Transcript Interprofessional Collaborative: Moving from Theory to

Interprofessional Healthcare Summit—From Education to Practice
Bonnie Pilon, PhD, NEA-BC, FAAN
Alexander Heard Distinguished Service Professor
Vanderbilt University School of Nursing
April 10, 2015
Disclosures
 None to declare
Objectives
 Review evolution of interprofessional education and
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practice (IPE; IPCP)
Describe relevant theories that undergird IPE and
IPCP
Briefly discuss state of the science related to IPCP
Discuss recent efforts to integrate IPE/IPCP within
nurse led teams and sites
Describe one implementation of IPE & IPCP at a nurse
led clinic
Definitions
 IPE
 WHO (2010): “when students from two or more professions
learn about, from and with each other to enable effective
collaboration and improve health outcomes.” (2010, p.XX)
 IPCP
 WHO (2010): “when multiple health workers from different
backgrounds work together with patients families, carers
[sic], and communities to deliver the highest quality of care”
 IPE Collaborative Expert Panel (2011): care delivered by
intentionally created, usually smaller work groups in health
care, who are recognized by others as well as by themselves as
having a collective identity and shared responsibility for a
patient or group of patients
 Interprofessional teamwork: “the levels of
cooperation, coordination and collaboration
characterizing the relationships between professions
in delivering patient-centered care.”
 Interprofessional team-based care: “care delivered
by intentionally created, usually relatively small work
groups in healthcare, who are recognized by others
as well as by themselves as having a collective
identity and shared responsibility for a patient or
group of patients, e.g. rapid response team, palliative
care team, primary care team, operating room team.”
Interprofessional Education Collaborative Expert Panel (2011). P. 2
 Interprofessionality: “the process by which
professionals reflect on and develop ways of practicing
that provides an integrated cohesive answer to the
needs of the client/family/population…It involves
continuous interaction and knowledge sharing
between professionals, organized to solve or explore
a variety of education and care issues all while seeking
to optimize the patient’s participation.
Interprofessionality requires a paradigm shift,
since interprofessional practice has unique
characteristics in terms of values, codes of
conduct, and ways of working.”
D’Amour & Oandasan (2005). P. 9
Key Milestones for IPE & IPCP
Development
 1972 IOM Educating for the Health Team
 1998 Pew Charitable Trust Report
 2000 IOM To Err is Human: Building a Safer Health
System
 2001 IOM Crossing the Quality Chasm
 2008-present AHRQ efforts on retraining to build
interprofessional teamwork and team based care
(TeamSTEPPS deployment)
 2009 Recovery and Reinvestment Act & 2010 Affordable
Care Act placing increased emphasis on medical home,
population health, improved primary care outcomes
Interprofessional Education by
Profession (examples)
 Nursing: AACN integrated interprofessional collaboration
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behavioral expectations into the Essentials documents for
baccalaureate (2008), master’s (2010), and doctoral education for
advanced practice (2006)
MD: AAMC called for attention to IPE on schools of medicine in
2008; ACGME began evaluation of team training on resident
experiences and patient outcomes
Pharmacy: curricular guidance (2004), vision for practice by
2015, accreditation requirements (2011) incorporate consistent
IPE and IPCP principles
DO: Launched exploratory analysis of relationship between
principals of osteopathic medicine and IPE; pilot IPE programs
at osteopathic medical schools implemented
Public Health: ASPH developed 10 competencies at the MPH
level for IPE
WHO (2010). Framework for Action on Interprofessional Education & Collaborative Practice
Three Types of Professional
Competencies
Common
Competencies
Individual
Professional
Competencies:
Complementary
IP
Collaborative
Competencies
Barr, H. 1998
Interprofessional Collaborative
Practice Competency Domains
 Values/Ethics for Interprofessional Practice
(moral obligation to work together to improve outcomes)
 Roles and Responsibilities
(shared understanding of each person’s roles and abilities)
 Interprofessional Collaboration
(openness, style, expression of feelings & thoughts aimed at
modifying teamwork environment)
 Teams and Teamwork
(essential component of patient centered practice)
College of Health Professions, Armstrong State University
Challenges to Implementation of
Interprofessional Competencies
 Institution
 Lack of other institutional collaborators
 Practical issues
 Faculty development issues
 Assessment issues
 Lack of regulatory expectations
State of the Science: Does IPCP
Create Improved Patient Outcomes?
Successful Collaboration—
Better Outcomes!
Majority of Studies Focus on…..
