Brenda J. Stutsky RN, PhD

Development and Testing of a Conceptual Framework for Interprofessional Collaborative Practice

Outline

Project Background1

2

3

4

5

6

Literature Review

Methods/Procedure

Instrument

Results

Conceptual Framework

7 Discussion

Project Background

• Post-doctoral work in Health Human Resource Optimization at UWO

• September 2011 – December 2012• Advisor: Dr. Heather Laschinger

Project Background

• Special thanks to:– Carol Cooke, Associate Librarian, University

of Manitoba– Catherine Hynes, Regional Manager Decision

Support, Northern RHA

Literature Review

• Extensive review of the interprofessional literature– Antecedents/consequences of:

• Interprofessional education (IPE)• Interprofessional collaborative practice (ICP)

Literature Review

• Problem– Interprofessional literature: Atheoretical– Terms are poorly conceptualized– Consistent framework for research is missing

(Reeves et al., 2011)

Literature Review

• Collaborative Practice“When multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings.” (WHO, 2010)

Literature Review

• Relationship-Centered Collaborative Care– Model developed by Tresolini & Pew-Fetzer

Task Force (1994)– 3 key relationships

1. Patient-practitioner

2. Community-practitioner

3. Practitioner-practitioner

– Used by researchers to guide ICP studies (Dix et al., 2008; Gaboury et al., 2011)

ConsequencesInterprofessional

Collaborative

Practice

Conceptual Framework

Antecedents

Personal Factors

Interprofessional Insight• Beliefs in IPC• Flexibility

Relational Skills• Trust• Cooperation• Communication Skills

Situational Factors

Leadership

Empowerment

Support Structures

Interprofessional

Collaborative

Practice

• Collective Ownership of Goals

• Understanding of Roles

• Interdependence• Knowledge Exchange

Work Behaviours & Attitudes

Personal• Work Satisfaction• Intent to Stay

Team• Perceived Team

Effectiveness• Conflict

Organizational Outcomes• Patient Safety• Quality of Patient Care

Patient Outcomes• Patient Biopsychosocial

Outcomes• Patient Satisfaction• Patient Empowerment• Length of Stay

Methods/Procedure

• Exploratory design• Regulated healthcare providers in Northern RHA

– Involved in direct patient care planning or team decision making

• 3 hospitals, 3 long-term care facilities, 4 primary healthcare centres

• Manager in RHA assisted with distribution of packages– Information sheet– Informed consent– $2.00 gift card & draw ballot

Instrument

• Interprofessional Collaborative Practice Survey (Stutsky & Laschinger, 2012)

– Constructed from existing standardized measures– 55 items with 9 demographic items– 5-point scale of strongly disagree to strongly agree

(1-2=low level, 3=moderate, 4-5=high level)

– Pt. safety, quality, degree of collaboration (5-point scale from low to high)

– 2 items measuring degree of collaboration used to validate ICP measure (r=.60 and r=.48)

Instrument

• Exploratory Factor Analysis (Construct Validity)

– ICP– Personal Antecedents– Situational Antecedents– Consequences: Work Behaviours and Attitudes

• Reliability was adequate (.67 to .88)

 Rotated Factor Loadings for Interprofessional Collaborative Practice

Scales/Question # Ownership of Goals

Understanding of Roles

Interdependence Knowledge Exchange

 Goals 37 .880      Goals 39 .789      Goals 40 .674      Goals 38 .522 .451    Roles 32   .794    Roles 35   .744    Roles 33   .623    Interdependence 31     .788  Interdependence 34     .633  Interdependence 30   .475 .584  Knowledge 44       .828Knowledge 41       .705Knowledge 43     .466 .473

4 factors with Eigenvalues greater than 1.00, explaining 59.73% of the cumulative variance

 Rotated Factor Loadings for Antecedents: Personal Factors

  

 Interprofessional Insight

 

 Relational Skills

Scales/Question # Beliefs in ICP Trust Communication Flexibility Cooperation 

Belief 2 .903        Belief 4 .859        Belief 3 .830        Belief 1 .760        Trust 10   .795      Trust 11   .782      Trust 9   .770      Trust 8   .756      Trust 14   .563   .470  Communication 15     .825    Communication 16     .706   .329Communication 17   .381 .634    Flexibility 5       .856  Flexibility 6       .737 .324Cooperation 12         .865Cooperation 13 .321 .346     .628

5 factors with Eigenvalues greater than 1.00, explaining 71.44% of the cumulative variance

 Rotated Factor Loadings for Antecedents: Situational Factors

   Situational Factors

 Scales/Question # Support Leadership Empowerment

 Support 24 .763    Support 25 .708    Support 23 .659 .425  Support 27 .557   .370Support 26 .398   .599Leadership 21   .876  Leadership 20   .799  Leadership 22 .359 .702  Empowerment 29     .880Empowerment 28 .315   .858

3 factors explained 67.50% of the cumulative variance

Rotated Factor Loadings for Consequences: Work Behaviours and Attitudes

   Work Behaviours & Attitudes:

