The Interprofessional Health Care Team: Understanding the Culture of Interprofessional Collaborative Practice. Contributors. Objectives 10/10/2015

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1 The Interprofessional Health Care Team: Understanding the Culture of Interprofessional Collaborative Practice Stephen R. Marrone, EdD, RN-BC, NEA-BC, CTN-A Associate Professor of Nursing Diane R. Maydick, EdD, RN, ACNS-BC, CWOCN Assistant Professor of Nursing Long Island University Zeckendorf Health Sciences Center Harriet Rothkopf Heilbrunn School of Nursing Brooklyn, New York USA Contributors Dr. Stephen R. Marrone School of Nursing Dr. Diane Maydick School of Nursing Co-Chair, LIU Brooklyn Campus IPE Task Force Dr. Stacy Jaffee-Gropack Dean, College of Health Professions and Nursing, C.W. Post Campus Former Associate Dean, College of Health Related Professions and Former Co-Chair, LIU IPE Task Force, Brooklyn Campus Dr. Bojana Beric College of Health Related Professions Public Health Dr. Lisa Gordon-Handler College of Health Related Professions Occupation Therapy Objectives 1. Define interprofessional education and collaborative practice. 2. Explain the purpose and design of interprofessional educational activities in an academic health sciences setting. 3. Describe the implementation of interprofessional educational activities in an academic health sciences setting. 4. Discuss the ongoing evaluation of interprofessional educational activities for health professions students in an academic health sciences setting. 1

2 Purpose To describe the design, implementation, and ongoing evaluation of interprofessional education initiatives in an urban academic health sciences center. Goal of IPE Initiatives Improve health professions students understanding of their own as well as other health professions professional cultures, values and ethics, roles and responsibilities, and communication strategies that advances interprofessional collaborative practice across diverse clinical settings. IPE Task Force Dr. Kathryn Krase, Co-Chair, Social Work Dr. Diane Maydick, Co-Chair, Nursing Dr. Anna Nogid, Co-Chair, Pharmacy Dr. Bojana Beric, Public Health Ms. Cindy Bravo-Sanchez, Respiratory Care Dr. Lisa Gordon Handler, Occupational Therapy Dr. Stephen Marrone, Nursing Dr. Joseph Nathan, Pharmacy Mr. Dwayne Williams, Physician Assistant Dr. Stacy Jaffee Gropack, School of Health Professions, Physical Therapy Former Co-Chair Dr. Harold Kirschenbaum, Pharmacy Former Co-Chair 2

3 3 Health Science Diagnostic Medical Sonography Athletic Training Physical Therapy Physician Assistant Studies Public Health Social Work Occupational Therapy Respiratory Care Pharmacology Toxicology Medicinal Chemistry Pharm.D. Ph.D. Pharmaceutic s M.S. Industrial Pharmacy M.S. Cosmetic Science M.S. Drug Regulatory Affairs M.S. Pharmacology /Toxicology Prelicensure BSN RN - BSN MSN Nurse Educator MSN Nurse Practitioner (Adult/Geriatric & Family)

4 Harriet Rothkopf Heilbrunn (HRH) School of Nursing Established in % of students are members of racial or ethnic minorities. 10% are men Only Academic Nursing Center in Brooklyn, N.Y. HRH Academic Nursing Center Healthy Living Stress Reduction Older Adults Health/Risk Assessment and Counseling Blood Pressure Monitoring Medication Review Weight Management HIV Screening Screening Mammogram Smoking Cessation Definitions Interprofessional education (IPE) occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes (WHO, 2010). The aim of interprofessional learning is to prepare health professions students for deliberatively working together within a patient-centered, community/population-oriented healthcare system. 4

5 Definitions Collaborative Practice Multiple healthcare workers from different professional backgrounds working together with each other, patients, clients, families, caretakers, and communities to deliver the highest quality of care (WHO, 2010). Definitions Culture is the learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways (Leininger, 2005). Trends and Realities Paradigm Shift Individual competence team effectiveness. Dominant culture in health care delivery models Trends in health professions education in academic and practice settings support the benefits of interprofessional collaboration in education and practice. Affordable Care Act (ACA) Affordable Care Organizations (ACO) Patient Centered Medical Homes Quality and Safety Data 5

