Collaborative Care: Better Health for All

Transcription

1 Collaborative Care: Better Health for All Lori Lamont, Vice President and Chief Nursing Officer 2012 Annual Provincial Long Term & Continuing Care Conference May 15, 2012

2 Outline of Today s Presentation What is collaborative care? Why is it important? Efforts to advance collaborative care in Winnipeg Partnerships with the University of Manitoba Overview of a recent interprovincial research study What collaborative care might look like in LTC? Lessons learned and next steps

3 Defining Collaborative Care Collaborative Care in healthcare occurs when multiple health providers from different professions provide comprehensive services by working with people, their families, care providers and communities to deliver the highest quality of care across settings. Practice includes both clinical and non-clinical healthrelated work, such as diagnosis, treatment, surveillance, health communications, management and support services.

4 Why Collaborative Care? Evidence continues to emerge that links Collaborative Care to: Improved quality, safety, and outcomes of care Higher client, family and provider satisfaction Enhanced system efficiency and effectiveness

5 Key Milestones 2008 WRHA Senior Management priorizes the need to advance interprofessional education and collaborative care within the Winnipeg Health Region - WRHA Professional Advisory Committee assigned to lead such work 2009 Development of regional action plan. Approved by Senior Management and endorsed by the Quality, