Health Services Executive Interprofessional Learning Master Class 20th June 2012 Helena Low.
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Transcript of Health Services Executive Interprofessional Learning Master Class 20th June 2012 Helena Low.
Health Services Executive
CAIPE Interprofessional Learning Master Class
Learning Together to Work Together,
Working Together to Learn together’
The foundations for collaborative Care
Helena LowVice Chair
Centre for the Advancement of Interprofessional Education
Themes and Questions
What is interprofessional collaborative practice / interprofessional collaborative care - what do we actually mean when we use these terms?
What difference does it make? Why the global emphasis on it? What are the competencies required? Why do we need interprofessional learning to develop collaborative practice ?
What do we mean by interprofessional education? Why is it essential for professional education?
Aims of the Master classFoster a greater and shared understanding of what collaborative care means and what is involved within the Irish context
Generate interest and engagement in interprofessional learning for collaborative practice
Encourage you to consider practical application in the workplace
Encourage you to identify further areas of interest in relation to taking forward collaborative initiatives
Interprofessional learning and collaborative practice in the context of global health
International / global trends Economic factors – limited Resources Modernisation Ageing population Integration, Collaboration, Decentralisation Service User focus Community participation Emphasis on patient safety
H. Low
Drivers of change resource constraints
Rising cost of care, Increasing demand, diminishing resources
demography Ageing population, Movement of people
technological advances More people surviving defects, Illness, disease, accidents
consumer expectations more informed recipients of care.
loss of confidence in professionals Medical errors, lack of communication between professionals
Health systems worldwide
are struggling with:
increasingly complex and costly challenges,
ever more demands on health workers
patients needs have become more complex and more - challenging.
Modernisation essential todeal with:
inequalities in access to health and care,
growing pressures of chronic non communicable illnesses
services for the vulnerable, older people and children suffering
Issues around patient safety
Global picture
‘In a world of radically increased interdependenceinterdependence, health nearly everywhere is being shaped by the same powerful forces, like demographic ageing, rapid urbanization, and the globalization of unhealthy lifestyles.’
Dr Margaret Chan Director-General WHO 2012
The impact of globalisation globalisation - the international movement of professionals and professional knowledge and the resulting cross cultural transition of ideas are all manifestations of the global interdependence in health and education.
Lancet Commission (2010)
World Health Reports A series of reports produced regularly by the
World Health Organization (WHO). Published annually or biennially in multiple languages, Each report includes an expert assessment of a specific
global health topic, relating to all countries that are Member States of the organization.
Learning Together to Work Together for Health. World Health Organisation (1988)
Report of a WHO Study Group on Multiprofessional Education for Health Personnel. The Team Approach Technical Report Series 769. Geneva: WHO
WHO significant Reports
World Health Report (2006) ‘Working Together for Health’ Highlighted a "global health workforce crisis". an estimated shortage of almost 4.3 million doctors, nurses, midwives, and other health human resources worldwide.
World Health Report (2008) Primary Health Care (Now more than ever)’ ‘Now, more than ever, the health of people worldwide depends on health professionals working together across the boundaries of disciplines, professions and conventions’
Framework for Action on Interprofessional Education & Collaborative Practice (2010) – Report to the WHO The WHO and its partners acknowledge that there is sufficient evidence to indicate that effective interprofessional education enables effective collaborative practice.’
In response to these challenges:
In countries across the world government policies on workforce development have focused on the need for
- collaborative frameworks for education and practice; - integrated approaches to care; - co-operation, - working across professional and organisational
boundaries
Internationally, IPE and collaborative practice are seen as potential strategies to mitigate global health workforce crisis
An effective, interagency, interprofessional workforce is seen as critical for the health and welfare of future generations.
Impact of this approach
Modernisation is about looking at the workforce in a different way, as teams of people rather than as different professional ‘tribes’
Global modernising politics reshaping healthcare relationships
Health and social care professions are faced with substantial changes in the pattern of their relationships.
Response to the Challenges by Governments around the world
Some examples
United Kingdom Canada Japan Australasia
In Ireland ?
