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Interprofessional Team
Collaboration (IPTC) in Hospitals


          Bachchu Kailash Kaini
             PhD Student (Part Time)

                Business School

             University of Greenwich
Context
• Health care is multifaceted and complex
  activity
• Changes in demographic structure and
  disease pattern
• Increased cost of care
• Concept of specialties and sub-specialties
  emerging
• Expansion of roles of health care professionals
  (HCPs)
• Well informed patients and more choices
• Changing health care environment requires
  new ways of working & collaborative practice
Hospital Environment
                                         Professional
                                           Groups


                                    Organisational
                                       Policies
               Voluntary                                               Regulatory
                Sectors                                                  Bodies


                               Medical                  Nursing


                   Boards &                Service                Resources
        Community Functional                                                Legislations
                    Teams                   Users                 Available


                                AHPs            Admin & Mgmt



             Commissioners                                           Government
                                       Organisational
                                         Structures


                                       Other Service
                                         Providers
Occupation and Profession
• Occupation refers to someone’s job
• Occupation can become profession when:
  – It gains full status and identity
  – It goes through various stages of training, education
    and qualifications
  – It is recognition by a regulatory body or authority
  – It gains high degree of autonomy
• Profession is special type of occupation
Profession
• A group of people who have undertaken a given
  programme of education and/or training, and as
  a result of this are permitted to become part of
  much larger and somewhat exclusive group
  (Hammick et al, 2009).

• Characteristics of profession
   –   Intellectual activities
   –   Based on science and learning
   –   Used for practical purposes
   –   Can be taught
   –   Organised internally
   –   Altruistic
                           (Flexer, 1915; quoted in Ducanis and Golin, 1979)
Interprofessional Care
• IPC is a collaborative working (Leathard, 2003;
  HFO, 2007; Hawley, 2007) in which HCPs share
  common purpose of developing mutually
  negotiated goals (Payne, 2000; Pietroni, 1992)
  which are achieved through agreeing a care
  plan, the management of it and procedures
  (Colyer, 2012).
• IPC to happen in practice, HCPs:
  –   Pool their skill, knowledge and expertise
  –   Shared professional view points
  –   Make joint decision
  –   Learn from each other
IPC, Teamwork and Collaboration

                       Collaboration


                         Teamwork




           Differing forms of interprofessional work (Reeves et al, 2010; p.44)
Different but Shared Approaches

                       Knowledge

    Professional
                                          Skills
    Contribution

                        Medical
  Professional
                                           Expertise
    Culture
                    Nursing     AHPs


         Care                            Personal
     Philosophies                       Attributes
                      Problem-solving
                           Styles
Interprofessional Team Collaboration

                Shared Goal of Interprofessional Team Collaboration (IPTC)
                            (Effective Delivery of Health Care)


                                                                IPTC
 IP Team Formation                IP Team Development           •Collaboration
 •Team composition                •Leadership                   •Co-ordination
 •Hierarchies                     •Support for team             •Co-operation
 •Roles and responsibilities      •Training & development       •Commitment
 •Protocols and strategies        •Regular review               •Communication
 •Resources                       •Reward                       •Cohesion
                                                                •Openness & trust


                                  Desired Outcome of IPTC
                        For Service Users               For HCPs
                      Satisfied Service Users     Satisfied Workforce
                            Healthy Life          Professional Growth
                     Improved Health Status       Employee Retention
Impact of IPTC

              Team Performance                                      Staff Satisfaction
Wider range of expertise & shared decision making                   Satisfied work force
          Burden and challenges shared                             Professional growth
        Tasks divided between members                               Employee retention
    Greater efficiency in the use of resources            Support and motivation from each other

                                           Quality of Care
                                    Consistent and continuity of care
                                     Timely and appropriate referral
                                      Reduced harms and incidents
                                      Reduced ambiguous message
                                         Satisfied service users

Better Interaction, Communication and Co-                        Delivery of Health Care
                 operation                                          Holistic approach
        Communicate closely and clearly                    Improve standards of service delivery
          Honest and open interaction
         Authenticity of communication
             Procedural documents
Impact of IPTC

              Team Performance
                                                                    Staff Satisfaction
Wider range of expertise & shared decision making
                                                                    Satisfied work force
          Burden and challenges shared
                                                                    Professional growth
        Tasks divided between members
                                                                    Employee retention
    Greater efficiency in the use of resources

