Life lessons in interprofessional collaboration

Interprofessional collaboration (IPC) is defined by the Canadian Interprofessional Health Collaborative (CIHC) as “the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients/clients/families and communities to enable optimal health outcomes” (CIHC, 2010, p. 8). IPC is considered a healthcare reform response to global health workforce shortages (World Health Organization, 2010). It is also considered a healthcare reform response to the growing demand for patient-centered care, provided interprofessional teams effectively include patients/caregivers as team members (NEJM Catalyst, 2017).

As an unregulated healthcare professional working on an interprofessional team, I am continuously learning and developing the skills necessary for effective IPC. In this process I look to the guiding frameworks that have been created at regional, provincial, national and international levels. I have curated these guiding documents for readers interested in reviewing them in greater detail.

In 2010, the CIHC published a list of six competency domains to highlight the knowledge, skills, and attitudes required of healthcare professionals for effective IPC (CIHC, 2010). These competencies are cited throughout the IPC guiding documents of my employer, Alberta Health Services (AHS, 2014; AHS, 2015). In this blog post, I will share stories of how I learned about each of these six competencies while working as a healthcare professional in Alberta.

1. Role Clarification: Learners/ practitioners understand their own role and the roles of those in other professions, and use this knowledge appropriately to establish and achieve patient/client/ family and community goals (CIHC, 2010, p. 12).

My team consists of regulated healthcare professionals (Registered Nurses, Registered Dietitians, Registered Social Workers), unregulated healthcare professionals (Health Promotion Consultant, Multicultural Outreach Workers, Child Life Specialist), and clients (patients) and their families. Roles, responsibilities, and processes for working together have been laid out for our team in our program manual. When questions arise about who should take on certain tasks, our team can turn to the program manual for direction. If questions remain unanswered, our team can then turn to the documents outlining professional scope for the regulated professions and job descriptions for the unregulated professions. If questions still remain, we can turn to our management team and our respective unions for support. Usually team members respect the roles of everyone involved and work efficiently. I recall one situation where one regulated professional felt her professional opinion was more valuable than that of a different regulated professional. This resulted in two transfer of care forms being filled out for a single client. A discussion with those involved took place with our manager. A larger discussion with our entire team helped remind everyone of the value of each team member and the importance of communication for working efficiently with less duplication.

2. Patient/Client/Family/ Community-Centred Care: Learners/ practitioners seek out, integrate and value, as a partner, the input and the engagement of the patient/client/ family/community in designing and implementing care/ services (CIHC, 2010, p. 13).

Our team works directly with clients of diverse backgrounds, perspectives, cultural norms for decision- making, and health literacy levels. Our program values client/family-centered care. To ensure our clients are active members of the interprofessional team, each healthcare professional on the team spends a significant amount of time building a relationship with every client. This is done through multiple contacts over the phone, at group education sessions, at individual appointments at community sites, or at home visits. This allows the client and the professionals to establish trust and respect in each other, opening the door for respectful communication and shared decision-making. When working with clients new to Canada, my colleagues feel their most important contribution is helping the clients navigate the Canadian health system. The navigation process allows newcomers to increase their understanding of health options and their ability to make health decisions that fit their needs, preferences, and beliefs. With this increase in knowledge and skills, our clients become increasingly valuable team members that can participate in the shared decision-making model.

3. Team Functioning: Learners/ practitioners understand the principles of team work dynamics and group/team processes to enable effective interprofessional collaboration (CIHC, 2010, p. 14).

Our team faces continual change. Each year we have new staff members join our team as we say goodbye to colleagues that leave for parenting duties, a new career, or retirement. We must work quickly to learn the strengths and skills of new team members to ensure they fit into our interprofessional team as seamlessly as possible, minimizing negative impacts on client care. Earlier this year our management team provided us with an Insights Discovery workshop, where we learned more about ourselves and each other. More importantly, we learned how to use the strengths, weaknesses, and communication styles of our colleagues to have more effective conversations. In addition, we were given self-awareness tools to help keep our own emotions and perspectives in check when dealing with difficult conversations. I have seen the overall stress level of our team decrease since completing the workshop. I have also observed our team function improve as the number of productive conversations, including healthy criticism, between team members increased.

