Interprofessional Collaboration A Social Work Ethic

Shelley Cohen Konrad PhD, LCSWUniversity of New England

Center for Excellence in Interprofessional Education

Associate Professor, School of Social WorkOctober 18, 2013

Waterville, ME

Case DiscussionPatricia (Pat) Chalmers is a 31-year-old woman from Biddeford who prides herself on self-sufficiency and resourcefulness. She works part-time as a bookkeeper and gets paid to take care of her aging grandmother with whom she lives. Pat describes herself as having been a caretaker since adolescence. It is therefore difficult for her to acknowledge her own needs or to seek others for help. Pat is tired of people commenting on her weight, diet, and need to exercise. She avoids health care as much as possible because she knows she’ll be told to lose weight or be blamed for “being fat” (her words). “I know what risks I face” she says. “But I’ve tried everything and nothing works. I’ve accepted my size and would like doctors to respect that. So far they’ve done nothing but make me feel bad about myself.”Pat found herself in the ED with a broken ankle several months ago. The break was significant enough to require surgery. Labs revealed elevated glucose levels and surgery was put off until further tests could be done to determine whether Pat might have diabetes. When a nurse asked Pat about this possibility, she reacted strongly. “I don’t have the time or money for diabetes,” she explained. “I just need my ankle fixed so I can get back to work and take care of Mémé.”

Interprofessional Practice Definition• “occasions when two or more professions

learn with, from and about each other to improve collaboration and the quality of care” (CAIPE, 1997).

“… interdisciplinary collaboration is the achievement of goals that cannot be reached when individual professions act on their own.”

(Bronstein, 1996)

Interprofessional Practice is not• Sharing electronic health records• Sole profession teams (neurologist, pulmonologist, radiologist)• Students hearing a talk about another profession• Reporting out at interdisciplinary team meetings• Co-location without intentional collaboration• A physician-only led team

WHY IPC IS IMPORTANT

To advance the aim of improving health of the population, enhancing patient care and controlling costs

To close the gap between health education and practice settings by aligning their needs and interests

The Triple Aim

The Institute of Health Care Improvement developed the triple aim framework to optimize and measure health

systems performance.

IPC Guiding Principles

http://www.aacn.nche.edu/education-resources/IPECReport.pdf

44,000 – 99,000 DEATHS every year in the U.S. from preventable adverse events – medical errors

Institute of Medicine (IOM) 1999

Crossing the Quality Chasm (2001)“One approach is to redesign the way health

professionals are trained and to emphasize the six aims for improvement, which will mean placing more stress

on teaching evidence-based practice and providing more opportunities for interdisciplinary training.”

World Health Organization (2010)“Once students understand how to work

interprofessionally, they are ready to enter the workplace as a member of the collaborative

practice team.”

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Donald Berwick, former IHI President & Chief Executive Officer

2.01 Respect(a) Social workers should treat colleagues with respect and should represent accurately and fairly the qualifications, views, and obligations of colleagues.

2.03 Interdisciplinary Collaborationa) As members of an interdisciplinary team social workers should contribute to decisions that affect the well being of clients.

2.03 Interdisciplinary Collaborationa)Professional and ethical obligations of the interdisciplinary team as a whole and of its individual members should be clearly established.

International Federation of Social Work -

2013Strategies for intervention, desired end states and policy frameworks are based on holistic, biopsychosocial, spiritual assessments and

interventions that transcend the micro-macro divide, incorporating multiple systems levels

and inter-sectorial and interprofessional collaboration.

Roles & Responsibilities• Communicate one’s roles and responsibilities • Engage diverse healthcare professionals to meet the needs of

patients, families and populations. • Social workers understand the roles of other disciplines and

accurately and fairly represent the qualifications and obligations of colleagues.

Advocacy

Emotional

Outreach Resource Access

Values & Ethics• Place the interests of patients and populations at the center of health care.

• Respect unique cultural values and perspectives of individuals, populations, and health professionals.

• Social workers examine a variety of approaches to achieve desired outcomes.

Communication• Use respectful and appropriate communication in all situations.• Listen actively and encourage ideas and opinions of all team

members. • Social workers strive for cultural competence in

interdisciplinary communication, just as in communication with clients.

• Social workers understand that relationships are important to the change process. They engage people as partners in care.

Collaborative Leadership• Strong leaders value contributions of all health team members

and also those of the patient, family, and community. • Leaders facilitate contributions from all team members and

build support for working together.• Social work leaders work creatively and effectively to catalyze

social change and address human problems.

Teams & Teamwork• Work with others to deliver patient-centered, community-

responsive care. • Integrate knowledge and experience of other professions to

inform effective clinical, ethical, and systems-based decisions.• Social Workers identify professional strengths that enhance the

interdisciplinary team process and contribute to positive client outcomes.

Patient-Centeredness• Respect for complementary expertise • Value for patients as a vital members of the team• Trust in each other & in the team• Connection & Compassion• Social workers respect and promote the right of

clients to self determination

Social Work as a Health ProfessionPublic Health Act, 1992

• Titles VII and VIII of the Public Health Services Act (PHA) expanded the geographic, racial and ethnic distribution of the health care workforce.

• Increased number of providers working in the public health sector and improving diversity of the public health work force.

