Interprofessional Collaboration: Moving from Theory to Practice

Interprofessional Healthcare Summit—From Education to Practice Bonnie Pilon, PhD, NEA-BC, FAAN

Alexander Heard Distinguished Service ProfessorVanderbilt University School of Nursing

April 10, 2015

DisclosuresNone to declare

ObjectivesReview evolution of interprofessional

education and practice (IPE; IPCP)Describe relevant theories that undergird IPE

and IPCPBriefly discuss state of the science related to

IPCPDiscuss recent efforts to integrate IPE/IPCP

within nurse led teams and sitesDescribe one implementation of IPE & IPCP

at a nurse led clinic

DefinitionsIPE

WHO (2010): “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.” (2010, p.XX)

IPCPWHO (2010): “when multiple health workers from different

backgrounds work together with patients families, carers [sic], and communities to deliver the highest quality of care”

IPE Collaborative Expert Panel (2011): care delivered by intentionally created, usually smaller work groups in health care, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients

Interprofessional teamwork: “the levels of cooperation, coordination and collaboration characterizing the relationships between professions in delivering patient-centered care.”

Interprofessional team-based care: “care delivered by intentionally created, usually relatively small work groups in healthcare, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients, e.g. rapid response team, palliative care team, primary care team, operating room team.”

Interprofessional Education Collaborative Expert Panel (2011). P. 2

Interprofessionality: “the process by which professionals reflect on and develop ways of practicing that provides an integrated cohesive answer to the needs of the client/family/population…It involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking to optimize the patient’s participation. Interprofessionality requires a paradigm shift, since interprofessional practice has unique characteristics in terms of values, codes of conduct, and ways of working.”

D’Amour & Oandasan (2005). P. 9

Key Milestones for IPE & IPCP Development1972 IOM Educating for the Health Team1998 Pew Charitable Trust Report2000 IOM To Err is Human: Building a Safer Health

System2001 IOM Crossing the Quality Chasm2008-present AHRQ efforts on retraining to build

interprofessional teamwork and team based care (TeamSTEPPS deployment)

2009 Recovery and Reinvestment Act & 2010 Affordable Care Act placing increased emphasis on medical home, population health, improved primary care outcomes

Interprofessional Education by Profession (examples)Nursing: AACN integrated interprofessional collaboration

behavioral expectations into the Essentials documents for baccalaureate (2008), master’s (2010), and doctoral education for advanced practice (2006)

MD: AAMC called for attention to IPE on schools of medicine in 2008; ACGME began evaluation of team training on resident experiences and patient outcomes

Pharmacy: curricular guidance (2004), vision for practice by 2015, accreditation requirements (2011) incorporate consistent IPE and IPCP principles

DO: Launched exploratory analysis of relationship between principals of osteopathic medicine and IPE; pilot IPE programs at osteopathic medical schools implemented

Public Health: ASPH developed 10 competencies at the MPH level for IPE

WHO (2010). Framework for Action on Interprofessional Education & Collaborative Practice

Common Competencies

IndividualProfessional Competencies:Complementary

IPCollaborativeCompetencies

Barr, H. 1998

Three Types of Professional Competencies

Interprofessional Collaborative Practice Competency Domains

Values/Ethics for Interprofessional Practice(moral obligation to work together to improve

outcomes)Roles and Responsibilities

(shared understanding of each person’s roles and abilities)

Interprofessional Collaboration(openness, style, expression of feelings & thoughts

aimed at modifying teamwork environment)Teams and Teamwork

(essential component of patient centered practice)

College of Health Professions, Armstrong State University

Challenges to Implementation of Interprofessional CompetenciesInstitutionLack of other institutional collaboratorsPractical issuesFaculty development issuesAssessment issuesLack of regulatory expectations

State of the Science: Does IPCP Create Improved Patient Outcomes?

Successful Collaboration—Better Outcomes!

CompetenciesComposition

Processes

Majority of Studies Focus on…..

