PromotingInterprofessionalCollaborativeCare

AmyV.Blue,PhDProfessorandAssociateDeanforEducationalAffairsCollegeofPublicHealthandHealthProfessionsAssociateVicePresidentforInterprofessionalEducation– UFHealth

SessionObjectives

• Discussinterprofessionaleducationandcollaborativecarepracticeconcepts

• Applytoolstopromoteinterprofessionalcollaborativecare

• Advocatethevalueofinterprofessionalcollaborativecare

WhyTeamsinHealthcare

BasedonIOMestimates,1jumbojet(270persons)crashingeveryday

InterprofessionalCollaborativePractice

Happenswhenmultiplehealthworkersfromdifferentprofessionalbackgroundsworktogetherwithpatients,families,careersandcommunitiestodeliverthehighestqualityofcare.

(WHO2010)

InterprofessionalCollaboration

Effectiveinterprofessionalcollaborationpromotestheactiveparticipationofeachdisciplineinpatientcare,wherealldisciplinesareworkingtogetherandfullyengagingpatientsandthosewhosupportthem,andleadershipontheteamadaptsbasedonpatientneeds.”

(RobertWood Johnson Foundation2015)

InterprofessionalEducation

“Interprofessionaleducationoccurswhentwoormoreprofessionslearnabout,fromandwith eachothertoimprovecollaborationandthequalityofcare.“

(WHO2010)

IPECCompetencies

May 2011

GuidingPrinciples

• Patient/familycentered(patient-centered)• Community/populationoriented• Relationshipfocused• Processoriented• Linkedtolearningactivities,educationalstrategies,andbehavioralassessmentsdevelopmentallyappropriate

GuidingPrinciples

• Abletobeintegratedacrosslearningcontinuum

• Sensitivetosystemscontext/applicableacrosspracticesettings

• Applicableacrossprofessions• Statedinlanguagecommon/meaningfulacrossprofessions

• Outcomedriven

CompetencyDomains

IPEinAccreditationStandards

• AccreditationCouncilforPharmacyEducation• AccreditationCouncilforPhysicalTherapyEducation

• AccreditationReviewCommissiononEducationforthePhysicianAssistant

• CommissiononCollegiateNursingEducation• CouncilonDentalAccreditation• LiaisonCommitteeonMedicalEducation

DoesIPCMakeaDifference?

• Froma2013Cochranereview(15studies):– 7studiesreportedpositiveoutcomes– 4studiesreportedmixedoutcomes– 4studiesreportedIPEinterventionshadnoimpactonpracticeorpatientcare

(Reevesetal2013)

TeamworkTraining

• Well-likedbytrainees• Improveslearningandtransferstothejob• Improvesorganizationaloutcomes– Safetyclimate,lengthofstay,turnover,jobsatisfaction

• Trueeffectforreducedpatientmortality,improvedpatienthealthandsatisfaction

(Salas2015)

LearningAbout,FromandWith

• Studentslearnmorefromeachother(thanusas“teachers”)

• Ourroleasteachersistocreate thelearningcontext,facilitate interaction,promotereflection

• Contentisthevehicleforlearningcollaborativeprocessskills

IPEInClinicalSettings

• Rolemodellingcollaborativecareimperative• Promotelearnerstointeractwithotherprofessionalsinanintentionalmanner

• Debriefwithlearnerstopromotereflection:– Howdidworkingwith…..helpyourpatientcare?–Whatotherprofessionsmightwewanttoinvolveinthecareofthispatient?

WhatisaTeam

• Twoormoreindividualswithahighdegreeofinterdependencegearedtowardtheachievementofagoalorthecompletionofatask.

• Teamsmakedecisions,solveproblems,providesupport,accomplishmissions,andplantheirwork.

WhatisTeamwork

• Itistheactions,events andbehaviors,cognition, feelings takentoaccomplishateamgoal.

• Itisabout…– …taskwork skills(i.e.,owntask).– …teamwork skills(i.e.,howtoworktogether).– …building andmaintaining both.

TeamsinHealthcare

• Healthcareprofessionalsbecomemembersofmanydifferenthealthcareteams.

• Theseteamsmaynotbeabletohaveasmuchtimetogetherasisideal.

• Therefore,eachprofessionalmustunderstandtheimportanceofteamsandhowtobeaneffectiveteammembertoallowtheteamtoworkwell.

EffectiveTeams:

�Membershaveacleargoalandarecommittedtothegoal

�Membershaveclearroles�Theyachievedecisionsthroughconsensus�Eachmemberfeelsempoweredtoact,speakup,offerideas

EffectiveTeams:

�Thereisdiversityamongteammembers�Membershaveeffectiveinterpersonalskills�Thereisperiodicself-assessment�Thereissharedleadershipoftheteam

ATeamworkFramework

22

OutcomesofTeamCompetencies

• Knowledge– SharedMentalModel

• Attitudes– MutualTrust– TeamOrientation

• Performance– Adaptability– Accuracy– Productivity– Efficiency– Safety

TeamStructures

• Thinkabouttheteamstructure(s)inyoursetting– Coreteam(patientcareproviders)– Contingencyteams(forspecificevents)– Coordinatingteams(daytodaymanagement)– Ancillaryandsupportservices(clinical,IT,

housekeeping,etc.)– Administration

Communication

“Theprocessbywhichinformationisclearlyandaccuratelyexchangedbetweentwoormoreteammembersintheprescribedmannerandwithproperterminologyandtheabilitytoclarifyoracknowledgethereceiptofinformation.”(Cannon-Bowers,etal1995)

SBAR….

