Slide 1

Report
Redefining Teamwork with Interprofessional
Education and Practice:
The Academic and Clinical Realities
Ruby Grymonpre, PharmD
Professor, Faculty of Pharmacy
IPE Coordinator, UofM
January 11, 2012
Interprofessional Education Initiative
Session Outline
By the end of this presentation, you will be able to:
• Describe the drivers for interprofessional education &
collaborative practice (IPE&P)
• Define key terms related to IPE&P
• Outline the systems approach being used in Manitoba to
implement IPE&P
• Articulate the key goals and actions for WRHA and UofM with
respect to IPE&P
Interprofessional Education Initiative
Health and Wellness of Individuals
• 55% of Canadians suffer 1 or
more chronic conditions
• 89% of deaths each year
due to chronic disease
• Chronic disease costs over $100 billion in Canada
• Prevention and management of chronic disease in
individuals has become health care priority
http://www.ocdpa.on.ca/docs/OCDPA_EconomicCosts.pdf accessed May 27, 2010
http://www.queensu.ca/sps/publications/press/intros_tocs/EmergingApproaches_Intro.pdf
May 27, 2010
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accessed
Health and Well-being
“Health is a state of complete physical,
mental and social well-being and not
merely the absence of disease or infirmity”
(World Health Organization, 1948)
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The problem
• Dependent on expensive
new technologies
• Hospital is central
• Provider-centred: patients
come to us
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The problem
• emergency room overcrowding
• difficult access to the necessary
care
• poor record on patient safety
• long wait times
• inconsistent quality
• high costs with poor outcomes
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The problem
• Health professions have evolved
in parallel with very different
traditions for education and
clinical service
• Professionals have poor
understanding of expertise and
scope of practice of colleagues
• Reimbursement systems have
fostered competition over
collaboration between
disciplines
Interprofessional Education Initiative
The problem
Health Human Resource
Crisis
estimated worldwide shortage of
almost 4.3 million health
workers
aging workforce
poor working conditions
job dissatisfaction
http://www.who.int/hrh/professionals/en/ Accessed Jan 11, 2012
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Interprofessional
Education
IPE&P
Interprofessional Education Initiative
Collaborative
Person Centred
Practice
Where’s the evidence for IPE&P?
• Increased access to health care
• Improved outcomes for people with chronic
diseases
• Less tension and conflict among caregivers
• Better use of clinical resources
• Easier recruitment of caregivers
• Lower rates of staff turnover
Canadian Health Services Research Foundation. Teamwork in Healthcare: Promoting Effective Teamwork in Healthcare in
Canada. Ottawa, ON: CHSRF; 2006. http://www.chsrf.ca/SearchResults.aspx?search=Teamwork%20in%20health%20care
Accessed January 11, 2012
Lemieux-Charles L, et al. What do we know about health care team effectiveness? Med Care Res Rev 2006;63(3):263–
300
Interprofessional Education Initiative
Cochrane Review (2008)
4 of 6 studies found that IPE resulted in:
• improved working culture in ED and patient satisfaction;
• decreased errors in ED
• improved management of the care delivered to domestic
violence victims
• improved knowledge and skills of professionals providing
care to mental health patients
2 of these 4 studies found mixed results
2 of 6 studies found that IPE had little to no effect
Reeves S et al. IPE: Effects on professional practice and health care outcomes.
Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD002213. DOI:
10.1002/14651858.CD002213.pub2.
Interprofessional Education Initiative
WHO statement
“After almost 50 years of enquiry, the World
Health Organization and its partners
acknowledge that there is sufficient evidence to
indicate that effective interprofessional
education enables effective collaborative
practice.”
“Collaborative practice strengthens health systems
and improves health outcomes.”
Framework for Action on Interprofessional Education and Collaborative Practice, 2010
http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf
p 7 accessed January 11, 2012
Interprofessional Education Initiative
WHO Statement
“Once students understand how to
work interprofessionally, they are
ready to enter the workplace as a
member of the collaborative practice
team. This is a key step in moving
health systems from fragmentation to
a position of strength.”
http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf p 10
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Sydney Interprofessional Declaration
•
•
All users of health and human services shall be entitled to fully integrated,
interprofessional collaborative health and human services.
All health and human services work to create and strengthen a culture that promotes
the delivery of contextual opportunities for interprofessional learning and collaborative
team training. Interprofessional education and training for collaborative practice
should be a core element of continuing professional development.
• Health worker education and training prior to practice
shall contain significant core elements/learning domains
of interprofessional education. These core
elements/learning domains shall contain practical
experiences, for example simulation. These core
elements/learning domains for interprofessional
education will be formally assessed.
•
•
Between ATBH5 and ATBH6 the global interprofessional community will undertake to
develop a globally agreed upon set of definitions and descriptions that capture
interprofessional education, learning, practice and care.
