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Collaboration

Objectives• To describe the evolution of the concept of

collaboration

• To delineate the characteristics of collaboration

• To demonstrate the application of collaboration concept into practice

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Collaboration

Definition• Working together for a common goals• Pooling of resources and ideas within or across

disciplines for innovation and problem-solving (CINAHL)

• Interaction of 2 or more persons or organizations directed toward a common goal which is mutually beneficial (MEDLINE, cooperative behavior)

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Societal Shifts

• Nationalism replaced with global economy

• Social ecology--needs for integration & connections

• Social capital--networks, norms, trust, coordination & cooperation

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TRENDS

• New organizations• New forms of delivery

systems-- managed care

• New ways of relating to each other

• Smaller companies

• High-value organizations depend on and expect workers at all levels to be capable of making decisions

• Health care being driven by changes in industry

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Changing Work Environment

• Technology• Demographics• Managed Care• Purchaser’s Influence• Health Insurance

Industry• Changing Health

Systems• Telemedicine

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Managed Care Environment

• Focus on outcomes, research based practice

• High quality care

• Cost-effective interventions

• 2/3 with MH insurance are enrolled in managed care plans

• 4/5 of all states are implementing changes in Medicaid programs

• Responsible for widespread application of information technology

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Telecommunications

– Greater use will increase collaboration among health care professionals in physically separated locations

– Over 50% of US workforce employed in information related jobs

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Relationship to Health

• Concern not only with costs & benefits but with social, emotional, & physical health

• Promoting health and providing health care, no longer the exclusive domain of any discipline

• Need for interdependence to improve population health care outcomes

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Health Problems Needing Collaboration

• Mortality rates for persons with brain disorders are twice that of general population– 50% have known medical disorders– 35% have undiagnosed medical disorders– One in five has a medical problem may cause

or exacerbate psychiatric condition– Increased risk CVD

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Substance Abuse Problems Needing Collaboration

• 53% of drug abusers have at least 1 serious psychiatric problem

• 37% of alcohol abusers have at least 1 serious psychiatric problem

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Surrogate Terms

• Joint practice -> collaborative practice

• Shared governance – people discuss, debate, and work from the same data base; shared vision

• Coalition – take joint action or resolve a mutually shared concern or reach a common goal

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Related Concepts

• Cooperation – mutual give & take

• Collegial – equal power or authority

• Working together – intellectual endeavor

• Teamwork – team approach

• Interdependence, - shared power/authority

• Professionalism – antecedent

• Professional practice - consequence

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Implications

• Patient care – pts are the true beneficiaries

• Education – 1st step in the learning strategy

• Research – application of the findings

• Organization – shared governance -> better decisions regarding pt care

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Partnership Attributes

• Respecting each other

• Communication

• Working together

• Partnership relationship

• Trusting each other

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Conditions

• Supportive environment

• Mutual trust--acquired through experience among participants

• Disciplinary interests & personal agendas are secondary

• Process of negotiation

• Team building

• Transformational leadership

• Cannot mandate

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Characteristics

• Legitimacy /power sharing – Individual’s identity & accountability &

relationship to overall power• Self-knowledge

– Self-awareness & future growth• Respect

– Individual autonomy & boundary

• Commitment – Responsibility for goal attainment

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Outcomes

• Increased access

• Improved quality

• Positive client outcomes

• Increased creative solutions

• Improved and increased human resources

• A more productive community

• Greater student achievement

• Job satisfaction

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Outcomes (II)

• Education--meets service mission & gains practice settings for faculty & students

• Service--gains excitement of a learning environment

• Joint ventures– research and demonstration projects– develop models of practice

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Essential elements in organization’s readiness for collaboration

• Compatible R among Drs & Ns. – common goal & unique competencies

• Support from administration -> quality care

• Clinically competent of the staff

• Collegial R

• Primary nursing

• N’s excellence is rewarded

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assertiveness

cooperationlow

high

high

Competition

Avoidance

Collaboration

Accommodation

Compromise

2-dimensional grid of collaboration

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The driving forces of successful collaboration partnerships

• People -> enliven– Sharing of human resources– Careful planning & monitoring– Communication & understanding of goals &

purposes• Time

– Relationship– Skills

• Energy & motivation– Enthusiasm & commitment

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Transdisciplinary Collaboration ProjectSan Jose State UniversitySan Jose State University

Office of Sponsored ProgramsOffice of Sponsored ProgramsCollege of Applied Sciences and ArtsCollege of Applied Sciences and Arts

School of Nursing School of Nursing Nurse Managed CentersNurse Managed Centers

Communication Disorders & Sciences:Communication Disorders & Sciences: Program & ClinicProgram & Clinic

Department of Occupational TherapyDepartment of Occupational TherapyDepartment of Recreation & Leisure Studies: TRDepartment of Recreation & Leisure Studies: TR

College of Social WorkCollege of Social WorkInstitute for Teaching & LearningInstitute for Teaching & Learning

Faculty and StudentsFaculty and StudentsRevised 5/99Revised 5/99

Psychosocial.Psychosocial.Occupational Occupational Therapy ClinicTherapy Clinic

Santa ClaraSanta ClaraCountyCountyMentalMentalHealthHealth

Santa Clara CountySanta Clara CountyAlliance for theAlliance for the

Mentally IllMentally Ill

ALLIANCE for ALLIANCE for Community CareCommunity Care

Zoe HouseZoe HouseCrossroads VillageCrossroads Village

Casa FelizCasa Feliz

ResidentsResidentsStaffStaff

FamiliesFamilies

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Through collaborative efforts, provide quality, cost effective services for

persons with serious mental illness living in the community while simultaneously

preparing future mental health professionals for practice.

Project Goal

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Behavioral Ecological Model of Community Mental HealthLawsLaws

Administration ofAdministration ofJusticeJustice

CommunityCommunity

Friends and PeersFriends and Peers

LawsLaws

Mental Health Mental Health SystemSystem

Social PolicySocial Policy

LegislationLegislation

ChurchChurch

FamilyFamily

UniversityUniversity

Training ofTraining ofProfessionalsProfessionals

PersonPerson

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Stress Management• Nursing

– Crisis intervention• Deep Breathing

• Self Talk

• Time out

• Visualization

– Prevention• Diet & nutrition

• Exercise

• Time management

• Communication Disorders– Organizing and

creating schedules

– Follow up on comprehension

– Routines

– Social Skills

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Stress Management

• Therapeutic Recreation - Identify triggers - Identify & practice strategies to manage stress - Example: exercise, visualization, relaxation

• Occupational Therapy- Identify causes- Assess coping strategies- Environmental adaptations- Problem solving- Frustration tolerance- Therapeutic activity

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Outcomes of Collaboration Clearly, the closer educators, researchers,

consumers, practitioners, and families come together in the service area, the more likely that curricula will be reality based and congruent with clients’ needs. At the same time, the possibility of improving the quality of life increases.