Interprofessional Education: A Necessity for Team-Based Care Hossein Khalili, BScN, MScN, PhD

Director, UW Center for Interprofessional Practice and Education (UW CIPE)Co-Founder & Co-Lead InterprofessionalResearch.GlobalBoard Member, Global Confederation for InterprofessionalPractice & EducationExecutive Board Member, Canadian InterprofessionalHealth Collaborative (CIHC)Adjunct Research Professor, Western University

@cipe_uw

9th Annual WCN Conference, April 12, 2019

OutlineAbout Me1

Team-Based Care & IPE3

IPE in Global, National & Local Contexts 4

Wrapping Up5

Introduction & Background; Team-Based Care2

TEAM-BASED CARE

Introduction & Background; Team-Based Care2 Team Based Care

• “Team-based health care is the provision of health servicesto individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient - to accomplish shared goals within and across settings to achieve coordinated, high-quality care.“

Naylor MD, Coburn KD, Kurtzman ET, et al. Inter-professional team-based primary care for chronically ill adults: state of the science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. 2010 March 24-25; Philadelphia, PA.Okun, S, Schoenbaum S, Andrews D, et al. Patients and health care teams forging effective partnerships. Discussion Paper. Washington, DC: Institute of Medicine; 2014.

Why Team-Based Care?

• No One Profession alone is able to holistically, effectively and efficiently address the needs of patient/population health any more!

• There are various health/social care professions andprofessionals, trained and skilled to help addressing patient/population health.

• Technological advancements made it possible to simultaneously, seamlessly and (relatively) securely collaborate with, and to provide team-based care!

If Not Enough Reasons, Here Are A Few More…

• Population Demographic is rapidly changing (aging, diversity, comorbidity,…)

• Patients/population are more knowledgeable, and willing to partner in own care

• Patients/population are demanding for a high-quality low-cost, effective, and efficient care

• Health Care Costs are skyrising! • Health Workforce Burnout (and Leaving

Professions) are Real and Imminent!

2019 WCN Annual Conference Workshop 2: Interprofessional Education - A Necessity for Team-Based Care

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Benefits of Team-Based Care

Improves clinical

outcomes

Better patient

access and experience

Improves support for

complex patients

Improves patient care coordination

Day et al., 2013; Helfrich et al 2014; Jesmin et al 2009; O’Malley et al, 2015; 5Song et al, 2015; Willard-Grace et. al, 2014

Team-based practice can also improve patient perception of confidence in care, care quality and coordination.

Reduces burnout & increases

work satisfaction

What Has Been Your Experience With Team-Based Care?

• At your table, please share your team-based care experience and discuss what made your team-basedcare a great one (or ….).

• Be ready to share your discussion with the larger group.

What Does the Team-Based Care Entail?Knowing

Respecting Listening

2019 WCN Annual Conference Workshop 2: Interprofessional Education - A Necessity for Team-Based Care

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Sharing Valuing

TrustingAnd, To Consider:

Team-Based Care is not Just an Approach, It Is the Philosophy of Collaboration, Coordination,

Interdependency, and Complementarity in Providing Care!

Two Main Root Causes:

– ‘‘Unin -ni-Professional Education/Socializationon’– ‘‘‘Unin -nii-Professional al l Culture’

Why Is the Change to Team-Based Care So Hard?

(Thomson, Outram, Gilligan & Levett-Jones, 2015; Khalili et al, 2013 &b2014; Olson & Bialocerkowski, 2014; Salvatori, Berry & Eva, 2007; Clark, 1997)

Unin -ni-Professional al Education

Unin -ni-Professional al Identity

One of the biggest challenges to the

teamwork approach is the ongoing ‘turf protection’

among ‘Us’

Social Identity theory...(((Tajfel

yel & Turner, 1986)

In-Profession Favoritism

Out-Profession Discrimination

(Khalili, 2013)

