Carole Orchard

Creating a Culture for Interdisciplinary Collaborative Professional Practice

Abstract The future of the health system is dependent on health professionals re-tooling the way we practice together. No longer can a multi-disciplinary model support the complex health needs of many clients nor can any one-health profession have all the knowledge needed to provide total patient-centred care. However, our current education and health systems are structured around a multidisciplinary model of practice with physicians or nurse practitioners as decision-makers and rarely are clients included in care planning. True interdisciplinary practice is defined as 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, requires a revamping of how future health professionals are educated and how the system can accommodate shared decision-making. A client-centered collaborative professional practice model is proposed in this paper as a means for fostering and facilitating the culture for this change.

The Importance of Human Resources Management in Health Care: A Global Context

BackgroundThis paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services.MethodsWe explored the published literature and collected data through secondary sources.ResultsVarious key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care.ConclusionProper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world.

An interprofessional socialization framework for developing an interprofessional identity among health professions students

Abstract Although health professional educational programs have been successful in equipping graduates with skills, knowledge and professionalism, the emphasis on specialization and profession-specific education has enhanced the development of a uniprofessional identity, which has been found to be a major barrier to interprofessional collaborative person-centred practice (IPCPCP). Changes within healthcare professional education programs are necessary to enable a shift in direction toward interprofessional socialization (IPS) to promote IPCPCP. Currently, there is a paucity of conceptual frameworks to guide IPS. In this article, we present a framework designed to help illuminate an IPS process, which may inform efforts by educators and curriculum developers to facilitate the development of health professions students’ dual identity, that is, an interprofessional identity in addition to their existing professional identity, as a first step toward IPCPCP. This framework integrates concepts derived from social identity theory and intergroup contact theory into a dual identity model of IPS.

Competencies for Interprofessional Collaboration

Background and Purpose. Interprofessional collaboration in health care is now considered a high priority, as concerns about patient safety, health and human resources shortages, and effective and efficient care have reached epic proportions. Although there are many models for interprofessional education for collaborative, patient‐centered care, there is little in the literature to describe competencies for an interprofessional collaborative practitioner. This article will describe an emerging Canadian competency framework for interprofessional collaboration that (1) considers previous descriptions of collaborative practice and (2) uses existing literature to support a model for describing competencies for collaborative practice. Model Description and Evaluation. In this emerging competency framework, 6 competency domains are described using a competency statement and a set of associated descriptors. The collaborative leadership, dealing with interprofessional conflict, team functioning, and role clarification domains intersect with all of the others, yet are distinct and require focused descriptions. While patient‐centered care and communication also are domains unto themselves, these competencies are integral elements of the other domains and are integrated throughout the framework. In the background supporting all of the domains are 3 key themes: context of practice, level of complexity, and quality improvement. The emerging framework was reviewed by a wide group of stakeholders, including an external review. Future use of the framework will assist in further shaping it to meet the needs of educators, researchers, practitioners, regulators, and accreditors. Discussion and Conclusion. The competency framework has been designed as a practical tool for a number of stakeholder groups. In particular, physical therapy educators can use it as a basis for interprofessional education programs and activities that prepare collaborative practitioners for the future. The framework is flexible and can be used in simple or complex situations, in a variety of practice settings, as a guide for learning outcomes and evaluation or assessment of performance, and as a tool for developing entry‐level curricula and continuing professional development. The strength of the framework will emerge as it evolves over time.

Assessment of Interprofessional Team Collaboration Scale (AITCS): Development and testing of the instrument†

Introduction: Many health professionals believe they practice collaboratively. Providing insight into their actual level of collaboration requires a means to assess practice within health settings. This chapter reports on the development, testing, and refinement process for the Assessment of Interprofessional Team Collaboration Scale (AITCS). There is a paucity of literature and measurement tools addressing interprofessional collaborative team performance and the nature of effective teamwork processes and patient roles within collaborative teams. These gaps limit our knowledge about how health care teams form and function. Instruments are therefore needed to assess collaborative relationships. Methods: The AITCS, with its 47 items within 4 subscales (partnership, cooperation, coordination, and shared decision making) and assessed on a 5‐point Likert scale, was administered to a total of 125 practitioners from 7 health care teams practicing within a variety of settings, in 2 provinces in Canada. Results: Principal components and factor analysis of data resulted in 37 items loading onto 3 factors, explaining 61.02% of the variance. The internal consistency estimates for reliability of each subscale ranged from 0.80 to 0.97, with an overall reliability of 0.98. Thus, the AITCS is a reliable and valid instrument. Discussion: The psychometric analysis of this instrument supports its value in measuring collaboration within teams and when patients are included as team members. The AITCS can be applied to continuing professional education interventions to determine change over time. It has limitations to the Canadian context and within the settings where participants practiced. Further test and retest reliability and longitudinal study application is needed.

