FUTURE DIRECTIONS <Executive summaryThe Clinical Education and Training Institute (CETI) was The second Team Health Consultation Forum took placeformally established on 1 July 2010 as a Chief Executive in August 2011 and aimed to consult on ways to betterGoverned Statutory Health Corporation (SHC) directly prepare pre-graduate and new clinical graduates for workresulting from the Special Commission of Enquiry into and ways to improve the development of interprofessionalAcute Care in NSW Public Hospitals. CETI will soon be collaborative practice or team-based care. The TEAM HEALTH FUTURE DIRECTIONSrenamed the Health Education and Training Institute consultation also sought to identify gaps and to highlight(HETI) in late 2011 as part of the NSW governance review. opportunities for existing programs to inform Team Health.CETI’s Team Health program aims to improve teamwork, This Consultation produced two prioritised lists ofcommunication and collaboration for safer patient- curriculum topics. One list consisted of proposedcentred care and better staff experiences. foundational topics for new clinical graduates in medical,This Report provides an overview of CETI’s newly formed nursing, midwifery and allied health and the other listTeam Health Program and presents outcomes and contained proposed topics to enhance team-based,emerging themes from two statewide consultation forums. patient-centred care. For new clinical graduates, topicsThe value of this Report is two-fold: it contains summaries such as time management, knowing when to escalateof evidence, expert opinion and program activities that for deteriorating patients, prioritising patient needs,support collaborative practice and team-based care, as communication at clinical handover and communicatingwell as key stakeholder opinion relating to the strengths, in medical records were deemed the most relevant andchallenges and opportunities for implementation of Team useful topics to prepare new graduates for the workplace.Health across New South Wales. Proposed topics to enhance team-based, patient-centred 1The Inaugural Team Health Consultation Forum in June care included understanding the roles of other health2011 aimed to establish features of a suitable model professionals; teamwork communication; team reflectiveof program governance for Team Health as well as practice and ways to facilitate this and engagingcanvassing opinion with respect to developing evidence- patients and their families to partner in decision-makingbased curriculum and monitoring and evaluation about their clinical care.approaches. The Consultation also sought feedback Throughout the two consultation forums, there wasrelating to other relevant programs Team Health may general consensus that the proposed Team Healthleverage from, as well as the identification of program is relevant, evidence based and can beopportunities and challenges for the program. implemented in coordination with Local Health DistrictsKey messages from the Inaugural Team Health and aligned with other programs with similar aims.Consultation were diverse and extensive. Messages from Consultation, collaboration and transparent processesdelegates confirmed that engagement from Local Health for program development were broad themes thatDistricts is vital for program success as is drawing on and emerged from Team Health’s consultation activities.adapting features of the ‘Optimal Model of Governance’; Over the next year, Team Health will work to ensure aengaging with professional colleges and associations; coordinated statewide approach to the developmentand a blended approach to curriculum development that of curricula which fosters improved teamwork,includes quality facilitators, social marketing strategies, communication and collaboration for safer patient-elearning modules and a robust system of project centred care, and better staff experiences.management. Opportunities included the coordinationand promotion of efforts among the other three pillaragencies: Agency for Clinical Innovation (ACI), Bureauof Health Information (BHI) and Clinical ExcellenceCommission (CEC) and the recognition of existinghigh-functioning teams and leaders as exemplars.Challenges included organisational barriers to team-based approaches, a need to build agreement on whatsuccess might look like and acknowledging the complexityand diversity of teams (casual, virtual, rotational) in theNSW public health system.
