Michael heffer interprofessional collaboration


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Michael heffer interprofessional collaboration

  1. 1. Can we achieve Interprofessional Collaboration?Learning from St. Joseph’s Health Centre Michael Heffer, RPh, BScPhm, MHSc.
  2. 2. What is Interprofessional Collaboration?McMaster IPC Research Group
  3. 3. What is Interprofessional Collaboration?St. Joseph’s Health Centre adds:• IPC is intentional• Supported by learning with, from and about one another to leverage individual and team capacity* St. Joseph’s Health Centre
  4. 4.
  5. 5. IPC Expected Outcomes• Increased access to healthcare for patients• Improved outcomes for patients with chronic diseases• Less tension and conflict among caregivers• Better use of clinical resources (healthcare professionals)
  6. 6. Structure/Enablers Required for IPC• Government support / Legislation• Senior Leadership support within your own hospital• Complimentary IPE structure in place• Change leaders within hospitals and universities
  7. 7. Government Support for IPCProvincial initiatives1st• Ministry of Health and Long Term Care (MOHLTC) created IPC Steering Committee 2006
  8. 8. Government Support for IPCProvincial initiatives2nd:• Joint initiative between MOHLTC and MTCU (Ministry of Training, Colleges and Universities)• Health Force Ontario 2006.• Mandate: Funding for IPC programs since Oct 2008
  9. 9. Government Support for IPCProvincial initiatives3rd• MOHLTC approached Health Professions Regulatory Advisory Council (HPRAC)• Bill 179 Expanded scope of practice for 12 professions Inter-College Collaboration
  10. 10. Government Support for IPCFederal Level IPC Initiatives• Health Canada funds the CIHC Canadian Interprofessional Health Collaborative• Fall 2008 created IPC Working Group• Published: National IPC Competency Framework Feb 2010
  11. 11. IPE Support for IPCTo Facilitate Adoption of IPC“There must be a seamless integration between the education system preparing the workforce and the health care system that employs it.” * Final report: IPC Strategic Implementation Committee May 2010
  12. 12. IPC Think Pair Share• Question: What activities are happening or need to happen in our education system to graduate students ready for IPC?• Task: Pair up with a colleague at your table Discuss /generate ideas
  13. 13. IPE Support for IPCMOHLTC and MTCU*• Financial support to the six Ont. Academic Health Science Centres• Dedicated resources to promote the development of an interprofessional curriculum.• PIPER at McMaster Program for Interprofessional Practice, Education and Research * MTCU: Ministry of Training, Colleges and Universities
  14. 14. Senior Leadership Support Within HospitalsImportant for:• Establishing IPC reporting structures that have accountability• Supporting IPC awareness initiatives that influence culture change /acceptance• Agreeing to devote resources to improvement initiatives that support IPC• All the above: helps establish credibility with staff
  15. 15. Senior Leadership Support Within HospitalsWhy should Senior Leaders support IPC?• Improved outcomes for patients = optimal patient care = decreased LOS (length of stay)• Less tension and conflict = staff satisfaction = lower staff turnover = improved recruitment (great reputation)• Better use of clinical resources = improved efficiency of team = lower cost per case compared to peer hospitals
  16. 16. Senior Leadership Support Within HospitalsExisting Structure at SJHC• IPAC Interprofessional Advisory Committee• Interprofessional Point of Care Teams• IPC listed as a Strategic Priority for 2011-2014 Objectives• Portfolios: Director of Interprofessional Practice Director of Interprofessional Education• Change Leaders: Professional Practice Leaders Education Coordinators Professional Clinical Coordinators
  17. 17. IPC Change LeadersDevelopment of our Change Leaders• Regarded as IPC project champions• Added skill set: Change management methodology Quality improvement methodology• Collaboration with centre of IPE UofT• ehpic program• Collaborative Change Leadership Program
  18. 18. Team Coaching Project• Enhancing Interprofessional Practice Resource Manual for Team Coaches
  19. 19. Roadmap for Co- Creating IPC Models of Care• A Roadmap for Co- Creating Interprofessional Models of Care• Available at http://www.stjoe.on .ca/education/reso urces.php)
  20. 20. IPC Core Competencies• Trust & Respect• Knowledge of other Professional Roles• Appreciating Difference & Conflict Resolution• Willingness to Share Power• Shared Decision MakingCIHC addition:• Focus on patient-centered care
  21. 21. Finding Opportunities for IPCCreating IPC Initiatives• Brainstorming sessions• Looking at existing patient care teams Areas for improvement?• Look at patient care populations that may benefit from a collaborative team approach – groups at high risk?
  22. 22. IPC Think Pair ShareQuestion: What areas of hospital practice can you think of that might benefit from a more collaborative approach to patient care?• Task: Pair up with a colleague at your table Discuss/generate ideas
  23. 23. The AIR Team ExperienceThe Assertive Interprofessional Respiratory Team• The Care Providers – Registered Nurse – Registered Pharmacist – Registered Respiratory Therapist• The Care Context – St. Joseph’s Health Centre – Emergency Dept (ED)• The Patient Population – Patients with a respiratory-related health issue
  24. 24. Guideline for Co-CreatingInterprofessional Models of Care
  25. 25. IPC Models of Care Step 1: Intraprofessional ReflectionExample Questions:• What is my profession’s traditional role within this type of setting?• What does my profession have in terms of knowledge, skill and judgement that can be used to enhance care for this type of patient?• How much am I personally prepared to negotiate my professional boundaries?
