Brenda J. Stutsky RN, PhD Development and Testing of a Conceptual Framework for Interprofessional Collaborative Practice

Outline Project Background Literature Review Methods/Procedure Instrument Results Conceptual Framework 77 Discussion

Project Background Post-doctoral work in Health Human Resource Optimization at UWO September 2011 – December 2012 Advisor: Dr. Heather Laschinger

Project Background Special thanks to: –Carol Cooke, Associate Librarian, University of Manitoba –Catherine Hynes, Regional Manager Decision Support, Northern RHA

Literature Review Extensive review of the interprofessional literature –Antecedents/consequences of: Interprofessional education (IPE) Interprofessional collaborative practice (ICP)

Literature Review Problem –Interprofessional literature: Atheoretical –Terms are poorly conceptualized –Consistent framework for research is missing (Reeves et al., 2011)

Literature Review Collaborative Practice “When multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings.” (WHO, 2010)

Literature Review Relationship-Centered Collaborative Care –Model developed by Tresolini & Pew-Fetzer Task Force (1994) –3 key relationships 1.Patient-practitioner 2.Community-practitioner 3.Practitioner-practitioner –Used by researchers to guide ICP studies (Dix et al., 2008; Gaboury et al., 2011)

Consequences Interprofessional Collaborative Practice Conceptual Framework Antecedents Personal Factors Interprofessional Insight Beliefs in IPC Flexibility Relational Skills Trust Cooperation Communication Skills Situational Factors Leadership Empowerment Support Structures Interprofessional Collaborative Practice Collective Ownership of Goals Understanding of Roles Interdependence Knowledge Exchange Work Behaviours & Attitudes Personal Work Satisfaction Intent to Stay Team Perceived Team Effectiveness Conflict Organizational Outcomes Patient Safety Quality of Patient Care Patient Outcomes Patient Biopsychosocial Outcomes Patient Satisfaction Patient Empowerment Length of Stay

Methods/Procedure Exploratory design Regulated healthcare providers in Northern RHA –Involved in direct patient care planning or team decision making 3 hospitals, 3 long-term care facilities, 4 primary healthcare centres Manager in RHA assisted with distribution of packages –Information sheet –Informed consent –$2.00 gift card & draw ballot

Instrument Interprofessional Collaborative Practice Survey (Stutsky & Laschinger, 2012) –Constructed from existing standardized measures –55 items with 9 demographic items –5-point scale of strongly disagree to strongly agree (1-2=low level, 3=moderate, 4-5=high level) –Pt. safety, quality, degree of collaboration (5-point scale from low to high) –2 items measuring degree of collaboration used to validate ICP measure (r=.60 and r=.48)

Instrument Exploratory Factor Analysis (Construct Validity) –ICP –Personal Antecedents –Situational Antecedents –Consequences: Work Behaviours and Attitudes Reliability was adequate (.67 to.88)

Rotated Factor Loadings for Interprofessional Collaborative Practice Scales/Question #Ownership of Goals Understanding of Roles InterdependenceKnowledge Exchange Goals Goals Goals Goals Roles Roles Roles Interdependence Interdependence Interdependence Knowledge Knowledge Knowledge factors with Eigenvalues greater than 1.00, explaining 59.73% of the cumulative variance

Rotated Factor Loadings for Antecedents: Personal Factors Interprofessional Insight Relational Skills Scales/Question #Beliefs in ICPTrustCommunicationFlexibilityCooperation Belief Belief Belief Belief Trust Trust Trust Trust Trust Communication Communication Communication Flexibility Flexibility Cooperation Cooperation factors with Eigenvalues greater than 1.00, explaining 71.44% of the cumulative variance

Rotated Factor Loadings for Antecedents: Situational Factors Situational Factors Scales/Question #SupportLeadershipEmpowerment Support Support Support Support Support Leadership Leadership Leadership Empowerment Empowerment factors explained 67.50% of the cumulative variance

