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LEARNING OBJECTIVES. Geriatrics. Inter-Professional. Inter-Organizational. advance directives capacity assessment caregiver support delirium dementia screening depression driving capacity end-of-life care falls incontinence oral health osteoporosis pain polypharmacy
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LEARNING OBJECTIVES Geriatrics Inter-Professional Inter-Organizational • advance directives • capacity assessment • caregiver support • delirium • dementia screening • depression • driving capacity • end-of-life care • falls • incontinence • oral health • osteoporosis • pain • polypharmacy • preventative screening • achieving high performance • decision making and • communications • inter-professional ethics • formal and informal • influence processes • leadership • managing task and process • needs • patients and families as • team players • team culture and • development • understanding behavioural • styles • anticipating expectancy • dynamics • assessing boundary • functions • ethics in network • environments • organizational culture • recognizing teams within • teams • understanding network • analyses THE GiiC NETWORK Steering Committee Project Director/Project Manager GiiC Resource Consultants Network of GiiC Facilitators within FHTs and CHCs across the Province of Ontario RGP of Hamilton RGP of Kingston RGP of London RGP of Ottawa RGP of Toronto CERAH Thunder Bay North East SGS Sudbury The Geriatrics, Inter-Professional Practice, and Inter-Organizational Collaboration (GiiC) Initiative Dr. David Ryan, GiiC Project Director and Director of Education, Regional Geriatric Program of Toronto Ken Wong, GiiC Resource Consultant, Regional Geriatric Program of Toronto PROJECT BACKGROUND Providing care to frail seniors requires competencies in three areas: geriatrics, inter-professional practice, and inter-organizational collaboration (GiiC). Geriatrics because the clinical presentations of frail seniors are unique and complex; inter-professional practice because this complexity is beyond the scope of any single healthcare provider; and inter-organizational collaboration because the management of frail seniors requires the sharing of care across many organizational boundaries from primary and community-based care to emergency and hospital- based services. The Regional Geriatric Programs (RGPs) of Ontario, the Centre for Education and Research in Aging and Health (CERAH) in Thunder Bay, and the North East Specialized Geriatric Services (SGS) in Sudbury have been given an opportunity to work together with Family Health Teams (FHTs) and Community Health Centres (CHCs) to develop our capacity to provide effective inter-professional and collaborative shared care for seniors across the province of Ontario. We call this the GiiC initiative. Through this initiative, a team of GiiC consultants from the RGPs, CERAH, and the North East SGS have developed a GiiC knowledge-to-practice toolkit. In a series of regional workshops, the consultants will, in turn, train staff nominated by their Family Health Team or Community Health Centre in the use of the toolkit. The GiiC facilitators within their teams will be coached and supported by the regional GiiC consultants, as they find ways to bring GiiC knowledge into their organizations’ practices. We anticipate training as many as 200 facilitators and, through this, enhancing effective shared care for seniors across Ontario. The RGPs of Ontario, CERAH, and the North East SGS are grateful to the Health Force Ontario branch of the Ministry of Health and Long Term Care for funding this initiative under the auspices of their Interprofessional Blueprint for Care, to the project’s evaluation team from the Arthritis Community Research and Education Unit, and to the Hamilton Family Health Team and the Anne Johnston Health Station, whose directors sit on the GiiC initiative steering committee.