Up a river! Interprofessional education and the Canadian healthcare professional of the future

The benefits of an interprofessional approach to patient care are becoming well known and the adoption of these ideas for collaboration by future healthcare professionals will be influenced by positive exposures during pre-licensure education. Although much work has been done, the establishment of interprofessional education in health care programs is still in the developmental phase in many centers. But the need for such education is obvious and urgent. Once these new professionals enter into practice, they will be expected to function as members of interprofessional teams. Therefore, they should be equipped with the skills they will need to function effectively on a team. The future of the healthcare system relies on the education of tomorrow's professionals. When we finally train healthcare professionals to perform as part of a team, "paddling in harmony", we will be able to steer toward our goal of an efficient, sustainable and safe health care system. If we do not learn to work together, we will continue to go in circles.     

Evaluation of a student-led interprofessional innovative health promotion model for an underserved population with diabetes: A pilot project

Interprofessional education seeks to encourage different health professions to interact and learn together during their training process which will eventually lead to collaborative healthcare practices and improved care for patients. This study determined whether student understanding of diabetes management and the role of health professionals in diabetes care improved after the implementation of an interprofessional health promotion program. Sixty-three students from five health professions led six educational sessions concentrating on critical components of diabetes management. The longitudinal program covered topics within the Alphabet Strategy (A–G). Students were surveyed to determine their understanding of diabetes management. Data were gathered at the beginning of the study and its conclusion. Forty-seven students completed the program and the pre- and post-survey. There were significant improvements in students' knowledge of diabetes care, understanding of the roles of healthcare professionals and ability to work with other healthcare professionals. Nineteen patients completed the study. There were no significant differences in patients' diabetes knowledge, understanding of diabetes care and clinical outcomes. This study acknowledged the potential value of an interprofessional team approach to care. This innovative model could be applied to other practice settings and used for the management of other chronic diseases.     

An interprofessional collaborative practice approach to transform heart failure care: An overview

Interprofessional collaborative practice (IPCP) approaches to health care are increasingly recognized as necessary to achieve the Triple Aim—improved health of the population, improved patient care experience, and improved affordability of care. This paper introduces and provides an overview of an interprofessional intervention to improve a healthcare team, healthcare system, and patient outcomes for hospitalized patients with heart failure. In this paper, we describe the overall project resulting from a workforce training grant and the proposed series of future papers resulting from the interprofessional intervention. Collectively, these papers will describe the results of a unique IPCP approach on team, system, and patient outcomes as well as describe and compare organizational and leadership traits that affect collaborative practice. Our hope is that the intervention approaches, evaluation results, and lessons learned described in these papers will help further the efforts to spread IPCP approaches to transforming health care.     

Sustainable interprofessional teamwork needs a team-friendly healthcare system: Experiences from a collaborative Dutch programme

ABSTRACT

The significance of effective interprofessional teamwork to improve the quality of care has been widely recognised. Effective interprofessional teamwork calls on good collaboration between professionals and patients, coordination between professionals, and the development of teamwork over time. Effective development of teams also requires support from the wider organisational context. In a Dutch village, healthcare professionals work closely together, and mutual consultations as well as interprofessional meetings take place on a regular basis. The network was created as a precondition for sustainable interprofessional teamwork in elderly care. However, several external barriers were experienced regarding the supportive structure and cooperative attitude of the healthcare insurer and municipality. The aim of the article is to examine these experience-based issues regarding internal organisation, perspective, and definition of effective teamwork. Complicating factors refer to finding the right key figures, and the different perspectives on team development and team effectiveness. Our conclusion is that the organisation of healthcare insurance companies needs to implement fundamental changes to facilitate an interprofessional care approach. Furthermore, municipalities should work on their vision of the needs and benefits of a fruitful collaboration with interprofessional healthcare teams. The challenge for healthcare teams is to learn to speak the language of external partners. To support the development of interprofessional teams, external parties need to recognise and trust in a shared aim to provide quality of care in an efficient and effective way.     

