Interprofessional Education for Collaborative RelationalCentred Practice:

1

• Interprofessional Education for Collaborative
  Relational-Centred Practice

A Wind of Change
2
Susan J. Wagner

• Faculty Lead Curriculum PlacementsOffice of
  Interprofessional Education andCoordinator of
  Clinical EducationDepartment of Speech-Language
  PathologyUniversity of Toronto

3

• Brian Simmons
• Faculty Lead Assessment
• Neonatologist
• Ivy Oandasan
• Director, Office of IPE
• Family Physician
• Sylvia Langlois
• Academy Associate
• Occupational Therapist

4
Agenda

• Welcome and Introductions
• Getting to Know You
• Setting the Stage
• History
• Theory, Definitions and Model
• Evidence
• Best Practice Model
• Interprofessional Education
• Interprofessional Collaborative
  Relational-Centred Practice
• Your Context
• Summary

5
Objectives

• Define and discuss interprofessional education
  (IPE) and collaborative relational-centred
  practice (CRCP) with respect to their history, a
  current model and current evidence.
• Describe an innovative best practice model and
  foundational core competencies for IPE and CRCP
  that crosses the academic/clinical interface.

6

• Explain perspectives on and strategies for
  promoting IPE and CRCP, informed by theory,
  practice and group discussion, that you may apply
  to your own context.

7
Setting the Stage
8
History of IPE

• Began in the 1960s in North America and Europe
• Parallel interprofessional movements developed in
  different professions
• E.g., with evolution and grouping of allied
  health professions in educational and work
  settings
• Focus on teamwork to deliver improved service

9

• More recent focus at universities in the 1990s to
  prepare students for the reality of practice
• Recognized need to move beyond uniprofessional
  educational silos and integrate curricula and
  practice

10
History of CRCP

• Collaboration has existed between/ among
  professions whenever there has been a need
• Therefore, much longer history

11
Why do IPE?

• To
• Modify negative attitudes and perceptions
• Remedy failures in trust and communication
  between professions
• Reinforce collaborative competence
• Secure collaboration to implement policies,
  improve services and effect change

12

• Cope with problems that exceed the capacity of
  any one profession
• Enhance job satisfaction and ease stress
• Create a more flexible workforce
• Counter reductionism and fragmentation as
  professions proliferate in response to
  technological advance
• Integrate specialist and holistic care
• (Barr, 2002)

13

• In fact, IPE is mandated by the government in the
  U.K.
• All health professionals should expect their
  education and training to include common learning
  with other professions at every stage from
  pre-registration courses throughout continuing
  professional development.
• (Barr, 2002)

14
General Theory of IPE

• the application of principles of adult learning
  to interactive, group-based learning that relates
  collaborative learning to collaborative practice
  within a coherent rationale informed by
  understanding of interpersonal, group,
  inter-group, organisational and
  inter-organisational relations and processes of
  professionalisation.
• (Barr, 2002)

15
Definition of IPE

• Occurs when two or more professions learn about,
  from, and with each other to enable effective
  collaboration and improve health outcomes.

( WHO, 2008)
16
IPE Model
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
DAmour, Oandasan, 2004
17
Definition Interprofessional Collaborative
Practice

• The provision of comprehensive health services
  to patients/clients by multiple health care
  providers who work collaboratively to deliver the
  best quality of care in every health care
  setting.
• 
  Health Force Ontario, 2008

18
CRCP Model
Patient/Provider/ Organizational/System
Outcomes PATIENT Clinical outcomes
Quality of care Satisfaction PROVIDER
Satisfaction Well-being ORGANIZATION
Efficiency Innovation SYSTEM
Cost effectiveness Responsiveness
Patient Task Complexity
DAmour, Oandasan, 2004
19
(No Transcript)
20
Collaborative Client/Patient-Centred Practice

• designed to promote the active participation of
  each discipline in patient care. It enhances
  patient and family-centred goals and values,
  provides mechanisms for continuous communication
  among caregivers, and optimizes staff
  participation in clinical decision making within
  and across disciplines fostering respect for
  disciplinary contributions of all professionals.
• Health Canada, 2007

21
Relational-Centred Care

• captures the importance of the interaction among
  people as the foundation of any therapeutic or
  healing activity.relationships are critical to
  the care provided by nearly all practitioners
  (regardless of discipline or subspecialty) and a
  source of satisfaction and positive outcomes for
  patients and practitioners.
• Pew-Fetzer Task Force,
  2000

