Canadian Healthcare Network

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Oct 21, 2013 - Awareness is growing in Canada and internationally that interprofessional education .... The Canadian Medical Protective Association (CMPA).
Canadian Healthcare Network

10/21/13 10:39 AM

Interprofessional education for collaborative person-centred practice Written by Ruby Grymonpre, PharmD, FCSHP on July 8, 2013 From what and why … to how?

Awareness is growing in Canada and internationally that interprofessional education for collaborative person-centred practice (IECPCP) can enhance healthcare delivery systems, address health workforce challenges, and ultimately optimize the health and wellbeing of individuals, their families, and communities.(1) The IECPCP movement is driven primarily by evidence that lack of communication and collaboration among health providers leads to gaps and duplication in service delivery, often resulting in serious adverse patient outcomes,(2,3) as well as job dissatisfaction and recruitment and retention issues. Studies show that when health professionals are educated together, have knowledge of the skills of other members of the healthcare team, and work together with the patient to decide on a course of treatment, patient outcomes are better and the overall job satisfaction of healthcare providers is improved.(4) The World Health Organization summarized the evidence in its Framework for Action on Interprofessional Education & Collaborative Practice.(5) Among many benefits, interprofessional practice can reduce lengths of hospital stay, improve quality of life for patients and families, improve access to care, enhance patient safety, and facilitate recruitment and retention of healthcare professionals.(5) In 2003, the Canadian government dedicated $16 billion towards a five-year Health Reform Fund. One goal of this fund was to ensure that at least “50% of Canadians had 24/7 access to multidisciplinary teams by 2011.”(6,7) Although this benchmark has not been met, across the country there is strong momentum to advance IECPCP. Whether practising in hospital, primary care, or community settings, pharmacists are integral members of interprofessional healthcare teams. It is critical that pharmacists participate with other members of their team in making the transition towards collaborative care. This article defines interprofessional education (IPE) and collaborative person-centred practice (CPCP) and provides a brief description of the six important collaborative competencies. It also outlines the role pharmacists might assume as leaders of change and provides recommended steps to advancing collaborative care. What is IPE and CPCP? Interprofessional education (IPE) has been defined as “occasions when two or more professions learn with, from, and about each other to improve collaboration and the quality of care.”(8) It occurs when health professionals across all health and social care disciplines are brought together to learn, study, and practise. Interprofessional education involves small group participatory learning that is problem-centred and nonthreatening; it is also relevant, has immediate application for the learner, and fosters self-directed and internally-motivated student engagement. It involves several additional learning principles in that collaboration must be explicitly taught, students must learn ‘about, with and from each other,’ and the knowledge exchanged should change the way learners perceive themselves or others. Because of the interprofessional nature of the learning experience, it is critical that sessions are facilitated and that there are opportunities for debrief and reflection. Interprofessional education is a complex educational approach to learning that must be embedded throughout the learning continuum, spanning from pre-licensure to continuing professional development. Achieving collaborative competence requires advancement of knowledge (cognitive), attitudes (affective), skills and behaviours (psychomotor), and group relationship abilities (social) within a purposely ‘scaffolded’ curriculum of increasing complexity and varying contexts, environments, and knowledge.(9) In other words, IPE is not an end in itself. The goal of IPE is to prepare learners to become competent members of collaborative person-centred teams, with the ultimate goal of improved health and wellbeing of individuals, families, and communities. Collaborative person-centred practice (CPCP) “is 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, optimizes staff participation in clinical decision making within and across disciplines, and fosters respect for disciplinary contributions of all professionals.”(1) Six key features of an interprofessional collaborative team To operationalize the preceding definition of CPCP, many academic and practice organizations have adopted the Canadian Interprofessional Health Collaborative (CIHC) National Interprofessional Competency Framework,(10) which describes the following six practices and behaviours of a highly functioning interprofessional collaborative team. Person-centred care. The composition of the team is determined by the needs of the person receiving care. As an equal member of the healthcare team, the person receiving care is respected and supported for their contributions in the design, implementation, and evaluation of their care plan. Teams have documentation that outlines how the expectations of persons receiving care are heard and this documentation is readily accessible and understood by all team members. Team communication. Communication among team members is open, respectful, responsive, and fosters the interprofessional contributions of all. Systems and processes are in place for effective and timely communication and decision making between healthcare providers and between healthcare providers and the person receiving care and his/her family. An accurate and complete health record is accessible to all. Shared leadership. The team leader is not a static position as it is determined by the needs of the person receiving care. An integrated plan of care is designed, implemented, and evaluated through the shared contributions of the person receiving care and all other members of the healthcare team. Policies are in place on how healthcare decisions are made and who is accountable for such decisions. Understanding roles and responsibilities. The benefits of interprofessional collaboration are maximized when all members of the team work to their full scope of practice. Each team member articulates his/her own scope of practice and that of other members of the team. Overlapping roles and care gaps are discussed and responsibilities are clearly delineated, respected, and trusted. Team dynamics. An interprofessional team understands the processes of team development and undertakes key strategies that enable effective collaborative team functioning. Policies and a procedural framework are in place to coordinate and manage the team and to define and support team function. Quality improvement processes are in place to monitor and improve team function and health outcomes. Conflict management. An interprofessional collaborative team fosters a safe environment that allows members to actively address disagreements and respond effectively to all types of conflict.