6 Trends and Realities Accountable Care Organizations (ACO) designed to improve care and reduce costs a structured group practice of physicians & other healthcare professionals. Patient Centered Medical Home (PCMH) access, coordination and comprehensive care. assures patients are actively engaged in the healthcare partnership. Trends and Realities It is no longer enough for healthcare workers to be professional; they must be interprofessional (IOM, 2010). It is necessary in preparing a collaborative practice-ready health workforce (WHO, 2010). Benefits of Collaboration Increased access, improved quality and better coordinated health care Increased patient and staff engagement and satisfaction Appropriate use of specialists Decreased cost of care total patient complications length of stay in health care facilities tension and conflict among caregivers staff turnover hospital admissions/re-admissions mortality rates recidivism 6

7 What is the Significance? Although each health profession identifies patientcenteredness as a core value, each has its own values, beliefs, norms, and practices that vary sufficiently to potentially create role conflict and communication failure when delivering patient care. Communication failure has been identified as the leading root cause of sentinel events and a primary contributing factor of adverse events and near misses in the clinical setting (Joint Commission, 2010; VA Center for Patient Safety, 2011). Background: Interprofessional Education Collaborative (IPEC) Six national health professions education associations formed a working group (IPEC) in 2009 to develop a framework of joint activities to support patient-centered teambased care, promote delivery reform, and foster interprofessional learning experiences. Faculty Development 7

8 Faculty Development Plenary sessions Group activity Facilitator education Four IPEC Competency Domains Invited 3 outside experts Served as facilitators Assisted with program design*** Plenary session Introduction to IPE Case studies/exemplars*** Small-group breakout sessions Large-group debriefing sessions Goal To prepare faculty for implementing IPE at the campus that would be in accordance with current and anticipated accreditation guidelines. Ensure that the program would be in accord with IPEC, IOM, WHO, ACO, etc. Faculty Development Program Why should IPE be important to LIU? Why now? How can you be involved? What core competency/competencies is/are (are) already addressed in the curriculum? How? As you move forward, which of the core competencies should be an initial priority focus? Why? Identify driving forces for IPE at LIU. Identify 3 programmatic, institutional, and/or local strengths that will facilitate implementation of IPE at LIU. Identify 3 potential challenges to implementation. Identify two potential short-term and long-term strategies. Brainstorm a list of potential partners within the University, within affiliated organizations, within the community. 8

9 Faculty Development Program 100 faculty and administrators with teaching responsibility participated College of Pharmacy: 65 participants School of Health Professions: 26 participants School of Nursing: 9 participants 7 Interprofessional teams faculty Moderator was identified Teams discussed case scenario answered assigned questions reported back Faculty Program Objectives List the four core competency domains delineated by IPEC. Describe examples of roles and responsibilities of other health professionals in managing patients/clients, families, groups, and/or communities. Discuss key findings from the survey conducted by the IPE Task Force. Discuss IPE initiatives undertaken at LIU. Suggest courses, topics or activities within each profession s curriculum that might be suitable for addressing IPE competencies. Delineate the rationale for incorporating IPE into each professional curriculum. Faculty Program Evaluations 9

10 Student Interprofessional Education Events Structure IPE events were designed based on the four Interprofessional Collaborative Practice Competency Domains (IPEC, 2013): Values and Ethics for Interprofessional Practice Roles and Responsibilities Interprofessional Communication Teams and Teamwork IPE initiatives are led by an interprofessional education team member. Goal: build on each profession s discipline-specific competencies and describe the culture and competencies for interprofessional collaborative practice. Values/ Ethics IPEC Core Competencies: Four Domains Roles/ Responsibilities Core Competencies Communication Teamwork 10

11 Values and Ethics Work with individuals of other professions to maintain a climate of mutual respect and shared values. Values and Ethics This IPE program will address the following IPEC competencies: Communicate one s roles and responsibilities clearly to patients, families, and other professionals Explain the roles and responsibilities of other care providers and how the team works together to provide care Demonstrate respect for the unique professional cultures, values, roles and responsibilities, and expertise of members of the health care team. Listen actively and encourage ideas and opinions of other team members Express one s knowledge and opinions to team members involved in patient care with confidence, clarity, and respect, working to ensure common understanding of information, and treatment and care decisions Roles and Responsibilities Use the knowledge of one s own role and those of other professions to appropriately assess and address the health care needs of the patients and populations served. The ability to use the knowledge of one s own role and those of other professions to appropriately assess and address the health care needs of the patients and populations served. 11

