ENHANCING INTERDISCIPLINARY COLLABORATION IN HEALTH CARE Ayman M. Hamdan-Mansour, RN, PhD School of Nursing-The University of Jordan

OUTLINE  Defining interdisciplinary collaboration  Composition of interdisciplinary teams  Principles of interdisciplinary collaborations in Primary Health Care  Best and promising examples from practices

INTERDISCIPLINARY  “Breakthrough innovation occurs when we bring down boundaries and encourage disciplines to learn from each other” Gyan Nagpal  Although each discipline contributes unique perspectives, together the team can provide optimal integrated services

DEFINITION  Interdisciplinary Health Care Team (IHCT) is "a group of individuals with diverse training and backgrounds who work together as an identified unit or system” (Drinka, 2000, p47).  Multidisciplinary care professionals from a range of disciplines work together to deliver comprehensive care that addresses as many of the patient's needs as possible

DEFINITION  Sharing expertise, knowledge, and skills to impact on patient care.  An interpersonal process characterized by healthcare professionals from multiple disciplines with shared objectives, decision-making, responsibility, and power working together to solve patient care problems.

COLLABORATION Defined as a joint communication and decision-making process with the goal of satisfying the health care needs of a target population

WHY INTERDISCIPLINARY???  Aging, chronic illnesses Complex needs  Complexity of skills and knowledge  Increasing specialization within health professions  Global calling to multi-professional team work  Moving towards continuous quality improvement

WHAT DO WE GET  Improved patient and family outcomes  Improve the diagnostic and prognostic abilities of health professionals.  Improved health outcomes  Enhanced satisfaction for clients  Efficient use of resources  Enhanced job satisfaction for team members

FACILITATING INTERDISCIPLINARY 1.Integration of information. 2.Integration of specific discipline assessments. 3.Collaborative assessment and diagnostics process 4.Collaborative plan of care 5.Understanding teammates' roles 6.Measurable outcomes

Interdisciplinary collaborations questions meanings and values of our daily working agenda

COMPONENTS OF INTERDISCIPLINARY  The five core components of the Model for Interdisciplinary Collaboration, developed by Bronstein (2003): 1.Interdependence 2.Newly created professional activities 3.Flexibility 4.Collective ownership of goals 5.Reflection on process.

Brining together the interdisciplinary components and getting them working truly in collaboration is a key challenge

PROCESS  The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non- linear fashion  The process is best attained through an interprofessional education that promotes an atmosphere of mutual trust and respect, effective and open communication, and awareness and acceptance of the roles, skills, and responsibilities of the participating disciplines

HINTS  First and foremost, interdisciplinary collaboration is described as a process  Sharing is a story of decision making and power  Interdisciplinary collaboration can’t be achieved without individual and organizational support

CONTROVERSIAL  For interdisciplinary collaboration, the problems relate to inconsistency in the term used to describe the concept and the blurring of the attributes and antecedents for the concept.  What is missing: How can the presence of the concept best be measured? How can the actual influence of the identified antecedents on the development of the concept best be measured?

MODELS OF TEAM PRACTICE  The Parallel Model  The Sequential Model  The Shared Model

TOOLS OF SUCCESS  Respect and trust between team members  The best use of the skill mix within the team  Agreed clinical governance structures  Agreed systems and protocols for communication and interaction  Valuing diversity of skills  Clear vision, role and purpose of the team  Role socialization and clarification  Power sharing

TOOLS OF SUCCESS  Good communication  Respecting and understanding the roles of other team members  outcomes of care was identified as an important component of a good team  Leadership and management  Team culture of trust, valuing contributions, nurturing consensus

PITFALLS  New members are confused regarding what is expected of them and what they can expect from others  Increased conflicts between team members  Crises arise when members assume that someone else was responsible for handling the situation  Team decisions are not carried out effectively  Not given sufficient autonomy  members remain stuck in their disciplines

THE JORDANIAN STORY The Psychiatric Care Experience

BRIEF  To prepare mental health workforce to manage needs of people in Jordan in the primary health centers and in the outpatient psychiatric clinics.  To increase mental health professionals’ competency.  To generalize the experience of dealing with war crises mental health problems of the nurses in this project to nurses in primary health centers and outpatient psychiatric clinics.

TARGET  Nurses and physicians working at primary and outpatients psychiatric settings  Targeted patients: people with mental health people; Jordanians and non-Jordanians (e.g., Iraqi …)  Period: 3 months

MODEL  We have utilized The Sequential Model of team work The nurses performs an initial history and psychiatric assessment while the physician assumes responsibility for differential diagnosis and management.

MODEL  Also utilized the Interdisciplinary Health Care Team (IHCT) as model of interdisciplinary collaboration: A group of individuals with diverse training and backgrounds who work together as an identified unit or system. Team members consistently collaborate to solve patient problems that are too complex to be solved by one discipline or many disciplines in sequence.

RATIONAL  Fragmented care  Stigma of seeking mental health care  Untreated mental health patients  Lack of specialized care  Shortage of resources

HOW: METHODS OF TEAM PRACTICE  Interactive Interdisciplinary Team 1.Primary care and out patients psychiatric care settings. 2.Integrated diagnoses (collaborative decision) 3.Development of interdisciplinary team care plan. 4.Members interdependent ( nurses and physicians have their own assessment and interventions) 5.Team structures enable collaboration ( bi-weekly meetings) 6.Work on team problems (using the interdisciplinary care plan) 7.Leadership appropriate to issue/ expertise (psychiatrists is the agreed leader of the team) 8.Individual decides based on knowledge (autonomy of decision considering the care plan)

EFFECTIVENESS  + ve Early detection Moderate patients and family satisfaction Integrated care plans Time effective Organized performance

EFFECTIVENESS  - ve LACK OF FOLLOW UP PROCEDUCRAL ISSUES CONFLICS

WHY: ISSUES TO CONSIDER AND NOT A RATIONAL  Shortage of health professionals  Logistics problems ( distances, transportation, referral, health insurance, …)  Lack of training  Reference items

Unity is strength... when there is teamwork and collaboration, wonderful things can be achieved.

THANKS