This document discusses interprofessional collaboration (IPC) and provides examples from St. Joseph's Health Centre of how IPC has been implemented. Some key points: 1) IPC involves intentional learning with, from, and about other professions to improve individual and team capacity and patient outcomes. 2) Government support through initiatives like funding academic health science centres has helped establish IPC. Hospitals also need senior leadership buy-in and dedicated roles to promote IPC. 3) St. Joseph's has implemented structures like an interprofessional advisory committee and point of care teams to facilitate IPC. Change leaders and competency frameworks also support its adoption. 4) Evaluating initiatives like St. Joseph

1. Can we achieve Interprofessional
Collaboration?
Learning from St. Joseph’s Health Centre
Michael Heffer, RPh, BScPhm, MHSc.

2. What is Interprofessional
Collaboration?
McMaster IPC Research Group

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. •

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. 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

8. Government Support for
IPC
Provincial initiatives
1st
• Ministry of Health and Long Term
Care (MOHLTC) created IPC
Steering Committee 2006

10. Government Support for
IPC
Provincial initiatives
2nd:
• Joint initiative between MOHLTC and
MTCU (Ministry of Training, Colleges
and Universities)
• Health Force Ontario 2006.
• Mandate: Funding for IPC programs
since Oct 2008

11. Government Support for
IPC
Provincial initiatives
3rd
• MOHLTC approached Health Professions
Regulatory Advisory Council (HPRAC)
• Bill 179
Expanded scope of practice for 12
professions
Inter-College Collaboration

12. Government Support for
IPC
Federal 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

14. IPE Support for IPC
To 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

15. 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

16. IPE Support for IPC
MOHLTC 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

18. Senior Leadership
Support Within Hospitals
Important 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

19. Senior Leadership
Support Within Hospitals
Why 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

20. Senior Leadership
Support Within Hospitals
Existing 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

22. IPC Change Leaders
Development 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

24. Team Coaching
Project
• Enhancing
Interprofessional
Practice
Resource
Manual for
Team Coaches

25. 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)

26. IPC Core Competencies
• Trust & Respect
• Knowledge of other Professional Roles
• Appreciating Difference & Conflict
Resolution
• Willingness to Share Power
• Shared Decision Making
CIHC addition:
• Focus on patient-centered care

29. Finding Opportunities for
IPC
Creating 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?

30. IPC Think Pair Share
Question: 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

31. The AIR Team
Experience
The 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

32. Guideline for Co-Creating
Interprofessional Models of Care

33. IPC Models of Care
Step 1: Intraprofessional Reflection
Example 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?

34. IPC Models of Care
Step 2: Re-story the Professional
Narrative
1. 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

36. IPC Models of Care
Step 3: Establish a Harmonization
Philosophy
Examples 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

37. 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?

38. 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

39. IPC Think Pair Share
Consider a Diabetes Clinic Team
The 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

40. Guidelines for Co-Creating
Interprofessional Models of Care

41. Step 8: Evaluate the
System
Evaluation 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

42. Access and Flow
Length of ED Stay
Average 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

43. 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<0.001
Percent 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

46. Other IPC initiatives at
St. Joseph’s
• Interprofessional Skills Fair
• Interprofessional Orientation
• Scope of Practice Quiz
• Interprofessional Journal Club
• Interprofessional Maze Activity

47. Interprofessional Skills Fair

52. 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 Illness
End 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

53. Scope of Practice
Interactive Quiz

54. Which is NOT a Regulated
Health Profession?
a) Naturopathy
b) Kinesiology
c) Paramedic
d) Traditional Chinese
Medicine
e) Psychology

55. C
Paramedic

56. How many of the 13 controlled acts were
authorized to physicians?
a) 10
b) 13
c) 11
d) 12
e) 9

57. D
12

58. 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

59. B
Conducting the assessment to determine needs,
the Formula, and rate

60. Interprofessional Journal
Club

61. Interprofessional Maze
Activity

62. Other Initiatives at SJHC
that support IPC
• Interprofessional Orientation
• IPE week
• Interprofessional Skills Fair
• Interprofessional Journal Club
• Scope of Practice Quiz

63. 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

64. Thank you to partners
& Change Leaders
Mary Kapetanos, Jeff Dionne, Marie Eason-Klatt, Helen
Papakyriacou, Marcia Sivilotti, Chris Ashdown, Lynne Strathern,
Scott Graney, Janice Klutt, Jenny Seah