Transcript Document

Inter-professional Possibilities in
Healthcare: What do they mean for oral
health?
Lesley Bainbridge
Director, Interprofessional Education
Faculty of Medicine and
Principal pro tem
College of Health Disciplines
University of British Columbia
Context for this presentation:
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What is IPE?
What is collaborative practice?
What is patient-centred care?
What are the emerging models?
Why should oral health practitioners care?
What are the barriers?
What helps to break down the barriers?
Where do you fit?
Interprofessional education isn’t
new so what is?
The policy language that is directing us to
interprofessional education and collaborative
practice and, to some extent, the research, although
there is a long road ahead of us still as we strive to
generate new knowledge.
Health Council of Canada
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Increase the number of interprofessional teams
providing primary health care beyond the goal set
out in the 2003 and 2004 agreements, which
currently call for 50 per cent of residents to have
24/7 access to health care teams by 2011. (2006)
Health Canada
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Changing how primary health care is organized,
funded and delivered in Canada is an enormously
challenging undertaking. It demands an
unprecedented level of collaboration and
consensus-building across jurisdictions and among
health care professionals. (PHCTF: 2005)
Romanow Report
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Review current education and training programs for health
care providers to focus more on integrated approaches for
preparing health care teams. One of the best ways of
ensuring that health care providers are able to work effectively
in new, more integrated settings is to begin with their education
and training. Education programs should be changed to focus
more on integrated, team-based approaches to meeting health
care needs and service delivery. (2002)
World Health Organization report
Preparing a Health Care Workforce for the 21st Century:
The Challenge of Chronic Conditions 2005
available at www.in-bc.ca
DRIVERS FOR CHANGE
Primary driver: patient safety
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To Err is Human (IOM)
The Canadian Adverse Events Study
Human factors research
Many other examples…..
Secondary drivers:
1. Health human resources:
• Looming shortages of health care (including oral
health care) providers.
• New ways of practicing.
• Shared competencies.
2. Chronic disease management
3. Primary health care
EMERGING MODELS OF PRACTICE
Goal
Interprofessional
Health Education
for Patient/Client
Centred
Interprofessional
Education
Model
Charles,
Bainbridge
Gilbert 2004
Collaborative
Practice
to&Improve
Patient Care
Learning Process
Professional
Personal
Interprofessional
Interprofessional Education Development Stages
Exposure
Immersion
Mastery
Health Canada’s Framework for IECPCP
IPE
PCC
PRACTITIONER
LEARNER
CP
IPE
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What does it look like if IPE is not evident?
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What does it look like if IPE is evident?
What do we say IPE is?
Interprofessional education:
•Is the process by which we train or educate collaborative practitioners
•Changes how health care providers view themselves
•Is a complex process that requires us to look at learning differently
•Requires the health provider to practice in a way that allows for and accepts
shared competencies
•Requires interaction between and among learners.
Perceived benefits of interprofessional education have been documented and
include:
•Enhancing motivation to collaborate
•Changing attitudes and perceptions
•Cultivating interpersonal, group and organizational relations
•Establishing common values and knowledge bases; and reinforcing
competence. (Barr, 1999)
Collaborative Practice
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What does it look like if collaborative practice is not
evident?
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What does it look like if collaborative practice is
evident?
What do we say collaborative practice is?
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Features of collaborative practice:
– using appropriate language when speaking to other people
– understanding that all health providers contribute to the team or
collaborative unit
– showing respect and building trust among team members
– introducing new members of the team in a way that is welcoming
and gives them the information they need in order to be a
contributing team member
– turning to colleagues for answers
– supporting each other when mistakes are made, and celebrating
together when success is achieved
– recognizing the assumptions we make about others and reflecting
on how to turn those assumptions into better communications with
colleagues, patients or families
Collaboration: A process through which parties who see
different aspects of a problem can constructively explore their
differences and search for solutions that go well beyond their
own vision of what is possible.
Patient-Centred Care
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What does it look like if patient-centred care is not
evident?
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What does it look like if patient-centred care is
evident?
What do we say patient-centred care is?
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Patient-centred care does not mean patients must get exactly what they ask
for, but rather that patients are working with their interprofessional team
members to determine health goals that are realistic and achievable.
Patient-centred care:
– ensures the patient is listened to, valued and engaged in conversation
about their own health care needs
– ensures the patient has input into how their needs can be addressed
– requires a balance between the professional knowledge of care
providers and the personal knowledge of the patient and their family
– includes both the health care provider team and the client
– focuses on the patient’s goals, their family’s goals and the professional
expertise of the team
– adds the knowledge of all team members to the patient’s self-knowledge
and self-awareness so that the final result is doable
BARRIERS
A non-exclusive list of some
barriers to inter-professional collaboration
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interpersonal differences e.g. age, gender, culture
fear of change e.g. place, time, persons
stereotypic rivalry e.g. me, him/her, them
power, income and status e.g. salary vs. fee-for-service
language e.g. gender, profession, social class, jargon
models of practice e.g. medicine, dentistry, dental hygiene
management structures e.g. acute care, community
management priorities e.g. money, space, people
scope of practice e.g. reserved acts, fear, silos
If we believe that IPE and collaborative
patient or family-centred practice lead to……
the highest quality
of care in oral health….
….what do we do?
MACRO:
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Get buy in from the
organization
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Articulate the concepts in
mission, vision and values
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Facilitate uptake of the
concepts throughout the
organization
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Allocate funds to support
the concepts
…and do…
MESO:
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Support collaborative
practice at the bedside and
in the community
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Educate providers, patients
and families
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Reward collaborative
practice
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Train interprofessional
teams
…and do.
MICRO:
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Recognize IPE as essential
learning for individuals
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Provide time for
collaboration and reflection
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Reassure staff and families
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Make collaboration across
professions the norm for
everyone
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Include it in performance
expectations and reward it
What we are doing…
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College of Health Disciplines (www.health-disciplines.ubc.ca)
BC Academic Health Council (www.bcahc.ca)
Health Canada IECPCP initiative
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$20 million allocated to projects across Canada
Range of background documents available
Range of projects and initiatives across Canada which link
post-secondary institutions and health organizations
InBC – the BC network (www.in-bc.ca)
Canadian Interprofessional Health Collaborative www.cihc.ca
links IECPCP projects across the country
International collaboration (CAIPE, ATBH IV, CAB)
IN SUMMARY….
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IPE is the means by which we train collaborative practitioners.
Collaborative patient/family-centred practice is increasingly the
way of the future.
Policy change is necessary to support a shift in education and
practice.
At the macro, meso and micro levels of organizations and
communities support must be tangible and evident.
We have a responsibilty as individuals to practice collaboratively.
We still have many research gaps but together, we can address
them.
Once we make the shift, we can never go back.
We are moving forward, slowly, so remember….
FORWARD IS A DIRECTION, NOT A
SPEED…
with thanks to Bruce Holmes,
Dalhousie University