Ruby Grymonpre, PharmD Professor, Faculty of Pharmacy IPE Coordinator, UofM January 11, 2012

1. Redefining Teamwork with Interprofessional Education and Practice:The Academic and Clinical Realities Ruby Grymonpre, PharmD Professor, Faculty of Pharmacy IPE Coordinator, UofM January 11, 2012

2. Session Outline By the end of this presentation, you will be able to: • Describe the drivers for interprofessional education & collaborative practice (IPE&P) • Define key terms related to IPE&P • Outline the systems approach being used in Manitoba to implement IPE&P • Articulate the key goals and actions for WRHA and UofM with respect to IPE&P

3. Health and Wellness of Individuals • 55% of Canadians suffer 1 or more chronic conditions • 89% of deaths each year due to chronic disease • Chronic disease costs over $100 billion in Canada • Prevention and management of chronic disease in individuals has become health care priority http://www.ocdpa.on.ca/docs/OCDPA_EconomicCosts.pdf accessed May 27, 2010 http://www.queensu.ca/sps/publications/press/intros_tocs/EmergingApproaches_Intro.pdf accessed May 27, 2010

4. Health and Well-being “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1948)

5. The problem • Dependent on expensive new technologies • Hospital is central • Provider-centred: patients come to us

6. The problem • emergency room overcrowding • difficult access to the necessary care • poor record on patient safety • long wait times • inconsistent quality • high costs with poor outcomes

7. The problem • Health professions have evolved in parallel with very different traditions for education and clinical service • Professionals have poor understanding of expertise and scope of practice of colleagues • Reimbursement systems have fostered competition over collaboration between disciplines

8. The problem Health Human Resource Crisis estimated worldwide shortage of almost 4.3 million health workers aging workforce poor working conditions job dissatisfaction http://www.who.int/hrh/professionals/en/Accessed Jan 11, 2012

9. Interprofessional Education Collaborative Person Centred Practice IPE&P

10. Where’s the evidence for IPE&P? • Increased access to health care • Improved outcomes for people with chronic diseases • Less tension and conflict among caregivers • Better use of clinical resources • Easier recruitment of caregivers • Lower rates of staff turnover Canadian Health Services Research Foundation. Teamwork in Healthcare: Promoting Effective Teamwork in Healthcare in Canada. Ottawa, ON: CHSRF; 2006. http://www.chsrf.ca/SearchResults.aspx?search=Teamwork%20in%20health%20care Accessed January 11, 2012 Lemieux-Charles L, et al. What do we know about health care team effectiveness? Med Care Res Rev 2006;63(3):263–300

11. Cochrane Review (2008) 4 of 6 studies found that IPE resulted in: • improved working culture in ED and patient satisfaction; • decreased errors in ED • improved management of the care delivered to domestic violence victims • improved knowledge and skills of professionals providing care to mental health patients 2 of these 4 studies found mixed results 2 of 6 studies found that IPE had little to no effect Reeves S et al. IPE: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD002213. DOI: 10.1002/14651858.CD002213.pub2.

12. WHO statement “After almost 50 years of enquiry, the World Health Organization and its partners acknowledge that there is sufficient evidence to indicate that effective interprofessional education enables effective collaborative practice.” “Collaborative practice strengthens health systems and improves health outcomes.” Framework for Action on Interprofessional Education and Collaborative Practice, 2010 http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf p 7 accessed January 11, 2012

13. WHO Statement “Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.” http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdfp 10

14. Sydney Interprofessional Declaration • All users of health and human services shall be entitled to fully integrated, interprofessional collaborative health and human services. • All health and human services work to create and strengthen a culture that promotes the delivery of contextual opportunities for interprofessional learning and collaborative team training. Interprofessional education and training for collaborative practice should be a core element of continuing professional development. • Health worker education and training prior to practice shall contain significant core elements/learning domains of interprofessional education. These core elements/learning domains shall contain practical experiences, for example simulation. These core elements/learning domains for interprofessional education will be formally assessed. • Between ATBH5 and ATBH6 the global interprofessional community will undertake to develop a globally agreed upon set of definitions and descriptions that capture interprofessional education, learning, practice and care. • The global interprofessional community will work with the World Health Organization to implement the Framework for Action on Interprofessional Education and Collaborative Practice. http://www.cihc.ca/files/The%20Sydney%20Interprofessional%20Declaration.pdf