Background The changing of a professional culture can only occur if the why and wherefore of reform is taught in the undergraduate and early clinical training years. The creation of a modern, well trained, flexible hospital workforce is a major objective of the recommendations I have made. In particular, I recommend that an Institute of Clinical Education and Training be established with a broad mandate to take charge of the training of a new generation of clinicians in inter disciplinary team-based treatment of patients, and to assess and evaluate the clinical training of junior doctors, nurses and allied health professionals. (Peter Garling SC 2009) The Clinical Education and Training Institute (CETI) was formally established on 1 July 2010 as a Chief Executive Governed Statutory Health Corporation (SHC) directly resulting from the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals (2008). CETI will soon be renamed the Health Education and Training Institute (HETI) in late 2011 as part of the NSW governance review. CETI’s mission is to provide a central source of leadership and coordination in the area of clinical education and training to ensure all health professionals have the necessary skills and knowledge to deliver high quality and safe2 patient care to the people of NSW. The purpose of this report is to provide an overview of CETI’s newly formed Team Health Program and to showcase outcomes to date from a series of statewide consultations. This report will also identify key messages that will inform the future directions of the program. The aim of Team Health is to improve teamwork, communication and collaboration for safer patient-centred care and better staff experiences. The aim relates specifically to Garling’s recommendation for a new generation of clinicians skilled in the interdisciplinary team-based treatment of patients. Dr Gaynor Heading, General Manager, and Professor Steven Boyages, Chief Executive of the Clinical Education and Training Institute
FUTURE DIRECTIONS <Why a team-based approach?Interprofessional collaborative practice (ICP) or team-based care describes a patient-centred process ofcommunication and decision-making that enables the separate and shared knowledge and skills of careproviders to synergistically influence the client/patient care (Way et al, 2000). The World Health Organisation’sFramework for Action on Interprofessional Education and Collaborative Practice (2010) summarises that“collaborative practice strengthens health systems and improves health outcomes” (WHO, 2010: 7). The TEAM HEALTH FUTURE DIRECTIONSFramework also describes the causal link between the provision of interprofessional education and thedevelopment of interprofessional collaboration:After almost 50 years of enquiry, the World Health Organization and its partners acknowledge thatthere is sufficient evidence to indicate that effective interprofessional education enables effectivecollaborative practice. (WHO, 2010: 7)A great deal of evidence – both nationally and internationally has emerged that identifies a range ofbenefits gained through interprofessional collaboration. Examples of these benefits include:• Increased patient safety;• Increased staff motivation, well-being and retention;• Decrease in staff turnover;• Increased patient and carer satisfaction; 3• Decrease in tension and conflict among caregivers;• Increase in appropriate use of specialist clinical resources;• Reductions in patient mortality and critical incidents, and;• Increase in access to and coordination of health services. (WHO, 2010)In a 2010 global Lancet review of health professional education, Julio Frenk et al (2010) outlined a series ofsystemic shortfalls including an outdated and static curricula for pre-graduates, mismatch of competenciesto patient and population needs; poor teamwork and a narrow technical focus.Of the many instructional reforms recommended, Frenk et al suggested the promotion of “interprofessionaland transprofessional education that breaks down professional silos while enhancing collaborative andnon-hierarchical relationships (Frenk et al, 2010: 1924):Put simply, the education of health professionals in the 21st Century must focus less on memorisingand transmitting facts and more on promotion of the reasoning and communication skills that willenable the professional to be an effective partner, facilitator, adviser and advocate.(Frenk et al, 2010: 1945)The overarching goal of interprofessional education is to promote interprofessional, patient-centred,collaborative practice or team-based care.
