Principles & Framework A Framework That Fits Enhancing Interdisciplinary Collaboration in Primary Health Care (EICP) Initiative Principles & Framework

EICP Initiative Enhancing Interdisciplinary Collaboration in Primary Health Care (EICP) $6.5M Contribution Agreement from Health Canada’s Primary Health Care Transition Fund (PHCTF) Led by ten national health care associations

Health professionals - all on the same page Canadian Coalition on Enhancing Preventative Practices of Health Professionals

EICP Steering Committee Canadian Association of Occupational Therapists Canadian Association of Social Workers Canadian Association of Speech-Language Pathologists and Audiologists Canadian Medical Association Canadian Nurses Association Canadian Pharmacists Association

EICP Steering Committee Canadian Physiotherapy Association Canadian Psychological Association College of Family Physicians of Canada Dietitians of Canada Canadian Coalition on Enhancing Preventative Practices of Health Professionals

Interdisciplinary Collaboration “Interdisciplinary collaboration refers to the positive interaction of two or more health professionals, who bring their unique skills and knowledge to assist patients/clients and families with their health decisions.” —(Canadian Association of Occupational Therapists (CAOT), 2005

Interdisciplinary Collaboration The right service, provided at the right time, in the right place, by the right professional

Purpose of the EICP To develop the regulated health professions’ shared vision of interdisciplinary collaboration (IDC) in primary health care (PHC) To develop support for fundamental and effective change in PHC in Canada that reflects this shared vision To help sustain this change at the association and the individual practitioner levels in cooperation with other partners (i.e. governments, providers, public etc.)

Deliverables Consultations Research Principles Framework Tool Kit -The EICP Initiative is focused on developing & proposing the principles & framework for interdisciplinary collaboration (IDC) that will create & sustain change in primary health care -Consultations & research have been led by a 10 member Steering Committee comprised of representatives from the key professionals in primary health care sector -“Next steps” include an IDC toolkit with practical & policy elements

Evidence Based Small group consultations (public, providers, government officials) Regional workshops (providers, experts, government officials) Analysis of workbooks completed by providers and policy-makers Two Leaders’ Forums (providers, experts, government officials) Five Barrier/Enabling Task Forces (providers, experts, government officials) Five full research reports (literature reviews) Input came from: Five Barrier and Enabling Factor Task Group sessions --184 participants in total Primary health care professionals Health ministry officials & policy-makers National health organizations Regulatory bodies Academia Private sector Legal representatives The public

What are Principles? Reflect shared values for interdisciplinary collaboration (IDC) Guide current and future decision about policies, programs and services

EICP Principles Patient/client engagement Population health approach Best possible care and services Access Trust and respect Effective communication Client-centered approach to care. A client-centered approach puts the individual and their family as the focus of primary health care services and ensures that services will be tailored to individual needs. Health professionals have a shared purpose to optimize the health of the individual and their family. Individuals and their families are actively engaged in the prevention and management of health problems. Privacy, confidentiality and informed decisions are respected. Trust and respect for the unique roles and contributions for all care providers. Each professional and volunteer brings his/her own set of knowledge and skills to collaborative primary health care, and has an important contribution to make to the individual’s health care. An attitude of mutual trust and respect is essential to ensure the individual and family have access to the most appropriate health professional(s) at the appropriate time and place. Trust and respect create a collegial environment to support shared decision-making, creativity and innovation. Care providers learn from each other and practice in a flexible way to best meet the individual and family needs. Accessibility of services. Accessibility means that people have access to the ‘right service provided at the right time, in the right place and by the right care provider’. Geographic barriers to care are minimized, through for example, telehealth, and appropriate resources (human and financial) for care exist. Services strive for equity in access considering age, gender, culture, language, religion or lifestyle. Services are available where people live, work and learn. Population health approach to services. “ A population health approach is a consistent and rational basis for setting priorities, establishing strategies and making investments in action to improve population health”[1] Providers need to know what the health problems are in the population and design services and policies to best meet those needs across the continuum including promoting health, preventing and managing health problems. Programs and services need to address the wide range of factors[2] that influence health, and involving the population itself in the identification of and response to health needs. Services respect the unique needs of the community and are evaluated to assess their impact on the population. High quality care Quality care includes seamlessness, continuity, and coordination among all care providers. It depends on effective communication and is evidence-based. Services are evaluated collaboratively with a quality improvement program. Service providers participate in continuing education. All service providers use skills in active listening, time management and open communication in working together. The primary health care infrastructure supports quality care. [1] FPT Committee on Population Health, 1994 [2] PHAC Website – Determinants of Health