Development and evaluation of a primary care interprofessional education intervention to support people with dementia

ABSTRACT

International policy documents emphasize the need to develop interprofessional education (IPE) to support collaborative dementia care in the community. The aim of this short report is to describe the development and pilot evaluation of an interprofessional dementia education workshop for primary care healthcare professionals. A three-hour workshop was iteratively developed through consultation with an expert reference group and people with dementia. The workshop was piloted with three separate primary care teams. A total of fifty-four primary care based healthcare staff who represented fourteen different health care roles in primary care participated in the pilot evaluation. The pilot workshops were evaluated using a mixed method approach which included post-workshop questionnaires for participants (n= 54)and a post-workshop focus group (n=8) with the program design team and workshop facilitators. The results of the pilot phase indicated that the workshop was useful and feasible. The workshop improved participants’ self-reported knowledge, understanding and confidence to support people with dementia and their families.Areas for improvement were identified and will be used to inform improvements to the workshop content and delivery in advance of a national roll-out. Future evaluations of the implementation of this interprofessional educational workshop will focus on its impact on healthcare professional behavior and outcomes for the person with dementia and their families.     

Using interprofessional simulation to improve collaborative competences for nursing,physiotherapy, and respiratory therapy students

Within the care of people living with respiratory conditions, nursing, physiotherapy, and respiratory therapy healthcare professionals routinely work in interprofessional teams. To help students prepare for their future professional roles, there is a need for them to be involved in interprofessional education. The purpose of this project was to compare two different methods of patient simulation in improving interprofessional competencies for students in nursing, physiotherapy, and respiratory therapy programmes. The Canadian Interprofessional Health Collaborative competencies of communication, collaboration, conflict resolution patient/family-centred care, roles and responsibilities, and team functioning were measured. Using a quasi-experimental pre-post intervention approach two different interprofessional workshops were compared: the combination of standardised and simulated patients, and exclusively standardised patients. Students from nursing, physiotherapy, and respiratory therapy programmes worked together in these simulation-based activities to plan and implement care for a patient with a respiratory condition. Key results were that participants in both years improved in their self-reported interprofessional competencies as measured by the Interprofessional Collaborative Competencies Attainment Survey (ICCAS). Participants indicated that they found their interprofessional teams did well with communication and collaboration. But the participants felt they could have better involved the patients and their family members in the patient’s care. Regardless of method of patient simulation used, mannequin or standardised patients, students found the experience beneficial and appreciated the opportunity to better understand the roles of other healthcare professionals in working together to help patients living with respiratory conditions.     

Utilising Medicare annual wellness visits to implement interprofessional education in the primary care setting

Interprofessional education (IPE) is an important component of healthcare professional curriculum in order to optimally prepare students for their roles as part of the healthcare team. Integrating IPE activities into direct patient care in the primary care clinic setting can help improve perceptions and student understanding of other healthcare professionals’ responsibilities in this ever-evolving practice setting. This report describes the implementation of an interprofessional clinic including a variety of healthcare professionals and students in the context of the Medicare Annual Wellness Visits (AWV). Design of the clinic and general roles of the professionals in optimising preventive care are described. Student perceptions of IPE and their knowledge of other healthcare professionals were also surveyed. Student knowledge of other professionals mildly improved. Student perception of actual cooperation and interprofessional interaction statistically improved, while perception of interprofessional learning slightly worsened. Utilising Medicare AWVs can be a way for various professionals to improve IPE in the primary care setting.     

A network model of communication in an interprofessional team of healthcare professionals: A cross-sectional study of a burn unit

Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to between team members from the same profession; and (3) which professions are more likely to form interprofessional ties. Health management and support personnel ties were 94% interprofessional while ties among nurses were 60% interprofessional. Nurses and other health professionals were significantly less likely than physicians to form ties. Nurses were 1.64 times more likely to communicate with nurses than non-nurses (OR = 1.64, 95% CI: 1.01–2.66); there was no significant role homophily for physicians, other health professionals, or health management and support personnel. Understanding communication networks in healthcare teams is an early step in understanding how teams work together to provide care; future work should evaluate the types and quality of interactions between members of interprofessional healthcare teams.     

Team effectiveness in academic primary health care teams

Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.     

Prospective health students’ perceptions of the pharmacist role in the interprofessional team

Negative perceptions or underdeveloped understanding of healthcare team member roles can impact the functionality of the team and stunt innovations in interprofessional practice and education. Therefore, the intent of this study was to explore the perception of pharmacists’ role on the healthcare team by future team members: prospective health professional students. The study utilised a survey to examine these perceptions in prospective health professional students (n = 34) nearing the application process to health professional school. A coding process was used to explore open-ended text responses through a line-by-line analysis and identify emerging themes regarding perception of pharmacists’ roles, responsibilities, and practice settings. Quantitative data examined perception of pharmacists by intended prospective profession, healthcare experience, and pharmacy experience. Results indicate that while prospective health professional students find pharmacists to be an important part of the healthcare team, they lack a developed understanding of pharmacists’ roles, responsibilities, and practice settings. Identifying and addressing prospective health professional students’ misperceptions surrounding pharmacists’ roles and responsibilities may encourage them to make informed career decisions and shape them into more knowledgeable future professionals with the ability to better impact patient care on interprofessional teams.     

