Fostering interprofessional collaborative practice in acute care through an academic-practice partnership

An interprofessional collaborative practice (IPCP) environment was implemented in four inpatient acute care unit accountable care teams (ACT) through an academic-practice partnership. An action research methodology was implemented to empower healthcare professionals and promote ownership and sustainment of the IPCP strategies. Healthcare professionals on the ACT units, students, and faculty engaged in the multi-year project. Interventions included staff engagement exercises and coaching and support of individual ACT unit IPCP strategies and education. Healthcare professional outcome data were collected in the form of participant surveys, measuring collaboration about care decisions and the extent to which professionals engaged in a culture of safety, collected at baseline and 6-month intervals. Healthcare outcome measures of the ACT units were also collected at baseline and 6-month intervals. Students had clinical learning experiences in the IPCP settings and completed post clinical surveys. Implementation of the interventions resulted in a positive trend in the healthcare professionals, although statistical significance was not observed. Student outcome data demonstrated statistically significant positive learning outcomes. Healthcare outcome measures demonstrated a significant decrease in readmissions and an overall decrease in catheter-associated urinary tract infections over time. Other measures were not significantly impacted. In conclusion, an academic – practice partnership can strengthen and support an IPCP environment by allowing healthcare clinicians to be directly involved in the selection and implementation of IPCP strategies and contribute to improved professional, healthcare and student outcomes.     

Observation of interprofessional collaboration in primary care practice: A multiple case study

Interprofessional collaboration (IPC) is known to improve and enhance care for people with complex healthcare and social care needs and is ideally anchored in primary care. Such care is complex, challenging, and often poorly undertaken. In countries such as Canada, the United Kingdom, the Netherlands, Australia, and New Zealand, primary care is provided predominantly via general practices, where groups of general practitioners and nurses typically work. Using a case study design, direct observations were made of interprofessional activity in three diverse general practices in New Zealand to determine how collaboration is achieved and maintained. Non-participant observation of health professional interaction was undertaken and recorded using field notes and video recordings. Observational data were subject to analysis prior to collection of interview data, subsequently gathered independently at each site. Case-specific themes were developed before determining cross-case themes. Cross-case themes revealed five key elements to IPC: the built environment, practice demographics and location, practice business models, shared goals, and team structure and climate. The combination of elements at each practice site indicated that strengths in one area helped offset challenges in others. The three practices (cases) collectively demonstrated the importance of an “all of practice” commitment to collaborative practice so that shared decision-making can occur.     

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.     

Best practice interprofessional stroke care collaboration and simulation: The student perspective

Interprofessional practice (IPP) is the accepted standard of care for clients following a stroke. A brief, embedded and evidence-based IPP team simulation was designed to address stroke care knowledge and IPP competencies for students within limited curriculum space. Each team was required to construct a collaborative care plan for their patient during the simulation and submit the care plan for evaluation of best practice stroke care knowledge and implementation with evidence of interprofessional collaboration (IPC). A total of 302 students (274 on-site, 28 by distance technology) representing four professions comprised of 55 teams took part in this experience. Post-simulation, voluntary and anonymous programme evaluations were completed using the standardised interprofessional collaborative competency assessment scale (ICCAS) and open-ended free-text responses to five questions. There was a significant improvement for all pre–post ratings on the ICCAS regardless of profession or previous interprofessional experience. Additionally, the open-ended responses indicated perceived changes to role clarification, communication, and teamwork. The combined interpretation of the programme evaluation results supports interprofessional team simulation as an effective and efficient learning experience for students regardless of previous interprofessional experience, and demonstrated positive changes in stroke best-practice knowledge and IPC competencies.     

Adherence to clinical guidelines in heart failure (HF) outpatients: Impact of an interprofessional HF team on evidence-based medication use

Abstract

Clinical systolic heart failure (HF) guidelines specify recommendations for ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta blockers according to doses used in clinical trials. However, many HF patients remain suboptimally treated. We sought to determine which provider type, between an interprofessional HF team, non-HF cardiologists, and primary care physicians (PCP), most optimally manages HF medications and doses. A retrospective chart review was performed on adult patients at an academic county hospital with an ejection fraction ≤40% and a diagnosis of HF, seen by a single provider type (HF team, cardiologist, or PCP) at least twice within a 12-month period. Utilization rates of any ACEI/ARB and any beta blocker were robust across provider types, though evidence-based ACEI/ARB and beta blocker were greatest from the HF team. Doses of evidence-based therapies dropped markedly in the non-HF team groups. The percent of patients prescribed optimal doses of an evidence-based ACEI/ARB AND beta blocker was 69%, 33%, and 25% for the HF team, cardiologists and PCPs, respectively (p?<?0.0167). Patients followed by the HF team were more frequently prescribed evidence-based medications at optimal doses. This supports using specialized interprofessional HF teams to attain greater adherence to evidence-based recommendations in treating systolic HF.     