The Interprofessional Socialization and Valuing Scale: A tool for evaluating the shift toward collaborative care approaches in health care settings

BACKGROUND There is a need for tools by which to evaluate the beliefs, behaviors, and attitudes that underlie interprofessional socialization and collaborative practice in health care settings. METHOD This paper introduces the Interprofessional Socialization and Valuing Scale (ISVS), a 24-item self-report measure based on concepts in the interprofessional literature concerning shifts in beliefs, behaviors, and attitudes that underlie interprofessional socialization. The ISVS was designed to measure the degree to which transformative learning takes place, as evidenced by changed assumptions and worldviews, enhanced knowledge and skills concerning interprofessional collaborative teamwork, and shifts in values and identities. The scales of the ISVS were determined using principal components analysis. RESULTS The principal components analysis revealed three scales accounting for approximately 49% of the variance in responses: (a) Self-Perceived Ability to Work with Others, (b) Value in Working with Others, and (c) Comfort in Working with Others. These empirically derived scales showed good fit with the conceptual basis of the measure. CONCLUSION The ISVS provides insight into the abilities, values, and beliefs underlying socio-cultural aspects of collaborative and authentic interprofessional care in the workplace, and can be used to evaluate the impact of interprofessional education efforts, in house team training, and workshops.

Students' perceptions of interprofessional learning through facilitated online learning modules

Background: Asynchronous e-learning is an appealing option for interprofessional education (IPE) as it addresses the geographic and timetabling barriers often encountered when organizing activities across educational programs. Aim: This study examined the extent to which pre-licensure students were able to learn with, from, and about each other through completion of innovative online IPE learning modules. Methods: Seventy-seven students completed e-learning modules developed through a consortium of educational institutions. Evaluation was primarily qualitative through focus groups, interviews, analyses on off-line discussions and an online feedback form. Results: Qualitative analyses of the discussion fora revealed that students were able to solve problems collaboratively, clarify their professional roles, and provide information from their professional perspective. Focus groups and interviews reinforced that students recognized the importance of working together and implicate clinical education as an important venue to reinforce learning about collaborative practice. Analyses of the online feedback form suggest the need for clear processes related to group assignments and deadlines. Conclusion: Students learned about each others role, solved problems together and had positive perceptions of the online modules as a venue for interprofessional learning. Results are encouraging to those interested in using e-learning in IPE as part of an overall curriculum.

The value of the hospital-based nurse practitioner role: development of a team perspective framework

Abstract There is a need to understand nurse practitioner (NP) interprofessional practice within hospital teams to inform effective role integration and evolution. To begin this understanding a supplementary analysis of 30 hospital team member focus groups was carried out using constructivist grounded theory methodology. This conceptual rendering of the team members’ shared perspective of NP actions provides insight into the meaning and importance of the NP role. Participants emphasized three hospital-based (HB) NP practice foci as the meaning of role value; easing others’ workload, holding patient care together and evolving practice. Trust emerged as a pre-requisite condition for HB NP role efficacy. A team member perspective framework of HB NP practice is presented as the first stage in developing a model of HB NP interprofessional practice within hospitals. The framework provides multiple perspectives to the meaning and value of the HB NP role beyond basic role description. The framework may be used by healthcare professionals, operational leaders, academia and HB NPs to enhance role respect and understanding.

The metamorphosis of a collaborative team: from creation to operation

Abstract This paper reports on the process of developing a community-based interprofessional team to provide diabetes related foot ulcer care. A new interprofessional team was formed in a local community, and the process of building a successful team was examined by the adoption of an exploratory qualitative case study approach that gathered a series of one-on-one interviews with participants at three points in time – prior to the team’s formation, two months into the team’s operation, and finally seven months later – shortly before the team and its clinic closed. Interviews were also conducted with a small sample of the team’s patients. The factors linked to the successes and challenges of building a care team in a community setting are explored. Informants highlighted the value of regular team meetings, role clarity, and a commitment to patient-centered care. However effective collaboration was not sufficient to maintain the team in the face of poor institutional and government support.

Labour saver or building a cohesive interprofessional team? The role of the nurse practitioner within hospitals

Abstract Nurse practitioners (NP) are employed within hospital interprofessional (IP) teams in several countries worldwide. There have been some efforts to describe the nature of the NP role within IP teams largely focussing on how the role may augment care processes. Here, using a constructivist grounded theory approach, the perceptions of NPs about their role were compared and integrated into a previously published team perspective as the second phase of a larger study. Seventeen hospital-based (HB) NPs across Ontario, Canada, participated in group and individual interviews. The NP perspective substantiated and expanded the previously reported team perspective, resulting in an IP perspective. The three practice foci illustrating role value meaning of this perspective became: evolve NP role and advance the specialty, focus on team working, and hold patient care together. The IP perspective, juxtaposed with an existing contingency approach, revealed that NPs were promoting IP work, predominantly at the collaboration and teamwork levels, and aiding IP team transitions to appropriate forms of IP work. The practice, “focus on team working”’ was strongly related to promoting IP work. The findings were consistent with HB NPs enacting a role in building IP team cohesiveness rather than merely acting as a labour saver. This is the first study to align NP and team understanding of HB NP role value using an IP framework.