2008 HEALTH SERVICES & POLICY RESEARCH DAY SINCLAIR LECTURE

1. 2008 HEALTH SERVICES &POLICY RESEARCH DAYSINCLAIR LECTURE New Vision, New Journey, New Promise: Interdisciplinary Health Care in a New Time 26 November 2008

2. Crucial to finding the way is this: there is no beginning or end. You must make your own map. Joy Harjo Map to the Next World: Poems

3. Barred Spiral Milky Way: - Credit: R. Hurt (SSC), JPL-Caltech, NASA Survey Credit: GLIMPSE Team

4. DR. DUNCAN G. SINCLAIRMAKER OF NEW MAPS

5. DR. DUNCAN G. SINCLAIRMAKER OF NEW MAPS • Veterinary College, Ph.D. in Physiology at Queen's • Markle Scholar in Academic Medicine at Queen's • Dean of the Faculty of Arts and Science at Queen’s • Vice-Principal (Institutional Relations) at Queen’s • Director General of Program Operations at MRC • Honorary Fellowship in the RCPSC • Ontario MOH Committee for Review of the Public Hospitals Act • Premier's Council on Health, Well-Being and Social Justice • Ontario Cancer Treatment and Research Board • National Forum on Health • Chair of Ontario's Health Services Restructuring Commission • Founding Chair of the Board of Canada Info Highway • Committee on Collaborative Health Professional Education and Research – Memorial University

6. At the end of the first decade of this twenty-first century, we are called to see with new eyes to hear with new ears to dare with new thinking to act with new passion if we are to help create a truly strong, safe and responsive health system in Canada.

7. OVERVIEW OF REFLECTIONS • Context in changing society • New vision = interdisciplinary health care • New journey = transformation of culture • New promise = leaders and champions • New hope = readiness to respond

9. CHANGES IN WESTERN SOCIETY • Demographic shifts • Cultural diversity • Financial uncertainty/volatility • Increasing urbanization • Impact of technology • Changing face of family • Reality of poverty and violence • Pollution of the environment • Role of women • Expectations of public service

10. CHANGING 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 and responsibilities • Increased expectations of inter-professional collaboration in education and practice • Focus on evidence-informed practice • Increasing demands for accountability and transparency • Internationalization • Loss of control over working conditions

11. EXAMPLES OF HEALTH DISCIPLINES

12. NEW VISION

13. COLLABORATION Collaborative patient-centered practice is designed to promote the active participation of several health care disciplines and professions. It enhances patient-, family-, and community-centred goals and values, provides mechanisms for continuous communication among health care providers, optimizes staff participation in clinical decision making (within and across disciplines), and fosters respect for the contributions of all providers. Health Canada, 2003

14. FINDING THE BALANCENEW PARADIGM All health professionals retain their high degree of competence and individual professional identities All health professionals develop the capacity to • work happily and productively together • be knowledgeable about and confident in one another’s contributions to health and community service teams Committee on Collaborative Health Professional Education and Research – MUN

15. SPECTRUM OF INTER-PROFESSIONALISM PRESENT IN MOST HEALTH ORGANIZATIONS • Climate of mutual respect and trust • Cooperation = formal communication, independent decision-making • Shared information • Consultation • Coordination = defined roles, some shared decision-making • Shared vision, goals and planning • Shared resources

16. SPECTRUM OF INTER-PROFESSIONALISM ABSENT IN MOST HEALTH ORGANIZATIONS • Collaboration= defined roles, frequent communication, shared decision-making, one system • Teamwork – specific tasks, patient-centered • Collective responsibility – organizational integration • Shared leadership, control, risk and accountability

17. OUTCOMES SOUGHT • Health professional graduates, comfortable and experienced in working together, who will create and staff collaborative teams • New knowledge, skills and attitudes that transcend traditional disciplinary and professional boundaries, derived from collaborative research and inter-professional education and practice • Exemplary practice models by which teams of health and community service professionals provide a range of services Committee on Collaborative Health Professional Education and Research – MUN

18. IMPLICATIONS FOR UNIVERSTY PLANNING • Articulation of new direction in values statements, strategic priorities and explicit goals • Faculties and Schools collaboratively offering programs of professional study • Practice experience in model environments representative of the people and communities • Curriculum elements (modules, courses, and programs) to prepare students to derive the greatest benefit from their collaborative practice experiences

