Module 1: Welcome & Program Overview

2. Module 1: Welcome & Program Overview

3. Acknowledgements • On behalf of the EnHANCE Ontario Project Partners, we would like to extend our appreciation to all of the individuals who have generously dedicated time to participating in brainstorming, planning, writing, reviewing, and editing the drafts of the resources.A wide range of stakeholders have contributed from their areas of expertise and experience, including college and university educators, service providers, organizational leaders and researchers. The iterative approach used to develop the education programs was critical to ensuring that these resources would meet the needs of the intended user.

4. Client Stories • The Client Stories have been adapted and modified by the EnHANCE Ontario project. They were originally published through the Canadian Collaborative Mental Health Initiative: Curran, V., Ungar, T., Pauzé, E. (2006). Strengthening Collaboration through Interprofessional Education:  A Resource for Collaborative Mental Health Care Educators. Mississauga, ON: Canadian Collaborative Mental Health Initiative; February 2006. Available at: www.ccmhi.ca

5. Adaptation of Tools • The EnHANCE Ontario Education Programs have been published in Word and PowerPoint formats to permit for the adaptation of these materials for different educational timeframes, processes, contexts and learners. In the interest of sharing resources and preventing the duplication of work, the project provides permission to individuals to modify the materials, to change the formatting, to use only certain sections, and to add or delete content to suit their needs. Individuals may photocopy, modify and distribute these materials for their use provided that proper attribution is given to the source.

6. Welcome! • Welcome to the EnHANCE OntarioEducation Program for Providers

7. What is EnHANCE? • “EnHANCE Ontario was a multi-partner project with a vision of leading the development of inter-organizational partnerships and enhancing capacity for the delivery of collaborative and interprofessional care for people seeking access to services across primary care, mental health and addictions organizations in Ontario.” • Funded by HealthForceOntario Interprofessional Care/Education Fund

8. Program Objectives The overall objectives of the EnHANCE Education Program include: • Examining ways providers can work together to enhance services for clients with complex mental health and addiction needs seeking access to services across MH&A and primary care settings • Exploring ways organizations can collaborate to enhance services for clients with complex mental health and addiction needs seeking access to services across MH&A and primary care settings • Reviewing elements of interprofessional collaboration and inter-organizational partnerships

9. Meet Stan • Stan is a 43 year old Caucasian male with chronic schizophrenia. He has had multiple admissions for his illness and is well known to the hospital and community team. • His mother, who had been his primary care giver, moved into a retirement home 5 years ago and has become more removed from his care.

10. Stan’s Story • When well, Stan is pleasant with a good sense of humour. Everyone likes him. When ill, Stan can be threatening and people quickly become afraid.

11. Stan’s Story (cont’d) • Stan has not been taking his medications. The pharmacist left a message at the Psychiatrist’s office • The community health nurse noticed Stan was becoming more suspicious and hostile • Stan’s mother reported that she thought Stan was becoming ill. What should she do?

12. Stan’s Story (cont’d) • Stan was brought by police to emergency. Stan refused bloodwork and became belligerent. Stan’s mother asked the nurses to check his blood sugar. They told her this would happen on the ward. • Stan’s mother came in the next day and found him listless and “out of it”. His blood sugar was checked and found to be dangerously high. He was transferred to a medical ward for stabilization.

13. Why EnHANCE? • Working together • Decreased competition • Decreased duplication • Less chance of “falling through the cracks” and blaming others • Recognizes the skills and expertise of others • For clients – working together increases the chances that their needs will be met by the right provider at the right time • For providers – working in an environment that supports their personal and professional needs • For the system – creating new and sustainable solutions

14. The Program • Goal: How do I become a better inter-organizational and intra-organizational collaborator? • Modules consist of theory, learning activities and in-depth case studies • Evaluation methods – Is there a test?

15. Module 2: Introduction to IPC

16. What is Interprofessional Collaboration (IPC)? • IPC occurs when members of two or more health disciplines come together around the client – to work together to address issues and concerns. • It is characterized by shared decision-making and mutual accountability within appropriate scope of practice roles. • Client is the focus.

17. Why IPE? • What is it? Interprofessional Education is…. "occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care” • Why is it important? Collaborative Patient-Centred Practice "is designed to promote the active participation of each discipline in patient care. It enhances patient- and family-centred goals and values, provides mechanisms for continuous communication among caregivers, optimizes staff participation in clinical decision making within and across disciplines and fosters respect for disciplinary contributions of all professionals”

18. Patient Safety • National Institute of Medicine’s comprehensive report on patient safety entitled To Err is Human, released in 2000 • In 2004, the Canadian Adverse Events Studywas released • 70,000 preventable adverse events (est.) each year in Canada

19. Canadian Interprofessional Health Collaborative (CIHC) • Competencies developed and releasedin 2010 • Interprofessional Communication • Patient/Client/Family/Community-Centred Care • Role Clarification • Team Functioning • Collaborative Leadership • Interprofessional Conflict Resolution

20. IECPCP Framework • Insert graphic

21. Foundation of the IECPCP Framework • Research to inform and evaluate • Social and cultural values • Government policies

22. The Professional System • The Professional System refers to regulatory context in which healthcare providers function. This context comprises the regulatory bodies that both define the scope of practice, and deal with liability issues. • Patient (Clients) – are central to collaborative client-centred practice. • Professionals – the term used for healthcare providers (regulated and non-regulated) • Task complexity – the types of services the client requires and interactions among the healthcare team and its clients.

