1. Published in Fall 2011 Edition of the Centre for IPE at UofT’s Newsletter and Fall 2011 Edition of
Michener News
A Student’s Reflections on Improving Health Care Delivery by Harmonizing
Interprofessional Education (IPE) Theory with Interprofessional Collaboration
(IPC) Practice
By Prasaanthan Gopee-Ramanan, B.Sc. (Hon), B.Sc. in Radiological Technology, TMI-UofT, Class of
2012 (in progress)
Ever since I read The Checklist Manifesto, by Dr. Atul Gawande, a renowned General
and Endocrine Surgeon in Boston, MA, I have been compelled to contemplate upon how
a systems perspective in health care delivery would impact patient care. Dr. Gawande’s
work in the realm of outcomes improvement using surgical checklists was finally
translated to practice in Ontario in the summer of 2010; the result is unprecedentedly
clear communication between various healthcare professionals before, during, and after
surgeries. In this manner, Ontario’s surgical checklist is a vivid example of applied
interprofessionalism, otherwise referred to as Interprofessional Collaboration (IPC).
In The Checklist Manifesto, Dr. Gawande questions the status quo of health care
delivery: if you want to make the best car on Earth, do you simply collect the best engine,
chassis, transmission, brakes, body and put them altogether? The answer is a resounding
no. The reason is that these parts work seamlessly together and achieve high performance
within their respective designs and models, but are dysfunctional if put together without a
pertinent design (Gawande, 2009). Why then, Dr. Gawande asks, do we place the top
medical specialists and health care professionals in a building with doors and rooms and
simply hope that we will produce better health care? I feel that the crux of the problems
plaguing the current health care system is that it is not quite a true system. It is more a
setting of isolated departments with professions and specialties that do not talk to each
other enough in spite of the fact that they are all there for the same goal, namely treating
and achieving good health and holistic well-being for the patient. Popular research has
also shown that medical care is in itself the cause of many errors leading to injury or even
death – a total opposite of the purpose of even having medical care! Now more than ever,
there is a dire need for the professionals in health care and its various specialties to
collaborate systemically to improve patient care. Change is not only needed in practice,
but also within all the various health professional education programs. Only with the
change in practice at the educational level in the form of Interprofessional Education
(IPE), wherein all health care professionals learn with, from, and about each other, will
this effort translate into practice in the form of Interprofessional Collaboration (IPC) in
the workplace. This change will not be instant; rather it will take years of perseverance
and concerted, collaborative effort in both the educational and clinical settings.
One of the chapters of The Checklist Manifesto is devoted to examining the
construction industry, in which thousands of new buildings and skyscrapers of
increasingly challenging design specifications are put up safely each year. Error rates are
extremely low, and even when they occur, these errors rarely ever cause a building to fail
catastrophically (Gawande, 2009). It turns out that the key to this high level of favorable
outcome generation is excellent interprofessional communication and a good systems
methodology to getting the job done (Gawande, 2009). When compared to the
construction industry, the health care industry has miles to go before we are able to
profess such levels of successful outcomes. The future of good healthcare with the patient

2. Published in Fall 2011 Edition of the Centre for IPE at UofT’s Newsletter and Fall 2011 Edition of
Michener News
at the center depends upon effective intraprofessional (within professions),
interprofessional communication (in-between professions) and extraprofessional
communication (with non-health care professionals). As with any change, there is bound
to be resistance, whether from students who may feel that clinical skills take precedence
to IPE or from practitioners that may feel clinical practice does not need to change. My
question to my fellow students and practitioners is how are we going to start this change?
In the case of my colleagues and I, we have taken IPE courses at The Michener Institute
(TMI) and the University of Toronto (UofT) and were subsequently involved in a chapter
of the National Health Sciences Students Association for interprofessional education; but
we cannot effect change alone. I know that my faculty at both institutions believes in IPE
for a better health care system, but how do we carry this forward into clinical practice?
The solution, I believe, is simple: unity in thought, word and deed. The workplace
must mirror what we learn in school about how to apply IPC in a patient-centered
manner. We must treat every patient holistically and the way we would want our own
family members to be treated. Students at TMI and the UofT spend time in multiple
courses on IPE and patient-centered care (PCC); the next step must be to translate these
theoretical ideas of effective teamwork and communication into the daily, more
collaborative routines of the workplace. There are definitely some change-resistors to
these seemingly abstract concepts being fully actualized in health care settings, but with
the leadership of some of Ontario’s best community teaching hospitals, their executives,
and their staff, change for the better is inevitable – it is only a matter of time. A systems
approach is very much in line with producing, maintaining, and improving the framework
within which the aforementioned communication excellence can yield drastically
improved outcomes and patient care in the years to come; to this effect, students must
catalyze the pursuit of such high ideals and model ideal professional conduct via
harmony in thought, word, and deed.
References:
Gawande, A. (2009). The Checklist Manifesto. (1st ed.). New York (NY): Metropolitan
Books.
Acknowledgements:
I would like to thank Dr. Gawande for inspiring me through his literary works and for
helping make surgeries safer throughout the world. I would also like to thank Lynne
Sinclair of the Centre for IPE, UofT, and Sheena Bhimji-Hewitt of The Michener
Institute for all their support and guidance on writing this piece.