Team Health Consultations This report focusses on two consultation forums held in Sydney in June and August 2011. Key stakeholders from across NSW were invited to provide expert opinion and to share ideas and ways forward. The two consultation forums had unique aims, targeted participants and a program of consultation that drew from newly emerging evidence and professional opinion. Both consultations were opened by Professor Steven Boyages who provided a broad overview of the following issues: • An outline of CETI’s new functions, team-based recommendations arising from the Special Commission of Enquiry into Acute Care in NSW Public Hospitals and the unique roles of the Clinical Excellence Commission (CEC), the Bureau of Health Information (BHI) and the Agency for Clinical Innovation (ACI) • A broad overview of the need for foundational skills of new graduates to more closely align with the demands of today’s clinical workplaces (including primary health care settings); • A need to identify, learn from and promote team-based skills of high performance teams within clinical settings, and; • A need to identify and support team-based, interprofessional collaborative practice in Advanced Settings of Care by developing a range of clinical modules and facilitated team communication activities. Team Health Program Coordinators, Rob Wilkins and Danielle Byers provided an overview of evidence, features of successful interventions and proposed ways forward for the program. Key points from their presentations included:4 • The aims for the Consultation forum • Key definitions and evidence for enhancing interprofessional collaborative practice or team-based care • A snapshot of international evidence and program activities occurring in other countries • A list of key programmatic lessons learned from other states and countries • A presentation of the conceptual model for Team Health including partnerships and key deliverables. Daniella Pfeiffer, Learning and Teaching Coordinator Allied Health, Dr Rob Wilkins, Learning and Teaching Coordinator, Team Health, Pamela Bloomfield, Program Coordinator Nursing and Midwifery and Jacqueline Dominish, Learning and Teaching Coordinator Allied Health
FUTURE DIRECTIONS <Overview of the Team Health Program1. Right Start ProgramRight start is a dedicated transition program for pre-graduate and new clinical graduates spanning from thelast semester of pre-graduate study and including the first two years of their employment in the NSW publichealth system. It is inclusive of all doctors, nurses, midwives and allied health professionals. Right Start aims tobetter prepare new clinical graduates for work by building a foundation of core skills for graduates to work in TEAM HEALTH FUTURE DIRECTIONSteams. Education modules will be provided both online and face-to-face, and will be developed in consultationwith Local Health Districts. Information will also be provided on new policies relevant to their clinical setting.Learning modules will cover topics such as collaborative decision-making, team work and interprofessionalconflict resolution skills. The program will also encourage learners to better understand their own roles and theroles of those around them.2. Clinical Team Education ModulesThe Clinical Team Education Modules component is aimed at both new and current employees within a clinicalteam. It will broadly employ a redesign methodology using a trained network of facilitators to explore aspectsof team function and to generate solutions which improve staff experiences. These modules may draw oninnovative tools, processes and ideas employed by other related programs.3. Policy DevelopmentThe Policy Development component of the Program is about influencing health policies and implementation 5plans towards collaborative decision-making and team-based patient-centred care. Embedding principlesof interprofessional practice within policy statements is a way of formalising and sustaining our Programcomponents as well as highlighting implications for training and education.4. Systems IntegrationTeam Health will link and align program components with other initiatives arising in CETI Directorates such asthe Hospital Skills Program and programs arising from the newly formed Allied Health Directorate. Team Healthwill also work in consultation and when appropriate, collaboration with the CEC, the ACI, the BHI, tertiaryeducation providers and Local Health Districts to make the best use of evidence and related programs.Team Health: Conceptual Model • Dedicated program targeting • A systems approach to redesign ward/unit new graduates and pre-graduates team communication and culture • Supported by e-learning, • Core modules to include rationale, evidence, simulation case scenarios redesign methodology, facilitation tools, • Align curriculum with Garling benefits recommendations and policy • Establish a state-wide network of directives IPL facilitators • Focus: Policy into practice • Link and align Team Health • Embed IPL/IPP into initiatives and other CETI portfolios emerging policy statements e.g. Hospital Skills Program, Allied and implementation plans Health Education e.g. The NSW Dementia Services • Link and align with LHDs, NSW Ministry Framework, Advance Planning for of Health, CEC, ACI, BHI initiatives Quality End of Life Strategic and • Embed IPE/IPL /IPP into undergraduate university Implementation Framework programs, including IPL clinical placements
