Can we achieve Interprofessional

Collaboration?

Learning from St. Joseph’s Health Centre

Michael Heffer, RPh, BScPhm, MHSc.

What is Interprofessional

Collaboration?

McMaster IPC Research Group

What is Interprofessional

Collaboration?

St. Joseph’s Health Centre adds:

• IPC is intentional

• Supported by learning with, from and

about one another to leverage

individual and team capacity

* St. Joseph’s Health Centre

•

IPC Expected Outcomes

• Increased access to healthcare for

patients

• Improved outcomes for patients with

chronic diseases

• Less tension and conflict among

caregivers

• Better use of clinical resources

(healthcare professionals)

Structure/Enablers

Required for IPC

• Government support / Legislation

• Senior Leadership support within your

own hospital

• Complimentary IPE structure in place

• Change leaders within hospitals

and universities

Government Support for

IPC

Provincial initiatives

1st

• Ministry of Health and Long Term

Care (MOHLTC) created IPC

Steering Committee 2006

Government Support for

IPC

Provincial initiatives

2nd:

• Joint initiative between MOHLTC and

MTCU (Ministry of Training, Colleges

and Universities)

• Health Force Ontario 2006.

• Mandate: Funding for IPC programs

since Oct 2008

Government Support for

IPC

Provincial initiatives

3rd

• MOHLTC approached Health Professions

Regulatory Advisory Council (HPRAC)

• Bill 179

Expanded scope of practice for 12

professions

Inter-College Collaboration

Government Support for

IPC Federal Level IPC Initiatives

• Health Canada funds the CIHC

Canadian Interprofessional Health Collaborative

• Fall 2008 created IPC Working Group

• Published:

National IPC Competency Framework Feb 2010

IPE Support for IPC

To Facilitate Adoption of IPC

“There must be a seamless integration between the education system preparing the workforce and the health care system that employs it.”

* Final report: IPC Strategic Implementation Committee May 2010

IPC Think Pair Share

• Question: What activities are

happening or need to happen in our

education system to graduate

students ready for IPC?

• Task: Pair up with a colleague at

your table

Discuss /generate ideas

IPE Support for IPC

MOHLTC and MTCU*

• Financial support to the six Ont. Academic Health Science Centres

• Dedicated resources to promote the development of an interprofessional curriculum.

• PIPER at McMaster

Program for Interprofessional Practice, Education and Research

* MTCU: Ministry of Training, Colleges and Universities

Senior Leadership

Support Within Hospitals Important for:

• Establishing IPC reporting structures that have accountability

• Supporting IPC awareness initiatives that influence culture change /acceptance

• Agreeing to devote resources to improvement initiatives that support IPC

• All the above: helps establish credibility with staff

Senior Leadership

Support Within Hospitals Why should Senior Leaders support IPC?

• Improved outcomes for patients = optimal patient care = decreased LOS (length of stay)

• Less tension and conflict = staff satisfaction

= lower staff turnover

= improved recruitment (great reputation)

• Better use of clinical resources

= improved efficiency of team

= lower cost per case compared to peer hospitals

Senior Leadership

Support Within Hospitals Existing Structure at SJHC

• IPAC Interprofessional Advisory Committee

• Interprofessional Point of Care Teams

• IPC listed as a Strategic Priority for 2011-2014 Objectives

• Portfolios: Director of Interprofessional Practice

Director of Interprofessional Education

• Change Leaders: Professional Practice Leaders

Education Coordinators

Professional Clinical Coordinators

IPC Change Leaders

Development of our Change Leaders

• Regarded as IPC project champions

• Added skill set: Change management methodology

Quality improvement methodology

• Collaboration with centre of IPE UofT

• ehpic program

• Collaborative Change Leadership Program

Team Coaching

Project

• Enhancing

Interprofessional

Practice

Resource

Manual for Team Coaches

Roadmap for Co-Creating IPC Models of Care

• A Roadmap for Co-Creating Interprofessional Models of Care

• Available at http://www.stjoe.on.ca/education/resources.php)

IPC Core Competencies

• Trust & Respect

• Knowledge of other Professional Roles

• Appreciating Difference & Conflict Resolution

• Willingness to Share Power

• Shared Decision Making

CIHC addition:

• Focus on patient-centered care

Finding Opportunities for

IPC

Creating IPC Initiatives

• Brainstorming sessions

• Looking at existing patient care teams

Areas for improvement?

• Look at patient care populations that may benefit from a collaborative team approach – groups at high risk?

IPC Think Pair Share

Question: What areas of hospital practice can you think of that might benefit from a more collaborative approach to patient care?

• Task: Pair up with a colleague at your table

Discuss/generate ideas

The AIR Team

Experience

The Assertive Interprofessional Respiratory Team

• The Care Providers

– Registered Nurse

– Registered Pharmacist

– Registered Respiratory Therapist

• The Care Context

– St. Joseph’s Health Centre – Emergency Dept (ED)

• The Patient Population

– Patients with a respiratory-related health issue

Guideline for Co-Creating

Interprofessional Models of Care

IPC Models of Care Step 1: Intraprofessional Reflection

Example Questions:

• What is my profession’s traditional role within this type of setting?

• What does my profession have in terms of knowledge, skill and judgement that can be used to enhance care for this type of patient?

• How much am I personally prepared to negotiate my professional boundaries?