‘
Programme of reform Universal health insurance Community based services
through a primary care setting New models of care National Clinical Care
Programmes designed and implemented by clinically led multidisciplinary teams
Emphasis on standards and patient safety
greater flexibilities in work practices and rosters to achieve more efficient delivery of services
HSE Report 2011
‘Implementation of theNational Clinical programmesis driving a re engineering oftraditional models of care andof service delivery’’
‘Our Health services arefacing challenges on a scale never experienced before’
‘All of these are being designedand implemented by clinicallyled multidisciplinary teams.’
No one profession can respond adequately to the multiplicity of problems that many patients present, be they children at risk, alienated young people, members of dysfunctional families, chronically sick and disabled people living longer, or amongst the growing number of old people surviving to an advanced age.
H. Low
Patient SafetyInquiries into medical errors, e.g. the United States (Institute of Medicine, 2001) and the United Kingdom (Kennedy, 2001), have attributed failure to problematic communications and relationships between professions (Meads & Ashcroft, 2005).
WHO (2011) Patient Safety Curriculum Guide: Multi-professional EditionFor the past three years, the World Health Organization has been exploring the links between education and health practice – between the education of the healthcare workforce and the safety of the health system. As an outcome, it has developed this multi-professional Patient Safety Curriculum Guide, which addresses a variety of ideas and methods for teaching and assessing patient safety more effectively.
Modernisation is about cultural change
Professions have to work in a different way – and make collaboration a normal part of professional practice.
Collaboration is easy to say, but working together with other professions, new partners and in different ways is not easy.
H. Low
Collaboration
complex process with multiple components
- can be a process, product or both
connecting,
cooperating,
consulting,
- encompasses: coordinating,
co-locating,
community building and
contracting.
- Is more than the sum of its parts
H.Lawson (2004)
Health & CareServicesbased on people’s
needs
Policy makersInternational, national, regional
and local government
Academic institutions Higher & Further education
new partnerships
CommunitiesVoluntary organisations
Service users and carers
Health & CareEmployers / managers
new organisations and agencies
Independent sector
Health & CareProfessionsnew roles, new
occupations, new professions
Connections for
Collaboration
The Lancet Commission Report – Health professional for a new century: transforming education to strengthen health systems in an interdependent world (2010)
Increasingly interdependent in terms of key health resources, especially skilled workers’
‘imperative to align professional competencies to changing contexts’
What are the competences of interprofessional learning and working
‘soft skills’ and complex achievements
social practices that are highly context dependent,
team working, developing supportive relationships, reflection and self awareness, working across boundaries, communication, interpersonal skills
Mix of dispositions, understandings, attributes andpractices
Competencies for Interprofessional Collaborative practice
CUILU (2006) Interprofessional capability framework. Sheffield: The Combined Universities Interprofessional Learning Unit.
Interprofessional Education Collaborative Expert Panel (2011) Core competencies for interprofessional collaborative practice: report of an expert panel. Washington D.C.: Interprofessional collaborative
Canadian Interprofessional Health Collaborative. A national competency framework for interprofessional collaboration. www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf
‘Core Competencies for Interprofessional Care’ in Healthforce Ontario (2010) Implementing Interprofessional Care in Ontario: Final Report of the Interprofessional Care Strategic Implementation Committee. Ontario
Why do we need inter-professional education
Learning for working across professional, organisational and agency boundaries, together, is essential
‘Inter-professional working must be grounded in inter-professional learning’ John Horder 2005
A flexible collaborative ready workforce is dependent on the way in which professionals are educated
Lancet Commission 2010
H. Low
Interprofessional education
‘Occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care’ (CAIPE 2002)
Principles
CAIPE commends a number of principles, drawn from the experience of its members and the interprofessional literature. These highlight the: values
process and
outcomes
deemed essential for effective interprofessional learning and working (CAIPE 2011)
The Evidence Base?
Patients report higher levels of satisfaction, better acceptance of care and improved health outcomes following treatment by a collaborative team.
There is now sufficient evidence to indicate that interprofessional education enables effective collaborative practice which in turn optimizes health services, strengthens health systems and improves health outcomes. World Health Organisation 2010
Hammick et al (2007)
21 studies discussed of the 399 reviewed (UK 11, USA 7, Canada 1, Finland 1, Sweden 1)
15 of the studies (72%) considered undergraduate IPE.