                                           Quality of Care
                                    Consistent and continuity of care
                                     Timely and appropriate referral
                                      Reduced harms and incidents
                                      Reduced ambiguous message
                                         Satisfied service users

Better Interaction, Communication and Co-                        Delivery of Health Care
                 operation                                          Holistic approach
        Communicate closely and clearly                    Improve standards of service delivery
          Honest and open interaction
         Authenticity of communication
             Procedural documents
Theoretical Constructs of IPTC


                                  Division of
                                   Labour
                                (Specialisation
                                 and Increased
                                  Productivity,
                               Social & Technical
                                Div. of Labour)
                               Human Factors
                               (Communication,
                                  Interaction,
                                 Professional
                                culture, Ethics,
                                 Personality)
            Role Theory                               Theory of
               (Roles &                               Profession
           Responsibilities,
             Leadership,                             (Professional
                                                    Power, Identity,
           Decision Making,
                                                      Autonomy,
              Training &
             Education)                             Boundaries etc.)
Issues and Challenges
•   Realising the value of IPTC
•   Interprofessional education & training
•   Different professional cultures
•   Professional identity, power and structures
•   Roles and responsibilities
•   Human factors
Focus of the Study

                           Interprofessional Team
 Input for Health Care                              Impact to HCPs
                                Collaboration



          Medical

                           Interprofessional Care
                                                        HCPs
                                                    Satisfied Workforce
                                                    Professional Growth
                                Teamwork            Employee Retention




Nursing             AHPs       Collaboration
Research Questions

  • How do various health care professionals
    interact and collaborate in hospitals?
  • What is the impact of IPTC on HCPs’ job
    satisfaction, employee retention and
    professional growth?
Research Objectives

  • To identify and analyse various factors that
    support and hinder IPTC
  • To examine the understanding of and
    perceptions of IPTC among health care
    professionals
  • To examine the impact of IPTC on job
    satisfaction, employee retention and
    professional growth
  • To make recommendations for improving
    interprofessional team collaborative practices
First Exploration – Pilot Study
• Team of HCPs – medical, nursing and AHPs
• Qualitative and quantitative study, semi-structure
  interview schedule & questionnaire used
• Observation of the clinical practice
• Findings of the pilot study
   – IPTC is part of their professional life
   – Roles and responsibilities of HCP well defined
   – Variety of personal and interprofessional skills and competencies are
     required to deliver effective interprofessional care
   – Professional autonomy is accepted and respected
   – IPTC is desirable as it brings many benefits to service users and HC
     professionals
   – IPTC boost employee morale and increase job satisfaction
   – Few opportunities for interprofessional learning and training are
     available at the organisational level
Research Methodology
• Mixed methods - qualitative and quantitative methods
• Purposive sampling
• Three hospitals in Nepal – public, private and
  voluntary hospitals
• Different teams with a different composition and types
  of professionals
• Survey - questionnaire
• Interviews with HCPs - semi structured schedule
• Documents and secondary data analysis
• Cross tabulation, frequency, descriptive analysis and
  correlation
• Phenomenological approach
References
•   Bope, E.T., & Jost, T.S. (1994). Interprofessional collaboration: factors that affect form, function
    and structure, in R. Michael Casto and Maria C. Julia, Interprofessional care and collaborative
    practice. California: Brooks/Cole Publishing. pp 61 – 69.
•   Canadian Health Services Research Foundation (2006). Teamwork in Health Care: Promoting
    effective teamwork in health care in Canada. CHSRF.
    http://www.chsrf.ca/Migrated/PDF/ResearchReports/CommissionedResearch/teamwork-
    synthesis-report_e.pdf. Accessed on 4 September 2012.
•   Colyer, H. (2012). Responsibilities and accountabilities in interprofessional working. In G. Koubel
    and H. Bungay (eds.), Rights, risks and responsibilities: Interprofessional working in health and
    social care. Basingstoke: Palgrave Macmillan.
•   Duncanis, A.J. and Golin, A.K. (1979). The Interdisciplinary Health Care Team: A Handbook.
    Maryland: Aspen Systems Corporation.
•   Hammick, M., Freeth D., Copperman, J and Goodsman. D. (2009). Being Interprofessional.
    Cambridge: Polity.
•   Hawley, G. (ed.) (2007). Ethics in clinical practices: an interprofessional approach. Essex:
    Pearson Education.
•   Health Force Ontario (HFO), (2007). Interprofessional Care: A Blueprint for Action in Ontario,
    Interprofessional Care Project. Ontario: Health Force Ontario.
•   Leathard, A. (2003). Interprofessional Collaboration: From Policy to Practice in Health and Social
    Care. East Sussex: Routledge.
•   Payne, M. (2000). Teamwork in Multiprofessional Care. New York: Palgrave.
•   Pietroni, P. (1992). ‘Towards reflective practice – the language of health and social care’, Journal
    of Interprofessional Care. 1: 7 – 16.
•   Reves, S., Lewin, S., Espin, S. and Zwarenstein, M. (2010). Interprofessional teamwork for health
    and social care. West Sussex: Wiley-Blackwell.
IPTC in Hospitals: A Review of Interprofessional Collaboration

