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. ClientStories • 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 Ontario Education Program for Healthcare Students

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 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 health disciplines come together around client care issues, whereby decision-making happens within the group, and a transformation occurs. • 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 released in 2010 • Role Clarification • Team Functioning • Patient/Client/Family/Community-Centred Care • Collaborative Leadership • Interprofessional Communication • Interprofessional Conflict Resolution

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

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

22. Module 3: Communities of Practice

23. Activity: Communities of Practice • Who will be on your team? • Where does the client fit in? • Are there others missing? • How can you include them?

24. Module 4: Partnership vs. Collaboration

25. Inter-Organizational Partnership vs. Inter-Organizational IPC Partnership: • Two or more organizations agree to formally or informally work together to provide services to a population of individuals Collaboration: • IPC at the provider level when the service providers are working together across organizations

26. 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?

27. Client-Centred Care • Promotes participation of each healthcare discipline • Enhances client and family-centred goals • Provides mechanisms for continuous communication • Optimizes staff participation in clinical decision making • Fosters respect for contributions made by all professionals • Function as a service team for the client

28. Client-Centred Care (cont’d)

29. Module 5: Knotworking Teams

30. Knotworking • Knotworking describes a type of collaboration within and between 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

31. 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

32. Knotworking in Action • In your group, list the many teams you have been part of – formally and informally during your training • Where are the examples of knotworking? • Where are the opportunities for teams to form?

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

34. Types of Teams • Multi-disciplinary – several professions working side by side, independently or in parallel. Decisions are made autonomously • 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, client is active in decision making

35. Continuum of Autonomy

36. Features of Partnerships to Consider • 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

37. Features of Partnerships to Consider (cont’d) • 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

38. What Features Have You Experienced? • What features of organizational support have you experienced that enhance collaboration?

39. Features of Successful Partnerships • Organizational structures to guide the integration of service delivery, support collaboration and maintain accountability • A single point of entry for clients through an interdisciplinary case management approach • Organized provider networks to enhance access and provide seamless care • Financial incentives to promote prevention, rehabilitation and service integration

40. Types of Partnerships • Partnership:A formal, typically long term, agreement between organizations where each has specific obligations and makes specific contributions • Affiliation: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

41. Types of Partnerships (cont’d) • Service Agreement: A formal relationship between a client and the provider of a service or product. • Secondment: An arrangement to temporarily “loan” an employee to another organization or department without any change to the employment relationship • Strategic Alliance: A formal relationship where organizations come together to plan, operate or evaluate shared services

42. 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.

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

44. Module 7: Types of Partnerships

45. Inter-Organizational Partnership Framework

46. Green Light Partnerships • Joint discussion of a health problem or need • Networking events • Research collaborations • Service planning • Service resolution tables (e.g., placing clients with complex needs, if organizations are already part of a informal partnership or network) • Case conferencing • Develop a program proposal for new joint service • Discussion of resources being spent to meet a community need for services • Education (e.g., staff development; joint conference for IPE) • Informal networks/committees/interest groups • Joint advocacy plan

47. Yellow Light Partnerships • Medium term resource transfer • Pilot program, or pilot phase of a program • Policy development • Secondment of staff or staff sharing (short to medium term) • Service networks (e.g., primary purpose of information sharing, planning) • Sharing common client information • Submitting a proposal to funders • Co-location (e.g., shared office space/program space if short-term) • Development of an IPE framework agreement • Feasibility analyses • Funding arrangement covered in Multi-Sectoral Service Accountability Agreement (MSAA), Health Services Accountability Agreements (HSAA) or LHIN agreements • Interventions with common clients • Joint discussion of a program response

48. Red Light Partnerships • Secondment agreement (e.g., outline payment, supervision, liability) • Shared administration (e.g., back office: information technology, accounting, human resources) • Shared care (e.g.,needs agreement on staff responsibilities, risk) • Shared client service responsibilities • Signing and implementing of IPE programs • Student involvement(e.g., placements, internships, practicum) • Co-located services • Coordinated access (needs agreement to specify obligations of parties, e.g., referral process) • Evaluation (e.g., how, what, when) • Funding (e.g., how, who, what for?) • Implementation of advocacy strategy • Mandated partnership/relationship • Research collaborations • Resource commitments (e.g., human, financial, equipment, other)

49. Reasons to Partner • Challenges accessing services for clients • Gaining access to specialized services • Requiring additional resources to better serve clients • Requiring services provided in other languages • Requiring services for a specialized population • Providing better continuity of care

50. Reasons to Partner (cont’d) • Gaining access to and sharing of client information • Gaining access to specialized diagnostic or treatment services • Wanting to explore an issue or problem • Looking for opportunities • Forming interest groups/committees • Believing that collaboration is a better approach than current risks