1 Collaboration Objectives To describe the evolution of the concept of collaboration To delineate the characteristics of collaboration To demonstrate the application of collaboration concept into practice

2 Collaboration Definition Working together for a common goals Pooling of resources and ideas within or across disciplines for innovation and problem-solving (CINAHL) Interaction of 2 or more persons or organizations directed toward a common goal which is mutually beneficial (MEDLINE, cooperative behavior)

3 Societal Shifts Nationalism replaced with global economy Social ecology--needs for integration & connections Social capital-- networks, norms, trust, coordination & cooperation

4 TRENDS New organizations New forms of delivery systems-- managed care New ways of relating to each other Smaller companies High-value organizations depend on and expect workers at all levels to be capable of making decisions Health care being driven by changes in industry

5 Changing Work Environment Technology Demographics Managed Care Purchaser’s Influence Health Insurance Industry Changing Health Systems Telemedicine

6 Managed Care Environment Focus on outcomes, research based practice High quality care Cost-effective interventions 2/3 with MH insurance are enrolled in managed care plans 4/5 of all states are implementing changes in Medicaid programs Responsible for widespread application of information technology

7 Telecommunications –Greater use will increase collaboration among health care professionals in physically separated locations –Over 50% of US workforce employed in information related jobs

8 Relationship to Health Concern not only with costs & benefits but with social, emotional, & physical health Promoting health and providing health care, no longer the exclusive domain of any discipline Need for interdependence to improve population health care outcomes

9 Health Problems Needing Collaboration Mortality rates for persons with brain disorders are twice that of general population –50% have known medical disorders –35% have undiagnosed medical disorders –One in five has a medical problem may cause or exacerbate psychiatric condition –Increased risk CVD

10 Substance Abuse Problems Needing Collaboration 53% of drug abusers have at least 1 serious psychiatric problem 37% of alcohol abusers have at least 1 serious psychiatric problem

11 Surrogate Terms Joint practice -> collaborative practice Shared governance – people discuss, debate, and work from the same data base; shared vision Coalition – take joint action or resolve a mutually shared concern or reach a common goal

12 Related Concepts Cooperation – mutual give & take Collegial – equal power or authority Working together – intellectual endeavor Teamwork – team approach Interdependence, - shared power/authority Professionalism – antecedent Professional practice - consequence

13 Implications Patient care – pts are the true beneficiaries Education – 1 st step in the learning strategy Research – application of the findings Organization – shared governance -> better decisions regarding pt care

14 Partnership Attributes Respecting each other Communication Working together Partnership relationship Trusting each other

15 Conditions Supportive environment Mutual trust--acquired through experience among participants Disciplinary interests & personal agendas are secondary Process of negotiation Team building Transformational leadership Cannot mandate

16 Characteristics Legitimacy /power sharing –Individual’s identity & accountability & relationship to overall power Self-knowledge –Self-awareness & future growth Respect –Individual autonomy & boundary Commitment –Responsibility for goal attainment

17 Outcomes Increased access Improved quality Positive client outcomes Increased creative solutions Improved and increased human resources A more productive community Greater student achievement Job satisfaction

18 Outcomes (II) Education--meets service mission & gains practice settings for faculty & students Service--gains excitement of a learning environment Joint ventures –research and demonstration projects –develop models of practice

19 Essential elements in organization’s readiness for collaboration Compatible R among Drs & Ns. – common goal & unique competencies Support from administration -> quality care Clinically competent of the staff Collegial R Primary nursing N’s excellence is rewarded

20 assertiveness cooperation low high Competition Avoidance Collaboration Accommodation Compromise 2-dimensional grid of collaboration

21 The driving forces of successful collaboration partnerships People -> enliven –Sharing of human resources –Careful planning & monitoring –Communication & understanding of goals & purposes Time –Relationship –Skills Energy & motivation –Enthusiasm & commitment

22 Transdisciplinary Collaboration Project San Jose State University Office of Sponsored Programs College of Applied Sciences and Arts School of Nursing Nurse Managed Centers Communication Disorders & Sciences: Program & Clinic Program & Clinic Department of Occupational Therapy Department of Recreation & Leisure Studies: TR College of Social Work Institute for Teaching & Learning Faculty and Students Revised 5/99 Psychosocial.Occupational Therapy Clinic Santa Clara CountyMentalHealth Santa Clara County Alliance for the Mentally Ill ALLIANCE for Community Care Zoe House Crossroads Village Casa Feliz ResidentsStaffFamilies

23 Through collaborative efforts, provide quality, cost effective services for persons with serious mental illness living in the community while simultaneously preparing future mental health professionals for practice. Project Goal

24 Behavioral Ecological Model of Community Mental Health Laws Administration of Justice Community Friends and Peers Laws Mental Health System Social Policy Legislation ChurchFamily University Training of Professionals Person

25 Stress Management Nursing –Crisis intervention Deep Breathing Self Talk Time out Visualization –Prevention Diet & nutrition Exercise Time management Communication Disorders –Organizing and creating schedules –Follow up on comprehension –Routines –Social Skills

26 Stress Management Therapeutic Recreation - Identify triggers - Identify & practice strategies to manage stress - Example: exercise, visualization, relaxation Occupational Therapy - Identify causes - Assess coping strategies - Environmental adaptations - Problem solving - Frustration tolerance - Therapeutic activity

27 Outcomes of Collaboration Clearly, the closer educators, researchers, consumers, practitioners, and families come together in the service area, the more likely that curricula will be reality based and congruent with clients’ needs. At the same time, the possibility of improving the quality of life increases.