This document discusses interprofessional practice and collaboration in healthcare. It defines interprofessional practice as multiple healthcare workers from different backgrounds working together to provide comprehensive patient care. Interprofessional collaboration is described as developing effective working relationships between professionals and with patients to enable optimal health outcomes. The document outlines some core competencies for interprofessional practice, including roles and responsibilities, values and ethics, communication, and teamwork. It provides evidence that team-based care can improve outcomes like continuity of care and patient satisfaction.

1. Interprofessional Practice
Multiple health workers from different professional
backgrounds providing comprehensive health
services working with patients, their families,
caregivers and communities to deliver the highest
quality of care across settings.
Framework for Action on Interprofessional Education & Collaborative Practice WHO, 2010.

2. Interprofessional Collaboration
“… the process of developing and maintaining
effective working relationships with learners,
practitioners, patients/clients/families and
communities to enable optimal health outcomes.
Elements of collaboration include respect, trust,
shared decision-making, and partnerships.”
Canadian Interprofessional Health Collaborative, 2010

3. Interprofessionality is not
• Simply sharing electronic health records
• Sole profession teams (neurologist, pulmonologist, radiologist)
• Learners hearing a talk about another profession
• Reporting out at interdisciplinary team meetings
• Co-location without intentional collaboration
• Decision-making without client/patient input

4. Why IP Teamwork? Why Now?
Since 1999 the Institute of
Medicine (IOM) has urged the
practice of IP team-based care
to prevent medical errors.
In 2013 the Journal of Patient
Safety reported that between
210,000 and 440,000 patients
each year suffer some type of
preventable harm when
receiving hospital care. If the
Centers for Disease Control
included preventable medical
errors as a category, these
conclusions would make it the
third leading cause of death in
America.
James, J. T. (2013) . A new, evidence-based estimate of patient harms
associated with hospital care. JPS, 9(3), 122-128.
• Demographic Changes,
aging population
• Chronic health conditions
needing complex care
• Technological advances
• Specialization in healthcare
• Patient Safety & Quality
agenda
• Workforce pressures and
gaps
• Healthcare and payment
reforms

5. Evidence for Teamwork
• Better continuity of care, access
to care, and patient
• Satisfaction*
• Higher patient-perceived
quality of care†
• Superior care for diabetes
patients‡
• Improved blood pressure
control
• Reduction in medication side
effects and improved
adherence+
*Stevenson K, Baker R, Farooqi A, et al.
Features of primary health care teams
associated with successful quality
improvement of diabetes care. Fam Pract
2001;18:21-26.
† Campbell SM, Hann M, Hacker J, et al.
Identifying predictors of high-quality care
in English general practice: observational
study. BMJ 2001;323:1-6.
‡ Bower P, Campbell S, Bojke C, et al. Team
structure, team climate, and the quality of
care in primary care: an observational
study. Qual Saf Health Care 2003;12:273-9.
+ Iezzoni, LI. Make no assumptions:
Communication between persons with
disabilities and clinicians. Assist Tech 2006;
18(2): 212-219.

6. BIG Picture

7. Change

8. Core Competencies
http://www.aacn.nche.edu/education-resources/ipecreport.pdf

10. Roles & Responsibilities
• Know one’s own role and those of team members
• Communicate team roles and responsibilities
• Engage diverse healthcare professionals to meet the
needs of patients
• Use the full scope of knowledge, skills, and abilities of
available health professionals and health care workers to
provide safe, timely, efficient, effective, and equitable care
• Use respectful health care practices

11. Values & Ethics
• Recognize and respect the unique cultures, values,
roles/responsibilities and expertise of other health
professions
• Work in cooperation with those who receive care, those
who provide care, and those who contribute to or support
the delivery of prevention and health care services
• Place the interests of patients and populations at the
center of interprofessional health care delivery

13. Communication
• Use respectful and appropriate communication in all
situations
• Organize and communicate information with patients,
families, and health care team members in a form and
format that is understandable, avoiding jargon
• Listen actively and encourage ideas and opinions of all
team members.

