Project Dr Marion Helme: Senior Project Officer, LTSN Triple Project Dr Margaret Sills: Academic Director, LTSN Subject Centre for Health Sciences and Practice Proposals for Developing and Sustaining Interprofessional Education Initiatives in Health and Social Care Introduction to Triple Project Proposals + discussion Contributions to IPE from systems, complexity and social practice theories Where next?

Project Officers: Dr Marion Helme and Dr Pawel Miklaszewicz IPE : “occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care” (CAIPE 1997) Triple: Three-centre Research on Interprofessional Practice in Learning and Education Project contexts LTSN and The UK Higher Education Academy IPE in UK health and social care Triple: a collaborative project

Contexts: IPE in health and social care in the UK Responses to question Why are you doing this interprofessional teaching? Because we have to Because we believe that what we are doing will ultimately improve patient care Because “ it’s enormous fun and one of the most rewarding experiences we …and our students have had!”

Triple objectives To map themes and issues in IPE in health and social care To create a website as a resource for IP teaching To provide opportunities to explore experiences of IPE LTSN Triple Project aims and activities

 ‘Getting the lemons in line’: logistics – timetables, rooms, funding …  Culture, power … silos and territorialism …archeologies of grievances  Sustaining IPE initiatives beyond individual commitment  Uni-, multi-, inter-PE ?  When (level) and where (university/practice)  Assessing IPL  Incorporating stakeholder perspectives  Evaluating the impact of IPE: teaching learning practice quality of care Themes and issues from mapping activities

Messages from and for IPE teams from Triple ‘learning from experience workshops’ “[think] about the wood as well as the trees, the dance as well as the dancers” (Trowler, Saunders et al. 2003)

‘Messages’ from Triple workshop participants

“ How can IPE offer understanding of conflicts and contradictions in health and social care rather than just serve as an instrument of the modernisation agenda”. (Canterbury Christ Church University College) My messages of advice (to new IPE initiatives) would be: Clarify what you mean by interprofessional as in my view this excludes certain groups like users of services and carers. Don’t assume people in health and social care know how to work effectively in an interdisciplinary way…” (Birmingham University Mental Health IPE initiative) … ‘Woods’ and ‘Dances’ : IPE as a complex problem?

Trees and dances: working together and practising differently? “If a patient wants to refuse therapy, there’s a difference between how a physio and an OT would deal with it” (interdisciplinary team Coventry University). “When I was a social worker I was never called as an expert witness in child protection court cases, despite having much more knowledge of the child and family than ‘expert witnesses’ from the medical profession” (IPESO meeting). “Clinicians and nurses are trained for outcomes. They know if they give somebody a particular drug they will get a particular outcome… They don’t like having to debate what might be effective” (IT Manager in Hospital Trust).

Proposals (December 2003): effective, sustainable teaching for IP learning and practice draws on: Involvement of interprofessional teaching teams in all processes (summative assessment?) Use of interactive learning methods ‘Built in’ evaluation Explicit models and purposes of IP practice – for example, quality of care for individual patients, community practice, professional identity Awareness of different ways of knowing in practice Awareness of role of teachers/facilitators/ mentors as more than facilitation, and as ‘acting out values’ which requires critical reflection by teachers/facilitators/ mentors (especially awareness of impact of own professional bias)

Models and purposes: What is an interprofessional health and social care service? What is interprofessional practice about? (Trees and woods) “Presentation and intersection of different knowledges of a patient” (Opie 2000) Teamwork skills – communication skills, conflict resolution, networking Enactment of values of respect, responsiveness, trust and accountability “Seamless” service experienced by (individual) patients and service users and their carers (?) A “community practice” Radical change …a social movement beyond health and social care

… a community practice: Towards Unity for Health Consensus (Phuket Declaration) …. Effective partnerships between individuals and communities and all sectors — private, public, professional and voluntary — are essential to creating and sustaining effective health interventions and programmes. Global society must ensure adequate resources for the health of all its members. Responsibility and accountability for health, particularly that of the most vulnerable, are shared by all partners across all sectors…

Critical Reflection and Reflexivity Critical Reflection identify your actions,thoughts and feelings; write a narrative, analyse using theory, come to new personal understandings and ways of being in a situation. (Tate 2004) Reflexivity Recognising how one’s own construct systems are used to appraise the constructs of others. Establishing the impact you had on a situation, how was it different as a result of who you are? Take into account the effect of the personality or presence of the researcher on the investigation (Holland 1999) / educator on the learning / practitioner on the practice.

Neighbour discussion Please discuss with one or two neighbours From your experience what would you change or add to these proposals? … and write a couple of points from your discussion on the post-it notes.

Summary: Theorising IPE IP practice is more than good teamwork Teaching for IP learning is more than facilitation Is a common language possible? Paradoxes – working together differently Uncertainty Diversity “All educational contexts represent and replicate, within their own internal processes, external power relations…” (Vince 1996)

Systems thinking and practice

Complexity theory

Communities of practice

Concluding points for development of IPE Power and dialogue Evolution and revolution Boundary working and border crossing Is it worth it? Risks: colonisation and politics

Triple Project: report and publication EIPEN: a European IPE network LTSN: Evaluating IPE– learning pack UK Higher Education: The Academy and “Centres of Excellence in IP Learning and Teaching” beyond health and social care – education etc UK: dissemination from government funded Common learning sites; development of IPE in social work programmes; health professions regulations and benchmarks Moving on?