• Increased the number of underrepresented minorities in the health care field.• Minority providers are more likely to treat minority patients and provide health

care to poor, uninsured and publicly insured patients, improving access to care.• 2001 review of PHA found that training workforce in “interdisciplinary” and

“community-based” concepts was effective and ensured national best practice sustainability in underserved geographic regions or in service to vulnerable populations.

U.S. Department of Education 1995

“… a new way of preparing all professionals needs to be built. This will require changes throughout the campus culture and new relationships between professional preparation programs, communities, and clients.”

Allen-Meares, P. (1998). The interdisciplinary movement. J SW in Education, 34(1), 2-5.

The Interdisciplinary Movement

“Education on all levels needs to forge institutional ties with health care providers and incorporate into

curriculum interactions with students from fields such as medicine, nursing, education, law, economics, and

political science.”

Allen-Meares, P. (1998). The interdisciplinary movement. J SW in Education, 34(1), 2-5.

CollaborationSocial Work Model

“Trends in social problems and professional practice make it virtually impossible to serve clients effectively without collaborating with professionals from various

disciplines.”

Bronstein, L. R. (2003). A Model for Interdisciplinary Collaboration, Social Work, 48(3), 297-306.

Natural Collaborations

Social Work & Public Health

School-based

Practice

Practice with

Children &

Families/Child

Welfare

Social Work & HealthCare

Social work

& Criminal Justice

Social Work & Social

Service

Collaboration takes place when “autonomous, interdependent stakeholders with their respective competency domains”

organize around common goals for the greater good.

Building Trust

Strategies for cooperation

Managing Diversity

Resolving Conflict

Naming Power

InequitiesIndividual

FamilyPopulationCommunity

Meet Pat

Patricia (Pat) Chalmers is a 31-year-old woman who prides herself on self-sufficiency, resourcefulness, and a no nonsense approach to life…

Ethical DilemmaPat’s post-surgical team consists of a physical therapist, occupational therapist, nurse practitioner (who provides nutritional counseling) and a clinical social worker by way of home visits. A pharmacist offers medication management and consultation to Pat and the health care team. Pat’s treatment and medications are paid for by MaineCare. She’s collecting disability until she returns to work. While visiting with Pat she shares that she is not complying with her medication protocol or diet plan. She has not told this to her other providers and asks you to keep it confidential. “The others are not as understanding as you are,” she says. “I tell them what they want to hear so they’ll leave me alone.” At the monthly phone huddle, the pharmacist voices concern that, with the exception of her pain medications, Pat does not seem to be refilling her prescriptions. In regard to the pain meds, the pharmacist also discloses that Pat has asked the pharmacy twice for an early pain med refill. The nurse practitioner states concern that Pat is gaining rather than losing weight despite insistence that she’s staying on her diet plan. “I don’t think she’s really committed to her treatment” he says. “She’s playing Russian roulette with her health.”

Ethical Challenge(b) Social workers for whom a team decision raises ethical concerns should attempt to resolve the disagreement through appropriate channels. If the disagreement cannot be resolved, social workers should pursue other avenues to address their concerns consistent with client well being.

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Collaboration: A Social Work Method

Collaboration proposes joint sharing and decision-making in the interest of change, as well as changes in relationships to facilitate these ends.

Collaboration assumes the inevitability of conflicting ideas; differentials in power; and necessity of compromise and continued advocacy.

Graham, J. R., Barter, K. (1999). Collaboration: A social work practice method. FIS, 80(1), 6-13.

National Association of Social Workers- Winter 2013

Making Interdisciplinary Collaboration WorkInterdisciplinary Collaboration can be one of the most rewarding, yet challenging, aspects of social work practice. It’s also increasingly essential, regardless of practice setting or client population. [NASW Tools & Techniques]

Articulate your role in the team

Understand the roles and

responsibilities of other team

members

Identify and seek common ground with

your interdisciplinary

colleagues

Acknowledge the differences among social

work and other disciplines

Address conflict and don’t let resentment accumulate

Be proactive in establishing and

maintaining collegial

relationships

http://www.socialworkers.org/assets/secured/documents/practice/interdisciplinarycollaboration.pdf

3 Things

Write down 3 reasons why social workers are natural collaborative leaders and

interprofessional champions. Offer examples to your colleagues.

Take Away Points• Interprofessional Collaborative Practice is

consistent with Social Work Ethical Practice• Social Work has a robust history of leadership in

interprofessional/cross-disciplinary work• Social Work Organizations must join the

conversation with other national health leadership groups both as champions and challengers

• Social workers play a critical role on the health team; as behavioral health practitioners and advocates and to raise awareness of health disparities, social determinants, and social justice

Take Away PointsSocial Work has a robust history of leadership in interprofessional/cross-

disciplinary work.

Interprofessional Collaborative Practice is

consistent with Social Work Ethical Practice.

Social Work Organizations must join the conversation with other national health

leadership groups as champions and challengers.

Social workers play a critical role on the health team as behavioral health experts.

Social workers play a critical role on the team as

advocates raising awareness of health disparities, social determinants, and social

injustice.

Shelley Cohen Konrad PhD, LCSWUniversity of New England716 Stevens AvenuePortland, ME 04103scohenkonrad@une.edu

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