All peer reviewed papers and reports, quantitative and qualitative approaches included
Considered the following outcomes of learning: learners reactions; changes in skills, knowledge, perceptions of and attitude to others; changes in behaviour as well as impact on service users
Findings
Competent facilitation of IPE essential
Learner reaction to IPE is related to multiple factors
IPE needs to reflect appropriate and relevant service delivery settings
Principles of adult learning are key
IPE generally well received and enables learning of the knowledge & skills for collaborative working
In the context of quality improvement initiatives IPE frequently used to enhance development of practice & improvement of services
Cochrane Systematic Review (Reeves et al 2009)
Six studies met the inclusion criteria (small but first IPE review in 2000 found none)
4 RCTs and 2 Controlled Before and After (CBA) Studies
Five studies conducted in the US, one in the UK
All studies undertaken with groups of qualified staff in established teams eg A&E, PHC
Findings
Four of the studies indicated that IPE produced positive outcomes in the following areas:
- emergency dept culture and pt satisfaction; - collaborative team behaviour & reduction of clinical error rates in
emergency dept teams; - management of care to domestic violence victims; - mental health practitioner competencies related to the delivery of
patient care
Two studies reported mixed outcomes (positive and neutral)
Two studies reported that IPE had no impact on either professional practice or patient care
Outcomes, Effectiveness & Evaluation
Outcomes: what you intend to achieve by theend of the Project
Effectiveness: the extent to which youroutcomes have been achieved
Evaluation: process of looking at the evidence /data, to determine whether something has made adifference, ie; to measure any changes that haveoccurred from the initial situation.
Outcomes of Interprofessional Education
Reaction Learners’ view on the learning experience and its interprofessional nature
Modifications of attitudes / perceptionsChanges in reciprocal attitudes or perceptions between participant groups. Changes in perception or attitude
towards the value and/or use of team approaches to caring for specific client group
Acquisition of knowledge / skillsIncluding knowledge and skills linked tointerprofessional collaboration
Outcomes of Interprofessional Education
Behavioural ChangeIdentifies individuals’ transfer ofinterprofessional learning to their practice setting and changed professional practice
Change in organisational practiceWider changes in the organisation and delivery of care
Benefits to patients / clientsImprovements in health or well being of patients and carers
Freeth et al 2003 (modified from Kirkpatrick 1967
Move towards competency based professional education – outcomes expressed as competences
contemporary professional education has adjusted and changed to meet workforce requirements;
so interprofessional education has been seen as necessary to equip professionals for multi dimensional collaboration
Standards and outcomes set by regulatory body and others eg, national occupational standards
Different types, different level.
Common, complementary and collaborative competences
Professionalism
Initial growth of professionalism mid 19th Century Uni professional education, By mid 20th Century professions being challenged Attempts to bring health and social care professions in
general and medicine in particular under greater control Growing concerns about public safety and professional
powers in light of, e.g. tragedies of Bristol Royal Infirmary events and Victoria Climbie
Reform of Professional Regulatory bodies Establishment of Council for Healthcare Regulatory
Excellence
Lancet commission Report (2010)
Idea of professions and professionalism beginning to change
New professions emerging Attempts to break down the barriers between professions Move towards interprofessional practice and
interprofessionalism Need for reforms guided by transformative learning and
interdependence Competency-based education transprofessional teamwork that includes non-professional
health workers
Challenges for IPE in professional
education
Professional socialization Professional culture Professional language / jargon Organizational difficulties Lack of service support Lack of equality and reciprocity
Challenges for IPE in Professional Education
Different educational and social backgrounds Fear of dilution of professional role / loss of
professional identity Separate professional education – stereotyping Perceived different status and power Poor communication Poor facilitation of IPL
Professionalism - key element in agendas related to interprofessional education in the UK
Professions as regulatory bodies assume different degrees of significance in different societies
These set the parameters at national international level for the operation of specific professions, including in education.
Opportunities for creating interprofessional education for practice are not just shaped by the educational institutions concerned and employer partners, but also by professional bodies.
