Lynne Sinclair

Conflicting messages: examining the dynamics of leadership on interprofessional teams.

Purpose Despite the importance of leadership in interprofessional health care teams, little is understood about how it is enacted. The literature emphasizes a collaborative approach of shared leadership, but this may be challenging for clinicians working within the traditionally hierarchical health care system. Method Using case study methodology, the authors collected observation and interview data from five interprofessional health care teams working at teaching hospitals in urban Ontario, Canada. They interviewed 46 health care providers and conducted 139 hours of observation from January 2008 through June 2009. Results Although the members of the interprofessional teams agreed about the importance of collaborative leadership and discussed ways in which their teams tried to achieve it, evidence indicated that the actual enactment of collaborative leadership was a challenge. The participating physicians indicated a belief that their teams functioned nonhierarchically, but reports from the nonphysician clinicians and the authors’ observation data revealed that hierarchical behaviors persisted, even from those who most vehemently denied the presence of hierarchies on their teams. Conclusions A collaborative approach to leadership may be challenging for interprofessional teams embedded in traditional health care, education, and medical-legal systems that reinforce the idea that physicians sit at the top of the hierarchy. By openly recognizing and discussing the tensions between traditional and interprofessional discourses of collaborative leadership, it may be possible to help interprofessional teams, physicians and clinicians alike, work together more effectively.

What's so great about rehabilitation teams? An ethnographic study of interprofessional collaboration in a rehabilitation unit.

OBJECTIVE To explore team structures, team relationships, and organizational culture constituting interprofessional collaboration (IPC) in a particular rehabilitation setting; to develop a description of IPC practice that may be translated, adapted, and operationalized in other clinical environments. DESIGN An ethnographic study involving: Field observations: 40 hours, over 4 weeks, daily activities, 7 interprofessional meetings, 3 care planning meetings, 1 business meeting, and 3 family meetings; Individual observations: a physiotherapist, an occupational therapist, and a social worker individually observed for 45 minutes to an hour; and Interviews: 19 participants, 11 professions, 27 informal, 5 formal interviews. Data analysis consisted of an iterative process involving coding field notes for themes by 3 members of the research team by qualitative analysis software. SETTING Single inpatient spinal cord rehabilitation care unit in a Canadian urban academic rehabilitation hospital. PARTICIPANTS Purposive convenience sample of core team, more than 40 professionals: physiatrist, over 21 nurses, 3 physiotherapists, 3 occupational therapists, 2 social workers, chaplain, psychologist, therapeutic recreationist, program assistant, program manager, pharmacist, advanced practice leader, 6 students (1 pharmacy, 4 registered nurse, and 1 psychology), and on-site community organizations. After university and hospital ethical approvals, all staff members were recruited to participate in the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS Recurrent examples of IPC fit 2 dominant themes: team culture (divided into leadership, care philosophy, relationships, and the context of practice) and communication structures (both formal and informal). CONCLUSIONS IPC practice in rehabilitation care is supported by clinical, cultural, and organizational factors. This understanding of daily IPC work may guide initiatives to promote IPC in other clinical team settings.

Structuring communication relationships for interprofessional teamwork (SCRIPT): A Canadian initiative aimed at improving patient-centred care

There is a growing movement in health care that advocates the use of interprofessional education to help deliver collaborative patient-centred care (Oandasan et al., 2004). For example, the Romanow Commission (2002) and the First Ministers’ Accord (Health Canada 2003) both stress the need for collaborative practice to help ensure that the quality of health care delivered to Canadians can be enhanced. Both reports identified that introducing interprofessional education within the health professional education system was the key to achieving this aim. Evidence of the effectiveness of interprofessional education suggests that it can generate a number of positive outcomes for professionals and for patients (Barr et al., 2005). However, at present, this evidence base is generally weak and fragmentary in nature (Zwarenstein & Reeves, 2006). To help generate a more informed understanding of interprofessional education and its potential impact on collaborative relationships and the delivery of patient care, the Canadian federal government has recently funded eleven projects across the country. This paper describes one of these projects based at the University of Toronto. The project involves the development of an intervention designed to improve interprofessional collaboration across three separate clinical settings: general internal medicine (GIM); primary care; and rehabilitation and complex continuing care. Each of these settings was selected as they represent key trajectories along which patients travel while receiving care in the Toronto Academic Health Science Network (TAHSN), the network of partnerships between the University of Toronto and its fully affiliated health services’ institutes. Journal of Interprofessional Care, January 2007; 21(1): 111 – 114

Effectiveness of a faculty development program on interprofessional education: A randomized controlled trial

Evidence of the effectiveness of interprofessional education (IPE) is largely untested. In particular, assessing the best model for educating clinical faculty about IPE and whether it impacts their teaching remains a challenge. The IPE literature recognizes that skilled, knowledgeable, interprofessional faculty facilitators are integral for the successful implementation of IPE interventions. For collaborative practice (CP), however, there are gaps in our educational knowledge base. First, the literature falls short in outlining how faculty should learn how to teach interprofessional collaborative practice. Second, the literature offers little in the way of empirical accounts of the effectiveness of these sparse descriptions for faculty development.

