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: 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 isnt 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 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 (2006)

Health Canada 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 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 21 st Century: The Challenge of Chronic Conditions 2005 available at

DRIVERS FOR CHANGE

Primary driver: patient safety 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

Interprofessional Education Model Charles, Bainbridge & Gilbert 2004 Goal Interprofessional Health Education for Patient/Client Centred Collaborative Practice to Improve Patient Care Learning Process Professional Personal Interprofessional Interprofessional Education Development Stages ExposureImmersionMastery

Health Canadas Framework for IECPCP

PCC IPE CP LEARNER PRACTITIONER

What does it look like if IPE is not evident? What does it look like if IPE is evident? IPE

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 What does it look like if collaborative practice is not evident? What does it look like if collaborative practice is evident?

What do we say collaborative practice is? 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 What does it look like if patient-centred care is not evident? What does it look like if patient-centred care is evident?

What do we say patient-centred care is? 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 patients goals, their familys goals and the professional expertise of the team –adds the knowledge of all team members to the patients self-knowledge and self-awareness so that the final result is doable

BARRIERS

A non-exclusive list of some barriers to inter-professional collaboration 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: Get buy in from the organization Articulate the concepts in mission, vision and values Facilitate uptake of the concepts throughout the organization Allocate funds to support the concepts

…and do… MESO: Support collaborative practice at the bedside and in the community Educate providers, patients and families Reward collaborative practice Train interprofessional teams

…and do. MICRO: Recognize IPE as essential learning for individuals Provide time for collaboration and reflection Reassure staff and families Make collaboration across professions the norm for everyone Include it in performance expectations and reward it

What we are doing… College of Health Disciplines ( BC Academic Health Council ( Health Canada IECPCP initiative $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 ( Canadian Interprofessional Health Collaborative links IECPCP projects across the countrywww.cihc.ca International collaboration (CAIPE, ATBH IV, CAB)

IN SUMMARY…. 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