Interprofessional Practice

1. Interprofessional Practice Promoting Partnerships in Health

2. Learning Objectives Define Interprofessional Practice Drivers of IPP Barriers to IPP Examples of IPP

3. Being Professional today means being … Interprofessional Inter- between, across, beyond -professional- a way of behaving

4. Types of Teams • Multidisciplinary • Interdisciplinary • Transdisciplinary

5. Interprofessional Teams • An interprofessional team is made up of members of different professions and positions • Individuals bring to the team the specialised knowledge, skills, methods and attitudes of their disciplines • Members integrate their observations, bodies of expertise and spheres of decision making to coordinate, collaborate, and communicate to optimise client care

6. Working Together for HealthWorld Health Report 2006 • Shift from tertiary hospital to patient centred, home based and team driven care • Increasing incidence of chronic conditions • Core competencies include: patient centred care, partnering, quality improvement, information and communication technology and a public health perspective.

7. Bio-psycho-social Model(Roberts, 1994) ‘‘the human being as a complex mix of internal physical, psychologic, social, and cultural variables living within an equally dynamic environmental mixture of social, cultural, interpersonal, economic, and political variables’’ (Kielhofner, 1985 as cited in Peloquin, 1997, p. 167)

8. Interprofessional Team /Multidisciplinary Team(Sheehan et al., 2007)

9. National Patient Safety Data (2006)(Nisbet, 2007)

10. Tragedies in Collaboration Bristol inquiry Kennedy Report Victoria Climbé Laming Report “Every Child Matters’

11. Patient/ Client/ Service User Identify a situation where you have been a service user.

12. Community Rehab Services –To maximise independence and community participation –To achieve durable outcomes and improved quality of life for clients –To reduce admissions and re-admissions –To improve continuity of care

13. Barriers to IPP • Differences in history and culture • Historical interprofessional and intraprofessional rivalries • Differences in language and jargon • Differing professional routines • Varying levels of preparation, qualifications and status • Fears of diluted professional identity

14. Professional Cultures Culture: the social heritage of a community. Values, beliefs, attitudes, customs and behaviours • Autonomy • Beneficence • Confidentiality • Dilemma • Duty • Ethics • Fidelity

15. Professional Culture • Justice • Morality • Non-malfeasance • Veracity

16. Stereotypes Stereotyping is a natural human process Positive : guide their intergroup behaviours efficiently deal with an outgroup with minimum expenditure of energy Negative : generate false or negative expectations of another groups’ attitudes or behaviours

17. Stereotypes in Health Care “Many allied health professionals work with patients for episodes of care. They have a distinct and purposive range of activities that can be easily explained and their contribution to patient care within the team can be clearly demarcated.” Scholes, 2002. “I see the occupational therapist as someone who walks around with a roll of Velcro in one hand and a lump of Blutak in the other. I think they try and stick Velcro anywhere they can.” “The doctors do what the consultants do which is to be standoffish and give very vague answers to your question in a rather imperial manner.”

18. Health Care Stereotypes Nursing Medicine Physiotherapists Occupational Therapists Speech Pathologists Pharmacists Dentists

19. Granny Draggers Physio terrorists Massage Therapists

20. Changing Health 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/responsibilities 􀀹 Increased expectations of interprofessional collaboration in education and practice 􀀹 Focus on evidence-informed practice 􀀹 Increasing demands for accountability/transparency 􀀹 Internationalization

21. Professional Cultures as Barriers • Social work perspective: Problem external ∆ Change the world • Health care perspective: Problem internal ∆ Change the person

22. Policy drivers The Multidisciplinary Health Team must adopt interprofessional practice to address: • the changing needs of the population; • changes in the incidence and treatment of disease; • changes in technology; and • changes in consumer expectations. WHO: Framework for Action 2010 The World Health Organization recognizes interprofessional collaboration in education and practice as an innovative strategy that will play an important role in mitigating the global health crisis.

23. Collaborative Skills for Teamwork • Cooperation • Assertiveness • Responsibility • Communication • Autonomy • Coordination

24. Interprofessional competencies • Interpersonal and Communication Skills • Patient/Client/ Service user –centred and Family focussed care (Relationship-based care) • Collaborative Practice

25. Interpersonal and Communication Skills • I effectively express my own knowledge and opinions to others involved in care. • I actively listen to the knowledge and opinions of other team members • I use information systems and technology to exchange relevant information among all professionals to improve care.