• Aframeworkforteammemberstoeffectivelycommunicateinformationtooneanother:– Situation―Whatisgoingonwiththepatient?– Background―Whatistheclinicalbackgroundorcontext?

– Assessment―WhatdoIthinktheproblemis?– Recommendation/Request―WhatwouldIrecommend?WhatdoIneedfromyou?

Check-BackinCommunication

LeadingTeams

Twotypesofleaders:– Designated– Thepersonassignedtoleadandorganizeadesignatedcoreteam,establishcleargoals,andfacilitateopencommunicationandteamworkamongteammembers.

– Situational– Anyteammemberwhohastheskillstomanagethesituationathand.

TeamLeaders

• Organizetheteam• Articulatecleargoals• Makedecisionsthroughcollectiveinputofmembers

• Empowermemberstospeakupandchallenge,whenappropriate

• Activelypromoteandfacilitategoodteamwork

• Areskillfulatconflictresolution

TeamLeaders

• FormingthePlan– “Briefs”–Whoisonteam,goals,rolesofmembers,plan

• MonitoringandModifyingthePlan–“Huddles”– “Touchbase”meetingstoregainawarenessofsituationandmodifyplanasneeded

• ReviewingtheTeam’sPerformance–“Debrief”– Toimproveteamworkandoutcomes;– whatwentwell,couldbeimproved

SituationMonitoring

Processofactivelyscanning behaviorsandactionstoassesselementsofthesituationorenvironment– Fostersmutualrespectandteamaccountability– Providessafetynetforteamandpatient– Includescross-monitoring

SharedMentalModels

• Theperceptionof,understandingof,orknowledgeaboutasituationorprocessthatissharedamongteammembersthroughcommunication

SharedMentalModels

• Leadtomutualunderstandingofsituation• Leadtomoreeffectivecommunication• Enableback-upbehaviors• Helpensureunderstandingofeachother’srolesand

howtheyinterplay• Enablebetterpredictionandanticipationofteam

needs• Createcommonalityofeffortandpurpose

WhatDoYouSee?

MutualSupport

Mutualsupportistheessenceofteamwork– Protectsteammembersfromworkoverloadsituationsthatmayreduceeffectivenessandincreasetheriskoferror

TaskAssistance

Teammembersfosteraclimateinwhichitisexpectedthatassistancewillbeactivelysought andoffered asamethodforreducingtheoccurrenceoferror.

MutualSupport:CUSWords

PleaseUseCUSWordsbutonly whenappropriate!

ReviewofObjectives

• Discussinterprofessionaleducationandcollaborativecarepracticeconcepts

• Applytoolstopromoteinterprofessionalcollaborativecare

• Advocatethevalueofinterprofessionalcollaborativecare

References• WHO.FrameworkforAction(Feb.2010):http://www.who.int/hrh/resources/framework_action/en/• RobertWood Johnson Foundation. Lessons fromtheField:PromisingInterprofessional Collaboration Practices.

2015.Availableat:http://www.rwjf.org/content/dam/farm/reports/reports/2015/rwjf418568• InstituteofMedicine.ToErrisHuman.Washington,DC:NationalAcademyPress.2000.• http://susannahfox.com/2013/02/22/a-jumbo-jet-a-day-who-said-it/• Interprofessional EducationCollaborative ExpertPanel.(2011).Corecompetenciesforinterprofessional

collaborativepractice:Reportofanexpertpanel.WashingtonD.C.:InterprofessionalEducationCollaborative.• ReevesS,PerrierL,GoldmanJ,FreethD,ZwarensteinM.Interprofessional education:effectsonprofessional

practiceandhealthcareoutcomes(update).CochraneDatabaseofSystematicReviews2013, Issue3.SalasE.CanTeamTrainingSaveLifes?CriticalConnections: Feb/March2015.http://www.sccm.org/Communications/Critical-Connections/Archives/Pages/Can-Team-Training-Save-Lives.aspx

• SalasE,ShufferML,ThayerAL,BedwellWL,LazzaraEH.Understandingandimproving teamworkinorganizations:ascientifically basedpracticalguide.HumanResourceManagement2014.DOI:10.1002/hrm.21628

• TeamSTEPPS.http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html• Cannon-Bowers JA,TannenbaumSI,SalasE,etal.Definingcompetenciesandestablishingteamtraining

requirements.InGuzzoRA,SalasE,andassociates, eds.Teameffectiveness anddecision-making inorganizations.SanFrancisco:Jossey-Bass; 1995.p.333.