15. Health Canada Building on Values: The Future of Health Care in Canada “…the direction of our health care system must be shaped around health needs of individual patients, their families and communities.”- CPCP - “If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.”- IPE – November 2002, Commissioner Roy J. Romanow, Q.C. http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/romanow_e.html Accessed January 12, 201

16. Health Canada – HHR Strategy Health Human Resource Planning—ensuring we have enough of the right types of health-care providers to meet the needs of Canadians; Recruitment and Retention—encouraging more people to enter the health-care field and improving working conditions to keep them there; and Interprofessional Education for Collaborative Patient-Centred Practice [IE(CP)2 ]—changing the way we educate health providers so Canadians will have better and faster access to the health-care provider they need when they need it, ultimately boosting the satisfaction of both patients and health-care providers. http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/index_e.html Accessed January 12, 2012

17. Reality check in Manitoba “there appears to be no active program of interprofessional learning at that centre [University of Manitoba]”. Cook D. “Models of Interdisciplinary Learning”Report to Health Canada. February, 2004 page 25

18. Total of 20 Health Canada funded projects across Canada 1 1 1 1 2 3 1 3 7

19. IPE Offices/Initiatives in Canada Ontario: Canadore College Centennial College Confederation College George Brown College Humber Institute of Technology & Advanced Learning McMaster University Michener Institute for Applied Health Sciences Niagara IP Health Education Institute Northern Ontario School of Medicine Queen’s University Ryerson University University of Toronto University of Western Ontario Nova Scotia: Dalhousie Alberta: University of Alberta Saskatchewan: University of Saskatchewan Quebec: McGill University University of Sherbrooke Manitoba: University of Manitoba British Columbia: University of British Columbia University of Victoria Vancouver Community College Newfoundland: Memorial University

20. Accreditation of Interprofessional Health Education (AIPHE) • Accreditation Council of Canadian Physiotherapy Academic Programs • Canadian Association of Occupational Therapists • Canadian Council for Accreditation of Pharmacy Programs • Canadian Association of Schools of Nursing • Canadian Association of Schools of Social Work • Committee on Accreditation of Canadian Medical Schools • Royal College of Physicians and Surgeons of Canada • College of Family Physicians of Canada

21. Accreditation of Interprofessional Health Education (AIPHE) Phase I – 2007- 2009 Phase II – 2010-2011 http://www.afmc.ca/aiphe-afiss/documents/AIPHE_Principles_and_Implementation_Guide_EN.pdf

22. National Health Sciences Students’ Association (NaHSSA) “The National Health Sciences Students’ Association strives to promote collaborative patient-centred practice and teamwork through interprofessional education in order to respond to the evolving health care needs of Canadians.” MaHSSA http://www.nahssa.caAccessed January 11, 2012

23. The systems shake

24. Manitoba Health Care System • Manitoba Health oversees provincial health care system and sets broad policy direction • RHAs responsible for assessing/prioritizing needs, goals and coordinating health services • 11 RHAs in Manitoba • WRHA responsible for health services for 60% of 1.2 million MB residents • WRHA encompasess over 200 programs, services, facilities • includes 9 acute & long term care centres, 16 community health offices and 39 personal care homes • 36 regional program teams

25. Post-Secondary Education in Manitoba 13 Academic Units: • Clinical Health Psychology • Dentistry • Dental Hygiene • Human Ecology • Kinesiology & Rec Management • Social Work • Medicine • Nursing • Occupational Therapy • Pharmacy • Physical Therapy • Physician Assistants • Respiratory Therapy Advanced Education & Literacy Council of Post Secondary Education oversees allocation of funds to the province's seven public post-secondary institutions University of Manitoba: 27,000 students

26. Council of Post Secondary Education Manitoba Health University of Manitoba Winnipeg Regional Health Authority COLLABORATIVE PERSON CENTRED CARE UofM IPE INITIATIVE

27. UofM IPE Initiative Mission • To graduate health professionals prepared to manage and adapt processes in interprofessional (IP) teams necessary to achieve person- and family- centred health and wellness outcomes. This will be achieved through innovative learning opportunities for students to learn about, with, and from each other at the University of Manitoba Vision • Improved health and well-being for Manitobans by building a culture of interprofessional education and practice.