Unin -ni-Professional Identities (

niUnnn((Uni

inn -

ofessional Identities rorPrPnini---)Professional Culture

All health professional groups develop their:own languageown communication patternsown ways of patient/client encountersown perceptions of knowledge & skills of own perceptions of knowo

other health professionals

What would be the Result….? Interprofessional Experiences of Recent Graduates in Health Care:

• Profession-focused, rather than patient- or team-focused practice, negative stereotyping, hierarchical communication, and competition

• Strong in-group identification (‘‘group-esteem’’) is leading to a tendency to protect and uphold the status of in-group

• Cross-group friendship reduces bias and leads to the development of more positive associations with out-groupmembers

• Mutual intergroup differentiation assists with team-identity Price, et al., 2018; Thomson, et al., 2015

Team-Based Care & Interprofessional Education (IPE)?

Team-Based Care & IPE3

If uniprofessional education leads to lack of effective collaboration & teamwork, then interprofessional education provides opportunities to likely lead to more effective collaboration and teamwork among health/social services professionals (Nexus, 2019, Thomson et al., 2015; Khalili, et al, 2014; Olson &Bialocerkowski 2014; WHO, 1978, 2005 & 2010; Health Canada , 2004; Lancet Commission Report, 2010)

Interprofessional Education (IPE) Movement Interprofessional Education

• Occasions when members or students of two or more professions learn with, from and about each other to improve collaboration and the quality of care and services. (CAIPE 2018)

… BUT

It takes time to change the previous It takes time to change the previous socialization into our professional roles

21st Century; A Call For ‘‘New Professionalism’’ In Health Care

Science-Based Informative Learning

Problem-Based Formative Learning

System-Based, Competency-Driven Transformative Learning;- New Professionalism- Leader & Change Agent

• Evolved from Informative to Formative Learning

• Now We Need to Evolve To Transformative Learning

New Professionalism

Just binging cross-professional members together is insufficient to reduce negative intergroup attitudes and stereotyping (Allport, 1979).

To reduce/eliminate out-group negativity and hostility, we need to first create an open & trusting environment where professional learners could intentionally break down their ‘Out-group Discrimination’.

Intergroup Contact Theory...g p(Pettigrew, 1998 & 2008)

Interprofessional Socialization (IPS) Framework (Khalili et al., 2013)

• Stage I: Breaking Down Barriers– UNI-professional Identity in ‘Parking lot’– Openness in Perspective

• Stage II: Interprofessional Role Learning– Learning to Collaborate– Cultivating IPC Culture

• Stage III: Dual Identity Development– Collective Unified Team – Development of dual professional & interprofessional Identity

Underpinned by social identity theory (SIT) and intergroup contact theory (ICT) & Socialization

Anticipatory Socialization Influence IPS-Based IPE Leads to 3-Stage IPS Results in Dual Professional &Interprofessional Identity & Readiness for IPCPCP

Personal Factors: IPE Believes & BehaviorsIndividualist-Collectivist OrientationIPE previous Experience

BreBreBreereeereeeaBrBr aa DowowoowDowDowwowowDowowDDowowDowDowowDowowwnDoDowwwwwowwwwnn rrrrrrrrrrrrrrrrrrieriereriererrierrierrierrrrierrsssssssssssrrieerierssssssDu

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WHERE ARE WE AT WITH IPE & NEXT STEPS?

IPE in Global, National & Local Contexts 4

Globally• Global Confederation for Interprofessional Practice&

Education: www.interprofessional.global

• The Global Network for Interprofessional Education andCollaborative Practice Research (InterprofessionalResearch.Global)

Nationally

• National Center for Interprofessional Practice & Education (Nexus): https://nexusipe.org/

– Nexus Summit 2019: August 18-20th, Minneapolis – Guidance on Developing Quality Interprofessional Education for the

Health Professions– IPE Resources

• American Interprofessional Health Collaborative (AIHC): https://aihc-us.org/

– Collaborating Across Borders (CAB) Conference: October 20-23, Indianapolis

• Interprofessional Education Collaborative (IPEC): https://www.ipecollaborative.org/