The Inaugural Team Health Consultation – June 2011 The first Team Health consultation targeted Directors of Workforce Development, Directors of Clinical Governance, Managers of Learning and Organisational Development Centres, Clinical Redesign Managers, representatives from the CEC, BHI, ACI, representatives from NSW Ministry of Health and senior clinicians with Local Health District-wide responsibilities. A total of 44 delegates participated. Consultation aims: • To consult with key stakeholders on Team Health’s four program areas; • To jointly establish a model of local governance to support Team Health’s implementation; • To identify resources (human, technological and other) required for local and sustained implementation; • To identify existing educational resources or programs that could be used to promote teamwork, communication and collaboration. Invited speakers were: • Dr Charles Pain, Director Health Systems Improvement, Clinical Excellence Commission. Presentation title: Building Effective Healthcare Unit Teams: Why, Who and How?6 Key Messages: – Healthcare systems have low perceived reliability and healthcare providers are under increasing pressure to improve reliability; – Root causes of this include poor governance, insufficient resources, insufficient skills and inadequate tools; – Root causes manifest as failures to set objectives of care, poor teamwork and coordination including poor communication, fragmentation of care, missed diagnosis, inadequate and inappropriate treatment, and failure to recognise deterioration; Dr Charles Pain – Increase in teamwork can lead to reduction in patient mortality; – There are existing models for Health Systems Improvement (eg CEC Health Systems Improvement Model) that provide useful ways forward; – Principles for a solution include the need to view patients as part of a team and the need for evidence-based, multivariate approaches; – We should start by understanding the functions that clinical unit teams perform and reorient the health system towards supporting them in performing these functions by giving them the tools; and – The need to draw on a range of tools (new or pre-existing) and methods to support them.
FUTURE DIRECTIONS <• Mr Terry Clout, Chief Executive, South Eastern Sydney LHD. Presentation title: Implementing the Optimal Model Key Messages: – The Optimal Model of Governance for postgraduate medical TEAM HEALTH FUTURE DIRECTIONS education and training in South Eastern Sydney and Illawarra Shoalhaven LHDs provides a useful model for Team Health to draw on; – The Model outlines a flexible structure with single point accountability for medical education and training in SESLHD/ISLHD; – Governance and communication identified as the main issues that can be addressed at LHD level; – The Model offers a transparent and consistent approach to medical Mr Terry Clout education and training that can be adapted for Health Reform changes; – The Model functions target communication, accreditation and coordination and oversight of networked training including the junior medical workforce; – The benefits of the Model include a prioritisation of medical education at the executive level; transparency of funding arrangements; dual network reporting lines to LHDs and CETI; cost effectiveness; – The Model requires the establishment of positions within LHDs such as 7 a Manager, and Director of Postgraduate Medical Education and Training; – There is opportunity for the principles of the Optimal Model to be applied to the Team Health program.
Small Group Discussion – June Consultation Following these presentations, small group discussions occurred over 50 minutes. Delegates were allocated to one of three discussion groups: 1. Team Health Governance 2. Curriculum Development 3. Monitoring and Evaluation All groups were asked to respond to the following opening questions before discussing questions specific to that topic area: 1. From what you’ve heard so far, what do you see as some of the opportunities and challenges to a sustainable Team Health Program? 2. Are there any further components for Team Health to consider? Key Messages Opportunities • Engagement with Local Health Districts (LHDs) and their leaders and managers from Program inception • Coordinate and promote efforts with the CEC, ACI and BHI • Recognise and promote existing teams as exemplars8 • Coordinate the use of other related programs from LHDs and other services. Challenges • A need to recognise the expertise of individual professions and identifying areas of commonality • Working with the rotational, casual and virtual nature of teams in health care • Removing the organisational barriers to collaboration • A need to make clear the unique roles of the four pillar organisations (including CETI) Team Health Governance • A central point of coordination • An advisory group that has representation from LHDs, the four pillars, the NSW Ministry of Health, links with the tertiary education sector and operationalised coordination in each LHD • Potential for the establishment of a sub-committee for the governance of education and training reporting directly to the LHD Board Curriculum Development • Need to look more broadly at both established statewide education programs as well as proprietary programs • Engage with professional colleges and associations during consultations and begin mapping competencies (skills, knowledge, and capabilities for example) common to all health professions • Curriculum needs to be accompanied with high quality facilitators, social marketing strategies and a robust system of project management Monitoring and Evaluation • Indicators of achievement could include a decrease in clinical incidents; improved coordination of patient care; use of staff surveys to gauge improved staff experiences and a decrease in patient complaints and waiting times.