Making organizational change to achieve improvement and interprofessional learning: perspectives from health professions educators

Health professionals must learn to work in the context of an interdisciplinary team in order to meet the needs of the evolving health care delivery system. These teams must work successfully with community systems to achieve common goals, while understanding and respecting diverse perspectives, experiences and skills. Strategies for changing health professions education to prepare new health professionals for such work have been tested by the Interdisciplinary Professional Education Collaborative. Illustrations of making educational change, and creating situations to sustain the change, are offered from the Collaborative's experience. Teams participating in the Collaborative engaged in interprofessional education, working on community-based health improvement issues. The illustrations are offered in the context of higher education, and the many barriers to making change that must be overcome. The work of the Collaborative provides valuable illustrations of successful activities to promote and create change, and ultimately to achieve improvement and interprofessional learning, better preparing new health professionals for the health systems in which they will work.     

Views of the United States healthcare system: Findings from documentary analysis of an interprofessional education course

As the healthcare system of the United States becomes more complex, collaboration among health professionals is becoming an essential aspect in improving the health of individuals and populations. An interprofessional education course entitled “Health Care System and Health Promotion” was developed to allow health profession students to work and learn together about issues related to healthcare delivery, health promotion, and the effect of policy issues on key stakeholders in the system. A qualitative document analysis research design was used to evaluate the effect of this interprofessional course on students’ views of the current healthcare system of the United States. Fifty-nine student articles were analysed using document analysis. Health professions represented in the sample included occupational therapy, physical therapy, athletic training, nursing, and radiation therapy, nuclear medicine technology, and magnetic resonance imaging. Eight themes were identified including: increased personal awareness, the need for a system change, concern for access, affordability of healthcare, vision for future practice role, need for quality care, the value of interprofessional collaboration (IPC), and the importance of disease prevention. The results of the study suggest that healthcare education can benefit from the integration of Interprofessional Education (IPE) courses into their curriculum especially when teaching content common to all healthcare professions such as healthcare systems and health promotion.     

Interprofessional education and working in mental health: in search of the evidence base

Aim To explore interprofessional attitudes arising from shared learning in mental health. Background Inter‐professional education in healthcare is a priority area for improving team‐working and communication. Many studies have attempted to evaluate its benefits and challenges, although few emanate from the mental health arena. However, producing evidence to link educational input with clinical outcomes is notoriously difficult. This project attempted to produce evidence for changes in interprofessional attitudes and stereotypes. Method(s) Mental health nursing students and clinical psychology trainees participated in inter‐professional education. An evaluation tool was designed to evaluate the experience and outcomes, and to consider implications for interprofessional working. Results There was an increase in clarity regarding roles, approaches and resources, and how to collaborate in practice. There was no significant change in professional identity. Many challenges were identified, including differences in academic level, previous experience, expectations, assessment, motivation and effort. Conclusion Despite the challenges, it remains important to offer collaboration with future mental health colleagues as a foundation for effective team‐working. Recommendations are made for creating inter‐professional education opportunities for diverse student groups. Implications for Nursing Management Mental health professionals need to work effectively in multidisciplinary teams. Drawing on available guidance, managers should encourage and support team members to undertake shared learning where possible, both within clinical settings and through more formal educational provision. In this way, managers can facilitate collaborative relationships which will pay dividends for the provision of effective mental health care. This project adds to the limited knowledge currently available on interprofessional learning and attitudes within a mental health context.     

Evaluation of a student-led interprofessional innovative health promotion model for an underserved population with diabetes: A pilot project

Interprofessional education seeks to encourage different health professions to interact and learn together during their training process which will eventually lead to collaborative healthcare practices and improved care for patients. This study determined whether student understanding of diabetes management and the role of health professionals in diabetes care improved after the implementation of an interprofessional health promotion program. Sixty-three students from five health professions led six educational sessions concentrating on critical components of diabetes management. The longitudinal program covered topics within the Alphabet Strategy (A-G). Students were surveyed to determine their understanding of diabetes management. Data were gathered at the beginning of the study and its conclusion. Forty-seven students completed the program and the pre- and post-survey. There were significant improvements in students' knowledge of diabetes care, understanding of the roles of healthcare professionals and ability to work with other healthcare professionals. Nineteen patients completed the study. There were no significant differences in patients' diabetes knowledge, understanding of diabetes care and clinical outcomes. This study acknowledged the potential value of an interprofessional team approach to care. This innovative model could be applied to other practice settings and used for the management of other chronic diseases.     

