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. Case Study • The Leader’s Case Study has been adapted and modified by the EnHANCE Ontario project. The Case Study was 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 tools 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 tools, 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 tools for their use provided that proper attribution is given to the source.

6. Welcome! • Welcome to the EnHANCE Ontario Education Program for Healthcare Leaders

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 leaders and 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 Hazel • Hazel is an 84 year old South Asian woman who came to Canada as a young woman, married with 2 small children. She is now widowed and has dementia which is worsening. She is becoming less able to live independently. • Her two daughters will not agree to institutionalize her, and would like more supports at home. The hospital has a policy that in order to qualify for behavioural rehabilitation you must be placed on a waiting list for a nursing home…

10. Hazel’s Story • Worsening dementia, now forgetting medications and leaving the stove, kettle on • Daughter has her own family and can’t provide care as she would like – she feels guilty about this • Can’t afford a private caregiver • Promised her mother she would never put her in a home • Daughter disagrees with medications prescribed – feels they are dangerous • Daughter feels excluded from care decisions and is becoming more angry and frustrated . Feels her mother deserves better from a system she supported with her taxes for over 60 years.

11. 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, professional and client care needs • For the system – creating new and sustainable solutions

12. The Program • Examines processes required to establish inter-organizational collaboration for enhanced client-centred relationship-based care • Modules consist of theory, learning activities and case studies • Evaluation methods

13. Some Terms Before We Begin • Inter-organizational partnerships: organizational relationships at the administrative or leadership level.   • Inter-organizational IPC: organizational relationships at the service delivery or healthcare provider level. • Inter-organizational relationships: in this context, refers to both inter-organizational partnerships and inter-organizational IPC relationships that exist among people who work together across organizations.   • Inter-organizational agreements: signed, written agreements that are shared across two or more organizations, defining how they will work together

14. Module 2:Introduction to IPC

15. What is Interprofessional Collaboration (IPC)? • IPC occurs when members of two or more health disciplines come together around the client – it is characterized by shared decision making and mutual accountability within appropriate scope of practice roles. • Client is the focus • Communication and relationships are key

16. 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”

17. 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

18. Canadian Interprofessional Health Collaborative (CIHC) • Competencies developed and releasedin 2010 • Role Clarification • Team Functioning • Patient/Client/Family/Community-Centred Care • Collaborative Leadership • Interprofessional Communication • Interprofessional Conflict Resolution • Bill 46 and IPC Ontario – Charter of Expectations and Commitments

19. Canadian Patient Safety Institute • Safer Healthcare Now! Campaign • 6 safety competency domains identified

20. Accreditation Canada

21. Module 3: How to Decide Whether to Partner

22. How Do We Decide Whether to Partner? • Reasons to partner… • Two or more individuals from different organizations identify a common issue • A person or group of one organization identifies an opportunity or a gap in service • Potential efficiencies identified • Partnership is mandated by governing bodies • You are approached by another organization to partner

23. Step ONE • Educate yourself and your organization about partnership in general

24. 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

25. What Do Inter-Organizational Partnerships Look Like? • Which form they takes depends on factors such as: • Types of services to be performed • Professional and organizational cultures of the partnering organizations • Size and complexity of partners • Degree of autonomy vs. team collaboration • Number of partners • Amount of funding available • Physical distance between partnering organizations • Number of each type of provider within each partner organization

26. Features of Successful Partnerships • ‘Umbrella’ organizational structures to guide the integration of service delivery, support collaboration and maintain accountability • Inter-disciplinary case managementto plan for client needs, to set up appropriately coordinated services, consistent access to care, evaluation of outcomes • Organized provider networks common protocols, training and information systems to enhance access and provide seamless care

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

28. Benefits of Inter-Organizational Partnerships (cont’d) • Ability for each partner to participate in innovative initiatives • Ability to help clients get access to a more complete range of services • Accountability for all partners • Capacity to monitor and improve the overall performance of the service system • Choice and satisfaction for clients resulting in client retention • Continuity of care • Professional and service development activities, and education 28

29. Client-Centred Care • Promotes participation of each healthcare provider in client care • Provides a mechanism for continuous communication among caregivers • Optimizes staff participation in clinical decision making • Fosters respect for disciplinary contributions • Functions as a service team for the client

30. The Current Situation • Currently 3 systems spanning physical health, mental health and addictions • Gaps and duplications

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

32. Step TWO • Determine whether your organization has the culture to be a good partner

33. The Foundations of Healthy Inter-Organizational Relationships • Characteristics which indicate a promising future… • Shared Vision • Clear Rules and Performance Indicators • Meta-communication

34. Step THREE Clarify the benefits of partnering: • Believing that working together is a better approach than current risks • Exploration of a common issue or problem • Forming interest groups and/or committees • Gaining access to and sharing of client information • Gaining access to specialized diagnostic or treatment services • Providing better continuity of care

35. Step THREE (cont’d) Clarify the benefits of partnering: • Reducing duplication of services and increasing efficiency, thereby increasing the ability to serve more clients • Requiring additional resources to better serve clients • Requiring services for a specialized population • Requiring services provided in languages other than English

36. Step FOUR • Determine whether your organization has the financial, physical and human resources to partner. Consider: • Your organization’s mandate • Your funding and funding sources • Your existing range of services • Your resources

37. Organizational Capital • What does your organization have to offer a partnership?

38. Step FIVE • Make your decision about whether to partner • What if my partnership is mandated? • How is the decision to partner made? • Senior team? • Strategic planning? • Note: a key barrier to successful partnership is lack of “buy-in” by staff to key changes. To avoid this, be sure to engage key professional and administrative informal leaders in discussions about whether to partner.

39. Module 4: How to Find Appropriate Partners

40. How to Find Appropriate Partners • Learn about the community • Identify potential partners • Create a shared vision • Plan collaboratively

41. Step ONE • Learn about the community to find appropriate partners • Community asset mapping • Where to find information about community organizations • Chambers of Commerce • Clients’ families • Community centers • Friends and family • Healthcare associations • Libraries • Literacy groups • Local business associations • Local politicians’ offices • Parks and Recreation services • Departments • Professional networks • Self-help groups • Service clubs • The United Way

42. Step TWO • Identify potential partners • Know what you are looking for (i.e., what problem you are trying to solve) • Check websites, call, drop in and introduce yourself! • If they can’t partner, try and get a referral for a similar organization

43. Meet Your Community • In your group, spend some time discussing potential partnering organizations • What types of problems could you explore? • What can you learn from other partnerships?

44. Step THREE • Create a shared vision • A vision is an inspirational statement describing what the partnering organizations intend to achieve together; it is intended as a “clear guide for choosing current and future courses of action.” • A vision statement provides a foundation for policy

45. Characteristics of Effective Vision Statements • Genuine Value: Aspirational statement describing what partner organizations intend to achieve together • Communicating the Vision: Leaders need to believe in the vision and the benefits it represents • Shared Philosophy: Vision should be based on an understood philosophy to which all partners are committed

46. Guiding Principles (Core Values) • Guiding Principles may include: • How the organization relates to those it serves • How it relates to its product of service • How members of the organization relate to each other • What is valued • What is discouraged

47. Sample Organization-Level Principles • Sample organization-level principles: • Equity • Transparency • Mutual Benefit • Stance • Cultural Competence • Integrative Systemic View

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

49. Create a Shared Vision • In groups, create a shared vision that represents your groups core values • Each group member should think of 3 words that represent his/her core values • Compile the words and draft them into a statement

50. Step Four • How do we enhance the quality of the partnership? • leadership • administration and management • partnership efficiency • nonfinancial resources • partner involvement challenges • community-related challenges