Interprofessional Care: Building on Collaborative Teams Mandy Lowe Faculty Lead, IPE Preceptorship & Facilitation Office of Interprofessional Education University of Toronto Interprofessional Education Leader Toronto Rehabilitation Institute Lowe.mandy@torontorehab.on.ca

Objectives Define teams and collaboration Recognize the importance of team collaboration Consider individual and team-based strategies to enhance collaboration

What is team? A collection of individuals who: are interdependent in their tasks share responsibilities for outcomes are seen by others as an intact social entity embedded in one or more larger social system manage their relationships across organizational borders Oandasan et al. (2006) Ehpic course, June 2009

What is interprofessional collaboration (IPC)? “…an interprofessional process of communication and decision-making that enables the separate and shared knowledge and skills …to synergistically influence the… care provided” Way , Jones & Busing (2000)

What does Interprofessional Education (IPE) Mean? Members (or students) of two or more professions associated with health or social care, engaged in learning with, from and about each other (Geissler, 2002)

Capacity to Collaborate It is believed by many that if we train competent collaborative practitioners, more collaborative practice settings will be developed over time… Hence practice is linked with education. p. 12, D’Amour & Oandasan (2005) Ehpic course, June 2009

Drivers for IPE and IPC International National Research and programs – e.g. UK, USA National Health Canada – Romanow, 2002 Provincial/Local Health Force Ontario’s Interprofessional Health Education Innovation Funds 2007 and 2008 “Regulation of Health Professions in Ontario: New Directions” (HPRAC, 2006 and 2008) U of T – Office of IPE - research, practice, curricula Enhance care Collaborative Practice improves outcomes in specific populations

Teamwork Positively Impacts Outcomes Improved Outcomes in specific populations Neonatal ICU, STD screening, geriatrics, fractured hips (Zwarenstein et al., 2005) Stroke Functional Outcome (Strasser et al., 2008) Improved Patient Safety SBAR Communication Tool (Velji et al., 2008) Fewer deaths when in ‘true’ team (West, 2006)

Teamwork Positively Impacts Outcomes Improved Cost Efficiency (D’Amour, 2005) Improved Health Professional Satisfaction (Cohen & Bailey, 1997) Leads to a Healthy Workplace (Shamian & El-Jaradali, 2007) www.cihc.ca www.chsrf.ca – Promoting effective teamwork in healthcare in Canada

Discussion Think about a time when you were part of or observed a highly collaborative team. What do you think made such successful collaboration possible?

7 Essential Elements for Collaboration Way , Jones & Busing (2000) Power & Hierarchy Conflict Resolution Ehpic course, June 2009

What elements define team collaboration in pediatric rehabilitation? Communication – open, clear, regular, jargon free Decision making – shared, effective problem solving strategies Goal setting – shared, clear, prioritized, regularly evaluated Organization – coordination of planning (e.g. single plan of care), structure, resources Team process – evaluation, mutual respect and role understanding Parent involvement – critical team members Nijhuis et al, 2007

How can team collaboration be fostered?

Three Key Questions for Collaborative Teams What is the goal of our team? How will our team communicate? How will our teamwork be coordinated? How will our team repeatedly review what we are trying to achieve and how effective we are? Balance of task/content (the ‘what’) and process (the ‘how’) Adapted from Aston West OD & Schmidt, 2006

1. What is the goal of our team? Shared goal and vision All team members are clear about roles Roles reviewed regularly to ensure satisfaction and optimal use Opportunities for team members to get to know each other to find out what contributions team members can make Government of Ontario, Family Health Team Guide to Collaborative Team Practice (2005)

2. How will our team communicate and coordinate? Strategies may include: Team members meet regularly Members involved in planning for activities in which they will be involved There is an effective decision-making method Issues are confronted and problems resolved as they arise There is a process for identifying/clarifying role overlap Role of leader is understood by team members Leader encourages active participation of all team members Government of Ontario, Family Health Team Guide to Collaborative Team Practice (2005)

Accomplishments and achievements are celebrated 3. How will our team repeatedly review what we are trying to achieve and how effective we are? Accomplishments and achievements are celebrated There is an evaluation process for follow-up, to ensure goals are being met Team process is reviewed Government of Ontario, Family Health Team Guide to Collaborative Team Practice (2005)

PROCESS affects OUTCOME Team Function High performance requires BALANCE PROCESS TASK Process- How the team functions –how the task is accomplished, what happens between the members, the way decisions are made Task – what is done and the problems associated with completion PROCESS affects OUTCOME Ehpic course, June 2009

Health Professional Collaborator Competencies KNOWLEDGE *roles of other health professionals SKILLS *communicating with others *reflecting upon my role and others ATTITUDES *mutual respect *willingness to collaborate *openness to trust Oandasan & Reeves (2005) Ehpic course, June 2009

Collaboration: What can you do? Knowledge of Roles Provide opportunities for clarifying your role (e.g. interview, education, shadow opportunities) Request opportunities to clarify team members’ roles Orientation for new team members? Or changes in roles over time?