19. IMPLICATIONS FOR UNIVERSTIES • Environment that draws together students, professional staff, faculty members, and health and community service professionals and facilitates their engagement in basic and applied collaborative inter-professional research • Non-hierarchical environment of “learning together” in which students in the participating professional programs will learn from one another: • the value of collaborative inter-professional contributions and inter-dependencies in the provision of services and programs both to individuals and to communities • knowledge of and respect for the particular competencies of each profession Committee on Collaborative Health Professional Education and Research – MUN

20. BARRIERS • Silo structures and long-standing disciplinary boundaries among and across the professions • Differences in history and culture, language and jargon, schedules and professional routines • Historical inter-professional and intra-professional rivalries • Varying levels of preparation, qualifications and status • Differences in requirements, regulations and norms of professional education • Fears of diluted professional identity • Differences in accountability, payment and rewards • Concerns regarding clinical responsibility Headrick, Wilcock & Batalden (1998)

21. CHALLENGES • Lack of funding to review curriculum and teaching methods and to make needed changes • Lack of funding for student placement, transportation, and model site expansion • Overly crowded curricula and competing demands • Lack of an evidence base assessing the impact of changes in teaching methods or curriculum • Fragmented responsibilities for undergraduate and graduate education • Little integration across oversight processes, including accreditation, licensing, and certification • Unsupportive culture and norms in health professions education • Emphasis on research and patient care in many academic settings, with little reward for teaching • Insufficient channels for sharing information and best practices • Lack of faculty and of faculty development

22. NEW JOURNEY

23. CULTURE CHANGE • Culture is dynamic and changing over time • Most individuals are able to adapt: some have a greater facility to accommodate otherness in their internal meaning structure than others • The need for change may be driven by survival or passion

24. NATURE OF CULTURAL ISSUES • Systemic: Pervasive throughout the organization usually based in polices, procedures, and organizational structures • Local: As cultures within cultures naturally form, practices, traditions, and norms emerge that are unique to a work group (e.g., profession, program, facility) • Individual: persons bring their own values, philosophies, and biases to the organization The Winters Group, Inc. (2001)

25. CHALLENGE OF CULTURE TRANSFORMATION OTT Management Consultants

26. KEYS TO CULTURAL TRANSFORMATION • Scanningthe environment • Determining implications • Revisitingthe mission • Banning the old hierarchy and building flexible, fluid structures and systems • Challenging – questioning every policy, practice, procedure, and assumption • Communicatingwith a few powerful, compelling messages • Dispersingthe responsibilities of leadership Frances Hesselbein

27. NEW PROMISE

28. LEADERS ACT WISELY • With Knowledge • At all Levels • Strategically • Tactically • Operationally • Collaboratively

29. LEADERS ACT PASSIONATELY • Intentionally • Persistently • Relationally

30. LEADERS ACTCOURAGEOUSLY • As catalysts • Knowing vulnerability • Caring for self and others

31. LEADERS AS CATALYSTS • Manage diversity, be inclusive • Respond within changing social realities • Understand globalization and health care reform • Reintroduce values of flexibility, discovery and innovation – stretch into new ways of thinking, allow creativity, questions, risk • Interconnect practice, education, research and administration • Tell stories • Re-inspire spirit

32. NEW HOPE

33. READINESS TO RESPOND • Awareness of complexity • Skills development • Strengths of tradition • Emotional preparedness • Reflection • Ceremonies and celebration • Symbols • Confidence/conviction

34. IMAGE OF COLLABORATION I’m sittin’ on my stage-head lookin’ out at where Skipper Joe Irwin’s schooner is ridin’ at her moorin’ … thinkin’ about how weak are the things that try to pull people apart – differences in colours, creeds and opinion – weak things like the ripples tuggin’ at the schooner’s chain. And thinkin’ about how strong are the things that hold people together – strong, like Joe’s anchor, and chain, and the good holdin’ ground below. Ted Russell, The Holdin’ Ground

36. A BLESSING FOR EQUILIBRIUM Like the joy of the sea coming home to shore,May the music of laughter break through your soul.As the wind wants to make everything dance,May your gravity be lightened by grace.Like the freedom of the monastery bell,May clarity of mind make your eyes smile.As water takes whatever shape it is in,So free may you be about who you become.As silence smiles on the other side of what’s said,May a sense of irony give you perspective.As time remains free of all that it frames,May fear or worry never put you in chains.May your prayer of listening deepen enoughTo hear in the distance the laughter of God. John O’Donohue, Benedictus – A Book of Blessings