− Principle− Patient/Client Engagement Patients/clients the priority focus Patients/clients involved in decision-making & management of their own health care Professionals work together to optimize the physical, cognitive & mental health & wellness of their patients/clients Privacy & confidentiality are paramount

− Principle − Population Health Approach Set priorities, establish strategies & make investments in action to improve the health of the population Assess needs and health problems present in a community  Needs are addressed in a holistic fashion across the continuum of care Programs & services are tailored to address health determinants, while meeting the needs of individual patients/clients

− Principle − Best Possible Care and Services Research results are basis for quality standards & treatment decisions Continuous evaluation to measure health outcomes, ensure accountability, track performance & assure quality Commitment to continuous improvement

− Principle − Access The right service, provided at the right time, in the right place & by the right professional Geographic barriers are minimized Services available close to where people live, work & learn Respect for age, income, gender, culture, language, religion & lifestyle factors/ differences

− Principle − Trust and respect Key to interdisciplinary collaboration Each profession brings its own set of knowledge & skills Supports shared decision-making, creativity & innovation Professionals learn from each other & understand the competencies of peers Direct benefit to patients/clients

− Principle − Effective Communication Both at the organizational & interpersonal levels Active listening and effective communication required with patients/clients & with colleagues Professionals & systems support team information-sharing and decision-making

What is a Framework? Built on the foundation principles Composed of structural elements required to sustain IDC Describes characteristics of a systemic approach and the elements need to support the operation of PHC Elements are interrelated

EICP Framework Elements Health Human Resources Funding Liability Regulation Information and Communications Technology Management and Leadership Planning and Evaluation

−Framework− Health Human Resources Must address the availability, education & distribution of health human resources (HHR) Maximize the skill sets & competencies of all professionals Help address the work–life balance issues & working conditions overall Clearly articulated roles & responsibilities for each team member Must address supply & demand issues More education about benefits of IDC & how it works – “Primary Health Care 101” Skills development – core IDC, communications, conflict resolution More data/research to support HHR planning with IDC in mind Reg. colleges & professions need to incorporate IDC philosophy in their scopes-of-services Changing legislation re: scopes-of-practice Leadership & champions to encourage IDC at all levels, especially in planning Creation of a health planning institute

−Framework− Funding Create a positive incentives through innovative funding models Payment methods (e.g. fee-for-service, salary, capitation or various blended mechanisms) can facilitate/promote IDC Align funding with EICP Principles for IDC Adequate and reliable funding needed to support IDC Educate health community about various payment options (e.g., salary, fee-for-service, blended, deliverables, user fees and capitation) & related risks, benefits & rewards of IDC Cost-benefit analysis could demonstrate benefits Fund systems & research that measures outcomes (e.g., of health systems, health status & cost-effectiveness) Clarify financing (source of funds) versus funding (how it is distributed) View funding from four angles: education, research, practice & policy Funding inter-professional education, training, courses & continuing education = fewer silos & more acceptance Fund pilot projects & process to select and implement relevant models Aim for a system that defines the basket of funding for IDC according to population base/needs (start with a stakeholder’s forum) Bridge the “public/private” divide in the current funding model Federal government should initiate a transfer payment to PT governments focused on PHC (to provided consistent funding for collaborative care) & revisit federal health legislation

−Framework− Liability Two directions required: integrated approach to liability insurance that links the various systems now in place & supports principles of IDC (e.g. recognizes shared decision-making) clear legislated scopes of practice for each health discipline Patient safety and risk management are priorities Alleviate worry about liability so focus is on the patient/client Education program for judicial/legal community about collaborative practice. Provide education & knowledge on scopes-of-practice Need research that quantifies liability in an IDC setting Disseminate evidence about the benefits of IDC & build-in feedback so everyone knows that liability issues have been addressed Work with the Patient Safety Institute Ensure that all providers in IDC are insured & regulated, but look for insurance system to take more responsibility (e.g. no-fault) so individual team members don’t bear the full burden Create a national discussion among insurers, professional organizations, government & the public about liability issues Develop & publicize joint statements from professional liability protection providers Create mission statements at all levels that focus on the patient’s needs Develop a national game plan to reform legislation including a national coalition of provincial/territorial regulators Develop a communications primer for health professionals