– Core Competencies forInterprofessional Collaborative Practice

VISIONCenter of Excellence in

Transforming Health/Social

Professional Education & Practice Through Interprofessional

Collaboration

n

n

Locally: UW CIPE UW CIPE: A National & International Lead in ‘IPE

Integration’ Across Programs, Schools, Simulation & Practice

UW CIPE: A Lead, In Wisconsin and Beyond, In Creation & Utilization of

IPE Integration BPGs Through Research & Scholarship

UW CIPE: A Lead, In Wisconsin and Beyond, In Training New

Generations of HCPs ‘Team Ready’ to Tackle the Quadruple Aim

Transforming Education and Practice Through Collaboration

Transformation Requires A Shift In Thinking:

• Need to Challenge Basic Assumptions

• Need to Refocus from ‘IPE as the End Goal’ to “IPE As Means To Get To The Goal”

• Need to Re-conceptualize “IPE An Ongoing Process Of Socialization Within A System” rather than ‘one‐size‐fits‐all intervention’

• Need to Recognize “IPE as a Right to Learn Together to Work Together in Practice” rather than ‘just as an option’

IOM, 2015; Khalili, et al, 2013/2014/2018; Olson & Bialocerkowski 2014

IPE Charter (Khalili © 2018)

IP Culture Development

IP Faculty Development

IP Learning Environment

IP Sustainable Resources

System Change

IP Sustainable

Infrastructure

IPE Impact

IP Socialization- Competencies

Theory Courses

Simulation

PracticeMastery

Immersion

Exposure

Learners' Team Ready

Team-Based Practice Performance

•Better Care•Better Health•Better Cost

Triple Aim

School/ Institution

Community & Clinical Partners

Programs/ Departments

IPE Integration

• Strategic DirectionsDevelopment &Implementation

• Partnership Development

CIPE Leadership & Partnership

• IPE Competency Modules • IPE Simulation• IPE Professional Development• IPE Knowledge Exchange

Series • IPE Planning & Piloting:

• IPE Clinical/Community Outreach

• IPE Curricula Integration

CIPE Teaching & Learning

• Research & Scholarship• CIPE Evaluative

Assessment Plan • CIPE Future Program

Development

CIPE Research & Development• Communication &

Visibility • Brand Marketing• Sustainability &

Revenue Generation• IPE Advocacy

CIPE Awareness & Public Relations

Visionary Plan for UW CIPE - Core Focus Areas 2019-2020

© Khalili, 2019

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WRAPPING UP

Wrapping Up5

•Discouraging Cross-Sector/Organization Collaboration

•DisempoweringClient

•Hindering Interprofessional Team Collaboration

•Inhibiting Cross-Professional Collaboration

Fear of ‘Identity

Loss’ ‘Turf War’

Power & Politics

Viewing Client as Outsider

Wrapping Up: Lessons Learned!Purpose of IPE shift in mindset;

feel we can admit one of our colleagues is

more qualified to deal with a particular

problem!

Dr John H.V. Gilbert, 2005

Let’s Finish the Workshop with a Short Video Clip :