14. Teams & Teamwork
• Work with others to deliver patient-centered, community-responsive
care
• Engage when possible in shared patient-centered problem
solving
• Integrate knowledge and experience of other professions
to inform effective/ethical decisions
• Apply leadership and facilitation practices that support
collaboration and team effectiveness
http://www.youtube.com/watch?v=cEHXkucl0lQ

16. Patricia Chalmers, 31
Patricia (Pat) Chalmers is a 31-year-old woman who prides herself on
self-sufficiency and resourcefulness. She works part-time as a
bookkeeper and gets paid to take care of her aging grandmother with
whom she lives.
Pat describes herself as having been a caretaker since adolescence. It is
therefore difficult for her to acknowledge her own needs or to seek
others for help.
Pat is tired of people commenting on her weight, diet, and need to
exercise. She avoids health care as much as possible because she
knows she’ll be told to lose weight or be blamed for “being fat” (her
words). “I know what risks I face” she says. “But I’ve tried everything
and nothing works. I’ve accepted my size and would like others to
respect that.”
Pat found herself in the ED with a broken ankle several months ago.
The break was significant enough to require surgery. Labs revealed
elevated glucose levels and surgery was put off until further tests could
be done to determine whether Pat might have diabetes. When asked
about this possibility, Pat reacted strongly. “I don’t have the time or
money for diabetes,” she explained.

17. Group Discussion
• What do we know about Pat?
• What role would your profession play on Pat’s
team?
• What role will the other professions play on the
team?
• Describe the role of the following professions on
Pat’s team:
Pharmacist
Social Worker
Physical Therapist
Occupational Therapist

18. Interprofessional Competencies at UNE

19. Collaborative Leadership
Value contributions of all
team members
Include patient, family, and
community
Facilitate contributions from
all team members
Build support for working
together
Purposefully work towards
ending health disparities
and improving access and
quality

20. Interprofessional
Facilitation
Interprofessional learning
is interactive and takes
place when individuals
from two or more
professions learn about,
from and with each other
to enhance practice and
improve the quality of
patient care.
Are two or more professions
involved?
Are you capitalizing on
learning moments?
Is the session interactive?
Are contributions of
different team members
acknowledged?
Are IP communication
strategies discussed?
Who’s doing most of the
talking, you or the learners?

21. IP Facilitation Skills
• Open to multiple perspectives
• Value people and their ideas
• Think quickly and logically
• Excellent and comfortable communicators
• Groupwork skills: patience, comfort with
silence, focus, redirection, conflict
management
• Product and process oriented

22. Role Modeling
• Role model collaborative competencies in
everyday practice
• Share your own process – what were your
misperceptions of other professions
• Orient learners to interprofessional principles
and values
• Facilitate introductions
• Clarify your role and have learners identify
theirs

23. Facilitate IP Team Meeting
• Orient learners to goals of the session
• Prompt learners to discuss their observations
• Encourage a non-judgmental environment
• Make interprofessional learning explicit (e. g. let’s
get the [discipline] view of Pat’s needs)
• What do we know about Pat?
• What information is missing and where might we
find it?
• Capture teachable moments
• Prompt self-reflection - model
• Encourage closure and final case determinations

24. Facilitation Video
• Observe group facilitation process
• Write down observations and critique
• What were the facilitator’s strengths
• What could have been handled better?

26. TeamSTEPPS & Primary Care
Evidence for Positive Teamwork Outcomes:
• Significant improvement in communication
and supportive behavior
• Increases in patient satisfaction and
adherence
• Improved perceptions of teamwork*
• Reductions in worker turnover rate
• Increases in employee satisfaction†
* Weaver, SJ, Rosen MA, DiazGranados D, et al. Does teamwork improve
performance in the operating room? A multilevel evaluation. Jt
Comm J Qual Patient Saf 2010 Mar;36(3):133-42.
† Leonard M, Graham S, Bonacum D. The human factor: the critical
importance of effective teamwork and communication in providing
safe care. Qual Saf Health Care 2004;13 Suppl 1:85-90.

27. What is TeamSTEPPS™
• A teamwork system designed for healthcare
professionals and workers.
• Developed by Department of Defense's in
collaboration with the Agency for Healthcare
Research and Quality (AHRQ).
• Provides attitudes, knowledge and skills for
improving patient safety and quality within health
and health-related settings.
• Informed by evidence-based research aimed at
improving communication and teamwork skills
among healthcare professionals and workers.

