Collaborative Care: Better Health for All

2012 Annual Provincial Long Term & Continuing Care Conference May 15, 2012

Lori Lamont, Vice President and Chief Nursing Officer

Outline of Today’s Presentation

• What is collaborative care?

• Why is it important?

• Efforts to advance collaborative care in Winnipeg

• Partnerships with the University of Manitoba

• Overview of a recent interprovincial research study

• What collaborative care might look like in LTC?

• Lessons learned and next steps

Defining Collaborative Care

Collaborative Care in healthcare occurs when

multiple health providers from different professions

provide comprehensive services by working with

people, their families, care providers and communities

to deliver the highest quality of care across settings.

Practice includes both clinical and non-clinical health-

related work, such as diagnosis, treatment,

surveillance, health communications, management

and support services.

Evidence continues to emerge that links Collaborative Care to:

• Improved quality, safety, and outcomes of care

• Higher client, family and provider satisfaction

• Enhanced system efficiency and effectiveness

Why Collaborative Care?

2008 WRHA Senior Management priorizes the need to advance

interprofessional education and collaborative care within the Winnipeg

Health Region - WRHA Professional Advisory Committee assigned to

lead such work

2009 Development of regional action plan. Approved by Senior Management

and endorsed by the Quality, Safety, and Innovations Committee of the

WRHA Board

Hosted regional leadership forum to further inform regional action plan

and identify possible sites for upcoming research projects

Key Milestones

2009/2010 Participated in MHHL funded Interprofessional Student Clinical

Placement Project with University of Manitoba

2010/2011 PAC approved an updated Action Plan for Collaborative Care

Interprofessional education and collaborative practice embedded in

regional strategic directions

Release of regional guiding principles for Collaborative Care

Key Milestones

Regional Action Plan for

Collaborative Care

1. Define structure and leadership

2. Develop awareness and common understanding

3. Identify and further develop collaborative practice and learning

environments

4. Promote enablers and reduce barriers

5. Build a robust infrastructure for continuing clinical education

6. Evaluate and measure impact

Regional Guiding Principles for

Collaborative Care

• Effective communication, mutual respect, and trust are

required for true team collaboration, and must occur both

within and between teams.

• Quality care results from an integrated plan of care provided

through the shared contributions of the person receiving care

and all the health providers within a given team.

• The person receiving care will be respected and supported as

an equal member of the health care team at all points in his/her

care journey.

Regional Guiding Principles for

Collaborative Care

• The care delivery model and subsequently the team

composition and leadership must be determined by the

needs of the people served.

• Successful implementation of Collaborative Care

maximizes the opportunities for health providers to work to

their full scope of practice.

• Health providers must be able to articulate their own scope

of practice and identify and respect areas of shared

competencies with other health providers.

Regional Guiding Principles for

Collaborative Care

• In incorporating assessment and evaluation of person, team and

system outcomes to allow for ongoing improvement and the

creation of new benchmarks.

• All health leaders and managers have a responsibility to champion

and shape interprofessional education and

Collaborative Care.

• Regional, site and program policies and

processes must support and facilitate

interprofessional education and

Collaborative Care.

Academic Partnerships

•Development of joint curriculum

blueprint for interprofessional

education at pre-licensure and

post-licensure levels

University of Manitoba IPE Initiative:

•Cross appointments on IP related committees

•Joint research studies

Developing Interprofessional Collaborative Practice and Learning Environments (ICP&LE) Across the Continuum of Care in Western and Northern Canada

Research Project

Project Vision • To establish and implement interprofessional collaborative

practice and learning environments (ICP & LEs) in a variety of multijurisdictional sites across the continuum of care.

• The ICP & LEs will serve as capacity centres to provide the essential tools, resources, processes and learning opportunities to facilitate replication of the successful interprofessional and change management practices for other clinical sites and settings in the future, as well as to provide the opportunities for learning for future students and healthcare practitioners.

Project Overview

• Total of 9 teams across 4 western provinces

• Project timeline of 6-9 months depending on jurisdiction

• Oversight provided by interprovincial steering committee and jurisdictional steering committee

• Full project report available at

http://www.icple.com/project-documents/icple-project-documents-global

The Manitoba Experience

Community Stroke Care Service

• A community based centralized, interprofessional service

• Provides case coordination from hospital to home, home care support and home based rehabilitation to adults who have recently suffered a stroke

• Staff include a team manager, case coordinator, occupational therapist, resource coordinator, physiotherapist, speech language therapist, and rehabilitation assistants (12 staff in total).

CSCS – Accomplishments CSCS Action Plan Completed

during Pilot Ongoing

Action Item

Develop information materials for patients/families/referral sources X

Develop Interprofessional Student Placements X

Improve access to assessment tools X

Improve information sharing/access to educational materials for all staff

X

Use of technologies to provide feedback to the clients X

Utilize technology to allow staff with remote access to files X

Include other disciplines i.e. social worker, recreational therapist, psychologist, dietician

X

Expand services to be able to accept referrals from other facilities X

Mature Women’s Centre

• Referral-based, nurse-managed centre that provides comprehensive management of health issues related to menopause and aging with an emphasis on health promotion, and disease and disability prevention from a physical, cultural, emotional and spiritual perspective.