22
Four Dimensions of Relational-Centred Care-
Pew-Fetzer Task Force (2000)

• Patient/Client Practitioner Relationship
• Community-Practitioner Relationship
• Practitioner-Practitioner Relationship
• Clinician Relationship to Self

23
Other Professions
YOU
Community
Uniprofessional
Patient / Client
24
Health Care Assumptions/Realities

• Aging Population
• Increasing Acuity, complexity chronicity of
  illnesses
• Sub-specialization of all health professionals
• Lack of access contributed by

25
A Looming Health Human Resource Crisis

• Interprofessional Collaborative Practice
• is one solution proposed to address the
  resource shortage

26
IPE Landscape in North America

• New attention being paid at the federal,
  state/provincial and local levels
• Cost-effectiveness believed to follow

27
In U.S.A.

• Institute of Medicine reports (2000 2001)
  heightened nationwide interest in health care
  safety and quality
• IPE and CRCP seen as solutions for both issues

28

• In 2003, Committee on the Health Professions
  Education Summit for the Board of Health Care
  Services of the Institute of Medicine noted
• there is a major disconnect between isolated
  professional education and increasing
  expectations for interdisciplinary team-based
  care.

29

• Focused on five areas and noted their
  interrelationship in a vision
• All health professional should be educated to
  deliver patient-centered care as members of an
  interdisciplinary team, emphasizing
  evidence-based practice, quality improvement
  approaches, and informatics

30
In Canada

• Health Canada interprofessional education for
  collaborative patient-centred practice (IECPCP)
  initiative
• National interprofessional student association
  (NaHSSA www.nahssa.ca) formed with support of
  Health Canada and University of British Columbia
• Provincial e.g., Health Force Ontario Strategy

31

• Accreditation
• Professional Standards
• Institutional Standards
• Payors

32
A New Vision

• If health care providers are expected to work
  together and share expertise in a team
  environment, it makes sense that their education
  and training should prepare them for this type of
  working arrangement. Commission on the
  Future of Health Care in Canada, 2002

33
Evidence

• Mounting evidence exists that Collaborative
  Practice improves Patient Outcomes in specific
  populations studied to date.
• Geriatrics, ER care for abused women, STD
  screening, Adult immunization, fractured hips
  neonatal ICU care
  (Zwarenstein et al,
  2005)

34

• Improved Health Professional Satisfaction
• (Cohen Bailey, 1997)
• Collaboration reduces stress amongst health care
  providers and it increases efficiencies and
  innovations.
  (DAmour et al, 2005)
• Improved Patient Safety
• (U.S. Joint Commission on Accreditation of
  Health Care Organizations and Baker, R., 2006)

35
Effectiveness of IPE

• there is no published evidence that
  Interprofessional Education promotes
  interprofessional collaboration or improves
  client relevant outcomes
• Zwarenstein et al, 2005

36

• No evidence of effectiveness
• is not evidence of ineffectiveness
• (Hammick, 2000)

More research is needed
37
Interprofessional Collaboration as an
Enabler for

• Enhanced Patient-Centred Care
• Improved Patient Safety
• Optimization of health human
  resources (HHR)
• Health Provider Satisfaction

38

• Interprofessional education is a key enabler for
  IPC on new ways of education and training.

39
Best Practice Model
40
IPE at University of Toronto

• Stand alone, linked and marquee sessions since
  1990
• IPE curriculum in rehabilitation sciences
  (OT/PT/SLP) overlaid on discipline-specific
  curricula since 2003
• Office of Interprofessional Education
  created in January 2006

41
IPE Initiatives

• University of Toronto (UT) and Toronto Academic
  Health Sciences Network (TAHSN), along with other
  educational and community institutions, working
  collaboratively to ensure IPE for IPC
• Innovative best practices model
• Overcoming challenges to produce effective
  integration across the academic/clinical
  interface

42
University-Wide IPE Curriculum at University of
Toronto

• Building upon rehabilitation sciences IPE
  curriculum
• Monies obtained from Ontario Ministry of Health
  and Long-Term Care

43

• Mandatory IPE curriculum by 2009 for all ten
  health science professions to allow graduation as
  competent collaborators in health care

44

• Dentistry
• Medical Radiation Sciences Michener Institute
• Medicine
• Nursing
• Occupational Therapy
• Pharmacy
• Physical Education and Health
• Physical Therapy
• Social Work
• Speech-Language Pathology

