Inter-professional Possibilities in Healthcare: What do they mean for oral

health?

Lesley Bainbridge

Director, Interprofessional EducationFaculty of Medicine and

Principal pro temCollege of Health Disciplines

University of British Columbia

Context for this presentation:

• What is IPE?• What is collaborative practice?• What is patient-centred care?• What are the emerging models?• Why should oral health practitioners care?• What are the barriers?• What helps to break down the barriers?• Where do you fit?

Interprofessional education isn’t new so what is?

The policy language that is directing us to interprofessional education and collaborative practice and, to some extent, the research, although there is a long road ahead of us still as we strive to generate new knowledge.

Health Council of Canada

• Increase the number of interprofessional teams providing primary health care beyond the goal set out in the 2003 and 2004 agreements, which currently call for 50 per cent of residents to have 24/7 access to health care teams by 2011. (2006)

Health Canada

• Changing how primary health care is organized, funded and delivered in Canada is an enormously challenging undertaking. It demands an unprecedented level of collaboration and consensus-building across jurisdictions and among health care professionals. (PHCTF: 2005)

Romanow Report

• Review current education and training programs for health care providers to focus more on integrated approaches for preparing health care teams. One of the best ways of ensuring that health care providers are able to work effectively in new, more integrated settings is to begin with their education and training. Education programs should be changed to focus more on integrated, team-based approaches to meeting health care needs and service delivery. (2002)

World Health Organization report

Preparing a Health Care Workforce for the 21st Century: The Challenge of Chronic Conditions 2005

available at www.in-bc.ca

DRIVERS FOR CHANGE

Primary driver: patient safety

• To Err is Human (IOM)• The Canadian Adverse Events Study• Human factors research• Many other examples…..

Secondary drivers:

1. Health human resources: • Looming shortages of health care (including oral

health care) providers.• New ways of practicing.• Shared competencies.2. Chronic disease management3. Primary health care

EMERGING MODELS OF PRACTICE

Interprofessional Education ModelCharles, Bainbridge & Gilbert 2004

Goal

Interprofessional Health Education for Patient/Client Centred Collaborative Practice to Improve Patient Care

Learning Process

Professional

Personal

Interprofessional

Interprofessional Education Development Stages

Exposure Immersion Mastery

Health Canada’s Framework for IECPCP

PCCIPE

CPLEARNER

PRACTITIONER

• What does it look like if IPE is not evident?

• What does it look like if IPE is evident?

IPE

What do we say IPE is?Interprofessional education:

•Is the process by which we train or educate collaborative practitioners•Changes how health care providers view themselves•Is a complex process that requires us to look at learning differently •Requires the health provider to practice in a way that allows for and accepts shared competencies•Requires interaction between and among learners.

Perceived benefits of interprofessional education have been documented and include:

•Enhancing motivation to collaborate•Changing attitudes and perceptions•Cultivating interpersonal, group and organizational relations•Establishing common values and knowledge bases; and reinforcing competence. (Barr, 1999)

Collaborative Practice

• What does it look like if collaborative practice is not evident?

• What does it look like if collaborative practice is evident?

What do we say collaborative practice is?

• Features of collaborative practice: – using appropriate language when speaking to other people– understanding that all health providers contribute to the team or

collaborative unit– showing respect and building trust among team members– introducing new members of the team in a way that is welcoming

and gives them the information they need in order to be a contributing team member

– turning to colleagues for answers – supporting each other when mistakes are made, and celebrating

together when success is achieved– recognizing the assumptions we make about others and reflecting

on how to turn those assumptions into better communications with colleagues, patients or families

Collaboration: A process through which parties who see different aspects of a problem can constructively explore their differences and search for solutions that go well beyond their

own vision of what is possible.

Patient-Centred Care

• What does it look like if patient-centred care is not evident?

• What does it look like if patient-centred care is evident?

What do we say patient-centred care is?• Patient-centred care does not mean patients must get exactly what they ask

for, but rather that patients are working with their interprofessional team members to determine health goals that are realistic and achievable.

• Patient-centred care:– ensures the patient is listened to, valued and engaged in conversation

about their own health care needs– ensures the patient has input into how their needs can be addressed– requires a balance between the professional knowledge of care providers

and the personal knowledge of the patient and their family– includes both the health care provider team and the client– focuses on the patient’s goals, their family’s goals and the professional

expertise of the team– adds the knowledge of all team members to the patient’s self-knowledge

and self-awareness so that the final result is doable

BARRIERS

A non-exclusive list of some barriers to inter-professional collaboration

• interpersonal differences e.g. age, gender, culture• fear of change e.g. place, time, persons• stereotypic rivalry e.g. me, him/her, them• power, income and status e.g. salary vs. fee-for-service• language e.g. gender, profession, social class, jargon• models of practice e.g. medicine, dentistry, dental hygiene• management structures e.g. acute care, community• management priorities e.g. money, space, people• scope of practice e.g. reserved acts, fear, silos

If we believe that IPE and collaborative patient or family-centred practice lead to……

the highest quality of care in oral health….

….what do we do?

MACRO:• Get buy in from the

organization• Articulate the concepts in

mission, vision and values• Facilitate uptake of the

concepts throughout the organization

• Allocate funds to support the concepts

…and do…

MESO:• Support collaborative

practice at the bedside and in the community

• Educate providers, patients and families

• Reward collaborative practice

• Train interprofessional teams

…and do.

MICRO:• Recognize IPE as essential

learning for individuals• Provide time for

collaboration and reflection• Reassure staff and families• Make collaboration across

professions the norm for everyone

• Include it in performance expectations and reward it

What we are doing…• College of Health Disciplines (www.health-disciplines.ubc.ca)• BC Academic Health Council (www.bcahc.ca)• Health Canada IECPCP initiative

• $20 million allocated to projects across Canada• Range of background documents available

• Range of projects and initiatives across Canada which link post-secondary institutions and health organizations

• InBC – the BC network (www.in-bc.ca)• Canadian Interprofessional Health Collaborative www.cihc.ca

links IECPCP projects across the country• International collaboration (CAIPE, ATBH IV, CAB)

IN SUMMARY….

• IPE is the means by which we train collaborative practitioners.• Collaborative patient/family-centred practice is increasingly the

way of the future.• Policy change is necessary to support a shift in education and

practice.• At the macro, meso and micro levels of organizations and

communities support must be tangible and evident.• We have a responsibilty as individuals to practice collaboratively.• We still have many research gaps but together, we can address

them.• Once we make the shift, we can never go back.• We are moving forward, slowly, so remember….

FORWARD IS A DIRECTION, NOT A SPEED…

with thanks to Bruce Holmes,

Dalhousie University