Transcript 2009 Symposium - Children's Treatment Network

Interprofessional Care:
Building on Collaborative Teams
Mandy Lowe
Faculty Lead, IPE Preceptorship & Facilitation
Office of Interprofessional Education
University of Toronto
Interprofessional Education Leader
Toronto Rehabilitation Institute
[email protected]
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Objectives
• Define teams and collaboration
• Recognize the importance of team
collaboration
• Consider individual and team-based strategies
to enhance collaboration
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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 borders
Oandasan et al. (2006)
Ehpic course, June 2009
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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)
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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)
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Capacity to Collaborate
It is believed by many that if we train competent
collaborative practitioners, more collaborative
practice settings will be developed over time…
Hence practice is linked with education.
p. 12, D’Amour & Oandasan (2005)
Ehpic course, June 2009
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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
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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)
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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.ca
www.chsrf.ca –
Promoting effective teamwork in
healthcare in Canada
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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?
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7 Essential Elements for
Collaboration Way , Jones & Busing (2000)
Ehpic course, June 2009
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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
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How can team collaboration be
fostered?
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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
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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)
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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)
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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 reviewed
Government of Ontario, Family Health Team Guide to Collaborative
Team Practice (2005)
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Team Function
High performance requires BALANCE
TASK
Task – what is
done and the
problems
associated with
completion
PROCESS
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
Oandasan & Reeves (2005)
Ehpic course, June 2009
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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?
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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
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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)
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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)
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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?
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“To talk well and eloquently is a very great
art, but that an equally great one is to
know the right moment to stop.”
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Thank you!
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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
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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, 21:195211.
• 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.
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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.
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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 prelicensure interprofessonal education and post-licensure collaborative
interventions Journal of Interprofessional Care. 19 Supl 1:148-65
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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
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