45
Challenges re the practicalities
Fitting IPE into a full curriculum – issues of ‘add on’ / integration
Timetabling and logistics
Resistance from colleagues and students
Hierarchies between professions
Silos and territorialism in universities and in practice
Lack of support from professional organisations
Poor communication systems
Interprofessional learning and working
Works to improve the quality of care Focuses on the needs of service users and
carers Encourages professions to learn with, from
and about each other Respects the integrity and contribution of each
profession Enhances practice within professions
H. Low
Benefits of Inter-professional Learning
and Working Shifts focus from professional roles to patient
needs
Implicitly builds inter-professional team learning/working
Demonstrates the power of sharing knowledge and experience
It fosters innovation and capacity for change
H. Low
Interprofessional Education
Applies principles of Adult Learning
Is practice led
Includes common and comparative learning
Is interactive
Involves service users
Is competency based
Is assessed
Improves practice
Is evaluated
Facilitating Interprofessional Learning
Evidence indicates that the success of interprofessional learning is dependent to a significant extent on the effectiveness of those who facilitate it, at every level.
Facilitation of interprofessional learning
Individuals may be experienced clinicians, practitioners and / or educationalists, but may lack the particular knowledge, skills and confidence to facilitate learning with groups of people from diverse professional backgrounds
Even very experienced teachers find the challenges of multi professional teaching difficult to manage. Preparation is crucial
Facilitation of interprofessional learning requires a level of expertise which builds on but extends beyond the range of knowledge, skills and attitudes required for uni professional teaching.
Facilitators of interprofessional learning of multi professional groups must:
Have the ability to discern and address a range of complex issues, such as different professional cultures. perceived power and status of different professions and professional language.
They must also have the sensitivity required to work across professional and organisational barriers to achieve change.
Members of different professions have different
Styles of learning Patterns of thinking Attitudes to authority
and therefore different constructions of reality.
Different professionals have different skills,
knowledge, concepts
and therefore different value systems
Values and relationships
The values that are part of professional culture will be reflected in the way professionals perceive other professions and affect the way relationships are (or not) developed.
These relationships are crucial to effective interprofessional working and collaboration and influence the way in which interprofessional education is taken forward.
H. Low
IPE is not achieved by structural and systems change alone
It relies on the development of collaborative relationships, changed attitudes and behavioursfor the long term, to develop a culture of IPE
is an applied discipline dependent on the context where it takes place
learning is transferable to new contexts and dependent on reinforcement
Some Key Factors for effective Interprofessional Learning and Interprofessional working
agreed aims, objectives and values address anxieties regarding any perceived reduction of
standards and dilution of professional service. recognise issues of status and authority equity – all contributions are valued, individual and
professional confidence enhanced respect differences Mutual respect and mutual support are important Recognise own and others’ knowledge and expertise Recognise where these are different and where they
overlapShared Learning: A Good Practice Guide ENB/CCETSW (Low.H,
Weinstein.J)
Key factors for successful planning & delivery of an IPE initiative
identify and get support of key stakeholders strong leadership identify enthusiasts/ champions for IPE work in a partnership of educators and service providers,
plan together involve staff at all levels involve service users resources Start with what you have!
Shared Learning: A Good Practice Guide ENB/CCETSW (Low.H, &Weinstein.J)
Health & CareServicesbased on people’s
needs
Policy makersInternational, national, regional
and local government
Academic institutions Higher & Further education
new partnerships
CommunitiesVoluntary organisations
Service users and carers
Health & CareEmployers / managers
new organisations and agencies
Independent sector
Health & CareProfessionsnew roles, new
occupations, new professions
Identifying stakeholders
potential partners
Connections for
Collaboration
Global Interprofessional networks - connections and relationships
INTERED THE
INTERNATIONAL ASSOCIATION FOR
INTER-PROFESSIONAL EDUCATION &
COLLABORATION
EIPEN EUROPEAN INTER-
PROFESSIONAL EDUCATION NETWORK IN
HEALTH & SOCIAL CARE
JAIPE THE JAPANESE
ASSOCIATION FOR INTER-PROFESSIONAL
EDUCATION
CAIPE UK CENTRE FOR THE
ADVANCEMENT OF INTER-
PROFESSIONAL EDUCATION