FUTURE DIRECTIONS <Team Health Clinical EducationConsultation Forum – August 2011The aims for the Clinical Education Consultation Forum were:• To consult with key stakeholders on Team Health’s programs;• To consult on ways to better prepare pre and new clinical graduates for work in the TEAM HEALTH FUTURE DIRECTIONS NSW public health system;• To consult on ways to improve the development of interprofessional collaborative practice (ICP) or team-based care, and;• To identify any gaps and to highlight opportunities for existing programs that aim to foster teamwork, collaboration and communication.Invited speakers were:• Dr Joanne Travaglia, A/Director Health Management Program, School of Public Health, UNSW. Working with teams: Lessons learned from a system-wide study of interprofessional practice. Key Messages: – There is great need for ICP in health settings; – A recent collaborative action-research program aiming to enhance teamwork, collaboration and the sharing of ideas, knowledge and practice amongst clinicians, 9 academics and students (AIHI IPC Project 2007 – 2010) provides useful lessons for Team Health; – Barriers to ICP are many and include lack of workplace trust, lack of psychological and cultural safety, discipline silos, information silos and lack of horizontal and Dr Joanne Travaglia vertical communication; – Structural and cultural factors contribute both to the facilitation of, and prevention of effective ICP; – IPL and IPE have been shown to contribute positively to the development of interprofessional collaborative practice in both education and clinical settings.• Professor Merrilyn Walton, Professor of Medical Education, Sydney School of Public Health, University of Sydney. Working together – Learning together: Improving workforce readiness. Key Messages: – Learning together does not dilute professional education and training or professional knowledge and skills; – New knowledge and skills are required from the health workforce which include partnerships with patients and carers, teamwork, risk communication, data collection, adverse events, professional responsibility and accountability; – Patient safety spans a number of fields and applies to all areas of clinical practice; – Static pedagogy, curricula rigidities, acting in isolation and competition and tribalism Professor Merrilyn Walton of professions all contribute to graduates being unprepared for work; – The National Patient Safety Education Framework is patient-centred and identifies the knowledge and performance required by all health care workers in relation to patient safety. It is designed to be flexible and can be used to develop curricula, competency- based training programs and other safety and quality initiatives; – Ways forward include: creating a learning culture, collaborating, using different environments for teaching (workplace, simulation centres), promoting multidisciplinary teamwork, recognising and encouraging opportunistic learning, creating incentives and support organisational enablers.
Small Group Discussion – August Consultation All groups were asked to respond to the following opening question before discussing questions specific to their small group topic area: From what you’ve heard so far, what do you see as some of the strengths and challenges to Team Health? Key Messages Strengths • The principles of ICP and in particular, the shared learning that occurs between and within teams; • Evidence-based benefits of ICP to increased patient safety; • Increased staff retention and morale, and; • Increased communication and understanding between disciplines. Challenges • The complexity of health service delivery; • The variety of team formations and health worker engagement within these; • ‘Breaking down silos’ or ‘getting tribes to respect each other’, and; • The broad scope of the program. Opportunities10 • A need for leadership (or leaders) to help drive the Program; • A recognition that education activities require a self-reflective or critically reflective component to assist with transformational learning; • A need to promote evidence based models, strategies and research in this area, and; • Draw on the patient-safety literature and existing ICP programs.
