presentation 4 - 'get ready

Team Health Right Start Program Showcase 27 February 2012

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Right Start Forum

Get Ready! A Course for Interprofessional Work-Place Readiness

Grainne O’Loughlin, Director Allied Health Marie Heydon, Get Ready! Project Officer

St Vincents & Mater Health Sydney University partners: University of New South Wales – St Vincent’s Clinical School The University of Sydney Australian Catholic University University of Tasmania, School of Nursing and Midwifery

27 February 2012


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Introduction & Background

Established an Interdisciplinary Working party to respond to the CETI EOI

Once successful, the Working party became a Project Steering Committee to provide project governance.

Agreed to design and deliver a 1 week pre-graduate interprofessional education program for 50 Nursing, Medical and Allied Health students in last semester of study in conjunction with several University partners

Key Project objectives: To develop a program that ensured participants gained an understanding of the scopes of

practice and roles of the different health professionals and an understanding of the importance of collaborative practice in delivering safe and quality patient care

To develop a program that improved confidence in team-based skills including communication, leadership, learning in teams, collaborative practice and/or collaborative care planning in an interdisciplinary team

To provide teamwork modelling in a simulated environment via formal teaching, e-learning, simulation training and clinical skill modelling.

To develop a n Interprofessional Competency framework: and a team based ‘vehicle’ for delivering program components


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Aim & Methods

Key educational strategies: Competency framework: interprofessional competencies adopted from CIHC: these are interprofessional

communication, patient/client/family/community centred care, role clarification, team functioning, collaborative leadership and interprofessional conflict resolution

Team based ‘vehicle’ for delivering program components Acute to chronic focus – simulation centre activities (advanced life support and deteriorating patient focus) and team

based case scenario discussion and case conference role plays Use of multi-modal techniques – DVD’s, lectures, simulation, clinical skill modeling and team based tasks

Program design: Day 1 – aims , evaluations, team formation & task, roles & case conference DVD, first Sim, ISBAR & communication Day 2 – usual clinical time, attend ward meetings, lecture on conflict resolution, communication, bullying &

harassment Day 3 – second Sim, difficult communication workshop, ‘just a routine operation’ DVD, first team time Day 4 - usual clinical time, attend ward meetings, integrating clinical and IPL objectives, case conference role play Day 5 – part morning usual clinical time, second team time, team case summary and team review & final evaluations

Evaluation strategies: Quantitative - repeated measures where possible: ISVS; WSEIS; Competency matrix; Get Ready!; RIPLS (pre) Qualitative – content evaluation; simulation centre evaluation; facilitator evaluation and focus group


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Results

Excellent attendance and participation from 52 Nursing, Medical and Allied Health students

Robust quantitative and qualitative data very strongly support the effectiveness of this one week program in addressing the core interprofessional competencies.

Quantitative 95% of all combined repeated measure items across four tools were statistically significant (two tailed paired t-test) ISVS: 30/34 sig. 1/3 of these for all subgroups – team participation. Another 1/3 – two subgroups. WSEIS: all questions significant. 63% for all subgroups. Med and Nursing had a majority sig. AH not sig for 17/38. Competency matrix: 38/41 sig. 9 of these sig for all groups – roles, team processes, conflict and collaboration Get Ready! All items sig. med 8/13; nursing 13/13; 12/13 AH. Confidence to collaborate and negotiate sig for all. RIPLS: Diversity between subgroups; greatly similarity between Nursing and AH. Most similar for all in teamwork and

collaboration and roles and responsibilities questions. Nursing students decisive; medical more equivocal

Qualitative: This feedback strongly supported quantitative data. Sample student comments: ‘absolutely enjoyed the program,

ability to work in a multidisciplinary team has improved a lot’; ‘concept great, very needed....simulation and Human Factors DVD excellent’; ‘terrific, informative and enjoyable, thanks’

92% students endorsed this program for other pre-graduates with either unqualified support or a range of constructive suggestions

Students actively contributed suggestions eg more Sim, more clinical cases, less lectures! Shorten program, increase medical facilitation


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Work Self-Efficacy Inventory

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Learning ProblemSolving

Pressure RoleExpectations

Teamwork Sensitivity Work Politics Overall

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Post

Figure 4 – WS-EI subscale results for St Vincent’s (pre and post). Error bars indicate ± 1 Standard Error.


6 Interprofessional Socialization and Valuing Scale

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Comfort Behaviour Attitude Overall

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Post

Figure 7 – ISVS subscale results for St Vincent’s (pre and post). Error bars indicate ± 1 Standard Error.


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Conclusions & Lessons Learned

Organisational infrastructure and resourcing Facilitation : skilled dedicated coordinator ; ample facilitation from each discipline represented - esp medical Simulation centre Educational centre Adaptable for regional settings and smaller groups

Competency package used is a sound theoretical base for such a program and provides a foundation for detailing specific competencies and

in constructing relevant educational strategies for implementation.

Simulating team work : Use of simulation centre for emergency scenarios with team based activities Use of team based case discussion and case conference role playing for ‘chronic’ clinical scenarios Reviewing team/group processes.

Using a team model as the educational ‘vehicle’ with built in reflective time provides opportunity for team building to occur in a ‘level playing field’ environment, that is,

all students are pre-graduates with no actual work experience. Therefore, there is not a work experience based hierarchy as occurs in the actual work environment.

Clinical scenarios: using as many as possible maintains student focus and motivation.


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Where to from here?

Highly successful. Incorporate feedback into reviewed program design. Several options already proposed.

Continue to run program at SV&MHS in collaboration with partner Universities.

Implement e-learning package as part of this

Advocate model for use across state as has flexible programming components that can allow for local material to be incorporated and for it to be adapted to student disciplines available at a given time. Will benefit from ClinConnect mapping for this.

Ongoing program evaluation and evolution.

Potential for further research and development regarding these competencies

Potential to consider supervisor competency evaluation as course component

presentation 4 - 'get ready

Health & Medicine