The role of nurse practitioners in hospital settings: implications for interprofessional practice

Expansion of the nurse practitioner (NP) role worldwide indicates a need to understand how the role functions in interprofessional healthcare teams. Through the adoption of a mixed methods approach that gathered on-site tracking and observation, self-recorded logs of consultations and focus group interviews of team members and NPs, we describe the extent of role activity and the nature of interprofessional practices of 46 NPs and their team members in nine hospital sites across the province of Ontario, Canada. Findings outline the nature of the NP role activities, which largely focused on providing clinical care, with the support of their team, to a range of patients across the study settings. We discuss how ‘embedding’ the NP in this way appears to contribute to utilization of expertise of all professions as well as enabling team members to promote evidence-based practices. We argue that the use of NPs augments interprofessional role utilization through their desire to consult with a range of professionals and the capacity to perform holistic care for patients that is not limited to traditional nursing boundaries.     

A critical examination of the role of appreciative inquiry within an interprofessional education initiative

Appreciative inquiry (AI) is a relatively new approach to initiating or managing organizational change that is associated with the ‘positiveness’ movement in psychology and its offshoot positive organizational scholarship. Rather than dwelling upon problems related to change, AI encourages individuals to adopt a positive, constructive approach to managing change. In recent years, AI has been used to initiate change across a broad range of public and private sector organizations. In this article, we report findings from a subset of 50 interviews gathered in a wider study of interprofessional education (IPE) in which AI was employed as a change agent for implementing IPE in a number of health care institutions in a North American setting. A multiple case study approach. (Yin, 2002) was employed in the wider study and semi-structured interviews were undertaken with participants both before their IPE programs and directly afterwards to obtain a detailed understanding of their expectations and experiences of IPE. Interviews were analyzed in an inductive thematic manner in order to produce key emergent themes from each of the IPE programs. A process of re-analysis provided a set of themes which offered an understanding of the role of AI within this IPE initiative. Our findings identify a strong resonance and fit for AI both among the health and social care professionals who participated in this initiative. Numerous individuals commented on the enthusiasm and energy AI engendered, while praising its ability to enhance their working lives and interprofessional relationships. Yet a number of difficulties were also reported. These focused on problems with the translation of the AI process into achievable structural level (e.g. professional, cultural) changes. Based on these findings, the article goes on to argue that the use of AI can overlook a number of structural factors, which will ultimately limit its ability to actually secure meaningful and lasting change within health care.     

Examining the interface between interprofessional practice and education: Lessons learned from Norway for promoting teamwork

Promoting teamwork in health and social care requires an understanding of the interface between interprofessional practice (IPP) and interprofessional education (IPE). A study with two parts, one qualitative and one quantitative, examined this interface in Norway. The first used focus groups to assess IPP rewards, barriers, and facilitating factors among practitioners in clinical settings. The second utilized an online survey to measure IPE attitudes, barriers, and facilitating factors among senior administrators in the educational system. Results of Part 1 indicate that providers report many intrinsic rewards of IPP; however, the more extrinsic impacts of collaborative practice on patient care need to be emphasized to system managers. Results of Part 2 suggest strong general support by academic deans and directors for IPE, though addressing specific potential barriers to its implementation has become increasingly important. Overall, bridging the IPP–IPE gap requires educating leaders in both settings about the resources needed for teamwork, linking clinical and educational settings through continuing professional development, and generally advocating more effectively for both IPP and IPE.     

Using reflective practice in interprofessional education and practice: a realist review of its characteristics and effectiveness

ABSTRACT

This article presents the results of a realist review of the use of reflective practice interventions aimed at improving interprofessional education and collaborative practice (IPECP). Reflective practice is recognized as one of the determining factors in health and social service professionals’ skills development and maintenance, as well as in the establishment of good collaboration practices. In this respect, it is a key element of interprofessional education (IPE) and its relevance in this field is being asserted more and more strongly. However, few studies have been conducted to document its effectiveness. The purpose of this article is therefore to advance knowledge in this field. Searches in health and social services electronic databases identified six studies presenting reflective practice interventions in IPECP aimed at enhancing collaboration among students or practicing professionals. Analysis provided preliminary answers as to the effectiveness of reflective practice interventions in IPECP, as well as pertinent information on the best methods for achieving effectiveness. It concludes by proposing recommendations designed to change reflective practice interventions in IPECP and by stressing the importance of further research in order to document more fully the effectiveness of reflective practice in IPECP and to identify the most promising intervention methods in this regard.     