FUTURE DIRECTIONS <Small Group Discussion – August ConsultationProposed Foundational Topics for New Clinical Graduates in Medicine,Nursing, Midwifery and Allied HealthThis small group discussion activity sought to identify and prioritise the ten foundational topics fornew clinical graduates. After small and large group discussion, delegates voted using an adapted TEAM HEALTH FUTURE DIRECTIONSnominal group process. Rural delegates placed an “R” on their choices to indicate that they werehealth practitioners based in a rural health care setting. Ranking Foundational Topic Points 1 Time Management 13 (Incl 3 rural) 2 Knowing when and how to escalate for the deteriorating patient 10 (Incl 1 rural) 3 Prioritising patient needs or tasks 9 (Incl 3 rural) 4 Communicating clinical handover 9 5 Communicating in medical records 9 (Incl 2 rural) 6 Expressing one’s opinion competently to colleagues 9 (Incl 2 rural) 7 Communicating with a challenging patient, family or peer 8 (Incl 2 rural) 8 Understanding the roles of other health professionals 5 (Incl 2 rural) 9 Breaking bad news 3 (Incl 2 rural) 11 10 Working with different cultures and demographics 3This small group discussion activity sought to identify and prioritise topics to enhance team-basedpatient-centred care. After small and large group discussion, delegates voted using an adaptednominal group process. Rural delegates placed an “R” on their choices to indicate that they werehealth practitioners based in a rural health care setting.Proposed topics to enhance team-based, patient-centred care Ranking Topics to enhance team-based patient-centred care Points 1 Understanding the roles of other health professionals 19 (Incl 1 rural) 2 Teamwork communication 16 (Incl 4 rural) 3 Team reflective practice – ways to facilitate 15 4 Team purpose, values and revisiting values regularly 13 (Incl 1 rural) 5 Engaging patients and their families to partner in decision-making 8 (Incl 2 rural) about their care 6 Professionalism 7 7 Collaborative decision-making 5 (Incl 1 rural) 8 Team ethics, including confidentiality 5 9 Knowing when and how to seek advice from other professionals 5 (Incl 1 rural) 10 Ongoing team learning 5
General feedback from both consultations Delegates were asked to provide further feedback. Key themes included: • A need to address undergraduate curriculum in universities (and TAFE) • An acknowledgement of the need for a cultural shift to occur as well as a ‘shift in the mindsets’ of health managers and staff • Acknowledge and build on the work of similar programs • Identify leaders who can drive change locally • Need to focus on sustainable change • Investigate successful teams and learn what makes them effective (i.e. oncology) • Consider investigating teams from other industries • Address team leadership in team training / facilitated activities • Need to be aware of national roll-out of TeamSTEPPS and coordinate efforts • Investigate team processes that facilitate team work (i.e. case conferences, team meetings, ward rounds) • Build interprofessional learning requirements into a framework of education and acknowledge the continuing education requirements mandated by Australian Health Practitioner Regulation Agency (AHPRA) • Take advantage of University Departments of Rural Health as they have broad experience in12 cross boundary health education. Next Steps: Planning for the future Team Health will take key messages from both Consultation forums and apply them to the next phase of program development. In particular, Team Health will: • Work in consultation, and at times, collaboration with LHDs, the 3 pillar agencies, NSW Department of Health, and education providers • Develop a model of program governance with a central point of coordination and broad representation • Draw from the interprofessional and patient safety literature and lessons learned from other related programs • Recognise existing high-functioning teams and leaders as exemplars • Establish a multiprofessional statewide advisory group • Adopt a blended approach to curriculum development and employ multi-faceted strategies. Expressions of Interest to map new and existing programs for Team Health A recurring message from delegates at both Consultation Forums was to draw from activities, programs and past lessons learned. To ensure Team Health makes use of the best available evidence and programs, A “Right Start” Expression of Interest (EOI) has been developed inviting Local Health Districts in partnership with tertiary education providers to design and implement programs to prepare pre-graduate health professionals (medical, nursing and midwifery, allied health) for the workplace. A total of twenty-three Expressions of Interest were received, which outlined programs aimed to increase workplace readiness of pre-graduate health professionals for working in the NSW public health system. This EOI is the first step in a collaborative effort to map new and existing programs that may align with and inform the development of the Team Health Program. CETI thanks all those who presented at the Team Health Consultation Forums as well as all delegates who provided their time and expertise.
