1. Health Services Executive
Interprofessional Learning Master Class
20th June 2012
Helena Low

2. Health Services Executive The foundations for collaborative Care
CAIPE
Interprofessional Learning Master Class
Learning Together to Work Together,
Working Together to Learn together’
The foundations for collaborative Care
Helena Low
Vice Chair
Centre for the Advancement of Interprofessional Education 2 2

3. Themes and Questions
What is interprofessional collaborative practice / interprofessional collaborative care - what do we actually mean when we use these terms?
What difference does it make? Why the global emphasis on it?
What are the competencies required? Why do we need interprofessional learning to develop collaborative practice ?
What do we mean by interprofessional education? Why is it essential for professional education?

4. Aims of the Master class
Foster a greater and shared understanding of what collaborative care means and what is involved within the Irish context
Generate interest and engagement in interprofessional learning for collaborative practice
Encourage you to consider practical application in the workplace
Encourage you to identify further areas of interest in relation to taking forward collaborative initiatives

5. Ground Rules Respect differences Value all contributions equally
Confidentiality
Avoid jargon
Check understanding
Important Mutual trust
Mutual respect
Mutual support

6. Economic factors – limited Resources Modernisation Ageing population
Interprofessional learning and collaborative practice in the context of global health International / global trends
Economic factors – limited Resources
Modernisation
Ageing population
Integration, Collaboration, Decentralisation
Service User focus
Community participation
Emphasis on patient safety
H. Low 6

7. Drivers of change resource constraints demography
Rising cost of care, Increasing demand, diminishing resources
demography
Ageing population, Movement of people
technological advances
More people surviving defects, Illness, disease, accidents
consumer expectations
more informed recipients of care.
loss of confidence in professionals
Medical errors, lack of communication between professionals

8. Global picture Health systems worldwide Modernisation essential to
are struggling with:
increasingly complex and costly challenges,
ever more demands on health workers
patients needs have become more complex and more - challenging.
Modernisation essential to
deal with:
inequalities in access to health and care,
growing pressures of chronic non communicable illnesses
services for the vulnerable, older people and children suffering
Issues around patient safety

9. ‘In a world of radically increased interdependence, health nearly everywhere is being shaped by the same powerful forces, like demographic ageing, rapid urbanization, and the globalization of unhealthy lifestyles.’
Dr Margaret Chan Director-General WHO 2012

10. The impact of globalisation - the international movement of professionals and professional knowledge and the resulting cross cultural transition of ideas are all manifestations of the global interdependence in health and education. Lancet Commission (2010)

11. World Health Reports
A series of reports produced regularly by the World Health Organization (WHO).
Published annually or biennially in multiple languages,
Each report includes an expert assessment of a specific global health topic, relating to all countries that are Member States of the organization.
Learning Together to Work Together for Health. World Health Organisation (1988)
Report of a WHO Study Group on Multiprofessional Education for Health Personnel. The Team Approach Technical Report Series 769. Geneva: WHO

12. World Health Report ‘Working Together for Health’ WHO (2006)
You will note that in all regions of the world except Europe, there is a critical shortage of doctors, nurses and midwives – other figures shoe a similar situation for other health and social care professions. Migration of health professions from developing to developed countries is a major issue.

13. WHO significant Reports
World Health Report (2006) ‘Working Together for Health’ Highlighted a "global health workforce crisis". an estimated shortage of almost 4.3 million doctors, nurses, midwives, and other health human resources worldwide.
World Health Report (2008) Primary Health Care (Now more than ever)’ ‘Now, more than ever, the health of people worldwide depends on health professionals working together across the boundaries of disciplines, professions and conventions’
Framework for Action on Interprofessional Education & Collaborative Practice (2010) – Report to the WHO The WHO and its partners acknowledge that there is sufficient evidence to indicate that effective interprofessional education enables effective collaborative practice.’

14. In response to these challenges:
In countries across the world government policies on workforce development have focused on the need for
- collaborative frameworks for education and practice;
- integrated approaches to care;
- co-operation,
- working across professional and organisational boundaries
Internationally, IPE and collaborative practice are seen as potential strategies to mitigate global health workforce crisis
An effective, interagency, interprofessional workforce is seen as critical for the health and welfare of future generations.