26. Relationship-based Care • I involve the service user and family (carers) in group decision making processes • I ensure continuous integration of service users and families (carers) in the team in order to maintain optimal, evolving care

27. Collaborative Practice • I take part in and support collaborative decision-making • I understand and respect roles and responsibilities • I actively contribute to team functioning • I participate actively in continuous quality improvement

28. CR Interdisciplinary Competencies 1. Frameworks of understanding 2. Networks and teams-collaborative practice 3.Cultural awareness 4. Holistic focus 5.Consumer engagement

29. ICF (WHO 2001, p.18)

30. CR Interdisciplinary Competencies 6. Service continuity 7. Reflective practice 8. Community engagement 9. Boundaries and personal safety 10. Systems advocacy

31. Interprofessional Education Interprofessional Education(IPE) “occasions where 2 or more professions learn with, from and about each other to improve collaboration and the quality of care” “ … lack of coordination between the education and health areas of government, leading to mismatches between education and training places and service delivery requirements” Productivity Research Report (2005:p.xxiv)

32. Children's Services • Multi-agency working acknowledges the inter-relatedness of family needs in the fields of health, social services, law enforcement, child welfare, housing and education. "there is a terrible danger here – is there not, doctor – of social services on the one hand and you on the other each expecting the other to do the investigation, with the result that nobody does".

33. IP & Palliative Care Origins of palliative care lie in religious care and nursing rather than medicine (Crawford & Price, 2001).

34. Community Rehabilitation Holistic framework Consumer Driven Advocacy Role Seamless Service

35. Interprofessional Practice in Health Interprofessional Practice is a partnership between a team of health professionals and a client in a participatory, collaborative and coordinated approach to shared decision making around health issues Together everyone achieves more

36. Interprofessional practice is reaching out beyond the team

37. Point 6 APA Code of Conduct APA members must communicate and cooperate with colleagues and relevant agencies in the best interests of their clients and the wider community. Members shall collaborate professionally with all relevant providers to achieve optimal client outcomes.

38. Longstanding fragmentation of health service delivery and the global health workforce shortage make collaborative teamwork an imperative. • The drive for collaborative teamwork is a World Health Organisation priority for action. • Collaborative teamwork is a sophisticated skill and some individuals are better at it than others; others may need staff development. • The main challenges to collaborative teamwork are understanding others’ roles, and effective communication. • If quality care is the goal for patients and families clinical competence must be balanced with collaborative competence. • Strategies to improve the effectiveness of service delivery need to be political, organisational and professional.

39. APA (2008) APA Code of Conduct http://www.physiotherapy.asn.au/images/APA_Corporate_Documents/apa_code_of_conduct.pdf Australian Health Ministers Conference National Health Workforce Strategic Framework 2004 Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). New York: Oxford University Press. Crawford, G. & Price, S. (2003)Team working: palliative care as a model of interdisciplinary practice MJA,179: S32–S34 Hindle, D., Braithwaite, J., Travaglia, J. & Iedema, R. (2006) Patient Safety: A comparative analysis of eight enquiries in six countries. http://www.cec.health.nsw.gov.au/files/patient-safety/publications/patient-safety-report.pdf Meads, G. & Ashcroft, J. (2005) The Case for Interprofessional Collaboration. In Health and Social Care CAIPE Blackwell Publishing. Nisbet, J. (2007) Interprofessional Learning: the Australian Perspective. http://www.clinicalsenate.health.wa.gov.au/presentations/doc/Aug07_Nisbet.pdf Roberts P (1994). Theoretical models of physiotherapy. Physiotherapy 80: 361-6. Scholes, J. (2002) Cross-boundary working : implications for the multiprofessional team. Journal of Clinical Nursing 11 (3) 399-408. Sheehan, D., Robertson, L. & Ormond, T. (2007) Comparison of language used and patterns of communication in interprofessional and multidisciplinary teams. Journal of Interprofessional Care.21 (1), 17-30. World Health Organisation (2010) Framework for Action on interprofessional education and collaborative practice. http://www.who.int/hrh/resources/framework_action/en/