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IPTC in Hospitals: A Review of Interprofessional Collaboration

  • 1. Interprofessional Team Collaboration (IPTC) in Hospitals Bachchu Kailash Kaini PhD Student (Part Time) Business School University of Greenwich
  • 2. Context • Health care is multifaceted and complex activity • Changes in demographic structure and disease pattern • Increased cost of care • Concept of specialties and sub-specialties emerging • Expansion of roles of health care professionals (HCPs) • Well informed patients and more choices • Changing health care environment requires new ways of working & collaborative practice
  • 3. Hospital Environment Professional Groups Organisational Policies Voluntary Regulatory Sectors Bodies Medical Nursing Boards & Service Resources Community Functional Legislations Teams Users Available AHPs Admin & Mgmt Commissioners Government Organisational Structures Other Service Providers
  • 4. Occupation and Profession • Occupation refers to someone’s job • Occupation can become profession when: – It gains full status and identity – It goes through various stages of training, education and qualifications – It is recognition by a regulatory body or authority – It gains high degree of autonomy • Profession is special type of occupation
  • 5. Profession • A group of people who have undertaken a given programme of education and/or training, and as a result of this are permitted to become part of much larger and somewhat exclusive group (Hammick et al, 2009). • Characteristics of profession – Intellectual activities – Based on science and learning – Used for practical purposes – Can be taught – Organised internally – Altruistic (Flexer, 1915; quoted in Ducanis and Golin, 1979)
  • 6. Interprofessional Care • IPC is a collaborative working (Leathard, 2003; HFO, 2007; Hawley, 2007) in which HCPs share common purpose of developing mutually negotiated goals (Payne, 2000; Pietroni, 1992) which are achieved through agreeing a care plan, the management of it and procedures (Colyer, 2012). • IPC to happen in practice, HCPs: – Pool their skill, knowledge and expertise – Shared professional view points – Make joint decision – Learn from each other
  • 7. IPC, Teamwork and Collaboration Collaboration Teamwork Differing forms of interprofessional work (Reeves et al, 2010; p.44)
  • 8. Different but Shared Approaches Knowledge Professional Skills Contribution Medical Professional Expertise Culture Nursing AHPs Care Personal Philosophies Attributes Problem-solving Styles
  • 9. Interprofessional Team Collaboration Shared Goal of Interprofessional Team Collaboration (IPTC) (Effective Delivery of Health Care) IPTC IP Team Formation IP Team Development •Collaboration •Team composition •Leadership •Co-ordination •Hierarchies •Support for team •Co-operation •Roles and responsibilities •Training & development •Commitment •Protocols and strategies •Regular review •Communication •Resources •Reward •Cohesion •Openness & trust Desired Outcome of IPTC For Service Users For HCPs Satisfied Service Users Satisfied Workforce Healthy Life Professional Growth Improved Health Status Employee Retention
  • 10. Impact of IPTC Team Performance Staff Satisfaction Wider range of expertise & shared decision making Satisfied work force Burden and challenges shared Professional growth Tasks divided between members Employee retention Greater efficiency in the use of resources Support and motivation from each other Quality of Care Consistent and continuity of care Timely and appropriate referral Reduced harms and incidents Reduced ambiguous message Satisfied service users Better Interaction, Communication and Co- Delivery of Health Care operation Holistic approach Communicate closely and clearly Improve standards of service delivery Honest and open interaction Authenticity of communication Procedural documents
  • 11. Impact of IPTC Team Performance Staff Satisfaction Wider range of expertise & shared decision making Satisfied work force Burden and challenges shared Professional growth Tasks divided between members Employee retention Greater efficiency in the use of resources Quality of Care Consistent and continuity of care Timely and appropriate referral Reduced harms and incidents Reduced ambiguous message Satisfied service users Better Interaction, Communication and Co- Delivery of Health Care operation Holistic approach Communicate closely and clearly Improve standards of service delivery Honest and open interaction Authenticity of communication Procedural documents