23. Factors Supporting the Client-Provider Relationship • Interactional Factors influence the relationships between and among healthcare providers: • Shared Goals/Vision – existence of common goals and endorsement of these goals by the healthcare team. • Sense of Belonging – reflects an awareness of interdependencies and relationships among healthcare team members

24. Organizational Factors • Organizational Factors such as governance (leadership) and formalization (rules) can significantly influence collaboration at three levels: within a team, within the context of an organization, and between organizations. • Governance refers to the leadership functions that turn collaboration into a systemic requirement. • Structuring Clinical Care is the process of creating documented procedures to clarify each partners’ responsibilities, and for ongoing re-negotiation of those responsibilities.

25. IPC from the Provider Perspective

26. Inter-Organizational IPC • Currently 3 systems spanning physical health, mental health and addictions • Gaps and duplications

27. The Goal • All providers work together on behalf of the client • The client is in the centre

28. Module 3: Communities of Practice

29. Activity: Communities of Practice • Who is on your team? • Where does the client fit in? • Who is missing? • How can you include them?

30. Module 4: Partnership vs. Collaboration

31. Inter-Organizational Partnership vs. Inter-Organizational IPC • Inter-organizational Partnership: • Two or more organizations agree to formally or informally work together to provide services to a population of individuals • Inter-Organizational IPC: • Collaborative process at the healthcare provider level when the providers are working together to deliver interprofessional care across organizations

32. Benefits of Inter-Organizational IPC • Take a moment to individually list all the benefits of inter-organizational IPC… • Now let’s brainstorm as a group – did we generate more?

33. Client-Centred Care • Promotes participation of each healthcare provider • Enhances client and family-centred goals • Provides mechanisms for continuous communication • Optimizes staff participation in clinical decision making • Fosters respect for contributions made by healthcare providers • Allows providers to function as a service team for the client

34. Client-Centred Care (cont’d)

35. Module 5: Knotworking Teams

36. Knotworking • Knotworking describes a type of collaboration that is specific to inter-organizational partnerships and is the key difference between collaborating with other members of your own organization and collaborating with members of other organizations. • From the perspective of the client – the healthcare team should change to meet their needs • The knotworking team forms up around the client to meet his/her needs

37. Knotworking Teams Physician Pharmacist Social Worker Dietitian Nurse Discharge Planner Specialist Nurse Practitioner Occupational Therapist Social Worker Physician Nurse Social Worker Pharmacist Physician Social Worker Dietitian

38. Knotworking in Action • In your group, list the many teams you are part of – formally and informally to provide client care • Where are the examples of Knotworking? • Where are the opportunities for teams to form?

39. Module 6: Types of Teams and Features of Partnerships

40. Types of Teams • Multi-disciplinary – several different healthcare providers work side-by-side, but do so in a way that is independent or in parallel. • Inter-disciplinary – several professions working together in an integrated fashion, drawing on the expertise of one another to solve complex problems • Trans-disciplinary – several professions working together, consensus seeking behaviour is intentional, deliberate exchange of knowledge, skills, expertise and decision-making.

41. Continuum of Autonomy

42. Partnership Characteristics • Types of services performed by each of the partnering organizations • Professional and organizational cultures of the partnering organizations • Degree of autonomy versus team collaboration practiced by the healthcare providers • Size and complexity of the partners • Number of partners • Amount of funding available to support collaborative work • Physical distance between partnering organizations • Number of each type of provider within each partnering organization

43. Successful Partnerships • In your group, discuss the features of effective collaborations across partnerships. What sort of organizational processes support collaboration?

44. Features of Successful Partnerships • “Umbrella” Organizational structures • Inter-disciplinary (interprofessional) case management • Organized provider networks

45. Types of Partnerships • Partnership Agreement: A formal, typically long term, relationship between organizations, where each has defined obligations and contributions to meet a common goal. • Affiliation Agreement: A formal relationship that comprises cooperative efforts between universities, colleges and/or service providers to affect the academic interchange of faculty and students, and academic and research information

46. Types of Partnerships (cont’d) • Service Agreement: A formal relationship between a customer or client and the provider of a service or product. A service level agreement can cover a straight forward provision of a service or the provision of a complete function. • Secondment: A formal arrangement to temporarily transfer or ‘loan’ an employee to another part of an organization or to c completely different organization without any change in the employment relationship. • Strategic Alliance: A formal relationship where organizations come together to plan, operate or evaluate services that involve the sharing, exchange and co-development of services, procedures, process, skills and resources.

47. Principles Forming the Foundations of Success • Core values are necessary to help people with day-to-day decision-making….People need “guiding stars” to navigate and make decisions day to day. But core values are only helpful if they can be translated into concrete behaviours • Operating principles of a partnership need to be articulated and understood by all members of the healthcare team – including the client.

48. Principles • Equity – an equal right to be at the table and a validation of those contributions that are not measurable • Transparency – openness and honesty build trust – a key ingredient of successful partnerships • Mutual benefit – reaping the rewards of the partnership fosters continued commitment to it and sustainability

49. Principles (cont’d) • Stance– a position of receptive open-mindedness that considers other ways of understanding without being personally threatened. • Cultural Competence – Actively striving to understand the culture and the context of the primary care physician. • Integrative Systemic View – the ability to hold different representations and viewpoints all at once.

50. Provider-Level Principles • EICP principles: • Client centredness • Population health approach • Best possible care and services • Access • Trust and respect • Effective communication