Ruby Grymonpre, PharmD Professor, Faculty of Pharmacy IPE Coordinator, UofM January 11, 2012
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Transcript of Ruby Grymonpre, PharmD Professor, Faculty of Pharmacy IPE Coordinator, UofM January 11, 2012
Interprofessional Education Initiative
Redefining Teamwork with Interprofessional Education and Practice:The Academic and Clinical RealitiesRuby Grymonpre, PharmD
Professor, Faculty of Pharmacy
IPE Coordinator, UofM
January 11, 2012
Interprofessional Education Initiative
Session Outline
By the end of this presentation, you will be able to:
• Describe the drivers for interprofessional education & collaborative practice (IPE&P)
• Define key terms related to IPE&P
• Outline the systems approach being used in Manitoba to implement IPE&P
• Articulate the key goals and actions for WRHA and UofM with respect to IPE&P
Interprofessional Education Initiative
Health and Wellness of Individuals
• 55% of Canadians suffer 1 or
more chronic conditions• 89% of deaths each year
due to chronic disease• Chronic disease costs over $100 billion in Canada • Prevention and management of chronic disease in
individuals has become health care priorityhttp://www.ocdpa.on.ca/docs/OCDPA_EconomicCosts.pdf accessed May 27, 2010http://www.queensu.ca/sps/publications/press/intros_tocs/EmergingApproaches_Intro.pdf accessed May 27, 2010
Interprofessional Education Initiative
Health and Well-being
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
(World Health Organization, 1948)
Interprofessional Education Initiative
The problem
• Dependent on expensive new technologies
• Hospital is central• Provider-centred: patients
come to us
Interprofessional Education Initiative
The problem
• emergency room overcrowding• difficult access to the necessary
care• poor record on patient safety• long wait times• inconsistent quality• high costs with poor outcomes
Interprofessional Education Initiative
The problem• Health professions have evolved
in parallel with very different traditions for education and clinical service
• Professionals have poor understanding of expertise and scope of practice of colleagues
• Reimbursement systems have fostered competition over collaboration between disciplines
Interprofessional Education Initiative
The problem
estimated worldwide shortage of almost 4.3 million health workers
aging workforcepoor working conditionsjob dissatisfaction
http://www.who.int/hrh/professionals/en/ Accessed Jan 11, 2012
Health Human Resource Crisis
Interprofessional Education Initiative
Interprofessional
Education
Collaborative Person Centred
Practice
IPE&P
Interprofessional Education Initiative
Where’s the evidence for IPE&P?
• Increased access to health care• Improved outcomes for people with chronic
diseases• Less tension and conflict among caregivers• Better use of clinical resources• Easier recruitment of caregivers• Lower rates of staff turnover
Canadian Health Services Research Foundation. Teamwork in Healthcare: Promoting Effective Teamwork in Healthcare in Canada. Ottawa, ON: CHSRF; 2006. http://www.chsrf.ca/SearchResults.aspx?search=Teamwork%20in%20health%20care Accessed January 11, 2012Lemieux-Charles L, et al. What do we know about health care team effectiveness? Med Care Res Rev 2006;63(3):263–300
Interprofessional Education Initiative
Cochrane Review (2008)4 of 6 studies found that IPE resulted in: • improved working culture in ED and patient satisfaction; • decreased errors in ED • improved management of the care delivered to domestic
violence victims• improved knowledge and skills of professionals providing
care to mental health patients
2 of these 4 studies found mixed results
2 of 6 studies found that IPE had little to no effect
Reeves S et al. IPE: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD002213. DOI: 10.1002/14651858.CD002213.pub2.
Interprofessional Education Initiative
WHO statement“After almost 50 years of enquiry, the World Health
Organization and its partners acknowledge that there is sufficient evidence to indicate that effective interprofessional education enables effective collaborative practice.”
“Collaborative practice strengthens health systems and improves health outcomes.”
Framework for Action on Interprofessional Education and Collaborative Practice, 2010http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf p 7 accessed January 11, 2012
Interprofessional Education Initiative
WHO Statement
“Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”
http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf p 10
Interprofessional Education Initiative
Sydney Interprofessional Declaration • All users of health and human services shall be entitled to fully integrated,
interprofessional collaborative health and human services. • All health and human services work to create and strengthen a culture that promotes
the delivery of contextual opportunities for interprofessional learning and collaborative team training. Interprofessional education and training for collaborative practice should be a core element of continuing professional development.
• Health worker education and training prior to practice shall contain significant core elements/learning domains of interprofessional education. These core elements/learning domains shall contain practical experiences, for example simulation. These core elements/learning domains for interprofessional education will be formally assessed.
• Between ATBH5 and ATBH6 the global interprofessional community will undertake to develop a globally agreed upon set of definitions and descriptions that capture interprofessional education, learning, practice and care.