−Framework− Regulation Regulatory colleges must embrace & support IDC Give regulators of various professional disciplines the mechanisms to work together An intermediary organization might play a role re: clarifying roles, education, supporting change Establish one overarching regulatory framework for IDC Helps diminish silos Supports change to scopes-of-practice Need more communication between regulators and associations National working group could promote IDC, promote networks & help create new regulatory bodies Champions are required Require training, communications & continuing education focused on: Patient/client centred practice benefits of IDC

−Framework− Information & Communications Technology Sharing information critical to quality care & basis of collaboration Linked to improved continuity of care, service delivery, & reduction of adverse events Provides timely access to up-to-date information Learning & adapting to technologies is a key challenge One electronic health record (EHR) required at the national level Joint effort of professional associations, privacy commissioners’ offices and FPT Ministries of Health Consolidated funding (cost-sharing would therefore not be necessary) Leadership (individual practice & system level) Look to best-practice initiatives such as the e-Therapeutics clinical decision-making tool View EHR as support to health promotion/prevention Need incentives (financial & non-financial) to encourage use by professionals Add IDC advocate to Canada Health Infoway Advisory Committee Conduct: Needs assessment of the practice community Cost-benefit analysis of the role of EHR in the broader health care system Needs analysis per profession Research about international communications technology systems, esp. where they support IDC

−Framework− Information& Communication Technology An interoperable, private and secure EHR will be fundamental to the ability of teams to collaborate

−Framework− Management & Leadership Leaders must be committed to a vision for collaborative primary health care Build on “best practices” Build skills in communication, change management, teamwork & leadership Best practices in areas such as workplace health, job satisfaction and retention and recruitment. A business vision required -Toolkit -Success stories/best practices Convert theory to action Need champions to encourage & create critical mass Funding for continuing education required Providers need IDC skills and processes: -team functioning -active listening -time management -open communication -conflict resolution -joint decision-making -leadership theory -communications primer

−Framework− Management & Leadership Strong administrative support Appropriate governance structures IDC takes time & resources Health students need: Standard IDC component/Joint curricula Info about benefits of IDC, payment models, the use of EHR & points of access Clinical placements in teams settings Health systems need: Good governance systems IDC friendly & centralized administrative support structures (scheduling, co-ordination, documentation& consultation, that considers patient safety) Transparent processes Marketing for IDC vision Patients/clients to take their responsibility Other supporting factors: Physical space Facilitators Referrals systems Mission statements Change Management approach Make it evidence based: Research on best practices, models, outcomes, benefits, role of clinical practice guideline

−Framework− Planning & Evaluation Does IDC deliver? Ultimate goal = measuring outcomes (health, team & organization) of IDC Strong centralized administrative support is required Based on the characteristics & needs of the population served Evaluation frameworks & assessment tools are being developed Frameworks and tools Benchmarking Wagner Model for chronic disease management widely accepted as a framework Integrates primary health care with other sectors of the health care system, including acute & community care, and public health services Being used in British Columbia Policy and financial support for P & E required to encourage: planning based on population needs effective P & E frameworks and tools the development of technology administrative support adequate compensation for professionals development of appropriate clinical services Other needs: Strong centralized administration functions Public involvement Clarity about what “scope-of-services” IDC collaborative practices will provide & who provides particular services P & E data will determine/provide: population profiles, trends and service needs impact of IDC on: individual providers and disciplines time use quality of the care Safety efficiency of each IDC practice IDC more generally

Get Involved EICP web site at www.eicp-acis.ca Register with our Guestbook to receive updates and our e-newsletter Talk to your professional association about how to get involved Ratification message: Explain how people can get involved and/or can ratify the P & F

Change Management Where are we, as professions, in collaborative, interdisciplinary care?

Toolkit Lexicon What tools (practical & policy) would help you facilitate the adoption of IDC practices in primary health care?