Origins of the Patient-Centred Clinical Method
- re-statement of old themes - interdisciplinary
team of authors - informed by literature from
several disciplines
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A Patient-Centred Approach
Two overarching principles - sharing power -
connecting at an emotional level
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Six Components of Patient-Centred Care
- Exploring both the health issues and the
patients' illness experiences - Understanding the
whole person - Finding common ground -
Incorporating prevention and health promotion -
Enhancing the patient-provider relationship -
Being realistic Stewart et al., 2003
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The Patient-Centred Clinical MethodSix
Interactive Components
1 - Exploring Both Health Issues and Illness
Experiences
2 - Understanding The Whole Person
Cues Prompts
Health Issues - explore - examine - order tests
Feelings Ideas Function Expectations
4 - Incorporating Prevention and Health Promotion
6 - Being Realistic
5 - Enhancing the Patient- Provider Relationship
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A case example
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- Primary Care Teams and Teamwork -
Patient-Centred Clinical Method - Bringing the
two together
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Parallel process
- patient-centred approach - team-centred approach
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Six Components of Team-Centred Approach
- Exploring both the disciplines and the members'
personal experiences of their discipline -
Understanding the whole person of each team
member - Finding common ground Towards the
shared culture/philosophy of the team - Enhancing
team functioning - Enhancing ongoing team
relationships - Being realistic
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Team-Centred Approach
Component 1 Exploring both the disciplines and
the members' personal experiences of their
discipline ? the discipline as described by the
licensing body, scope of practice ? the
member's personal experiences of their discipline
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Team-Centred Approach
Component 2 Understanding the whole person of
each team member ? the "person" (life history,
and personal and cognitive development, stress
management in individuals) ? the context
(opportunities and constraints of the
current/proposed team environment)
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Team-Centred Approach
Component 3 Finding common ground Towards the
shared culture/philosophy of the team ?
underlying goals of care ? issues of the team,
conflict resolution
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Team-Centred Approach
Component 4 Enhancing team functioning ?
supporting each other's strengths, knowledge and
skills ? team communication
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Team-Centred Approach
Component 5 Enhancing ongoing team
relationships ? trust ? sharing power ?
empathy, respect, congruence ? self-awareness,
awareness of others ? transference and
counter-transference
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Team-Centred Approach
Component 6 Being realistic ? time ? resources
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(No Transcript)
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A case exampleMrs. Martina Morgan
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• Patient-centred approach Teamwork