29. WRHA Professional Advisory Committee • Senior patient care committee reporting to CEO and Board with representation from nursing, allied health, and medical leadership • Focus is on collaborative practice, scope of practice and evidence informed practice • In 2009, action plan developed to advance interprofessional education and practice within the region

30. WRHA Collaborative Care http://www.wrha.mb.ca/professionals/collaborativecare/

31. What is Interprofessional Education? “…..occurs when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes…” * Professional is an all-encompassing term that includes individuals with the knowledge and/or skills to contribute to the physical, mental and social well-being of a community. Framework for Action on Interprofessional Education and Collaborative Practice, 2010 http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf p 13 accessed Jan 12, 2012

32. What does IPE look like? • An educational approach • Requires interaction • Something must be exchanged that changes how they perceive themselves and others • Changes must positively affect clinical practice http://www.afmc.ca/aiphe-afiss/documents/AIPHE_Principles_and_Implementation_Guide_EN.pdf

33. What does IPE not look like? It is not: a collective of learners from different professions sitting in the same room listening to the same lecture - or - learners from one profession sharing knowledge with one or more other professions in a one way exchange http://www.afmc.ca/aiphe-afiss/documents/AIPHE_Principles_and_Implementation_Guide_EN.pdf

34. Terminology ‘Uni’ professional: occasions when professionals or students from one profession learn together ‘Multi’ professional : occasions when two or more professions learn side by side but in parallel (minimal interaction) ‘Inter’ professional: occasions when two or more professionals learn about, with, and from each other to improve collaboration and the quality of care ‘Trans’ professional: occasions in real practice where professional boundaries have been crossed or merged Carpenter J, Dickinson H Interprofessional Education and Training. Policy Press. Great Britain. 2008. p.3

35. What does collaboration look like?

36. The 3 C’s Communication: the imparting or interchange of thoughts, opinions, or information Cooperation: parallel activities among individuals or organizations that associate informally to accomplish their common goals Denise L, Collaboration vs C-Three. Innovating 1999(Spring): 7(3)

37. Collaboration “...is the process of shared creation: two or more individuals with complementary skills interacting to create a shared understanding that none had previously possessed or could have come to on their own. Collaboration creates a shared meaning about a process, a product, or an event. In this sense, there is nothing routine about it. Something is there that wasn’t there before.” Michael Schrage, Shared Minds, NY: Random House, 1990, p. 140

38. Canadian Interprofessional Health Collaborative (CIHC) www.cihc.ca/resources/publications

39. Here Now: Getting it Wrong - The Problem with Words

40. What’s in a name? Individual Family Recipient Consumer Patient Service user Expert by experience Person Customer Client Caregiver Participant

41. Whats in a name? Rotation Practicum Fieldwork placement Service Learning Experiential learning Community project Clinical placement Cooperative learning Clerkship Structured practical experience Internship Externship Community placement Practice education

42. UofM IPE Curriculum Blueprint Guide and monitor implementation of IPE • a ‘balance’ of competencies are addressed through a student’s university education • learning occurs along a continuum • by graduation, learning around all competencies has been accomplished To ensure IPE: • strategic, transparent, uses common terminology • explicitly states/addresses ≥ 1 learning objective • is assessed (students) and evaluated (session)

43. The University of Manitoba IPE Curriculum Blueprint

44. Understanding Roles and Responsibilities Exposure: Knowledge • Articulate your professional role in the care of individuals • Articulate the roles and scopes of practice of other members of the IP team and identify areas of responsibility overlap Attitudes: • Reflect on personal values/beliefs regarding scopes of practice and role overlap

45. Understanding Roles and Responsibilities Immersion: Skills/Behaviours: • During an IP shared care planning session negotiate responsibilities/actions based on role constraints, overlap, and discipline-specific legal/ethical practice standards.

46. Understanding Roles and Responsibilities Mastery: Has sufficient confidence in and knowledge of: • one’s own discipline to work effectively with others in order to optimize person centred care • others’ professions to work effectively with others in order to optimize outcomes for individuals

47. Curriculum Overload

48. Guiding Principles • We value interprofessional education (IPE) and foster its existence where and when two or more professions are involved. • We value IPE that is integrated in University of Manitoba curricula and foster its development through: • We value IPE in which its uniqueness is a well understood identity within the university culture through: • We value a common understanding of IPE among all faculty, in which: • We value evaluation of and scholarship in UofM IPE Initiative in which:

49. ? ? ? Questions? ? ? ?