What fosters or prevents interprofessional teamworking in primary and community care? A literature review

BACKGROUND: The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved. OBJECTIVES: This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century. DESIGN: A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods. FINDINGS: Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed. CONCLUSIONS: These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision.     

Interprofessional education about shared decision making for patients in primary care settings

With an increasingly complex array of interventions facing healthcare professionals and patients, coupled with a potentially diverse number of professionals operating within the primary care team, the adoption of shared decision making (SDM) ? with or without patients’ decision aids ? in an interprofessional manner is essential to ensure the highest quality of care for patients. In this article, we propose a framework for interprofessional education about SDM targeted to primary care settings. Five areas of knowledge and skills were agreed to be essential for all relevant stakeholders for interprofessional education in SDM to be successful: understanding the concept of SDM; acquiring relevant communication skills to facilitate SDM; understanding interprofessional sensitivities; understanding the roles of different professions within the relevant primary care group; and acquiring relevant skills to implement SDM. We suggest a series of teaching methods for the aforementioned areas, using principles from adult learning.     

Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model

Most shared decision-making (SDM) models within healthcare have been limited to the patient–physician dyad. As a first step towards promoting an interprofessional approach to SDM in primary care, this article reports how an interprofessional and interdisciplinary group developed and achieved consensus on a new interprofessional SDM model. The key concepts within published reviews of SDM models and interprofessionalism were identified, analysed, and discussed by the group in order to reach consensus on the new interprofessional SDM (IP-SDM) model. The IP-SDM model comprises three levels: the individual (micro) level and two healthcare system (meso and macro) levels. At the individual level, the patient presents with a health condition that requires decision-making and follows a structured process to make an informed, value-based decision in concert with a team of healthcare professionals. The model acknowledges (at the meso level) the influence of individual team members' professional roles including the decision coach and organizational routines. At the macro level it acknowledges the influence of system level factors (i.e. health policies, professional organisations, and social context) on the meso and individual levels. Subsequently, the IP-SDM model will be validated with other stakeholders.     

Interdisciplinary health care training in the USA: lessons learned from a rural training grant program

Abstract

For almost half a century, research has identified that effective teamwork is essential in order to enhance care provision and health outcomes for patients. Although the value of teamwork is well-recognized in healthcare, the historically rooted dynamics of workplace relationships create a myriad of challenges to creating collaborative teams. Understanding the history of interpersonal dynamics between health professionals can provide direction for future interprofessional education and collaboration strategies. The aim of this paper is to provide a historical overview of the social positioning of nursing and medicine in the context of interprofessional collaboration. Few professions work as closely as nursing and medicine. Despite the well-recognized benefits of interprofessional collaboration, these two professions are often socially positioned in opposition to one another and depicted as adversarial. This analysis will seek to advance our understanding of the historical roots between these two professions and their relationships with and among each other in relation to career choice, early socialization and patient care delivery. An exploration of the historical social positioning of nursing and medicine can provide an enhanced understanding of the barriers to interprofessional collaboration and inform future successes in interprofessional education and practice among all health and social care professions.     

Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication,teamwork, and patient-centred care

Abstract

Achieving safe, quality health care is highly dependent on effective communication between all members of the healthcare team. This study explored the attitudes and experiences of recent healthcare graduates regarding interprofessional teamwork and communication within a clinical setting. A total of 68 pharmacy, nursing, and medicine graduates participated in 12 semi-structured focus group discussions in clinical workplaces across three Australian states. Discussion focussed on graduates’ experiences of interprofessional education and its impact on their capacity for interprofessional teamwork and communication. The Social Identity and Realistic Conflict theories were used as a framework for qualitative data analysis. A consistent pattern of profession-focussed, rather than patient- or team-focussed goals was revealed along with reports of negative stereotyping, hierarchical communication, and competition for time with the patient. Graduates acknowledged the importance of communication, teamwork, and patient-centred care and felt a better understanding of the roles of other health professionals would assist them to work together for patients’ wellbeing. Identifying workplace identities and differential goals has uncovered possible motivations underlying health professionals’ behaviour. These insights may help improve interprofessional collaboration by focusing attention on common team goals, increasing feelings of worth and being valued among different professionals, and decreasing the need for competition.