The global interprofessional community will work with the World Health Organization
to implement the Framework for Action on Interprofessional Education and
Collaborative Practice.
http://www.cihc.ca/files/The%20Sydney%20Interprofessional%20Declaration.pdf
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Health Canada
Building on Values: The Future of Health Care in Canada
“…the direction of our health care system must be shaped
around health needs of individual patients, their families
and communities.”
- CPCP -
“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.”
- IPE –
November 2002, Commissioner Roy J. Romanow, Q.C.
http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/romanow_e.html
Accessed January 12, 201
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Health Canada – HHR Strategy
Health Human Resource Planning—ensuring we have enough of the
right types of health-care providers to meet the needs of Canadians;
Recruitment and Retention—encouraging more people to enter the
health-care field and improving working conditions to keep them there;
and
Interprofessional Education for Collaborative
Patient-Centred Practice [IE(CP)2 ]—changing
the way we educate health providers so
Canadians will have better and faster access to
the health-care provider they need when they
need it, ultimately boosting the satisfaction of both
patients and health-care providers.
http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/index_e.html
Accessed January 12, 2012
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Reality check in Manitoba
“there appears to be no active program
of interprofessional learning at that
centre [University of Manitoba]”.
Cook D. “Models of Interdisciplinary Learning” Report
to Health Canada. February, 2004 page 25
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Total of 20 Health Canada funded projects across Canada
1
1
1
1
2
3
7
Interprofessional Education Initiative
1
3
IPE Offices/Initiatives in Canada
Ontario:
Alberta:
Canadore College
Centennial College
Confederation College
George Brown College
Humber Institute of Technology &
Advanced Learning McMaster
University
Michener Institute for Applied Health
Sciences
Niagara IP Health Education Institute
Northern Ontario School of Medicine
Queen’s University
Ryerson University
University of Toronto
University of Western Ontario
University of Alberta
Nova Scotia:
Dalhousie
Saskatchewan:
University of Saskatchewan
Quebec:
McGill University
University of Sherbrooke
Manitoba:
University of Manitoba
British Columbia:
University of British Columbia
University of Victoria
Vancouver Community College
Newfoundland:
Memorial University
Interprofessional Education Initiative
Accreditation of Interprofessional
Health Education (AIPHE)
• Accreditation Council of Canadian Physiotherapy
Academic Programs
• Canadian Association of Occupational Therapists
• Canadian Council for Accreditation of Pharmacy
Programs
• Canadian Association of Schools of Nursing
• Canadian Association of Schools of Social Work
• Committee on Accreditation of Canadian Medical
Schools
• Royal College of Physicians and Surgeons of Canada
• College of Family Physicians of Canada
Interprofessional Education Initiative
Accreditation of Interprofessional
Health Education (AIPHE)
Phase I – 2007- 2009
Phase II – 2010-2011
http://www.afmc.ca/aiphe-afiss/documents/AIPHE_Principles_and_Implementation_Guide_EN.pdf
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National Health Sciences Students’
Association (NaHSSA)
“The National Health Sciences Students’
Association strives to promote collaborative
patient-centred practice and teamwork through
interprofessional education in order to respond
to the evolving health care needs of
Canadians.”
MaHSSA
http://www.nahssa.ca Accessed January 11, 2012
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The systems shake
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Manitoba Health Care System
• Manitoba Health oversees
provincial health care system
and sets broad policy direction
• RHAs responsible for
assessing/prioritizing needs,
goals and coordinating health
services
• 11 RHAs in Manitoba
• WRHA responsible for health
services for 60% of 1.2 million
MB residents
• WRHA encompasess over 200
programs, services, facilities
• includes 9 acute & long term
care centres, 16 community
health offices and 39 personal
care homes
• 36 regional program teams
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Post-Secondary Education in Manitoba
Advanced Education & Literacy
Council of Post Secondary
Education oversees allocation
of funds to the province's
seven public post-secondary
institutions
University of Manitoba:
27,000 students
13 Academic Units:
• Clinical Health Psychology
• Dentistry
• Dental Hygiene
• Human Ecology
• Kinesiology & Rec Management
• Social Work
• Medicine
• Nursing
• Occupational Therapy
• Pharmacy
• Physical Therapy
• Physician Assistants
• Respiratory Therapy
Interprofessional Education Initiative
Council of Post Secondary Education
University of Manitoba
Manitoba Health
Winnipeg Regional Health Authority
COLLABORATIVE PERSON CENTRED CARE
UofM IPE INITIATIVE
Interprofessional Education Initiative
UofM IPE Initiative
Mission
• To graduate health professionals prepared to manage
and adapt processes in interprofessional (IP) teams
necessary to achieve person- and family- centred
health and wellness outcomes. This will be achieved
through innovative learning opportunities for students to
learn about, with, and from each other at the University
of Manitoba
Vision
• Improved health and well-being for Manitobans by
building a culture of interprofessional education and
practice.