Outcomes

Case Example: Vanderbilt School of NursingApproachTheory and evidence to guide the workHRSA Division of Nursing supportLessons learned

VUSN Population Health Model

Vanderbilt Program for Interprofessional Learning Model

Framework for Interprofessional Values and Core Competencies (University of Toronto, 2008)

Exposure Immersion Competence

Values/Ethics

Recognizes ethical issues Describes and clarifies

values

Values/Ethics

Describes ethical framework

Uses ethical decision-making

Demonstrates advanced interprofessional values

Values/Ethics

Shared team values are demonstrated

Ethical interprofessional practice is evident

Demonstrates respect & values others’ contributions

Communication

Can articulate uniqueness of self and others

Communication

Is self-reflecting Addresses conflict Open to learning

interprofessional communication skills

Communication

Effective communicator Advanced

interprofessional group function is evident

interprofessional team continues to improve

Collaboration

Can describe: One’s own role Interprofessional theory Interprofessional context

Collaboration

Can describe: Roles of others

involved in patient care

Collaboration

Collaborative work can be measured

Interprofessional team is preferred model of practice

Leadership for interprofessional practice emerges

Measuring CollaborationTeam Development Measure

Looks at team development from the perspective of individual members of the team

31 items, 4 scale response: Strongly Agree to Strongly Disagree

4 domains Cohesiveness Communication Role clarity Goals & Means Clarity

2 levels How many of the components are in place How firmly they are in place

Stock, R., Mahoney, E. & Carney, P.A. (2013).

TDM StagesStage Score Range Components

PresentSolidification

Pre-Team 0-36 None to building Cohesiveness

-

1 37-46 Cohesiveness In Place

2 47-54 Communication

3 55-57 Role Clarity

4 58-63 Goals & Means Clarity

5 64-69 Cohesiveness Firmly in Place

6 70-77 Communication

7 78-80 Role Clarity

8 81-86 Goals & Means Clarity

Fully Developed

87-100 Everything

Time pointAverage TDM

score Team Stage

Winter 2013 58.25 Stage 4

Summer 2013 58.50 Stage 4

Winter 2014 62.00 Stage 4

Summer 2014 58.86 Stage 4

Winter 2015 60.16 Stage 4

Team Members Self-Assessment

Student Assessment of Team Development

What We Have Learned so far…Intentional practice

Pre-planning makes a difference using theory to guide team training

Structured communication times and techniques are essential to success SBAR Huddles Team Briefs Complex Case Reviews

Primary care TeamSTEPPS is a set of tools that supports IPCP

Iterative practice; continuously evolvingPDSA used to improve IPCP

AcknowledgementsThe Vanderbilt IPCP project was partially supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UD7HP25064, Division of Nursing NEPQR-Interprofessional Collaborative Practice program (total award amount:$1,394,204 over three years). The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Other important financial support was received from The Memorial Foundation, Hendersonville, TN, The Boulevard Bolt Committee, Nashville, TN and Vanderbilt School of Nursing. Specific funding for the VPIL program was received from the Josiah Macy Foundation, New York, NY, and from the Baptist Healing Trust, Nashville, TN.

References World Health Organization (WHO). (2010). Framework for action on

interprofessional education & collaborative practice. Geneva: World Health Organization. http://www.who.int/hrh/resources/framework_action/en/

Interprofessional Education Collaborative Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.

D’Amour, D. & Oandasan, I. (2005). Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care, 19(Supplement 1), 8-20.

Barr, H. (1998). Competent to collaborate: Toward a competency-based model for interprofessional education. Journal of Interprofessional Care, 12(2), 181-187

VUSN population heath model adapted from: Peterson, K.W. & Kane, D.P. (1997). Beyond disease management. In W.E. Todd & D. Nash, (Eds.), Disease Management: A Systems Approach to Improving Patient Outcomes (pp. 305-346). Chicago, IL: American Hospital Publishing, Inc.

University of Toronto, 2008. University of Toronto Interprofessional Education Curriculum/Program. http://www.rehab.utoronto.ca/PDF/IPE.pdf

Stock, R., Mahoney, E. & Carney, P.A. (2013). Measuring team development in clinical care settings. Family Medicine, 45(10). 691-700.