45
1st cohort Med Rad Sc (BSc-3yr)
2nd cohort Med Rad Sc (BSc 3yr)
3rd cohort Med Rad Sc (BSc 3yr)
1st cohort Dentistry, Medicine, Pharmacy, Phys
Ed Health (Bachelors 4yr)
2nd cohort Dentistry, Medicine, Pharmacy, Phys
Ed Health (Bachelors 4yr)
1st cohort Nursing (BScN), OT, PT,
SW, SLP ( Masters -2yr)
3rd cohort Dentistry, Medicine, Pharmacy, PhysEd
Health (Bachelors 4yr)
2nd cohort Nursing (BScN), OT PT, SW,
SLP (Masters 2yr)
3rd cohort Nursing (BScN), OT, PT, SW, SLP (
Masters 2yr)
4th cohort Nursing (BScN), OT PT, SW,
,SLP (Masters 2yr)
46
Organizational Structure
47
Curriculum Overview

• Mandatory competency-based longitudinal
  curriculum
• Woven within each uniprofessional curricula

48

• Completion of four core and a number of elective
  IPE approved learning activities staged over the
  length of program
• Flexible IPE curriculum with a menu of learning
  activities to choose from

49
IPE Curriculum Components
50
Curriculum Framework Core Competencies

• Current popular model of education -
  competency-based curricula and assessment
• Core competency development thus essential
  foundational step

51

• Competence
• Evidence of the development of the necessary
  skills/behaviours, knowledge and/or attitudes to
  successfully engage in entry-level
  interprofessional collaborative practice

52
Key Features

• Foundational values
• Entry-to-practice focus
• Learning continuum
• Evidence-based
• Measurable

53

• Levels
• Exposure introduction
• pre-placement
• Immersion development - interprofessional
  placement
• Competence entry-to-practice

54

• Hierarchy of constructs
• Values and Ethics
• Communication
• Collaboration

55

• Specific competencies aligned with constructs
• Knowledge
• Skills/Behaviours
• Attitudes
• Within a larger educational and professional
  context

56
(No Transcript)
57
(No Transcript)
58
Values and Ethics Competence
59
Communication Competence
60
Collaboration Competence
61
Learning Activities

• Four Core
• Year 1 Session - Introduction to
  Interprofessional Relational-Centred Care
• Conflict in Interprofessional Life
• Case-Based Session (e.g., Pain Curriculum)
• IPE Component in a Clinical Placement

62

• Complementary elective learning activities\
• Build upon IPE learning activities in existence
• Emergency Preparedness
• Global Health
• Maternity Care
• Palliative Care
• Dying and Death
• Patient Safety
• Wellness and Prevention

63
(No Transcript)
64

• Assessment
• Evaluation
• Faculty Leadership

65
Critical Structures

• Human resources devoted to IPE
• Development of IPE leaders across university
• Comprehensive diverse curriculum implemented in
  elective format and integrated into existing
  curricula
• Curriculum slot for IPE

66

• Integration and links with collaborative practice
  clinical sites
• Departmental curriculum committees
• IP Healthcare Student Association supporting IPE

67

• University IPE Office collaborating with and
  integrating efforts across university, clinical
  sites, professional regulatory bodies and
  government to promote IP education, practice and
  policy

68
What U of T Students Say About Their IPE
Experiences

• Teamwork is important and the patient and
  family are part of the team.
• Our health care system is changing, and we need
  to know where we fit in and how we can make a
  difference
• "It opened me up to new ways of thinking, new
  ideas and thoughts and what roles are to be
  played in the future."

69

• Each profession has a unique role to play in
  patient care.
• By understanding each others professions,
  goals, ideals and feelings towards people with
  illnesses and/or disabilities we will be creating
  a strong team of professionals dedicated to
  assisting the clients in each and every sphere of
  health care.

70
CRCP - TAHSN

• Monies received from Ontario Ministry of Health
  and Long-Term Care to catalyze and sustain
  communities of collaboration around IPC
• Focus on learning environment in teaching
  hospitals
• Creating an interprofessional foundation for
  collaboration

71
(No Transcript)
72
Key Components

• Leadership
• Led by Centre for Faculty Development, Faculty of
  Medicine and Office of IPE, UT
• Teams from each TAHSN hospital took an
  interprofessional leadership course
• Focus on learning and applying principles within
  home institutions

73

• Principles focused on
• coaching,
• mentoring,
• organizational change and
• interprofessional collaboration
• Ask the Experts follow-up sessions
• Created a Community of Collaboration

74

• Mentorship
• Led by St. Michaels Hospital
• Created a skilled and knowledgeable cadre of
  leaders and champions promoting and engaging in
  ICP, IPE and research Community of Mentorship
  Professionals Assisting and Supporting
  Students/Staff (COMPASS)
• Developed LinkHealthPro on-line mentorship
  networking tool

