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

2. 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

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

4. 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

5. 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

6. 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

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

8. 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.)

9. 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

10. 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 participants in total
Primary health care professionals
Health ministry officials & policy-makers
National health organizations
Regulatory bodies
Academia
Private sector
Legal representatives
The public

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

12. 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

13. − 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

14. − 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

15. − 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

16. − 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

17. − 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

18. − 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

19. 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

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

21. −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

22. −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

23. −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

24. −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

25. −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

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

27. −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

28. −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

29. −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

30. 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

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

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