• Staff includes clerical staff, RN’s, a pharmacist, dietitian, kinesiologist (11 staff in total) and a Medical Director.

MWC – Accomplishments MWC Action Plan Completed

during Pilot Ongoing

Action Item

Conduct daily morning meetings X

Present case rounds more regularly/consistent weekly rounds X

New orientation manual - Physician section and Role of Clinician X X

Include a patient representative on Advisory Committee X

Increase satisfaction survey to patients X

Expand MWC team to include Psychiatric Health service X

Improved efficiencies through reorganization of chart storage X

Expand opportunities for Interprofessional Student Placements X

River Park Gardens

• 80 bed Personal Care Home in South Winnipeg

• Provides 24 hour professional nursing services and care

• 80 staff including registered nurses, licensed practical nurses, health care aides, a physician, administrative staff, housekeeping, and dietary staff

RPG – Team Interventions

• Appreciative Inquiry sessions

• Interprofessional Collaborative Organizational Map & Preparedness Assessment (IP-COMPASS) – 6 team members

• Collaborative care education session

– CIHC Competency Framework

– 6 core team competencies

RPG – Accomplishments RPG Action Plan Completed

during Pilot Ongoing

Action Item

Work force optimization maximizing the role of the nurse X

Enhance effective communication between Victoria General Hospital emergency department and River Park Gardens.

X

Remain open to new ideas – Use of PIECES (physical, intellectual, emotional, capabilities, environment, and social assessment tool)

X

Continue to hire staff with empathy and high work ethics; reflect IP principles in position descriptions

X

Extended practice prescribing pharmacist on site daily Removed from Action Plan as NP was to be added to

team

RPG – Unique Challenges

• 80 plus staff

• Large interprofessional team and multiple unit/shift based teams

• 24/7 operation (compared to M to F service)

• Changes in leadership during course of project

Knowledge Transfer

WRHA webpage for interprofessional education and

collaborative care resources http://www.wrha.mb.ca/professionals/collaborativecare/

• Snapshots/summaries of key WRHA and

national/international collaborative practice documents

• Collation of national and international interprofessional

resources and tools

• Success Stories and photos of the three teams in the pilot

project

• Education and facilitator materials

Evaluation Questions

• To what degree is implementation of a model of ICP & LE associated with changes in current staff attitudes, roles, relationships, and team functioning & skills?

• To what degree have learning and change management strategies helped sites’ to achieve collaborative patient centred care and expected outcomes?

Methods

• Qualitative (document review, observations, key

informants, focus groups, interviews) and

• Quantitative (questionnaires, tracking and collating of administrative data) data collection

Short Term Objectives

• Provider (staff) – Increased knowledge, skills, and abilities related to the core

competencies of interprofessional practice

– Satisfaction with facilitated change management practices

• Workforce Optimization – Improved enactment of full scope of practice

– Improved understanding of team members’ respective roles

Success The project accomplished its short term objectives.

That is, based on the outcomes of Appreciative Inquiry (engaging the site), IP‐COMPASS (action planning), a collaborative care education session, brochure development, and other team based activities, participants’ awareness, knowledge and abilities related to ‘working collaboratively’ has increased.

Evaluation Findings

All sites felt that the ICP project had a good impact on their team and, on the individuals participating. The project:

– reinforced and echoed staffs’ belief of being a strong collaborative team

– increased awareness, knowledge and skills/abilities related to ICP concepts

– assisted with the drafting of action items to work on to achieve collaborative patient centered care and to strengthen on going team work.

Evaluation Findings

ICP projects would be enhanced by: • having client & family perspectives on the effectiveness of ICP

• undertaking periodic evaluations (6 months to 1‐year post completion of ICP implementation) to explore ICP sustain-ability:

– progress/completion of action items planned

– re‐visiting the Appreciative Inquiry (AI) and IP‐COMPASS action plan processes to formulate a new wish list and action items

– the status and effectiveness of interprofessional student placement

Evaluation Findings

Defining the components/aspects/competencies of ICP so that staff with different educational preparedness can easily grasp what ICP means to clients and what the team’s practice would look like if ICP was fully developed throughout a site.

Lessons Learned

• Commitment of the ENTIRE team required

• Need for dedicated time to work on teaming

• Value of linking such work to quality and safety improvement projects

• External facilitator (coach) critical

• Need for strategies to ensure physician engagement

Next Steps

Based on findings and lessons learned from this experience:

•Briefing note presented to Senior Management for resourcing to support expansion to other teams

•Role descriptions for site champions, team champions and facilitators developed

Next Steps

Based on findings and lessons learned from this experience:

• Collaborative care competencies being embedded in regional role descriptions

• Team development framework and online toolkit of resources linked to the framework developed

WRHA Collaborative Care

Team Development Model