12 Roles and Responsibilities Define interprofessional education. Explain the roles and responsibilities of other health professionals with whom you interact in managing patients/clients. Explain similarities in the roles and responsibilities between and among the various health professionals participating in the session. Explain differences in the roles and responsibilities between and among the various health professionals participating in the session. Explain the need to collaborate with other health professionals to design a comprehensive care plan for the patient/client. Discuss the benefits of interprofessional collaborative practice. Interprofessional Communication Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease. Teams and Teamwork Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-/population-centered care that is safe, timely, efficient, and equitable. 12

13 Process IPE events offered over a period of two academic years. Students from each health professions program were invited to participate. Events focused on the Interprofessional Collaborative Practice Competency Domains. Each work team included 10 students representing different health professions. *** Process All teams worked on a case scenario aimed at fostering shared decisionmaking and consensus regarding a particular patient care issue and/or decision. Student s pre- and post-event perceptions of their understanding of the culture, values and ethics for interprofessional practice, team roles and responsibilities, interprofessional communication, and teamwork were collected and analyzed. Process Briefing Overview of Interprofessional Education Interprofessional Core Competencies Each activity was domain-specific Values and Ethics Role and Responsibilities Interprofessional Communication Teams and Teamwork Teaching Methods Case based learning Small group discussion Debriefing Team Reports Follow-up Next steps 13

14 Debriefing How did your team come to an agreement on a recommendation? What other people did you wish were available to your group? How did your team include patients and their families in the decision making process? Roles and Responsibilities ~ Student Evaluations Preliminary Findings Students understanding of the culture and values of their own profession, the culture and values of other health professions, and the shared culture and values of the healthcare team. understanding of team culture and interprofessional collaborative practice. understanding of shared decision-making. 14

15 Preliminary Findings Faculty understanding of the culture and values of other health professions and the shared culture and values of the healthcare team. understanding of team culture and interprofessional collaborative practice. Lessons Learned Venue is critical!!! Integrate IPE into the Philosophy, Curricula, and Outcomes. Integrate IPE activities into a specific course. Learning objectives Teaching methods Evaluation methods Include Online activities. Follow-up/Follow-through. Lessons Learned Faculty development is critical. Faculty involvement is critical. Administrative support is (Select all that apply) a. Critical b. Important c. Nice to have d. Not necessary Funding is elusive. Return on Investment/Business results Outcomes evaluation essential. Kirkpatrick s Model 15

16 Next Steps Cross-campus programs Online case study Simulation Additional workshops More Facilitator workshops Partner with healthcare facilities IPE initiatives follow-up with graduates Disseminate findings Practice Implications For Patients Increased access to care Improved quality of care Decreased cost of care Increased satisfaction Increased engagement For Staff Decreased tension and conflict among caregivers Increased satisfaction Increased engagement For Organizations Coordinated healthcare services Appropriate use of specialists Decreased total patient complications Decreased cost of care delivery Decreased length of stay Decreased staff turnover Decreased hospital admissions/re-admissions Decreased mortality rates Decreased recidivism Continued progress Faculty and student events Lead to relationship building and thinking outside the box Developed other IPE collaborative projects including Disseminating IPE experiences IPE Student Interview Project January 2015 IPE implementation in the clinical setting (2013-present) 16

17 References 1. Health and Human Services. (2015). The affordable care act. Retrieved from 2. Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press. 3. Interprofessional Education Collaborative (2013). Core competencies for interprofessional collaborative practice. Retrieved from 4. Joint Commission. (2010). Patient safety. Retrieved from 5. McFarland, M.R. & Wehbe-Alamah, H.B. (2014). Leininger s theory of culture care diversity and universality: A worldwide nursing theory (3 rd ed.). Burlington, MA: Jones & Bartlett. 6. U.S. Department of Veterans Affairs. (2011). VA National Center for Patient Safety. Retrieved from asp 7. World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. Geneva: WHO. 17