15. Impact of this approach
Modernisation is about looking at the workforce in a different way, as teams of people rather than as different professional ‘tribes’
Global modernising politics reshaping healthcare relationships
Health and social care professions are faced with substantial changes in the pattern of their relationships.
Politics is about relationships

16. Response to the Challenges by Governments around the world
Some examples
United Kingdom
Canada
Japan
Australasia

17. In Ireland ? Programme of reform Universal health insurance‘
Programme of reform
Universal health insurance
Community based services through a primary care setting
New models of care
National Clinical Care Programmes designed and implemented by clinically led multidisciplinary teams
Emphasis on standards and patient safety
greater flexibilities in work practices and rosters to achieve more efficient delivery of services
‘Our Health services are
facing challenges on a scale never experienced before’
‘Implementation of the
National Clinical programmes
is driving a re engineering of
traditional models of care and
of service delivery’’
‘All of these are being designed
and implemented by clinically
led multidisciplinary teams.’
HSE Report 2011

18. Health systems
are social institutions. Properly managed and adequately funded, a well-functioning health system contributes to social cohesion and stability.
In a world beset by one global crisis after another, social cohesion and stability are prized assets.
Health systems are highly context-specific.
Dr Margaret Chan Director-General WHO 2012

19. Interprofessional Learning and Collaborative Practice
The first thing we need to do is to be clear about what we / you mean by the terms interprofessional learning / interprofessional education / collaborative practice

20. No one profession can respond adequately to the multiplicity of problems that many patients present, be they children at risk, alienated young people, members of dysfunctional families, chronically sick and disabled people living longer, or amongst the growing number of old people surviving to an advanced age.
No one profession can meet the needs of every patient
H. Low

21. Patient Safety
Inquiries into medical errors, e.g. the United States (Institute of Medicine, 2001) and the United Kingdom (Kennedy, 2001), have attributed failure to problematic communications and relationships between professions (Meads & Ashcroft, 2005).
WHO (2011) Patient Safety Curriculum Guide: Multi-professional Edition
For the past three years, the World Health Organization has been exploring the links between education and health practice – between the education of the healthcare workforce and the safety of the health system. As an outcome, it has developed this multi-professional Patient Safety Curriculum Guide, which addresses a variety of ideas and methods for teaching and assessing patient safety more effectively.
Medical errors attributed to the failure of problematic communications and in effective relationships between profession.

22. Modernisation is about cultural change
Professions have to work in a different way – and make collaboration a normal part of professional practice.
Collaboration is easy to say, but working together with other professions, new partners and in different ways is not easy.
Collaboration essential but not easy
H. Low

23. Collaboration complex process with multiple components
can be a process, product or both
connecting,
cooperating,
consulting,
- encompasses: coordinating,
co-locating,
community building and contracting.
- Is more than the sum of its parts
H.Lawson (2004)

24. Academic institutions
Connections for Collaboration
Policy makers
International, national, regional and local government
Health & Care
Employers / managers
new organisations and agencies
Independent sector
Health & Care
Services
based on
people’s
needs
Health & Care
Professions
new roles, new occupations, new professions
Communities
Voluntary organisations
Service users and carers
Academic institutions
Higher & Further education new partnerships

25. Patient Voices
Why Collaborate?
A Video

26. The Lancet Commission Report – Health professional for a new century: transforming education to strengthen health systems in an interdependent world (2010)
Increasingly interdependent in terms of key health resources, especially skilled workers’
‘imperative to align professional competencies to changing contexts’

27. What are the competences of interprofessional learning and working
‘soft skills’ and complex achievements
social practices that are highly context dependent,
team working,
developing supportive relationships,
reflection and self awareness,
working across boundaries,
communication,
interpersonal skills
Mix of dispositions, understandings, attributes and
practices
Consider these competences – You need them for any kind of professional practice, but especially interprofessional practice

28. Competencies for Interprofessional Collaborative practice
CUILU (2006) Interprofessional capability framework. Sheffield: The Combined Universities Interprofessional Learning Unit.
Interprofessional Education Collaborative Expert Panel (2011) Core competencies for interprofessional collaborative practice: report of an expert panel. Washington D.C.: Interprofessional collaborative
Canadian Interprofessional Health Collaborative. A national competency framework for interprofessional collaboration
‘Core Competencies for Interprofessional Care’ in Healthforce Ontario (2010) Implementing Interprofessional Care in Ontario: Final Report of the Interprofessional Care Strategic Implementation Committee. Ontario

29. Why do we need inter-professional education
Learning for working across professional, organisational and agency boundaries, together, is essential
‘Inter-professional working must be grounded in inter-professional learning’ John Horder 2005
A flexible collaborative ready workforce is dependent on the way in which professionals are educated Lancet Commission 2010
. We need interprofessional education – we have to learn how o work across professional, organisation and agency boundaries
H. Low 29

30. Interprofessional education
‘Occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care’ (CAIPE 2002)
Principles
CAIPE commends a number of principles, drawn from the experience of its members and the interprofessional literature. These highlight the: values
process and
outcomes
deemed essential for effective interprofessional learning and working (CAIPE 2011)