28. "Your spoken word, your courage to challenge, your
will to engage in teamwork, and your determination
to ensure no harm can all be pivotal in determining
if a patient lives or dies.“ Sue Sheridan
http://www.ahrq.gov/professionals/education/curriculum-tools/
teamstepps/instructor/videos/ts_Sue_Sheridan/Sue_Sheridan-400-
300.html

29. A Shared Mental Model Is...
The perception of, understanding of, or
knowledge about a situation or process that is
shared among team members through
communication.
"Teams that perform well hold shared mental models."
(Rouse, Cannon-Bowers, and Salas 1992)

30. ISBAR
Introduce Situation Background Assessment Recommendation
A Shared Mental Model for Communication

31. Patient
• Sally Hinton is a 55 year old single women who lives on her own, receives
MaineCare and SSI disability. She previously worked for 30 years as a school
bus driver and continues to do volunteer work in the schools.
• Sally was discharged a week ago after 2 days in the hospital being worked
up for angina. Her diagnoses include insulin dependent diabetes, obesity,
depression, and hydradenitis suppurativa (i.e., the development of cysts in
the breasts, arm pits, neck and groin which require occasional draining). She
takes nine different medications.
• During a routine office visit today Sally seems uncharacteristically
disoriented. She denies using alcohol or other intoxicating substances. You
ask if she’s taking her medication appropriately to which she replies that
she thinks so. When you ask to see her medications she tells you that they
are stored in their vials in a kitchen drawer. She cannot however tell you
which medications she takes, when she takes them or their dosages.
• Sally also describes two falling incidents that occurred last week during the
night. Although nothing was apparently broken, she shows you large bruises
on her hip and forearm. She also has an open injury on her shin that she
says is painful and not healing properly.
• What are your thoughts about Sally’s health and well-being?
• Describe how you would use ISBAR when transferring or referring Sally’s
care.

32. Stop the Line: CUS
• I am Concerned
• I am Uncomfortable
• There is a Safety issue

33. CUS
Sally’s friend Alma brings her to the ED after another fall during which
time she badly injures her arm. The ED is very busy.
The attending evaluates Sally’s arm and disorientation. He asks her
about any substance misuse which she denies and her friend agrees.
Sally’s arm is x-rayed and it appears to be a severe bruise, not a fracture.
The attending prescribes Tylenol with codeine for the pain and is ready
to discharge her home.
• What if any concerns do you have about Sally given her recent
medical history? How and to whom might these be raised in the
medical setting?
• Would you be uncomfortable with sending Sally home and if so, how
might you convey this dilemma/differences with the attending
practitioner?
• Might these recommendations cause an unsafe situation for Sally. If
you’re concern about patient safety has not yet been acknowledged,
what would you do next?

34. 34
Briefs, Huddles & Debriefs
Brief
Who is on the team?
Agree on Goals
Roles & Responsibilities
Understood
Plan of Care
Availability
Access
Resources
Huddle
Problem-solving
Review situation
Discuss new &
emerging events
Anticipate outcomes &
possibilities
Assign resources
Express Concerns
Debrief
Communicate clearly
about event
Go over details
Were roles &
responsibilities
understood?
What went well
What should change
Can we improve?

35. Situation Monitoring
• Process of actively scanning behaviors and
actions to assess elements of the situation or
environment
• Fosters mutual respect and team
accountability
• Provides safety net for team and patient
• Includes cross-monitoring
…Remember, engage the patient
whenever possible.