Rotated Factor Loadings for Consequences: Work Behaviours and Attitudes Work Behaviours & Attitudes: Team Work Behaviours & Attitudes: Team Scales/Question #ConflictTeam Effectiveness Intent to StayWork Satisfaction Conflict Conflict Conflict Conflict Team Effectiveness Team Effectiveness Team Effectiveness Stay Stay Stay Work Satisfaction Work Satisfaction factors explained 74.71% of the cumulative variance

Results Demographics Response rate 32% (N=117) 95 females, 21 males, 1 not indicated yrs. of age (M=43.30, SD=11.77) yrs. of experience (M=15.51, SD=12.45) 75% nurses, 17% allied health, 8% physicians 59% acute care, 34% community care, 7% long-term care 72% full-time, 24% part-time, 4% casual 78% direct patient care

Results Subscale Scores Means ranged 3.25 (SD=.81) to 4.41 (SD=.63) Conflict 3.05 (SD=.73) –Only 34% did not have frequent conflicts over sharing of responsibilities (M=2.97, SD=1.03) –Only 25% did not believe that interprofessional relationships had winners and losers (M=3.27, SD=1.05)

Results Correlations Correlations between ICP and its antecedents and consequences All factors were significantly correlated with overall ICP (r= , p<.01) except for flexibility

Results Hierarchical Multiple Regression Influence of personal and situational antecedents on overall ICP 37% of the variance of ICP was attributed to personal factors with an additional 12% being explained by situational factors Hierarchical Multiple Regression for Personal and Situational Factors on ICP R2R2 ∆R2∆R2 BSEβP Personal Factors.366** ** Situational Factors.123** ** Total ICP R 2.489** **p<.001

Results Hierarchical Multiple Regression Influence of individual components of subscales of personal and situational antecedents on overall ICP 49% of the variance of ICP was explained by personal factors with an additional 10% being attributed to situational factors

Hierarchical Multiple Regression for Personal and Situational Subscales on ICP R2R2 ∆R2∆R2 BSEβP Personal Factors.485** Beliefs in IPC Flexibility Trust * Cooperation * Communication ** Situational Factors.098** Leadership Empowerment Support Structures ** Total ICP R 2.583** *p<.05, **p<.001

Results Series of Regression Analyses Combined effect of personal and situational antecedents and overall ICP on consequences Combination of predictors explained a significant variance in all six consequences of ICP

Hierarchical Multiple Regression for the Entire Model Work Behaviours & Attitudes: Personal Work Behaviours & Attitudes: Team Organizational Outcomes Work Satisfaction Intent to Stay Team Effectiveness Conflict Patient Safety Quality Patient Care Standard Coefficients Beta Personal Factors Beliefs in IPC * Flexibility Trust ** Cooperation * Communication * Situational Factors Leadership Empowerment.570**.364* Support Structures * ICP ICP Overall.305*.405**.329*.450**.283* R 2 and ∆R 2 Personal Factors R 2.200**.178**.377**.417**.207**.270** Situational Factors ∆R 2.232**.096*.090** * ICP ∆R2.039*.069**.045*.085**.033* Total Model R 2.472*.313*.537**.469*.334**.380* *p<.05, **p<.001

Discussion Encouraging preliminary empirical support for the conceptual framework Results were consistent with findings in the literature including the importance of relationship-centered collaborative care Limitations include small sample size and response rate Limited power prevented more sophisticated analyses (SEM) Psychometric properties of the ICPS are promising but continual refinement and validation is needed Patient outcomes need to be captured in future studies

Discussion Use of the framework –Healthcare leaders: Guide for facilitating ICP to enhance patient safety and quality of care –Educators: Strengthen IPE curricula –Healthcare professionals: Evidence linking personal attitudes and behaviours to effective ICP and patient safety and quality may motivate them to reflect on own behaviours and make a commitment to ICP Further research to validate the framework