Team

 Work Behaviours & Attitudes: Team

 Scales/Question # Conflict Team

EffectivenessIntent to Stay Work Satisfaction

 Conflict 59 .767      Conflict 57 .722     .475Conflict 60 .715      Conflict 58 .691     .378Team Effectiveness 55

  .870    

Team Effectiveness 54

  .768 .364  

Team Effectiveness 56

  .728   .356

Stay 49     .884  Stay 51     .870  Stay 50   .306 .587 .581Work Satisfaction 52       .783Work Satisfaction 53   .363 .369 .681

4 factors explained 74.71% of the cumulative variance

Results

Demographics• Response rate 32% (N=117)• 95 females, 21 males, 1 not indicated• 23-68 yrs. of age (M=43.30, SD=11.77)• 0.5-40 yrs. of experience (M=15.51, SD=12.45)• 75% nurses, 17% allied health, 8% physicians• 59% acute care, 34% community care, 7% long-term care• 72% full-time, 24% part-time, 4% casual• 78% direct patient care

Results

Subscale Scores• Means ranged 3.25 (SD=.81) to 4.41 (SD=.63)• Conflict 3.05 (SD=.73)

– Only 34% did not have frequent conflicts over sharing of responsibilities (M=2.97, SD=1.03)

– Only 25% did not believe that interprofessional relationships had winners and losers (M=3.27, SD=1.05)

Results

Correlations• Correlations between ICP and its antecedents and

consequences• All factors were significantly correlated with overall ICP

(r=.33-.65, p<.01) except for flexibility

Results

Hierarchical Multiple Regression • Influence of personal and situational antecedents on

overall ICP• 37% of the variance of ICP was attributed to personal

factors with an additional 12% being explained by situational factors

Hierarchical Multiple Regression for Personal and Situational Factors on ICP  R2 ∆R2 B SE β P

Personal Factors .366**   .400 .076 .405 .000**Situational Factors   .123** .250 .048 .403 .000**Total ICP R2 .489**          **p<.001

Results

Hierarchical Multiple Regression • Influence of individual components of subscales of

personal and situational antecedents on overall ICP• 49% of the variance of ICP was explained by personal

factors with an additional 10% being attributed to situational factors

Hierarchical Multiple Regression for Personal and Situational Subscales on ICP

  R2 ∆R2 B SE β PPersonal Factors .485**          

Beliefs in IPC

    .029 .047 .043 .542

Flexibility     -.051 .043 -.078 .242Trust     .091 .044 .165 .043*

Cooperation    .151 .052 .207 .005*

Communication    .205 .049 .333 .000**

Situational Factors   .098**        

Leadership    .004 .048 .006 .942

Empowerment    .013 .037 .032 .723

Support Structures

    .174 .043 .330 .000**

Total ICP R2 .583**          *p<.05, **p<.001

Results

Series of Regression Analyses• Combined effect of personal and situational antecedents

and overall ICP on consequences• Combination of predictors explained a significant variance

in all six consequences of ICP

Hierarchical Multiple Regression for the Entire Model

   Work Behaviours & Attitudes: Personal

 

 Work Behaviours &

Attitudes: Team

 Organizational

Outcomes

  Work Satisfaction

Intent to Stay

Team Effectiveness

Conflict PatientSafety

QualityPatient Care

Standard Coefficients BetaPersonal Factors            

Beliefs in IPC

.068 -.008 .018 .279* .120 .024

Flexibility -.055 .061 -.152 -.073 -.113 -.103Trust -.049 .055 .100 .357** .087 -.018Cooperation .087 -.073 -.092* -.049 -.038 -.075

Communication-.080 .033 .171 -.002 -.018 .230*

Situational Factors            Leadership .050 .127 .050 .092 -.025 .015

Empowerment.570** .364* .144 -.040 .091 .195

Support Structures

-.131 -.235* .078 -.076 .020 .064

ICP            ICP Overall .305* .305* .405** .329* .450** .283*

R2 and ∆R2

             Personal Factors R2 .200** .178** .377** .417** .207** .270**Situational Factors ∆R2 .232** .096* .090** .007 .042 .076*ICP ∆R2 .039* .039* .069** .045* .085** .033*Total Model R2 .472* .313* .537** .469* .334** .380**p<.05, **p<.001            

Discussion

• Encouraging preliminary empirical support for the conceptual framework

• Results were consistent with findings in the literature including the importance of relationship-centered collaborative care

• Limitations include small sample size and response rate• Limited power prevented more sophisticated analyses

(SEM)• Psychometric properties of the ICPS are promising but

continual refinement and validation is needed • Patient outcomes need to be captured in future studies

Discussion

• Use of the framework– Healthcare leaders: Guide for facilitating ICP to enhance patient

safety and quality of care– Educators: Strengthen IPE curricula– Healthcare professionals: Evidence linking personal attitudes and

behaviours to effective ICP and patient safety and quality may motivate them to reflect on own behaviours and make a commitment to ICP

• Further research to validate the framework