Interprofessional Practice in healthcare Valerie dzubur edd arpn fnp-bc Samuel merritt university

Learning objectives Define Interprofessional Collaborative Practice Compare team work with interprofessional team-based care Discuss Patient/Family Centered Healthcare Educating healthcare professionals for the 21st century

Interprofessional practice History… we have been thinking and talking about this for awhile 1972 IOM report goals: Practice at full scope of expertise A conscious effort to form teams sharing common goals Incorporating the patient, family, and/or community as members To grow a cost-effective, safer, more responsive healthcare system But the movement did not gain any traction Professional stayed in their siloes

Interprofessional practice Why now? In the past ten years compelling large-scale practice issues have prompted broad- base support for changing the way we education healthcare professionals Widespread errors in hospitals Substantial preventable mortality and morbidity Major quality issues High costs Information technology Changes in the educational environment A need to prepare professionals for the future

Healthcare for the 21st century How care is delivered is as important as what care is delivered We need new primary care approaches with… Expanded accountability for population management of chronic diseases Primary Care provided by teams with a medical home Responsibilities for addressing health promotion and primary prevention To help individuals/families/communities in behavior change Healthy environments Public health responsive to emergencies

The system was based on Hierarchy MD Hospital Insurance Pharmacy Nursing Workers Patients

The healthcare team Based on hierarchical relationships Avoid overlapping roles and responsibilities Physicians direct the team Conflict is resolved by power which flows top down Unique contribution of members is not mentioned Care responsibilities are often based on tradition and are often fragmented Patients/team members follow the doctor’s orders// administrative policies

Interprofessional collaborative practice When multiple health workers from different professional backgrounds Work together with patients, families, carers, and communities to Deliver the highest quality of care (WHO, 2010)

Interprofessional healthcare teams Care delivered by intentionally created, usually relatively small work groups in healthcare, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients, e.g., rapid response teams, palliative care team, primary care team, operating room team

Key Processes for Collaborative teams Communication Cooperation coordination collaboration

Interprofessional healthcare Patient Centered Interprofessional teams Apply Quality Improvement Evidence Based Informatics

Interprofessional practice domains Family Patient Populations Community Team based practice Interprofessional communication Roles/Responsibilities for Collaborative practice Values /ethics for interprofessional practice

Competency based healthcare For interprofessional collaborative practice Patient/family centered (termed “Patient Centered” Community/population oriented Relationship focused Process oriented Linked to learning and behavioral assessments Able to be integrated across the learning continuum Sensitive to the systems context/applicable across practice settings Applicable across professions Stated in language common and meaningful across professions Outcome driven

Interprofessional teams Domain I Values/Ethics Competency The interests of patients/populations is at the center of care Respect the dignity & privacy of patients/populations Embrace cultural diversity Respect culture/expertise of other health professionals Work in cooperation patients/support/deliver healthcare Develop trusting relationship patient/family/team members High standard ethical conduct/ manage dilemmas Act with honesty/integrity with patients/families/ team members Maintain competence in one’s own profession/scope

Interprofessional teams Domain Roles and Responsibilities Competency Communicate one’s roles/responsibilities to patients/families/team Recognize one’s limitations/resources to meet needs Explain how the team works to provide care Use full scope to provide care safe/timely/efficient/ equitably Communicate with team to execute treatment plan Forge interdependent relationships with other professionals Engage in continuous professional development to enhance team Use abilities of all team members

Interprofessional teams Domain Interprofessional Communication Competency Choose effective communication tools including informatics Organize & communicate information with patients/family/team members Express one’s own knowledge & opinions confidence clarity respect Listen actively, encourage ideas of other team members Give timely sensitive instructive feedback to team members Use respectful language especially if there is conflict Recognize how one’s own uniqueness contributes to the team Communicate consistently the importance of teamwork

Interprofessional teams Domain Teams and Team Work Competencies Describe the process of team development Develop consensus on ethical principles Engage others in share patient-centered problem-solving Apply leadership to practice that supports team effectiveness Engage self and others to constructively manage disagreements Share accountability with other professionals/patients for outcomes Reflect on individual and team performance for improvement Use process improvement to increase effectiveness Use available evidence to inform team-based practice Perform effectively on teams in a variety of settings

Interprofessional teams Autonomy or Collaboration? What are the issues for NP? Is this a false dichotomy or a practical dilemma? Dose working at full scope of practice clarify the question? Is it a possibility that collaboration actually requires autonomy Components of autonomy Readiness Empowerment Actualization Valuation