4. Collaborative Leadership: Learners/ practitioners understand and can apply leadership principles that support a collaborative practice model (CIHC, 2010, p. 15).

Collaborative leadership is dynamic leadership, with team roles shifting as the situation warrants. This means that leadership duties may be assigned to any member of the interprofessional collaborative team, including the client if they so desire. Empowering clients to take the lead of their own health is a goal for any team that values client/family-centered care. We take time to teach our clients health literacy skills, respectful communication skills, and decision-making skills. It is our hope that this will enable clients to take control of their healthcare in a way that feels personally comfortable and acceptable. Although clients do not attend our monthly case conferences for confidentiality reasons, any healthcare professional on the team can lead the discussion of a client’s care. I believe this is one example of collaborative leadership in action.

5. Interprofessional Communication: Learners/ practitioners from different professions communicate with each other in a collaborative, responsive and responsible manner (CIHC, 2010, p. 16).

I have already given one example of how our team members learned to have more effective conversations in the Insights Discovery workshop. As our clients are members of our interprofessional collaborative team, I would like to give an example of one tool we use for communicating with our clients and their families. Originally developed in 1983 by Berlin and Fowkes, the LEARN model is used by many healthcare professionals throughout the globe today. It is helpful for addressing communication and cultural differences. The steps in the LEARN framework are: listen to client’s perspective, explain your perspective, acknowledge differences and similarities, recommend a course of action, and negotiate final decision (Berlin & Fowkes, 1983). I encourage readers to view the original article using the link above for a greater description of each step in the framework.

6. Interprofessional Conflict Resolution: Learners/practitioners actively engage self and others, including the client/patient/family, in positively and constructively addressing disagreements as they arise (CIHC, 2010, p. III).

Although listed separately, all six competency domains are related. I believe that many of the examples I have already given also apply to conflict resolution. The LEARN model and the strategies learned in the Insights Discovery workshop focus on respectful communication as a method of resolving conflict. If respectful communication is not enough to solve a conflict, reviewing the policies and procedures related to role clarification may help resolve the issue. If further support is required for conflict resolution, a team may refer to leadership for additional insight. I commit to resolving conflict quickly and respectfully, thereby allowing my team to function at a high level of efficiency.

Learning and living out the IPC competencies is a continuous process. I can find examples of how I learn to become a more collaborative team member almost daily. Investing in my Master of Health Studies degree is another way that I am developing as a collaborative healthcare professional. I look forward to the life lessons to come.

Figure 1. IPC Competencies as outlined in the National Competency Framework. Adapted from "A National Interprofessional Competency Framework" by Canadian Interprofessional Health Collaborative, 2010. Copyright 2010 by Canadian Interprofessional Health Collaborative.

References

Alberta Health Services. (2014). Accountability , Responsibility and Legal Liability of Regulated and Unregulated Health Care Providers Working in Collaborative Care. Edmonton: Alberta Health Services.

Alberta Health Services. (2015). Collaborative Practice Principles Supporting Patient and Family Centred Care. Edmonton: Alberta Health Services.

Berlin EA. & Fowkes WC. (1983). A teaching framework for cross cultural health care: Application in family practice. The Western Journal of Medicine, 12(139), 93-98. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1011028/pdf/westjmed00196-0164.pdf

Canadian Interprofessional Health Collaborative. (2010). A National Interprofessional Competency Framework. Retrieved from https://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf

NEJM Catalyst. (2017). What is Patient-Centered Care? Retrieved from https://catalyst.nejm.org/what-is-patient-centered-care/

World Health Organization. (2010). Framework for Action on Interprofessional Education & Collaborative Practice. WHO reference number WHO/HRH/HPN/10.3. Retrieved from https://www.who.int/hrh/resources/framework_action/en/