• The global interprofessional community will work with the World Health Organization to implement the Framework for Action on Interprofessional Education and Collaborative Practice.
http://www.cihc.ca/files/The%20Sydney%20Interprofessional%20Declaration.pdf
Interprofessional Education Initiative
Health CanadaBuilding on Values: The Future of Health Care in Canada
“…the direction of our health care system must be shaped around health needs of individual patients, their families and communities.” - CPCP -
“If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.” - IPE –
November 2002, Commissioner Roy J. Romanow, Q.C.http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/romanow_e.htmlAccessed January 12, 201
Interprofessional Education Initiative
Health Canada – HHR StrategyHealth Human Resource Planning—ensuring we have enough of the
right types of health-care providers to meet the needs of Canadians; Recruitment and Retention—encouraging more people to enter the
health-care field and improving working conditions to keep them there; and
Interprofessional Education for Collaborative Patient-Centred Practice [IE(CP)2 ]—changing the way we educate health providers so Canadians will have better and faster access to the health-care provider they need when they need it, ultimately boosting the satisfaction of both patients and health-care providers.
http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/index_e.html Accessed January 12, 2012
Interprofessional Education Initiative
Reality check in Manitoba
“there appears to be no active program of interprofessional learning at that centre [University of Manitoba]”.
Cook D. “Models of Interdisciplinary Learning” Report to Health Canada. February, 2004 page 25
Interprofessional Education Initiative
21
1
1
13
7
1
3
Total of 20 Health Canada funded projects across Canada
Interprofessional Education Initiative
IPE Offices/Initiatives in CanadaOntario:Canadore CollegeCentennial CollegeConfederation CollegeGeorge Brown CollegeHumber Institute of Technology &
Advanced Learning McMaster University
Michener Institute for Applied Health Sciences
Niagara IP Health Education InstituteNorthern Ontario School of Medicine Queen’s UniversityRyerson UniversityUniversity of Toronto University of Western Ontario
Nova Scotia:Dalhousie
Alberta:University of Alberta
Saskatchewan:University of Saskatchewan
Quebec:McGill UniversityUniversity of Sherbrooke
Manitoba:University of Manitoba
British Columbia:University of British ColumbiaUniversity of VictoriaVancouver Community College
Newfoundland:Memorial University
Interprofessional Education Initiative
Accreditation of Interprofessional Health Education (AIPHE)
• Accreditation Council of Canadian Physiotherapy Academic Programs
• Canadian Association of Occupational Therapists• Canadian Council for Accreditation of Pharmacy
Programs• Canadian Association of Schools of Nursing• Canadian Association of Schools of Social Work • Committee on Accreditation of Canadian Medical
Schools• Royal College of Physicians and Surgeons of Canada• College of Family Physicians of Canada
Interprofessional Education Initiative
Accreditation of Interprofessional Health Education (AIPHE)
Phase I – 2007- 2009 Phase II – 2010-2011
http://www.afmc.ca/aiphe-afiss/documents/AIPHE_Principles_and_Implementation_Guide_EN.pdf
Interprofessional Education Initiative
National Health Sciences Students’ Association (NaHSSA)
“The National Health Sciences Students’ Association strives to promote collaborative patient-centred practice and teamwork through interprofessional education in order to respond to the evolving health care needs of Canadians.”
MaHSSA
http://www.nahssa.ca Accessed January 11, 2012
Interprofessional Education Initiative
• Manitoba Health oversees provincial health care system and sets broad policy direction
• RHAs responsible for assessing/prioritizing needs, goals and coordinating health services
• 11 RHAs in Manitoba• WRHA responsible for health
services for 60% of 1.2 million MB residents
• WRHA encompasess over 200 programs, services, facilities
• includes 9 acute & long term care centres, 16 community health offices and 39 personal care homes
• 36 regional program teams
Manitoba Health Care System
Interprofessional Education Initiative
Advanced Education & LiteracyCouncil of Post Secondary
Education oversees allocation of funds to the province's seven public post-secondary institutions
University of Manitoba: 27,000 students
13 Academic Units:• Clinical Health Psychology• Dentistry • Dental Hygiene • Human Ecology • Kinesiology & Rec Management • Social Work • Medicine • Nursing • Occupational Therapy• Pharmacy • Physical Therapy• Physician Assistants• Respiratory Therapy
Post-Secondary Education in Manitoba
Interprofessional Education Initiative
University of Manitoba
Manitoba Health
COLLABORATIVE PERSON CENTRED CARE
UofM IPE INITIATIVE
Council of Post Secondary Education
Winnipeg Regional Health Authority
Interprofessional Education Initiative
UofM IPE Initiative
Mission• To graduate health professionals prepared to manage
and adapt processes in interprofessional (IP) teams necessary to achieve person- and family- centred health and wellness outcomes. This will be achieved through innovative learning opportunities for students to learn about, with, and from each other at the University of Manitoba
Vision• Improved health and well-being for Manitobans by
building a culture of interprofessional education and practice.