36. Check-Back Is when Practitioners…

37. Teach-Back Is…
• Confirmation of understanding
• Opportunity to correct miscommunication
• Comprehensive
– “Tell me in your own words how you will take
this medicine when you get home…”

38. Patient
• Frank is a 71 year old married male who is in and out
of the hospital for a variety of health conditions. He is currently in the
hospital admitted for dehydration and kidney failure. His other diagnoses
include heart disease, renal insufficiency, alcohol abuse, renal insufficiency
and a past medical history of stroke, quadruple bypass, and multiple joint
replacements. He walks slowly with a walker and smokes a pack a day.
• Frank and his wife, Mollie, 74, are waiting for his discharge to be
authorized. He’s leaving the hospital with an indwelling catheter that will
require home care and also new medications that advise no alcohol usage.
The couple has been at odds since Frank flunked his driving test and
Mollie took away his car keys.
• It is your job to make sure that Frank and Mollie understand how to
manage his care. How will you ensure this is done? What variables do you
need to check?
• A nurse practitioner and social worker will follow up on Frank’s situation
through home visits. How will you guarantee that they understand his
physical, emotional, and psychosocial care needs?

39. Team-based Leaders:
• Motivate people to work
together to accomplish common goals
• Model facilitation and collaboration
• Share information and listen
• Offer constructive and timely feedback
• Include patients and families as decision-makers

40. Patient- and Family-Centered Care
• Hear the patient’s stories
• Be open and honest
• Respect the patient and family as the central hub
of the care team
• Make sure patients share fully in decision making
• Speak to patients in a way they can understand
and enable them to feel empowered to be in
control of their care

41. Equipping Patients & Families
• Quality care is a team effort
• Patients and families can
improve their care by taking
active roles in the process
• Invite patients to ask questions,
and evaluate their option
• Be culturally responsive to
patients
• Encourage shared decision-making
in their health care
• The AHRQ Web site
―www.ahrq.gov/questionsareth
eanswer/
Questions Your Patients Should
Ask
What is the test for?
When will I get the results?
Why do I need this treatment?
Are there any alternatives?
What are the possible
complications?
Which hospital is best for my
needs?
How do you spell the name of
that drug?
Are there any side effects?

42. Racial & Ethnic Disparities
• IOM’s Unequal Treatment
highlighted evidence of
racial and ethnic disparities
in health care
• Language barriers are less
well documented
• The root causes of patient
safety events for non-
English speaking patients in
are: (1) poor
communication and (2)
insufficient use of qualified
medical interpreters and
cultural navigators
http://www.youtube.com/watch?v=
ABn0sE1aiGo

44. References
1. Barrett, J., Curran, V., Glynn, L., & Godwin, M. (2007). CHSRF Synthesis: Interprofessional
Collaboration and Quality Primary Healthcare. Ottawa: Canadian Health Services
Research Foundation.
2. Dow, A., Konrad, S. C., Blue, A. V., Earnest, M., & Reeves, S. (2013). The Moving Target:
Outcomes of Interprofessional Education, Journal of Interprofessional Care, 27, (5),
353.
3. Driessen, E., van Tartwijk & Dorman, T. (2008). The self-critical doctor: Helping students
become more reflective. British Medical Journal, 336, 827-829.
4. Haynes, A. B., Weiser, T. G. et al (2009). A Surgical Safety Checklist to Reduce Morbidity
and Mortality in a Global Population. New England J of Med (360; 5), 419.
5. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st
Century. Washington, D. C. National Academies Press.
6. Interprofessional Education Collaborative Expert Panel. Core Competencies for
Interprofessional Collaborative Practice: Report of an Expert Panel. Washington D.
C.: Interprofessional Education Collaborative 2011.
7. Konrad, S. C. & Browning, D. M. (2012). Relational Learning and Interprofessional
Practice: Transforming Health Education for the 21st Century. WORK: The Journal
of Prevention, Assessment & Rehabilitation, 41, 247.
8. Reeves, S., Lewin, S., Espin, S, Zwarenstein, M. (2010). Interprofessional Teamwork for
Health and Social Care. Oxford: Blackwell Publishing.
9. World Health Organization. Framework for Action on Interprofessional Education and
Collaborative Practice. Geneva: WHO 2010.
10. Zwarenstein, Reeves, Perrier. (2005). Effectiveness of pre-licensure interprofessional
education and post-licensure collaborative interventions. J of Interprofessional
Care(Supplement 1), 148.

45. Shelley Cohen Konrad PhD, LCSW, FNAP
Jennifer Morton D.N.P., M.S., M.P.H., RN
University of New England
scohenkonrad@une.edu; jmorton@une.edu