  26. 26. IPC Models of Care Step 2: Re-story the Professional Narrative1. What are some stereotypes about our profession?2. Which activities, practices or roles do we need to keep?3. What possible future practice could be supported by the knowledge, skills and judgement of our profession
  27. 27. IPC Models of Care Step 3: Establish a Harmonization PhilosophyExamples of Assumptions:• Each skill or competency will be considered in light of what the profession is currently doing, should be doing or could be doing.• Decisions will be made with the provincial College regulators in mind• Scopes of practice will be optimized for the purpose of enhancing patient-centered care
  28. 28. Step 4: Analyze Activities• Create a list of activities• Then ask the 3D questions – Which of the professions is currently doing this? – Which of the professions should be doing this? – Which of the professions could be doing this?
  29. 29. Scope and Team Optimization• Step 4 Analyze Activities & Develop Competency Framework• Negotiating which clinician(s) will be responsible for specific patient care processes leads to team optimization• Negotiating which clinician(s) will be responsible for specific clinical skills and competencies leads to scope optimization
  30. 30. IPC Think Pair ShareConsider a Diabetes Clinic TeamThe team consists of a nurse, physician, dietitian and pharmacist.Questions:• Can you think of activities that could be shared to promote team optimization?• What activities might be negotiated for scope optimization?• Task: Discuss /generate ideas with a colleague at your table
  31. 31. Guidelines for Co-CreatingInterprofessional Models of Care
  32. 32. Step 8: Evaluate the SystemEvaluation focused on whether the AIR team Interprofessional model of care would impact quality of care as evidenced by:• Key access and flow indicators• Patient experience of care
  33. 33. Access and Flow Length of ED StayAverage Length of ED Stay (minutes) 2000 1800 1600 226 min (p<0.01) 1400 1200 1000 800 600 400 200 0 All Patients Admitted Non-Admitted Intervention 1319 1542 581 Baseline 1398 1769 592
  34. 34. Patient Experience of Care Patient Experience of Care by Dimension 100.0 p<0.001 p<0.001 p<0.001 p<0.001 p<0.001Percent Positive Score 80.0 60.0 40.0 20.0 0.0 Respect for Continuity Emotional Access & Information & Physical Patient and Courtesy Support Coordination Education Comfort Preferences Transition AIR Team 89.1 80.4 82.4 80.0 81.9 76.6 100.0 Baseline 52.8 54.7 50.0 41.7 77.5 52.1 89.7 Ontario Average 63.5 66.4 63.3 62.4 77.5 64.0 89.6
  35. 35. Other IPC initiatives at St. Joseph’s• Interprofessional Skills Fair• Interprofessional Orientation• Scope of Practice Quiz• Interprofessional Journal Club• Interprofessional Maze Activity
  36. 36. Interprofessional Skills Fair
  37. 37. Interprofessional Orientation 0% 20% 40% 60% 80% 100% WHIMIS Library Services Interpreter Services Infection Control Self Care Therapeutic Relationships Documentations Code White/CPI Critical Thinking/Time Management Consent and Capacity Falls Standard of Care Least Restraints DNR order/case examples Domestic Abuse Major Mental IllnessEnd of Life Care, Bereavement, Suffering & Loss CCAC Services IP Pain Assessment & Management Partially IP Addictions and Mental Health Consultations Oxygen Therapy Pharmacy I/V Venipuncture Skin & Wound Diabetic Monitoring PICC & Central Lines Blood Administration & Products Tubes and Drains Transcription Hypodermoclysis Traches & Suctioning Epidurals NG Feeds, Flushes etc. Chest Tubes Bladder Scanning
  38. 38. Scope of PracticeInteractive Quiz
  39. 39. Which is NOT a Regulated Health Profession? a) Naturopathy b) Kinesiology c) Paramedicd) Traditional Chinese Medicine e) Psychology
  40. 40. CParamedic
  41. 41. How many of the 13 controlled acts were authorized to physicians? a) 10 b) 13 c) 11 d) 12 e) 9
  42. 42. D12
  43. 43. The Registered Dietician (RD) is responsible for which of the following re: tube feeding? a) Determining access & inserting the tube b) Conducting the assessment to determine needs, the Formula, and rate c) Teaching the patient/family to use the feeding pump d) Flushing the tube with sterile water
  44. 44. BConducting the assessment to determine needs, the Formula, and rate
  45. 45. Interprofessional Journal Club
  46. 46. Interprofessional Maze Activity
  47. 47. Other Initiatives at SJHC that support IPC• Interprofessional Orientation• IPE week• Interprofessional Skills Fair• Interprofessional Journal Club• Scope of Practice Quiz
  48. 48. Interprofessional Collaboration What do our patients want?• To be seen not as an OHIP #, not even as a patient but as a person who is valued.• Health professionals coaching and cheerleading me to improve my health.• A team working together, communicating the care I want to receive• Providers who are good at explaining what they are doing as they are doing it* Focus groups: Report on Implementing IPC in Ontario May 2010
  49. 49. Thank you to partners & Change Leaders Mary Kapetanos, Jeff Dionne, Marie Eason-Klatt, HelenPapakyriacou, Marcia Sivilotti, Chris Ashdown, Lynne Strathern, Scott Graney, Janice Klutt, Jenny Seah