Interprofessional Education Initiative
WRHA Professional Advisory Committee
• Senior patient care committee reporting to CEO and Board with representation from nursing, allied health, and medical leadership
• Focus is on collaborative practice, scope of practice and evidence informed practice
• In 2009, action plan developed to advance interprofessional education and practice within the region
Interprofessional Education Initiative
WRHA Collaborative Care
http://www.wrha.mb.ca/professionals/collaborativecare/
Interprofessional Education Initiative
What is Interprofessional Education?
“…..occurs when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes…”
* Professional is an all-encompassing term that includes individuals with the knowledge and/or skills to contribute to the physical, mental and social well-being of a community.
Framework for Action on Interprofessional Education and Collaborative Practice, 2010 http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf p 13 accessed Jan 12, 2012
Interprofessional Education Initiative
What does IPE look like?
• An educational approach
• Requires interaction
• Something must be exchanged that changes how they perceive themselves and others
• Changes must positively affect clinical practice
http://www.afmc.ca/aiphe-afiss/documents/AIPHE_Principles_and_Implementation_Guide_EN.pdf
Interprofessional Education Initiative
What does IPE not look like?
It is not:a collective of learners from
different professions sitting in the same room listening to the same lecture
- or - learners from one profession
sharing knowledge with one or more other professions in a one way exchange
http://www.afmc.ca/aiphe-afiss/documents/AIPHE_Principles_and_Implementation_Guide_
EN.pdf
Interprofessional Education Initiative
Terminology‘Uni’ professional: occasions when professionals or students from one profession learn together‘Multi’ professional : occasions when two or more professions learn side by side but in parallel (minimal interaction)‘Inter’ professional: occasions when two or more professionals learn about, with, and from each other to improve collaboration and the quality of care‘Trans’ professional: occasions in real practice where professional boundaries have been crossed or merged
Carpenter J, Dickinson H Interprofessional Education and Training. Policy Press. Great Britain. 2008. p.3
Interprofessional Education Initiative
The 3 C’s
Communication: the imparting or interchange of thoughts, opinions, or information
Cooperation: parallel activities among individuals or organizations that associate informally to accomplish their common goals
Denise L, Collaboration vs C-Three. Innovating 1999(Spring): 7(3)
Interprofessional Education Initiative
Collaboration“...is the process of shared
creation: two or more individuals with complementary skills interacting to create a shared understanding that none had previously possessed or could have come to on their own. Collaboration creates a shared meaning about a process, a product, or an event. In this sense, there is nothing routine about it. Something is there that wasn’t there before.”
Michael Schrage, Shared Minds, NY: Random House, 1990, p. 140
Interprofessional Education Initiative
Canadian Interprofessional Health Collaborative (CIHC) www.cihc.ca/resources/publications
Interprofessional Education Initiative
Patient
Consumer
Client
Service user
Customer
Recipient
Expert by experience
Participant
Individual
Family
Caregiver
What’s in a name?
Person
Interprofessional Education Initiative
Clinical placement
Service Learning
Community project
Whats in a name?
Community placement
Experiential learning
Cooperative learning
Fieldwork placement
Practice education Externship
Practicum
Internship
Clerkship
Structured practical experience
Rotation
Interprofessional Education Initiative
UofM IPE Curriculum Blueprint
Guide and monitor implementation of IPE • a ‘balance’ of competencies are addressed
through a student’s university education• learning occurs along a continuum • by graduation, learning around all competencies
has been accomplishedTo ensure IPE:• strategic, transparent, uses common terminology • explicitly states/addresses ≥ 1 learning objective• is assessed (students) and evaluated (session)
Interprofessional Education Initiative
Understanding Roles and Responsibilities Exposure:
Knowledge• Articulate your professional role in the care of
individuals• Articulate the roles and scopes of practice of
other members of the IP team and identify areas of responsibility overlap
Attitudes:• Reflect on personal values/beliefs regarding
scopes of practice and role overlap
Interprofessional Education Initiative
Understanding Roles and Responsibilities
Immersion:
Skills/Behaviours:• During an IP shared care planning session
negotiate responsibilities/actions based on role constraints, overlap, and discipline-specific legal/ethical practice standards.
Interprofessional Education Initiative
Understanding Roles and Responsibilities
Mastery:
Has sufficient confidence in and knowledge of:• one’s own discipline to work effectively with
others in order to optimize person centred care• others’ professions to work effectively with
others in order to optimize outcomes for individuals
Interprofessional Education Initiative
Guiding Principles
• We value interprofessional education (IPE) and foster its existence where and when two or more professions are involved.
• We value IPE that is integrated in University of Manitoba curricula and foster its development through:
• We value IPE in which its uniqueness is a well understood identity within the university culture through:
• We value a common understanding of IPE among all faculty, in which:
• We value evaluation of and scholarship in UofM IPE Initiative in which: