Transcript Interprofessional Practice

Interprofessional Practice
Promoting Partnerships
in
Health
Learning Objectives
Define Interprofessional Practice
Drivers of IPP
Barriers to IPP
Examples of IPP
Being Professional today means
being …
Interprofessional
Inter- between, across, beyond
-professional- a way of behaving
Types of Teams
• Multidisciplinary
• Interdisciplinary
• Transdisciplinary
Interprofessional Teams
• An interprofessional team is made up of
members of different professions and positions
• Individuals bring to the team the specialised
knowledge, skills, methods and attitudes of their
disciplines
• Members integrate their observations, bodies of
expertise and spheres of decision making to
coordinate, collaborate, and communicate to
optimise client care
Working Together for Health
World Health Report 2006
• Shift from tertiary hospital to patient centred,
home based and team driven care
• Increasing incidence of chronic conditions
• Core competencies include: patient centred care,
partnering, quality improvement, information
and communication technology and a public
health perspective.
Bio-psycho-social Model
(Roberts, 1994)
‘‘the human being as a complex mix of internal
physical, psychologic, social, and cultural
variables living within an equally dynamic
environmental mixture of social, cultural,
interpersonal, economic, and political variables’’
(Kielhofner, 1985 as cited in Peloquin, 1997, p. 167)
Interprofessional Team /Multidisciplinary Team
(Sheehan et al., 2007)
Cooperative work, common Worked in parallel, noticed
understandings and goals
others contributions, passed
on information
Commitment to joint
communication, genuine
valuing and interest
Clinical decision making
drew on other health
professionals information
Clear communication
Lack of common
processes and understanding understanding of patient
of roles
management issues
Language inclusive, frequent Minimal use of inclusive
use of ‘we’ and ‘team’
language but all
contributions valued
National Patient Safety Data (2006)
(Nisbet, 2007)
Contributing factor
WA
NSW QLD
Policy & Procedure
26% 25%
23%
Communication
23% 25%
20%
Human factors (scheduling/training) 18% 14%
20%
Information
(availability/completeness)
Knowledge & skills
12%
13%
18%
Tragedies in Collaboration
Bristol inquiry
Kennedy Report
Victoria Climbé
Laming Report
“Every Child Matters’
Patient/ Client/ Service User
Identify a situation where you have been a
service user.
Community Rehab Services
–To maximise independence and community
participation
–To achieve durable outcomes and improved quality
of life for clients
–To reduce admissions and re-admissions
–To improve continuity of care
Barriers to IPP
• Differences in history and culture
• Historical interprofessional and intraprofessional
rivalries
• Differences in language and jargon
• Differing professional routines
• Varying levels of preparation, qualifications and
status
• Fears of diluted professional identity
Professional Cultures
Culture: the social heritage of a community.
Values, beliefs, attitudes, customs and behaviours
• Autonomy
• Beneficence
• Confidentiality
• Dilemma
• Duty
• Ethics
• Fidelity
Professional Culture
• Justice
• Morality
• Non-malfeasance
• Veracity
Stereotypes
Stereotyping is a natural human process
Positive : guide their intergroup behaviours
efficiently deal with an outgroup with minimum
expenditure of energy
Negative : generate false or negative expectations
of another groups’ attitudes or behaviours
Stereotypes in Health Care
“Many allied health professionals work with patients for
episodes of care. They have a distinct and purposive
range of activities that can be easily explained and their
contribution to patient care within the team can be
clearly demarcated.” Scholes, 2002.
“I see the occupational therapist as someone who walks
around with a roll of Velcro in one hand and a lump of
Blutak in the other. I think they try and stick Velcro
anywhere they can.”
“The doctors do what the consultants do which is to be standoffish
and give very vague answers to your question in a rather imperial
manner.”
Health Care Stereotypes
Nursing
Medicine
Physiotherapists
Occupational Therapists
Speech Pathologists
Pharmacists
Dentists
Granny Draggers
Physio terrorists
Massage Therapists
Changing Health Professions
􀀹 Move from traditional inward-looking, reactive culture to
outward-looking, proactive culture
􀀹 Shift from profession-centred to patient-centred culture
􀀹 Blurring professional boundaries
􀀹 Changes in law re scope of practice/responsibilities
􀀹 Increased expectations of interprofessional collaboration in
education and practice
􀀹 Focus on evidence-informed practice
􀀹 Increasing demands for accountability/transparency
􀀹 Internationalization
Professional Cultures as Barriers
• Social work perspective: Problem external
∆ Change the world
• Health care perspective: Problem internal
∆
Change the person
Policy drivers
The Multidisciplinary Health Team must adopt
interprofessional practice to address:
• the changing needs of the population;
• changes in the incidence and treatment of
disease;
• changes in technology; and
• changes in consumer expectations.
WHO: Framework for Action 2010
The World Health Organization recognizes interprofessional collaboration in
education and practice as an innovative strategy that will play an important role in
mitigating the global health crisis.
Collaborative Skills for Teamwork
•
•
•
•
•
•
Cooperation
Assertiveness
Responsibility
Communication
Autonomy
Coordination
Interprofessional competencies
• Interpersonal and Communication
Skills
• Patient/Client/ Service user –centred
and Family focussed care
(Relationship-based care)
• Collaborative Practice
Interpersonal and Communication
Skills
• I effectively express my own knowledge
and opinions to others involved in care.
• I actively listen to the knowledge and
opinions of other team members
• I use information systems and technology
to exchange relevant information among all
professionals to improve care.
Relationship-based Care
• I involve the service user and family
(carers) in group decision making
processes
• I ensure continuous integration of service
users and families (carers) in the team in
order to maintain optimal, evolving care
Collaborative Practice
• I take part in and support
collaborative decision-making
• I understand and respect roles and
responsibilities
• I actively contribute to team functioning
• I participate actively in continuous quality
improvement
CR Interdisciplinary Competencies
1. Frameworks of understanding
2. Networks and teams-collaborative practice
3. Cultural awareness
4. Holistic focus
5. Consumer engagement
ICF (WHO 2001, p.18)
CR Interdisciplinary Competencies
6. Service continuity
7. Reflective practice
8. Community engagement
9. Boundaries and personal safety
10. Systems advocacy
Interprofessional Education
Interprofessional Education (IPE)
“occasions where 2 or more professions learn with,
from and about each other to improve
collaboration and the quality of care”
“ … lack of coordination between the education
and health areas of government, leading to
mismatches between education and training
places and service delivery requirements”
Productivity Research Report (2005:p.xxiv)
Children's Services
• Multi-agency working acknowledges the interrelatedness of family needs in the fields of
health, social services, law enforcement, child
welfare, housing and education.
"there is a terrible danger here – is there not, doctor – of
social services on the one hand and you on the other each
expecting the other to do the investigation, with the result
that nobody does".
IP & Palliative Care
Origins of palliative care lie in religious care and
nursing rather than medicine (Crawford & Price, 2001).
Community Rehabilitation
Holistic framework
Consumer Driven
Advocacy Role
Seamless Service
Interprofessional Practice in Health
Interprofessional Practice is a
partnership between a team of
health professionals and a client in a
participatory, collaborative and
coordinated approach to shared
decision making around health issues
Together everyone achieves more
Interprofessional practice is reaching
out beyond the team
Point 6 APA Code of Conduct
APA members must communicate and cooperate
with colleagues and relevant agencies in the best
interests of their clients and the wider
community.
Members shall collaborate professionally with
all relevant providers to achieve optimal client
outcomes.
 Longstanding fragmentation of health service delivery and the
global health workforce shortage make collaborative teamwork an
imperative.
 The drive for collaborative teamwork is a World Health
Organisation priority for action.
 Collaborative teamwork is a sophisticated skill and some individuals
are better at it than others; others may need staff development.
 The main challenges to collaborative teamwork are understanding
others’ roles, and effective communication.
 If quality care is the goal for patients and families clinical
competence must be balanced with collaborative competence.
 Strategies to improve the effectiveness of service delivery need to
be political, organisational and professional.
APA (2008) APA Code of Conduct
http://www.physiotherapy.asn.au/images/APA_Corporate_Documents/apa_code_of_conduct.pdf
Australian Health Ministers Conference National Health Workforce Strategic Framework 2004
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). New York:
Oxford University Press.
Crawford, G. & Price, S. (2003)Team working: palliative care as a model of interdisciplinary
practice MJA,179: S32–S34
Hindle, D., Braithwaite, J., Travaglia, J. & Iedema, R. (2006) Patient Safety: A comparative analysis
of eight enquiries in six countries. http://www.cec.health.nsw.gov.au/files/patientsafety/publications/patient-safety-report.pdf
Meads, G. & Ashcroft, J. (2005) The Case for Interprofessional Collaboration. In Health and Social
Care CAIPE Blackwell Publishing.
Nisbet, J. (2007) Interprofessional Learning: the Australian Perspective.
http://www.clinicalsenate.health.wa.gov.au/presentations/doc/Aug07_Nisbet.pdf
Roberts P (1994). Theoretical models of physiotherapy. Physiotherapy 80: 361-6.
Scholes, J. (2002) Cross-boundary working : implications for the multiprofessional team. Journal of
Clinical Nursing 11 (3) 399-408.
Sheehan, D., Robertson, L. & Ormond, T. (2007) Comparison of language used and patterns of
communication in interprofessional and multidisciplinary teams. Journal of Interprofessional
Care.21 (1), 17-30.
World Health Organisation (2010) Framework for Action on interprofessional education and
collaborative practice. http://www.who.int/hrh/resources/framework_action/en/