75

• Preceptorship
• Led by Toronto Rehabilitation Institute
• Created preceptorship manual and tools for
  structured IPE placements
• Goal to increase number and quality of structured
  IPE clinical placements

76

• Coaching
• Led by the University Health Network, Sunnybrook
  Health Sciences Centre and Mount Sinai Hospital
• UHN focused on coaching and mentorship provided
  to leaders and teams in emergency and general
  internal medicine

77

• Sunnybrook focused on dissemination of Best
  Practice in Emergency Elder Care
• Mount Sinai developed core resource teams within
  targetted areas of the hospital for IPE/IPC

78

• Evaluation
• Led by the Wilson Centre for Research in
  Education, UT
• Evaluation of project overall

79

• Integration and Change Management
• Expert support provided to change culture
• Common element across initiatives

80

• The Interprofessional Mentoring Preceptorship
  Leadership and Coaching (IMPLC) Super Toolkit
  created from initiatives
• Available on-line from Office of IPE, UT

81
(No Transcript)
82
Critical Structures

• Leadership
• Resources
• Communication structure
• Process orientation

83
Your Context
84
Think-Pair-Share

• What are some of the challenges and strategies
  you have found, employed or anticipate in
  developing and promoting IPE/CRCP in your
  university/college/ institution?

85
Challenges

• Perceived value
• Commitment and resources
• Time and logistics
• Implementation
• Integration
• Evaluation
• Sustainability
• Recognition

86

• The problem of changing the curriculum is
  analogous to moving a graveyard. Its not moving
  the graveyard thats the problem its the friends
  of the dead.
• (John Gilbert, Principal College of Health
  Disciplines, UBC, 2004)

87
Implementation Strategies to Promote Integration

• Resources
• Initiative - Champions
• Collaboration
• Value
• Support
• Model
• Time and logistics

88

• Clear process
• Equality
• Applicability
• Flexibility
• Creativity
• Evaluation
• Persistence!
• Fun!

89
References

• Barr H. (1998). Competent to collaborate
  Towards a competency-based model for
  interprofessional education. Journal of
  Interprofessional Care 12(2), 181 187.
• Commission on the Future of Health Care in
  Canada.(2002). Building on values The future of
  health care in Canada. Ottawa Health Canada.
• DAmour, D. Oandasan, I. (2005).
  Interprofessionality as the field of
  interprofessional practice and interprofessional
  education An emerging concept. Journal of
  Interprofessional Care, 19 (Supplement 1), 8-20.

90

• Hammick, M. (2000). Interprofessional education
  Evidence from the past to guide the future.
  Medical Teacher, 22(5), 461-467.
• Health Canada. (2007). Interprofessional
  education for collaborative patient-centred
  practice. Retrieved April 22, 2008, from the
  world wide web http//www.hc-sc.gc.ca/hcs-sss/hhr
  -rhs/strateg/interprof/index_e.html
• Health Force Ontario. (2008). Interprofessional
  care. Retrieved April 22, 2008, from the world
  wide web http//www.healthforceontario.ca/WhatIs
  HFO/AboutInterprofessionalCare.aspx

91

• Institute of Medicine. (L.T. Kohn, J.M. Corrigan
  M.S. Donaldson (Eds)). (2000). To Err is Human
  Building a Safer Health System. Washington,
  D.C. National Academies Press.
• Institute of Medicine. (2001) Crossing the
  Quality Chasm A New Health System for the 21st
  Century. Washington, D.C. National Academies
  Press.
• Institute of Medicine. (A.C. Greiner E.
  Knebel. (Eds)). (2003). Health Professions
  Education A Bridge to Quality. Washington,
  D.C. National Academies Press.

92

• Oandasan, I., DAmour,D. et al. (2004).
  Interprofessional education for collaborative
  patient-centred practice Research findings
  report. Ottawa Health Canada.
• Oandasan, I. Reeves, S. (2005). Key elements
  for interprofessional education. Part 1 The
  learner, the educator and the learning context.
  Journal of Interprofessional Care, 19(Supplement
  1), 21-38.

93

• Pew-Fetzer Task Force on Advancing Psychosocial
  Health Education. (2000). Health professions
  education and relationship-centred care. Pew
  Health Professions Commission and the Fetzer
  Institute.
• Zwarenstein, M., Reeves, S. Perrier, L. (2005).
  Effectiveness of pre-licensure interprofessional
  education and post-licensure collaborative
  intervention. Journal of Interprofessional Care,
  19(Supplement 1), 148-165.

94
www.ipe.utoronto.ca

• For more information
• susan.wagner_at_utoronto.ca