FUTURE DIRECTIONS <Glossary of TermsInterprofessional education (IPE) Occasions when two or more professions learn with, from andabout each other to improve collaboration and the quality of care (CAIPE, 2002)Interprofessional learning (IPL) is centrally concerned with improving the way people work together TEAM HEALTH FUTURE DIRECTIONSso that clinicians can grow professionally, learn from others, provide support to colleagues and improvethe quality of care to patients. (Braithwaite and Travaglia, 2006: 5)Interprofessional Collaborative Practice (ICP): a patient-centred process of communication anddecision-making that enables the separate and shared knowledge and skills of care providers tosynergistically influence the client/patient care. (Way et al, 2000)Patient-Centred Care is an innovative approach to the planning, delivery, and evaluation of health carethat is grounded in mutually beneficial partnerships among health care providers, patients, and families.Patient - and family-centered care applies to patients of all ages, and it may be practiced in any healthcare setting. (Australian Commission on Safety and Quality in Health Care, 2010)Team is a distinguishable set of two or more people who interact dynamically, interdependently andadaptively towards a common and valued goal/objective/mission, who have been each assigned specificroles or functions to perform and who have a limited lifespan of membership. (WHO, 2010: 134)References 13Australian Council on Safety and Quality in Health Care. National patient safety education framework.Canberra: Commonwealth of Australia 2005. Cited Aug 2011 http://www.health.gov.au/internet/safety/publishing.nsf/Content/C06811AD746228E9CA2571C600835DBB/$File/framework0705.pdfCentre for Advancement of Interprofessional Education (CAIPE) Cited Aug 2011 http://www.caipe.org.uk/Centered Care in Patient-Centred Care in Improving Quality and Safety by Focussing on Care on Patientsand Consumers Australian Commission on Safety and Quality in Health Care. Cited Sept 2010 www.safetyandquality.gov.auFreeth, D., Hammick, M., Reeves, S., Koppel, I., & Barr, H., (2005) Effective Interprofessional Education:Development, Delivery and Evaluation. Oxford, UK: Blackwell Publishing.Frenk, J. Chen, L., Bhutta, Z., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Garcia, P., Ke, Y., Kelley,P., Kistnasamy, B., Meleis, A., Naylor, D., Pablos-Mendez, A., Reddy, S., Scrimshaw, S., Sepulveda, J.,Serwadda, D., and Zurayk, H (2010). Health Professionals for a new century: Transforming education tostrengthen health systems in an Interdependent world. The Lancet, 376(9756), 1923-1958.Garling P. ( Nov 2008) Final report of the Special Commission of Inquiry: Acute Care Services in NSWPublic Hospitals. Sydney: NSW Government. Cited Oct 2011: http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_finalreportWay, D., Jones, L., & Busing, N. (2000). Implementing strategies: Collaboration in Primary Care - FamilyDoctors & Nurse Practitioners delivering shared care. Discussion paper written for the Ontario College ofFamily Physicians. Cited 10 August 2011, from Ontario College of FamilyPhysicians Cited Aug 2011:http://www.ocfp.on.ca/english/ocfp/communications/publications/default.asp?s=1World Health Organisation (2010) Framework for Action on Interprofessional Education and CollaborativePractice. Cited Aug 2011: http://www.who.int/hrh/resources/framework_action/en/index.htmlWorld Health Organisation (2010) WHO Patient Safety Curriculum Guide: Multi-Professional Edition. CitedOctober 2011: http://whqlibdoc.who.int/publications/2011/9789241501958_eng.pdf