Evaluating the perceived impact of an interprofessional childhood obesity course on competencies for collaborative practice

Interprofessional education (IPE) is needed to prepare health professional students to address the complexities of childhood obesity in practice. This mixed-method study sought to evaluate the perceived impact of a childhood obesity IPE intervention on health professional students’ collaborative competency development within two domains: roles/responsibilities and teams/teamwork. Fourteen health professional students participated in this mixed-methods study. Quantitative data were collected through pre/post surveys, while qualitative data were collected through reflection assignments. Survey findings indicated that students reported significant increases in growth within both interprofessional competency domains. Qualitative data elaborated on the types of learning students experienced relative to each domain. Implications of this study for research and practice related to IPE to address complex health issues, such as childhood obesity, are shared.     

Nursing and medical students teaming up: Results of an interprofessional project

Health professions programmes are increasing the number of interprofessional events in their curricula. Many of these programmes are grounded in case study or simulation events in order to prepare students for eventual practice. We designed an interprofessional education collaborative practice (IPECP) that provides direct interprofessional practice experience while students are still in their health profession programmes. In our programme, teams of senior baccalaureate nursing and third-year medical students provided health coaching to patients in need of chronic disease management. The purpose of the project and study was to determine whether repeated exposure to opportunities for interprofessional communication would lead to improvement in the individual and team communication skills. Teams met with their assigned patients monthly to provide coaching and had follow-up conversations with the patients between meetings. Faculty were present at each meeting to review the healthcare and coaching plans, observe the teams’ interactions, and provide a debriefing after each meeting. Results demonstrated that both individual and team communication skills significantly increased over time. The IPECP project was successful in providing a context where students could develop and improve upon key interprofessional communication skills.     

Development and validation of a tool to assess self-efficacy for competence in interprofessional collaborative practice

ABSTRACT

Although interprofessional education and collaborative practice have gained increasing attention over the past five decades, development of rigorous tools to assess related competencies is still in infancy. The purpose of this study was to develop an instrument to evaluate health professions students’ self-efficacy in interprofessional collaborative competency and to assess the instrument’s psychometric properties. We developed a new instrument based on the Interprofessional Education Collaborative’s (IPEC) Core Competencies for Interprofessional Collaborative Practice. In a cross-sectional study design, 660 students from 11 health programmes at an urban university in the Midwest USA completed the Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET). Rasch analysis evaluated the following: (1) functioning of the instrument; (2) fit of items within each subscale to a unidimensional construct; (3) person-response validity; (4) person-separation reliability; and (5) differential item functioning in relation to gender and ethnicity. After removing seven items with suboptimal fit, each subscale demonstrated high internal validity. Two items demonstrated differential item functioning (DIF) for “Gender” and none for “Race/Ethnicity.” Our findings provide early evidence of IPECC-SET as a valid measure of self-efficacy for interprofessional competence for health professions students. Additional research is warranted to establish external validity of the new instrument by conducting studies across institutions.     

Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care

Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, ‘Enhancing Knowledge and Interprofessional Care for Heart Failure’, was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention’s acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.     

Views from the field: Medical student experiences and perceptions of interprofessional learning and collaboration in rural settings

Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning and collaboration, (c) experiencing the importance of social connections to interprofessional collaboration and learning, and (d) realisations that interprofessional collaboration is a means of overcoming barriers in rural areas. We discuss our findings using the socio-material perspective of complexity theory. These findings may be used to inform undergraduate programs in re-defining, re-creating, developing, and fostering interprofessional learning opportunities for medical students in rural communities as well as to support clinical faculty through ongoing professional development.     

The role of interprofessional collaboration for intimate partner violence in psychiatric care: A research and development project

In Finland, policy requirements have demanded providers to work collaboratively together with regard to intimate partner violence (IPV). This research and development project seeks to identify efficient tools for stopping IPV. The project included staff training to recognize and respond to IPV, the development of a research-based guideline for use in the care situations of victims and perpetrators and the integration of the guideline into practices and staff development. Networking was developed during the project through interprofessional and multiagency collaboration, whereas appraisal information was collected at different stages of the process. This paper focuses on the issues of interprofessional collaboration, and uses psychiatric care as an example. There is some evidence that interprofessional interventions reduce the cost of patient care and improve the quality of IPV services. That is why it is important to discuss these issues and solve possible problems arising in interprofessional patient care.     

Treating diabetes in underserved populations using an interprofessional care team

Abstract

Community Health Centers that provide diabetic care for underserved patients have unique challenges. This study describes how interprofessional care improves outcomes and results in cost savings. Interprofessional diabetes education and structured team building are discussed. The team consisted of a physician, nurse practitioner, clinical pharmacist, and a number of pre-medicinal, nursing, and pharmacy students. The outcomes were measured at one year intervals for a total of three years. During the two year period with the interprofessional care team, the diabetic patients in this study achieved a 10% improvement in HgA1c, and 9% improvement in systolic blood pressure, a 5% improvement in diastolic blood pressure, and a 62.6% reduction in triglycerides. These findings suggest that this interprofessional care model in a free clinic significantly improved the HgA1c, triglycerides, and blood pressure.