Competencies
Composition
Processes
Outcomes
Case Example: Vanderbilt School
of Nursing
 Approach
 Theory and evidence to guide the work
 HRSA Division of Nursing support
 Lessons learned
VUSN Population Health Model
Vanderbilt Program for Interprofessional Learning Model
Framework for Interprofessional Values and Core Competencies (University of Toronto, 2008)
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Exposure
Immersion
Competence
Values/Ethics
Values/Ethics
Values/Ethics
Recognizes ethical issues
Describes and clarifies values
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Communication
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Can articulate uniqueness of
self and others
Can describe:
One’s own role
Interprofessional theory
Interprofessional context
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Communication
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Collaboration
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Describes ethical
framework
Uses ethical decisionmaking
Demonstrates advanced
interprofessional values
Is self-reflecting
Addresses conflict
Open to learning
interprofessional
communication skills
Communication
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Collaboration
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Can describe:
Roles of others involved in
patient care
Shared team values are
demonstrated
Ethical interprofessional
practice is evident
Demonstrates respect & values
others’ contributions
Effective communicator
Advanced interprofessional
group function is evident
interprofessional team
continues to improve
Collaboration
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Collaborative work can be
measured
Interprofessional team is
preferred model of practice
Leadership for
interprofessional practice
emerges
Measuring Collaboration
 Team Development Measure
 Looks at team development from the perspective of
individual members of the team
 31 items, 4 scale response: Strongly Agree to Strongly
Disagree
 4 domains
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Cohesiveness
Communication
Role clarity
Goals & Means Clarity
 2 levels
 How many of the components are in place
 How firmly they are in place
Stock, R., Mahoney, E. & Carney, P.A. (2013).
TDM Stages
Stage
Score Range
Components
Present
Pre-Team
0-36
None to building
Cohesiveness
1
37-46
Cohesiveness
2
47-54
Communication
3
55-57
Role Clarity
4
58-63
Goals & Means
Clarity
5
64-69
Cohesiveness
6
70-77
Communication
7
78-80
Role Clarity
8
81-86
Goals & Means
Clarity
Fully Developed
87-100
Everything
Solidification
In Place
Firmly in Place
Team Members Self-Assessment
Time point
Average TDM
score
Team Stage
Winter 2013
58.25
Stage 4
Summer 2013
58.50
Stage 4
Winter 2014
62.00
Stage 4
Summer 2014
58.86
Stage 4
Winter 2015
60.16
Stage 4
Student Assessment of Team
Development
What We Have Learned so far…
 Intentional practice
 Pre-planning makes a difference using theory to guide team
training
 Structured communication times and techniques are
essential to success
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SBAR
Huddles
Team Briefs
Complex Case Reviews
 Primary care TeamSTEPPS is a set of tools that supports
IPCP
 Iterative practice; continuously evolving
 PDSA used to improve IPCP
Acknowledgements
The Vanderbilt IPCP project was partially supported by the Health
Resources and Services Administration (HRSA) of the U.S.
Department of Health and Human Services (HHS) under grant
number UD7HP25064, Division of Nursing NEPQRInterprofessional Collaborative Practice program (total award
amount:$1,394,204 over three years). The information or content
and conclusions are those of the author and should not be
construed as the official position or policy of, nor should any
endorsements be inferred by HRSA, HHS or the U.S. Government.
Other important financial support was received from The
Memorial Foundation, Hendersonville, TN, The Boulevard Bolt
Committee, Nashville, TN and Vanderbilt School of Nursing.
Specific funding for the VPIL program was received from the Josiah
Macy Foundation, New York, NY, and from the Baptist Healing
Trust, Nashville, TN.
References
 World Health Organization (WHO). (2010). Framework for action on interprofessional
education & collaborative practice. Geneva: World Health Organization.
http://www.who.int/hrh/resources/framework_action/en/
 Interprofessional Education Collaborative Panel. (2011). Core competencies for
interprofessional collaborative practice: Report of an expert panel. Washington, DC:
Interprofessional Education Collaborative.
 D’Amour, 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.
 Barr, H. (1998). Competent to collaborate: Toward a competency-based model for
interprofessional education. Journal of Interprofessional Care, 12(2), 181-187
 VUSN population heath model adapted from: Peterson, K.W. & Kane, D.P. (1997).
Beyond disease management. In W.E. Todd & D. Nash, (Eds.), Disease Management: A
Systems Approach to Improving Patient Outcomes (pp. 305-346). Chicago, IL: American
Hospital Publishing, Inc.
 University of Toronto, 2008. University of Toronto Interprofessional Education
Curriculum/Program. http://www.rehab.utoronto.ca/PDF/IPE.pdf
 Stock, R., Mahoney, E. & Carney, P.A. (2013). Measuring team development in clinical
care settings. Family Medicine, 45(10). 691-700.