Collaboration: What can you do? Communicate and reflect Enhance your own collaborative communication e.g. giving and receiving feedback, conflict resolution, monitor for jargon, etc. Invite feedback re: specific collaborative competencies

Collaboration: What can you do? “We may look in the same direction, even at the ‘same lines,’ and not see what our colleague sees.” McKee (2003) Reflect on your own ways of knowing, e.g. What assumptions am I making? Where did I learn these values? What values orient me? How might someone whose role is different than mine look at this?

Collaborative Attitudes: An IDEA Interact with others whose role differs from my own Collect Data about others’ roles e.g. how others are educated; competencies others possess; the many settings in which they may work Expertise - “… open to the views and approaches of their colleagues (and) altering …perceptions via the discussion when appropriate” Attention to one’s own professional and personal background, biases, stereotypes and assumptions - including skills in exploring and appreciating others’ approaches Pecukonis (2008)

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Objectives Define teams and collaboration Recognize the importance of team collaboration Consider individual and team-based strategies to enhance collaboration

Learning from Teams: Displays What has enabled your team to collaborate so effectively? How did your team successfully address challenges to collaboration? What was your shared goal as a team? How did you arrive at this goal? What approaches/strategies did you find most successful for coordinating and communicating as a team? How did you learn and benefit from your collective experience? How did you repeatedly review your work and experiences?

“To talk well and eloquently is a very great art, but that an equally great one is to know the right moment to stop.”

Thank you!

References Aston West, OD. The Aston team performance toolkit (2007). In Jelphs, K & Dickinson, H (2008) Better Partnership Working: Working in Teams. The Policy Press: UK. Cohen, SG & Bailey, DE (1997). What makes teams work: Group effectiveness research from the shop floor to the executive suite. Journal of Management, 23(3):239-290. D’Amour, D & Oandasan, I (2005). Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessinal C are, 19(Suppl 1):8-20. Government of Ontario (2005). Family Health Teams - Advancing Primary Health Care: Guide to Collaborative Team Practice. Available at: http://www.health.gov.on.ca/transformation/fht/guides/fht_collab_team.pdf

References Lemieux-Charles, L., & McGuire, W. L. (2006). What do we know about health care team effectiveness? A review of the literature. Medical Care Research and Review, 63(3), 263-300. McKee, M. (2003). Excavating our frames of mind: The key to dialogue and collaboration. Social Work, 48(3):401-8. Nijhuis, BJG et al. (2007). A review of salient elements defining team collaboration in paediatric rehabilitation. Clinical Rehabilitation, 21:195-211. Oandasan et al. (2006) Teamwork in Healthcare: Promoting Effective Teamwork in Healthcare in Canada – Policy Synthesis and Recommendations, CHSRF. Available from www.chsrf.ca Oandasan, I & Reeves, S (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal of Interprofessional Education, 19(Suppl 1):21-38.

References Pecukonis E; Doyle O, & Bliss, D.L. (2008). Reducing barriers to interprofessional training: Promoting interprofessional cultural competence. Journal of Interprofessional Care, 22(4): 417–428. Pew-Fetzer Task Force on Advancing Psychosocial Health Education (2000). Health professions education and relationship-centred care. San Francisco, USA: Pew Health Professions Commission and the Fetzer Institute. Schmidt, M et al (2006). Outcomes study of a customer relations educational program in dialysis practice. Advances in Chronic Kidney Disease, 13(1):86-92. Shamian, J., & El-Jardali, F. (2007). Healthy workplaces for health workers in Canada: knowledge transfer and uptake in policy and practice. Healthcare Papers, 7, 6–25. Strasser et al. (2008). Team training and stroke rehabilitation outcomes: A cluster randomized trial. Archives of Physical Medicine in Rehabilitation, 89.

References Velji, K et al. (2008). Effectiveness of an adapted SBAR communication tool for a rehabilitation setting. Health Care Quarterly, 11:72-9. Way, D., Jones, L., and Busing N. Implementation strategies: "Collaboration in primary care -family doctors & nurse practitioners delivering shared care" Discussion paper for the Ontario College of Family Physicians. 1-10. 2000 West, MA et al. (2006). Reducing patient mortality in hospitals: The role of human resources management. Journal of Organizational Behavior, 27:983-100. Zwarenstein M.  Reeves S.  & Perrier L.  (2005). Effectiveness of pre-licensure interprofessonal education and post-licensure collaborative interventions Journal of Interprofessional Care. 19 Supl 1:148-65

Websites www.cihc.ca – Canadian Interprofessional Health Collaborative www.ipe.utoronto.ca – Office of IPE, University of Toronto www.chsrf.ca – Canadian Health Services Research Foundation