Interprofessional education and practice guide No. 5: Interprofessional teaching for prequalification students in clinical settings.

ABSTRACT The importance of interprofessional education in health professions training is increasingly recognised through new accreditation guidelines. Clinician teachers from different professions may find themselves being asked to teach or supervise learners from multiple health professions, focusing on interprofessional dynamics, interprofessional communication, role understanding, and the values and ethics of collaboration. Clinician teachers often feel prepared to teach learners from their own profession but may feel ill prepared to teach learners from other professions. In this guide, we draw upon the collective experience from two countries: an institution from the United States with experience in guiding faculty to teach in a student-run interprofessional clinic and an institution from Canada that offers interprofessional experiences to students in community and hospital settings. This guide offers teaching advice to clinician educators in all health professions who plan to or already teach in an interprofessional clinical setting. We anticipate that clinician teachers can learn to fully engage learners from different professions, precept effectively, recognise common pitfalls, increase their confidence, reflect, and become role models to deliver effective teaching in interprofessional settings.

Evaluating the effectiveness of an interprofessional education faculty development course: The transfer of interprofessional learning to the academic and clinical practice setting

Centre for Interprofessional Education, University of Toronto, Toronto, Canada, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada, Sunnybrook Health Science Centre, Toronto, Canada, University Health Network, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada, Faculty of Pharmacy, University of Toronto, Toronto, Canada, Centre for Faculty Development, Faculty of Medicine, University of Toronto, Toronto, Canada, Mount Sinai Hospital, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada, Toronto Rehabilitation Institute, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada, Division of Physiatry, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada, Office of Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Toronto, Canada, Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada, and Department of Speech-Language Pathology, Faculty of Medicine, Toronto, University of Toronto, Canada

Catalyzing and sustaining communities of collaboration around interprofessional care: An evaluation of four educational programs

Given the complexity of patients’ needs and a shifting health care environment, effective interprofessional collaboration (IPC) is regarded by many as essential to the delivery of high quality patient care (e.g., Health Canada, 2003; Department of Health, 2002). Interprofessional relationships can, however, be undermined by boundary infringements, a lack of understanding of one another’s roles, limited communication and poorly coordinated teamwork (e.g., Reeves & Lewin, 2004). Interprofessional education (IPE) is increasingly being seen as a key approach to improving poor collaboration (e.g., Health Canada, 2003; Department of Health, 2002). It is argued that because professionals have been traditionally trained in isolation from one another they are often not equipped with the attitudes, skills or knowledge to work effectively in interprofessional teams. IPE for both students and professionals is advocated as a way to address this problem. A growing body of evidence, generated from systematic review work (e.g., Barr et al., 2005) has indicated that IPE can help foster a range of attributes required for effective collaboration. To encourage health care workers in Ontario, Canada to work collaboratively to improve job satisfaction, achieve efficiencies within the health care system and enhance the delivery

Evaluation of perceived collaborative behaviour amongst stakeholders and clinicians of a continuing education programme in arthritis care.

Abstract Successful implementation of new extended practice roles which transcend conventional boundaries of practice entails strong collaboration with other healthcare providers. This study describes interprofessional collaborative behaviour perceived by advanced clinician practitioner in arthritis care (ACPAC) graduates at 1 year beyond training, and relevant stakeholders, across urban, community and remote clinical settings in Canada. A mixed-method approach involved a quantitative (survey) and qualitative (focus group/interview) evaluation issued across a 4-month period. ACPAC graduates work across heterogeneous settings and are on teams of diverse size and composition. Seventy per cent perceived their team as actively working in an interprofessional care model. Mean scores on the Bruyère Clinical Team Self-Assessment on Interprofessional Practice subjective subscales were high (range: 3.66–4.26, scale: 1–5 = better perception of team’s interprofessional practice), whereas the objective scale was lower (mean: 4.6, scale: 0–9 = more interprofessional team practices). Data from focus groups (ACPAC graduates) and interviews (stakeholders) provided further illumination of these results at individual, group and system levels. Issues relating to ACPAC graduate role recognition, as well as their deployment, integration and institutional support, including access to medical directives, limitation of scope of practice, remuneration conflicts and tenuous funding arrangements were barriers perceived to affect role implementation and interprofessional working. This study offers the opportunity to reflect on newly introduced roles for health professionals with expectations of collaboration that will challenge traditional healthcare delivery.