Interprofessional learning : lessons from health care?

1. Interprofessional learning :lessons from health care? Dr Charles Campion-Smith GP & Senior adviser in primary care education and development, School of Health & Social Care, Bournemouth University.

3. Presentation outline Background ideas • “Interprofessional” vsmultiprofessional & multidisciplinary • Adult learning • Appreciative inquiry • Teams and teamworking • Working in a complex world • Narrative Some stories of our learning • Palliative care Masterclass course • Practice professional development plans • Palliative care teaching in Tanzania

4. Interprofessional learning • Occasions when two or more professions learn with, from and about each other, to improve collaboration and the quality of care CAIPE (UK Centre for the Advancement of Interprofessional Education) 2001

5. Interprofessional learning • Learning about the roles, strengths and limitations of other professions • Dispelling myths and stereotypes • Learning about others’ values and mental models • Building relationships • Clarifying one’s own professional identity

6. Interprofessional Learning • How we work, not something we teach • Based on sound and secure professional knowledge • Helps health care staff do something they want to do – improve the life of patients and users

7. Exploring problems together Improvement is part of life…… When a group of optimistic and motivated people ask the same questions they become part of a dynamic curious team, exploring ways of working together and bringing them home to test them out. There is a special synergy in the collective energy of people working together to explore a question. Berwick D, speaking at launch of NHS Modernisation Agency Associate programme London March 18th 2002

10. Adult learners • Are not beginners but are in a continuing process of growth • Bring a wealth of experiences and values • Come to education with intentions • Already have set patterns of learning • Need to know why they need to learn something • Need to learn experientially • Approach learning as problem-solving • Learn best when the topic is of immediate value • Have competing interests – the realities of their lives (Knowles & Brookfield)

11. Continuous Quality Improvement • Takes a patient / user focus • Match service to users’ need • Quality improves as the match improves • Views care as the product of a complex system comprising a number of inter-related processes • Has clear aims • Uses balanced sets of outcome measures • Encourages serial experimentation and measurement

12. Complexity and CPD • Primary care is a world of uncertainty • Feelings, values and beliefs matter greatly • Critical judgement is important • We deal with individuals, not populations • We can be informed by evidence, but not dictated to by it • Shared decision making is vital – “Evidence-based patient choice”

14. Complexity and Improvement • Inputs and outcomes are often not linearly related • Understanding the process and interactions is key • Lasting change is only achieved by changing the system – trying harder is not enough

16. Learning & complexity • Learning takes place in the zone of complexity, where relationships between items of knowledge are not predictable or linear, but neither are they chaotic. • Learning builds a capability to enable people to work effectively in unfamiliar contexts, but this cannot be taught or gained passively.

17. Capability is more than competence • Competence – what individuals know or are able to do in terms of knowledge, skills & attitude. • Capability – extent to which individuals can adapt to change, generate new knowledge and continue to improve their performance. Fraser & Greenhalgh BMJ 2001

18. Appreciative Inquiry ~ 1 • The search for the best in people, their organisations and the world around them • Looking at a system when it is functioning at its best, most effective and capable in human, ecological and economic terms • It is better to seek out what goes well and do more of it, than seeking what does not work and doing it less.

19. Appreciative Inquiry ~ 2 • “Human systems move in the direction of what we most persistently ask questions about.” (Cooperider) • A shift of focus from deficiencies to resources, from failures to successes and from shortcomings to competence and capacity. • Using positive stories to establish a sense of competence and confidence.

20. Appreciative Inquiry ~ 3 • Helps groups, teams, organisations and communities create new, generative images for themselves based on affirmative understanding of their past. • Focuses on positive conversations, language and behaviour as being key to change and improvement.

21. Appreciative inquiry ~ 4 • Dialogue is deliberate and generates creative and collaborative conversations, which lead to improvement. • There is constructive engagement with the views, values and feelings of team members. • A readiness to change one's perceptions and purpose encourages reflection and builds common purpose and understandings in teams.

22. Group work ~ 5 Minutes • Please work in pairs or threes to share stories of successful learning or team working you have been involved with as a teacher or learner, in your professional or leisure activities. • Use the AI model to say what happened and how it felt. • Can you think of any good metaphors or similes to describe this • Reflect on the more general principles of successful interprofessional education • Be ready to share 2-3 points with the main group

23. Improvement • Improvement is. I believe, an inborn human endeavour…….And so, it is my premise that almost all human organisations contain in their workforce an internal demand to improve their work. It saddens me how few organisations seem to know this and fewer still act on it. Improvement is not forcing something; it is releasing something. Berwick D, BMJ 8 May 2004.

24. Sharing stories, changing practice: an interprofessional narrative-based palliative care course

25. Who came? • General Practitioners • Community / District Nurses • Community & Acute Hospital Nurses • Social workers • Hospital Doctor • Emergency care practitioner

26. The preliminary meeting • Appreciative Inquiry model • Discussion of style and format of course • Hearing participants’ ideas about content • Invitation to sign up for whole series

29. Group work • Agreed ground-rules: acknowledge status & power differentials • Active facilitation • Preparation – homework • Sharing stories • Preparing questions • Reflecting on practice and learning

30. Evaluation Immediate • by ‘fast feedback’ forms at end of each session • Ask about pace, clarity and relevance to practice • Ask about outstanding issues Later (4 months after end of course) • Research ethics approval • Qualitative evaluation by telephone interview • Asking participants to tell the story of their learning and any change to their practice • Prompting reflection on benefits and problems of interprofessional nature of the course

32. Our hopes for the next three months

33. Five first steps in establishing palliative care in Korogwe

35. Important steps • Discovering what are the needs of the patients /users (and wider community) • Understanding the system of care • Focusing on a balanced set of patient-centred outcomes

36. Involving all the team • No one person understands the whole process • Together the team has great knowledge and understanding • Team members often undervalue their worth and contribution • The process needs to support the contribution of all • Active management to ensure all voices heard

37. Miller’s ‘Pyramid’ After Ram 1998

38. Barr’s modification of Miller’s pyramid: levels of evaluation of IPE. • Learner's reactions • Modification of attitudes and perceptions • Acquisition of knowledge and skills • Change in behaviour • Change in organisational practice • Benefits to patients or clients

39. Facilitating interprofessional learning • Use your established teaching skills • Use case and scenario based discussion that encourages all to contribute • Make differing perspectives, mental models and contribution of all explicit • Ensure good ground rules for safety. • Avoid stereotyping – focus on issues not people or professions

40. Centre for the advancement of interprofessional education. A registered charity • Membership of CAIPE is open to individuals, students and organisations. www.caipe.org.uk