IPC Models of Care Step 2: Re-story the Professional

Narrative

1. What are some stereotypes about our

profession?

2. Which activities, practices or roles do we

need to keep?

3. What possible future practice could be

supported by the knowledge, skills and

judgement of our profession

IPC Models of Care Step 3: Establish a Harmonization

Philosophy

Examples of Assumptions:

• Each skill or competency will be considered in

light of what the profession is currently doing,

should be doing or could be doing.

• Decisions will be made with the provincial

College regulators in mind

• Scopes of practice will be optimized for the

purpose of enhancing patient-centered care

Step 4: Analyze

Activities

• Create a list of activities

• Then ask the 3D

questions

– Which of the

professions is

currently doing this?

– Which of the

professions should be

doing this?

– Which of the

professions could be

doing this?

Scope and

Team Optimization • Step 4 Analyze Activities &

Develop Competency Framework

• Negotiating which clinician(s) will be responsible for specific patient care processes leads to team optimization

• Negotiating which clinician(s) will be responsible for specific clinical skills and competencies leads to scope optimization

IPC Think Pair Share

Consider a Diabetes Clinic Team

The team consists of a nurse, physician, dietitian and pharmacist.

Questions:

• Can you think of activities that could be shared to promote team optimization?

• What activities might be negotiated for scope optimization?

• Task: Discuss /generate ideas with a colleague at your table

Guidelines for Co-Creating

Interprofessional Models of Care

Step 8: Evaluate the

System

Evaluation focused on whether the AIR team

Interprofessional model of care would impact

quality of care as evidenced by:

• Key access and flow indicators

• Patient experience of care

Access and Flow

Length of ED Stay

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Av

era

ge

Le

ng

th o

f E

D S

tay

(m

inu

tes

)

Intervention 1319 1542 581

Baseline 1398 1769 592

All Patients Admitted Non-Admitted

226 min (p<0.01)

Patient Experience of Care

Patient Experience of Care by Dimension

0.0

20.0

40.0

60.0

80.0

100.0

Pe

rce

nt

Po

sit

ive

Sc

ore

AIR Team 89.1 80.4 82.4 80.0 81.9 76.6 100.0

Baseline 52.8 54.7 50.0 41.7 77.5 52.1 89.7

Ontario Average 63.5 66.4 63.3 62.4 77.5 64.0 89.6

Emotional

Support

Access &

Coordination

Information &

Education

Physical

Comfort

Respect for

Patient

Preferences

Continuity

and

Transition

Courtesy

p<0.001 p<0.001 p<0.001 p<0.001 p<0.001

Other IPC initiatives at

St. Joseph’s

• Interprofessional Skills Fair

• Interprofessional Orientation

• Scope of Practice Quiz

• Interprofessional Journal Club

• Interprofessional Maze Activity

Interprofessional Skills Fair

Interprofessional Orientation

0% 20% 40% 60% 80% 100%

WHIMIS

Library Services

Interpreter Services

Infection Control

Self Care

Therapeutic Relationships

Documentations

Code White/CPI

Critical Thinking/Time Management

Consent and Capacity

Falls Standard of Care

Least Restraints

DNR order/case examples

Domestic Abuse

Major Mental Illness

End of Life Care, Bereavement, Suffering & Loss

CCAC Services

Pain Assessment & Management

Addictions and Mental Health Consultations

Oxygen Therapy

Pharmacy

I/V Venipuncture

Skin & Wound

Diabetic Monitoring

PICC & Central Lines

Blood Administration & Products

Tubes and Drains

Transcription

Hypodermoclysis

Traches & Suctioning

Epidurals

NG Feeds, Flushes etc.

Chest Tubes

Bladder Scanning

IP

Partially IP

Scope of Practice

Interactive Quiz

Which is NOT a Regulated

Health Profession?

b) Kinesiology

c) Paramedic

d) Traditional Chinese

Medicine

e) Psychology

a) Naturopathy

C

Paramedic

How many of the 13 controlled acts were

authorized to physicians?

a) 10

b) 13

c) 11

d) 12

e) 9

D

12

The Registered Dietician (RD) is responsible for which

of the following re: tube feeding?

a) Determining access & inserting the tube

b) Conducting the assessment to

determine needs, the Formula, and rate

c) Teaching the patient/family to use the

feeding pump

d) Flushing the tube with sterile water

B

Conducting the assessment to determine needs,

the Formula, and rate

Interprofessional Journal

Club

Interprofessional Maze

Activity

Other Initiatives at SJHC

that support IPC

• Interprofessional Orientation

• IPE week

• Interprofessional Skills Fair

• Interprofessional Journal Club

• Scope of Practice Quiz

Interprofessional Collaboration

What do our patients want?

• To be seen not as an OHIP #, not even as a patient but as a person who is valued.

• Health professionals coaching and cheerleading me to improve my health.

• A team working together, communicating the care I want to receive

• Providers who are good at explaining what they are doing as they are doing it

* Focus groups: Report on Implementing IPC in Ontario May 2010

Thank you to partners

& Change Leaders

Mary Kapetanos, Jeff Dionne, Marie Eason-Klatt, Helen

Papakyriacou, Marcia Sivilotti, Chris Ashdown, Lynne Strathern,

Scott Graney, Janice Klutt, Jenny Seah