31. The Evidence Base?
Patients report higher levels of satisfaction, better acceptance of care and improved health outcomes following treatment by a collaborative team.
There is now sufficient evidence to indicate that interprofessional education enables effective collaborative practice which in turn optimizes health services, strengthens health systems and improves health outcomes World Health Organisation 2010

32. Hammick et al (2007)
21 studies discussed of the 399 reviewed (UK 11, USA 7, Canada 1, Finland 1, Sweden 1)
15 of the studies (72%) considered undergraduate IPE.
All peer reviewed papers and reports, quantitative and qualitative approaches included
Considered the following outcomes of learning: learners reactions; changes in skills, knowledge, perceptions of and attitude to others; changes in behaviour as well as impact on service users

33. Findings Competent facilitation of IPE essential
Learner reaction to IPE is related to multiple factors
IPE needs to reflect appropriate and relevant service delivery settings
Principles of adult learning are key
IPE generally well received and enables learning of the knowledge & skills for collaborative working
In the context of quality improvement initiatives IPE frequently used to enhance development of practice & improvement of services

34. Cochrane Systematic Review (Reeves et al 2009)
Six studies met the inclusion criteria (small but first IPE review in 2000 found none)
4 RCTs and 2 Controlled Before and After (CBA) Studies
Five studies conducted in the US, one in the UK
All studies undertaken with groups of qualified staff in established teams eg A&E, PHC

35. Findings
Four of the studies indicated that IPE produced positive outcomes in the following areas:
emergency dept culture and pt satisfaction;
collaborative team behaviour & reduction of clinical error rates in emergency dept teams;
management of care to domestic violence victims;
mental health practitioner competencies related to the delivery of patient care
Two studies reported mixed outcomes (positive and neutral)
Two studies reported that IPE had no impact on either professional practice or patient care

36. Outcomes, Effectiveness & Evaluation
Outcomes: what you intend to achieve by the
end of the Project
Effectiveness: the extent to which your
outcomes have been achieved
Evaluation: process of looking at the evidence /
data, to determine whether something has made a
difference, ie; to measure any changes that have
occurred from the initial situation.

37. Outcomes of Interprofessional Education
Reaction
Learners’ view on the learning experience and its
interprofessional nature
Modifications of attitudes / perceptions
Changes in reciprocal attitudes or perceptions between
participant groups. Changes in perception or attitude towards the value and/or use of team approaches to
caring for specific client group
Acquisition of knowledge / skills
Including knowledge and skills linked to
interprofessional collaboration

38. Outcomes of Interprofessional Education
Behavioural Change
Identifies individuals’ transfer of
interprofessional learning to their practice
setting and changed professional practice
Change in organisational practice
Wider changes in the organisation and delivery of care
Benefits to patients / clients
Improvements in health or well being of patients and carers
Freeth et al 2003 (modified from Kirkpatrick 1967

39. Move towards competency based professional education – outcomes expressed as competences
contemporary professional education has adjusted and changed to meet workforce requirements;
so interprofessional education has been seen as necessary to equip professionals for multi dimensional collaboration
Standards and outcomes set by regulatory body and others eg, national occupational standards
Different types, different level.
Common, complementary and collaborative competences

40. Professionalism Initial growth of professionalism mid 19th Century
Uni professional education,
By mid 20th Century professions being challenged
Attempts to bring health and social care professions in general and medicine in particular under greater control
Growing concerns about public safety and professional powers in light of, e.g. tragedies of Bristol Royal Infirmary events and Victoria Climbie
Reform of Professional Regulatory bodies
Establishment of Council for Healthcare Regulatory Excellence

41. Lancet commission Report (2010)
Idea of professions and professionalism beginning to change
New professions emerging
Attempts to break down the barriers between professions
Move towards interprofessional practice and interprofessionalism
Need for reforms guided by transformative learning and interdependence
Competency-based education
transprofessional teamwork that includes non-professional health workers

42. Challenges for IPE in professional education
Professional socialization
Professional culture
Professional language / jargon
Organizational difficulties
Lack of service support
Lack of equality and reciprocity

43. Challenges for IPE in Professional Education
Different educational and social backgrounds
Fear of dilution of professional role / loss of professional identity
Separate professional education – stereotyping
Perceived different status and power
Poor communication
Poor facilitation of IPL
Professionalism - key element in agendas related to interprofessional education in the UK

44. Professions as regulatory bodies assume different degrees of significance in different societies
These set the parameters at national international level for the operation of specific professions, including in education.
Opportunities for creating interprofessional education for practice are not just shaped by the educational institutions concerned and employer partners, but also by professional bodies.