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Interprofessional Education Initiative
WRHA Professional Advisory Committee
• Senior patient care committee reporting to CEO
and Board with representation from nursing,
allied health, and medical leadership
• Focus is on collaborative practice, scope of
practice and evidence informed practice
• In 2009, action plan developed to advance
interprofessional education and practice within
the region
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WRHA Collaborative Care
http://www.wrha.mb.ca/professionals/collaborativecare/
Interprofessional Education Initiative
What is Interprofessional Education?
“…..occurs when two or more professions learn
about, from and with each other to enable
effective collaboration and improve health
outcomes…”
* Professional is an all-encompassing term that
includes individuals with the knowledge and/or
skills to contribute to the physical, mental and
social well-being of a community.
Framework for Action on Interprofessional Education and Collaborative Practice, 2010
http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf p 13 accessed Jan 12, 2012
Interprofessional Education Initiative
What does IPE look like?
• An educational approach
• Requires interaction
• Something must be exchanged
that changes how they perceive
themselves and others
• Changes must positively affect
clinical practice
http://www.afmc.ca/aipheafiss/documents/AIPHE_Principles_and_Implementation_
Guide_EN.pdf
Interprofessional Education Initiative
What does IPE not look like?
It is not:
a collective of learners from
different professions sitting in
the same room listening to the
same lecture
- or learners from one profession
sharing knowledge with one or
more other professions in a one
way exchange
http://www.afmc.ca/aipheafiss/documents/AIPHE_Principles_and_Implem
entation_Guide_EN.pdf
Interprofessional Education Initiative
Terminology
‘Uni’ professional: occasions when professionals
or students from one profession learn together
‘Multi’ professional : occasions when two or more
professions learn side by side but in parallel
(minimal interaction)
‘Inter’ professional: occasions when two or more
professionals learn about, with, and from each
other to improve collaboration and the quality of
care
‘Trans’ professional: occasions in real practice
where professional boundaries have been crossed
or merged
Carpenter J, Dickinson H Interprofessional Education and Training. Policy Press. Great Britain. 2008. p.3
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What does collaboration look like?
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The 3 C’s
Communication: the imparting or
interchange of thoughts, opinions, or
information
Cooperation: parallel activities among
individuals or organizations that associate
informally to accomplish their common
goals
Denise L, Collaboration vs C-Three. Innovating 1999(Spring): 7(3)
Interprofessional Education Initiative
Collaboration
“...is the process of shared
creation: two or more
individuals with complementary
skills interacting to create a
shared understanding that
none had previously
possessed or could have come
to on their own. Collaboration
creates a shared meaning
about a process, a product, or
an event. In this sense, there is
nothing routine about it.
Something is there that wasn’t
there before.”
Michael Schrage, Shared Minds, NY: Random House, 1990, p. 140
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Canadian Interprofessional Health Collaborative (CIHC)
www.cihc.ca/resources/publications
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Here Now: Getting it Wrong - The Problem
with Words
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What’s in a name?
Individual
Family
Recipient
Patient
Consumer
Service user
Expert by experience
Person
Customer
Client
Caregiver
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Participant
Whats in a name?
Rotation
Practicum
Clinical placement
Clerkship
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UofM IPE Curriculum Blueprint
Guide and monitor implementation of IPE
• a ‘balance’ of competencies are addressed
through a student’s university education
• learning occurs along a continuum
• by graduation, learning around all competencies
has been accomplished
To ensure IPE:
• strategic, transparent, uses common terminology
• explicitly states/addresses ≥ 1 learning objective
• is assessed (students) and evaluated (session)
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The University of Manitoba IPE Curriculum Blueprint
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Understanding Roles and Responsibilities
Exposure:
Knowledge
• Articulate your professional role in the care of
individuals
• Articulate the roles and scopes of practice of
other members of the IP team and identify areas
of responsibility overlap
Attitudes:
• Reflect on personal values/beliefs regarding
scopes of practice and role overlap
Interprofessional Education Initiative
Understanding Roles and Responsibilities
Immersion:
Skills/Behaviours:
• During an IP shared care planning session
negotiate responsibilities/actions based on role
constraints, overlap, and discipline-specific
legal/ethical practice standards.
Interprofessional Education Initiative
Understanding Roles and Responsibilities
Mastery:
Has sufficient confidence in and knowledge of:
• one’s own discipline to work effectively with
others in order to optimize person centred care
• others’ professions to work effectively with
others in order to optimize outcomes for
individuals
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Curriculum Overload
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Guiding Principles
• We value interprofessional education (IPE) and foster its
existence where and when two or more professions are
involved.
• We value IPE that is integrated in University of Manitoba
curricula and foster its development through:
• We value IPE in which its uniqueness is a well
understood identity within the university culture through:
• We value a common understanding of IPE among all
faculty, in which:
• We value evaluation of and scholarship in UofM IPE
Initiative in which:
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