  • 12. Theoretical Constructs of IPTC Division of Labour (Specialisation and Increased Productivity, Social & Technical Div. of Labour) Human Factors (Communication, Interaction, Professional culture, Ethics, Personality) Role Theory Theory of (Roles & Profession Responsibilities, Leadership, (Professional Power, Identity, Decision Making, Autonomy, Training & Education) Boundaries etc.)
  • 13. Issues and Challenges • Realising the value of IPTC • Interprofessional education & training • Different professional cultures • Professional identity, power and structures • Roles and responsibilities • Human factors
  • 14. Focus of the Study Interprofessional Team Input for Health Care Impact to HCPs Collaboration Medical Interprofessional Care HCPs Satisfied Workforce Professional Growth Teamwork Employee Retention Nursing AHPs Collaboration
  • 15. Research Questions • How do various health care professionals interact and collaborate in hospitals? • What is the impact of IPTC on HCPs’ job satisfaction, employee retention and professional growth?
  • 16. Research Objectives • To identify and analyse various factors that support and hinder IPTC • To examine the understanding of and perceptions of IPTC among health care professionals • To examine the impact of IPTC on job satisfaction, employee retention and professional growth • To make recommendations for improving interprofessional team collaborative practices
  • 17. First Exploration – Pilot Study • Team of HCPs – medical, nursing and AHPs • Qualitative and quantitative study, semi-structure interview schedule & questionnaire used • Observation of the clinical practice • Findings of the pilot study – IPTC is part of their professional life – Roles and responsibilities of HCP well defined – Variety of personal and interprofessional skills and competencies are required to deliver effective interprofessional care – Professional autonomy is accepted and respected – IPTC is desirable as it brings many benefits to service users and HC professionals – IPTC boost employee morale and increase job satisfaction – Few opportunities for interprofessional learning and training are available at the organisational level
  • 18. Research Methodology • Mixed methods - qualitative and quantitative methods • Purposive sampling • Three hospitals in Nepal – public, private and voluntary hospitals • Different teams with a different composition and types of professionals • Survey - questionnaire • Interviews with HCPs - semi structured schedule • Documents and secondary data analysis • Cross tabulation, frequency, descriptive analysis and correlation • Phenomenological approach
  • 19. References • Bope, E.T., & Jost, T.S. (1994). Interprofessional collaboration: factors that affect form, function and structure, in R. Michael Casto and Maria C. Julia, Interprofessional care and collaborative practice. California: Brooks/Cole Publishing. pp 61 – 69. • Canadian Health Services Research Foundation (2006). Teamwork in Health Care: Promoting effective teamwork in health care in Canada. CHSRF. http://www.chsrf.ca/Migrated/PDF/ResearchReports/CommissionedResearch/teamwork- synthesis-report_e.pdf. Accessed on 4 September 2012. • Colyer, H. (2012). Responsibilities and accountabilities in interprofessional working. In G. Koubel and H. Bungay (eds.), Rights, risks and responsibilities: Interprofessional working in health and social care. Basingstoke: Palgrave Macmillan. • Duncanis, A.J. and Golin, A.K. (1979). The Interdisciplinary Health Care Team: A Handbook. Maryland: Aspen Systems Corporation. • Hammick, M., Freeth D., Copperman, J and Goodsman. D. (2009). Being Interprofessional. Cambridge: Polity. • Hawley, G. (ed.) (2007). Ethics in clinical practices: an interprofessional approach. Essex: Pearson Education. • Health Force Ontario (HFO), (2007). Interprofessional Care: A Blueprint for Action in Ontario, Interprofessional Care Project. Ontario: Health Force Ontario. • Leathard, A. (2003). Interprofessional Collaboration: From Policy to Practice in Health and Social Care. East Sussex: Routledge. • Payne, M. (2000). Teamwork in Multiprofessional Care. New York: Palgrave. • Pietroni, P. (1992). ‘Towards reflective practice – the language of health and social care’, Journal of Interprofessional Care. 1: 7 – 16. • Reves, S., Lewin, S., Espin, S. and Zwarenstein, M. (2010). Interprofessional teamwork for health and social care. West Sussex: Wiley-Blackwell.