http://www.youtube.com/watch_popup?v=nN-aD5i87rI&vq=medium#t=118

ReferencesFrenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., ... & Kistnasamy, B. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The lancet, 376(9756), 1923-1958. Gilbert, J. H., Yan, J., & Hoffman, S. J. (2010). A WHO report: framework for action on interprofessional education and collaborative practice. Journal of Allied Health, 39(3), 196-197. http://www.who.int/hrh/resources/framework_action/en/ Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Institute of Medicine. (2015). Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington, DC: The National Academies Press. Helfrich, C. D., Dolan, E. D., Simonetti, J., Reid, R. J., Joos, S., Wakefield, B. J., … Nelson, K. (2014). Elements of team-based care in a patient-centered medical home are associated with lower burnout among VA primary care employees. Journal of General Internal Medicine, 29 Suppl 2, S659–666. Jesmin, S., Thind, A., & Sarma, S. (2012). Does team-based primary health care improve patients’ perception of outcomes? Evidence from the 2007-08 Canadian Survey of Experiences with Primary Health. Health Policy (Amsterdam, Netherlands), 105(1), 71–83. Khalili, H. (2013). Interprofessional socialization and dual identity development amongst crossdisciplinary students. Unpublished Doctoral Dissertation, University of Western Ontario, London, Ontario, Canada. Khalili, H. (2015). Interprofessional Charter, Fanshawe College Khalili, H., Hall, J., & DeLuca, S. (2014). Historical analysis of professionalism in western societies: Implications for interprofessional education and collaborative practice. Journal of Interprofessional Care, 28(2), 92-97. Khalili, H., Orchard, C., Laschinger, H. K. S., & Farah, R. (2013). An interprofessional socialization framework for developing an interprofessional identity among health professions students. Journal of Interprofessional Care, 27(6), 448-453. Lutfiyya, M. N., Schicker, T., Jarabek, A., Pechacek, J., Brandt, B., & Cerra, F. (2017). Generating the Data for Analyzing the Effects of Interprofessional Teams for Improving Triple Aim Outcomes. In Big Data-Enabled Nursing (pp. 103-114). Springer, Cham. Naylor, D., Girard, F., Mintz, J., Fraser, N., Jenkins, T., & Power, C. (2015). Unleashing Innovation: Excellent Healthcare for Canada. Report of the Advisory Panel on Healthcare Innovation.Olson, R., & Bialocerkowski, A. (2014). Interprofessional education in allied health: a systematic review. Medical education, 48(3), 236-246.Pettigrew, T. F. (1998). Intergroup contact theory. Annual review of psychology, 49(1), 65-85. Price SL, Reeves S, Andrews C, Davies H, Harman K, Sutton E, Almost J, Khalili H. Sim SM. (May 24-26, 2018) Evolving Narratives of professional socialization across five health professions. Canadian Association of Health Services and Policy Research conference, Toronto, ON.Reeves, S., Palaganas, J., & Zierler, B. (2017). An updated synthesis of review evidence of interprofessional education. Journal of allied health, 46(1), 56-61. Song, H., Ryan, M., Tendulkar, S., Fisher, J., Martin, J., Peters, A. S., … Singer, S. J. (2015). Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study. Health Care Management Review. http://doi.org/10.1097/HMR.0000000000000091. [Epub ahead of print].Tajfel, H., & Turner, J. C. (1986). The social of identity theory of intergroup behavior. In S. Tajfel, H., & Turner, J. C. (2004). The social identity theory of intergroup behavior. In J. T. Jost & J. Sidanius (Eds.), Key readings in social psychology. Political psychology: Key readings (pp. 276-293). New York, NY, US: Psychology Press. Worchel & W. G. Austin (Eds.), Psychology of intergroup relations (pp. 7-24). Chicago, IL: Nelson. Thomson, K., Outram, S., Gilligan, C., & Levett-Jones, T. (2015). Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication, teamwork, and patient-centred care. Journal of interprofessional care, 29(6), 634-640.University of British Columbia (2018). Interprofessional Education & Collaborative Practice Frameworks. Retrieved from: https://health.ubc.ca/education/resources/interprofessional-education-collaborative-practice-frameworks University of Toronto, (2015). Centre for Interprofessional Education Strategic-Plan-2015-2019, University of Toronto & University Health Network, Retrieved from: https://ipe.utoronto.ca/news/strategic-plan-2015-2019 Willard-Grace, R., Dubé, K., Hessler, D., O’Brien, B., Earnest, G., Gupta, R., … Grumbach, K. (2015). Panel management, team culture, and worklife experience. Families, Systems & Health: The Journal of Collaborative Family Healthcare, 33(3), 231–241. World Health Organization (2010). Framework for Action on Interprofessional Education and Collaborative Practice. Geneva, WHO, 2010. Available at: World Health Organization. (2013). Transforming and scaling up health professionals’ education and training: World Health Organization guidelines 2013. World Health Organization.

Questions & Comments

THANK YOU!