45. Challenges re the practicalities
Fitting IPE into a full curriculum – issues of ‘add on’ / integration
Timetabling and logistics
Resistance from colleagues and students
Hierarchies between professions
Silos and territorialism in universities and in practice
Lack of support from professional organisations
Poor communication systems

46. Interprofessional learning and working
Works to improve the quality of care
Focuses on the needs of service users and carers
Encourages professions to learn with, from and about each other
Respects the integrity and contribution of each profession
Enhances practice within professions
Just to reinforce what I have been saying about IPE
H. Low

47. Benefits of Inter-professional Learning and Working
Shifts focus from professional roles to patient needs
Implicitly builds inter-professional team learning/working
Demonstrates the power of sharing knowledge and experience
It fosters innovation and capacity for change
As above
H. Low 47

48. Interprofessional Education
Applies principles of Adult Learning
Is practice led
Includes common and comparative learning
Is interactive
Involves service users
Is competency based
Is assessed
Improves practice
Is evaluated
These are the principles of IPE. As long as these are in place, iy does not matter which model, or theory you use.

49. Facilitating Interprofessional Learning Evidence indicates that the success of interprofessional learning is dependent to a significant extent on the effectiveness of those who facilitate it, at every level.

50. Facilitation of interprofessional learning
Individuals may be experienced clinicians, practitioners and / or educationalists, but may lack the particular knowledge, skills and confidence to facilitate learning with groups of people from diverse professional backgrounds
Even very experienced teachers find the challenges of multi professional teaching difficult to manage. Preparation is crucial
Facilitation of interprofessional learning requires a level of expertise which builds on but extends beyond the range of knowledge, skills and attitudes required for uni professional teaching.

51. Facilitators of interprofessional learning of multi professional groups must:
Have the ability to discern and address a range of complex issues, such as different professional cultures. perceived power and status of different professions and professional language.
They must also have the sensitivity required to work across professional and organisational barriers to achieve change.

52. Members of different professions have different
Styles of learning
Patterns of thinking
Attitudes to authority
and therefore different constructions of reality.
Different professionals have different skills,
knowledge, concepts
and therefore different value systems

53. Values and relationships
The values that are part of professional culture will be reflected in the way professionals perceive other professions and affect the way relationships are (or not) developed.
These relationships are crucial to effective interprofessional working and collaboration and influence the way in which interprofessional education is taken forward.
H. Low

54. IPE is not achieved by structural and systems change alone
It relies on the development of collaborative
relationships, changed attitudes and behaviours
for the long term, to develop a culture of IPE
is an applied discipline dependent on the context where it takes place
learning is transferable to new contexts and dependent on reinforcement

55. agreed aims, objectives and values
Some Key Factors for effective Interprofessional Learning and Interprofessional working
agreed aims, objectives and values
address anxieties regarding any perceived reduction of standards and dilution of professional service.
recognise issues of status and authority
equity – all contributions are valued, individual and professional confidence enhanced
respect differences
Mutual respect and mutual support are important
Recognise own and others’ knowledge and expertise
Recognise where these are different and where they overlap
Shared Learning: A Good Practice Guide ENB/CCETSW (Low.H, Weinstein.J)

56. Key factors for successful planning & delivery of an IPE initiative
identify and get support of key stakeholders
strong leadership
identify enthusiasts/ champions for IPE
work in a partnership of educators and service providers, plan together
involve staff at all levels
involve service users
resources
Start with what you have!
Shared Learning: A Good Practice Guide ENB/CCETSW (Low.H, &Weinstein.J)

57. Academic institutions
Connections for Collaboration
Identifying stakeholders
potential partners
Policy makers
International, national, regional and local government
Health & Care
Employers / managers
new organisations and agencies
Independent sector
Health & Care
Services
based on
people’s
needs
Health & Care
Professions
new roles, new occupations, new professions
Communities
Voluntary organisations
Service users and carers
Academic institutions
Higher & Further education new partnerships

58. Global Interprofessional networks - connections and relationships
CAIPE UK CENTRE FOR THE ADVANCEMENT OF INTER-PROFESSIONAL EDUCATION
EIPEN EUROPEAN INTER-PROFESSIONAL EDUCATION NETWORK IN HEALTH & SOCIAL CARE
INTERED THE INTERNATIONAL ASSOCIATION FOR INTER-PROFESSIONAL EDUCATION & COLLABORATION
JAIPE THE JAPANESE ASSOCIATION FOR INTER-PROFESSIONAL EDUCATION 58

59. Interprofessional learning & working is not just about individuals, groups and organisations coming together and redesigning the way they do things.
It is also about reflecting on the quality of
relationships with each other