A students reflections on improving health care delivery by harmonizing interprofessional education (ipe) theory with i
Published in Fall 2011 Edition of the Centre for IPE at UofT’s Newsletter and Fall 2011 Edition ofMichener News A Student’s Reflections on Improving Health Care Delivery by Harmonizing Interprofessional Education (IPE) Theory with Interprofessional Collaboration (IPC) Practice By Prasaanthan Gopee-Ramanan, B.Sc. (Hon), B.Sc. in Radiological Technology, TMI-UofT, Class of 2012 (in progress) Ever since I read The Checklist Manifesto, by Dr. Atul Gawande, a renowned Generaland Endocrine Surgeon in Boston, MA, I have been compelled to contemplate upon howa systems perspective in health care delivery would impact patient care. Dr. Gawande’swork in the realm of outcomes improvement using surgical checklists was finallytranslated to practice in Ontario in the summer of 2010; the result is unprecedentedlyclear communication between various healthcare professionals before, during, and aftersurgeries. In this manner, Ontario’s surgical checklist is a vivid example of appliedinterprofessionalism, otherwise referred to as Interprofessional Collaboration (IPC). In The Checklist Manifesto, Dr. Gawande questions the status quo of health caredelivery: if you want to make the best car on Earth, do you simply collect the best engine,chassis, transmission, brakes, body and put them altogether? The answer is a resoundingno. The reason is that these parts work seamlessly together and achieve high performancewithin their respective designs and models, but are dysfunctional if put together without apertinent design (Gawande, 2009). Why then, Dr. Gawande asks, do we place the topmedical specialists and health care professionals in a building with doors and rooms andsimply hope that we will produce better health care? I feel that the crux of the problemsplaguing the current health care system is that it is not quite a true system. It is more asetting of isolated departments with professions and specialties that do not talk to eachother enough in spite of the fact that they are all there for the same goal, namely treatingand achieving good health and holistic well-being for the patient. Popular research hasalso shown that medical care is in itself the cause of many errors leading to injury or evendeath – a total opposite of the purpose of even having medical care! Now more than ever,there is a dire need for the professionals in health care and its various specialties tocollaborate systemically to improve patient care. Change is not only needed in practice,but also within all the various health professional education programs. Only with thechange in practice at the educational level in the form of Interprofessional Education(IPE), wherein all health care professionals learn with, from, and about each other, willthis effort translate into practice in the form of Interprofessional Collaboration (IPC) inthe workplace. This change will not be instant; rather it will take years of perseveranceand concerted, collaborative effort in both the educational and clinical settings. One of the chapters of The Checklist Manifesto is devoted to examining theconstruction industry, in which thousands of new buildings and skyscrapers ofincreasingly challenging design specifications are put up safely each year. Error rates areextremely low, and even when they occur, these errors rarely ever cause a building to failcatastrophically (Gawande, 2009). It turns out that the key to this high level of favorableoutcome generation is excellent interprofessional communication and a good systemsmethodology to getting the job done (Gawande, 2009). When compared to theconstruction industry, the health care industry has miles to go before we are able toprofess such levels of successful outcomes. The future of good healthcare with the patient
Published in Fall 2011 Edition of the Centre for IPE at UofT’s Newsletter and Fall 2011 Edition ofMichener Newsat the center depends upon effective intraprofessional (within professions),interprofessional communication (in-between professions) and extraprofessionalcommunication (with non-health care professionals). As with any change, there is boundto be resistance, whether from students who may feel that clinical skills take precedenceto IPE or from practitioners that may feel clinical practice does not need to change. Myquestion to my fellow students and practitioners is how are we going to start this change?In the case of my colleagues and I, we have taken IPE courses at The Michener Institute(TMI) and the University of Toronto (UofT) and were subsequently involved in a chapterof the National Health Sciences Students Association for interprofessional education; butwe cannot effect change alone. I know that my faculty at both institutions believes in IPEfor a better health care system, but how do we carry this forward into clinical practice? The solution, I believe, is simple: unity in thought, word and deed. The workplacemust mirror what we learn in school about how to apply IPC in a patient-centeredmanner. We must treat every patient holistically and the way we would want our ownfamily members to be treated. Students at TMI and the UofT spend time in multiplecourses on IPE and patient-centered care (PCC); the next step must be to translate thesetheoretical ideas of effective teamwork and communication into the daily, morecollaborative routines of the workplace. There are definitely some change-resistors tothese seemingly abstract concepts being fully actualized in health care settings, but withthe leadership of some of Ontario’s best community teaching hospitals, their executives,and their staff, change for the better is inevitable – it is only a matter of time. A systemsapproach is very much in line with producing, maintaining, and improving the frameworkwithin which the aforementioned communication excellence can yield drasticallyimproved outcomes and patient care in the years to come; to this effect, students mustcatalyze the pursuit of such high ideals and model ideal professional conduct viaharmony in thought, word, and deed.References:Gawande, A. (2009). The Checklist Manifesto. (1st ed.). New York (NY): MetropolitanBooks.Acknowledgements: I would like to thank Dr. Gawande for inspiring me through his literary works and forhelping make surgeries safer throughout the world. I would also like to thank LynneSinclair of the Centre for IPE, UofT, and Sheena Bhimji-Hewitt of The MichenerInstitute for all their support and guidance on writing this piece.