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Pharmacist’s role In practice, the transition from multidisciplinary teams to interprofessional collaborative care requires a change in the way that teams currently practise. Pharmacists are key members of interprofessional collaborative teams and many pharmacists are assuming leadership roles in supporting his/her team’s transition. Below is a suggested list of actions that an interprofessional team champion might want to consider (11): Knowledge. Have a good understanding of what interprofessional education for collaborative person-centred care (IECPCP) is. Consider joining a community of practice involving like-minded healthcare professionals passionate about advancing collaborative care. Seek out opportunities for inperson and virtual networking, webinars, and sharing of valuable resources and tools. Partnerships. Partnerships with academia, community agencies, other independent health providers, and self-help advocacy groups create synergies and strengthen efforts. Awareness and commitment. The transition to collaborative care is not a ‘one man show.’ The likelihood of sustainability is increased when support is obtained from all levels of management within all partner ‘organization(s).’ Provisions must be made to ensure the team is able to dedicate the time for team development. One or more collaborative care champions must be identified. Define the team. This is an obvious but frequently forgotten step. The composition of the team is determined by the needs of the persons receiving care. This exercise will likely reveal the contributions of many care providers and personnel who, on first thought, may not be considered “typical” members of the team. Assess and plan for the transition. It is highly recommended that an external facilitator be assigned to the team to provide basic core education on the collaborative competencies, to support the team in their self assessment, observe team collaboration, and work with the team to develop a collaborative care action plan and team goals. Revise structures and processes as required to support collaborative care. Guided by the six collaborative competencies, the team should ensure responsibilities and accountabilities are clearly documented and understood by all members to ensure optimal patient outcomes and minimize the medicolegal risks of IECPCP. Establish policies and processes that support and facilitate collaborative care, such as embedding collaborative care competencies in job descriptions and setting aside time and space for interprofessional care planning. All health professionals should carry adequate liability protection.(12-14) Evaluate for improvement. Reassessment and evaluation of person, team, and system outcomes allows for ongoing improvement and the creation of new benchmarks. Summary The movement towards interprofessional education for collaborative care is not a passing trend or transient fad. In addition to ensuring efficiencies in healthcare delivery and improved health outcomes for individuals, families, and communities, IECPCP provides opportunities for pharmacists to work to their full scope of practice and gain increased job satisfaction. The transition to collaborative care requires knowledge, commitment, and purposeful planning. Pharmacists are encouraged to serve as leaders and champions of change to advance collaborative care. Ruby Grymonpre ([email protected]) is a professor at the Faculty of Pharmacy and Interprofessional Education Co-ordinator at the University of Manitoba in Winnipeg, Manitoba. The author acknowledges the support of Maria James, Research Technician, IPE Initiative, University of Manitoba, in the preparation of this report.

References 1. Oandasan I, Baker R, Barker K, et al. Teamwork in health care: promoting effective teamwork in health care in Canada. Policy synthesis and recommendations. Ottawa, ON: Canadian Health Services Research Foundation; 2006. 2. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer healthsystem. Volume 627. National Academies Press; 2000. 3. Baker GR, Norton PG, Flintoft V, et al. The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. Can Med Assoc J 2004;170:1678-86. 4. Health Force Ontario. Interprofessional care. Toronto, ON. www.healthforceontario.ca/en/Home/Policymakers_and_Researchers/Interprofessional_Care (accessed June 26, 2013). 5. World Health Organization Department of Human Resources for Health. Framework for action on interprofessional education & collaborative practice. Geneva, Switzerland. www.chd.ubc.ca/files/file/resources%20and%20publications/Framework%20for%20Action%20on%20Interprofessional%20Education%20and%20Collaborative%20Practice.pdf (accessed June 26, 2013). 6. Health Council of Canada. Modernizing the management of health human resources in Canada: identifying areas for accelerated change. November 2005. Toronto, ON. www.healthcouncilcanada.ca/rpt_det.php?id=134 (accessed June 26, 2013). 7. Health Council of Canada. Health care renewal in Canada: clearing the road to quality. Toronto, ON. February 2006. www.healthcouncilcanada.ca/rpt_det.php?id=332 (accessed June 26, 2013). 8. Centre for the Advancement of Interprofessional Education (CAIPE). Defining IPE. Fareham, UK. www.caipe.org.uk/about-us/defining-ipe/ (accessed June 26, 2013). 9. D’Eon M. A blueprint for interprofessional learning. J Interprof Care 2005;19(S1):49-59. 10. Canadian Interprofessional Health Collaborative (CIHC). A national interprofessional competency framework. Vancouver, BC. www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf (accessed June 26, 2013). 11. Winnipeg Regional Health Authority (WRHA). Collaborate better health for all. Winnipeg, MB. www.wrha.mb.ca/professionals/collaborativecare/index.php (accessed June 27, 2013). 12. The Canadian Medical Protective Association (CMPA). Collaborative care: a medical liability perspective. Ottawa, ON. www.cmpaacpm.ca/cmpapd04/docs/submissions_papers/pdf/06_collaborative_care-e.pdf (accessed June 26, 2013). 13. The Canadian Medical Protective Association (CMPA). The new reality: expanding scopes of practice. Ottawa, ON. www.cmpaacpm.ca/cmpapd04/docs/member_assistance/more/com_p1001_3-e.cfm (accessed June 26, 2013). 14. The Conference Board of Canada. Liability risk in interdisciplinary care: thinking outside the box. Ottawa, ON. www.eicp.ca/en/toolkit/liability/liability_risks.pdf (accessed June 26, 2013).

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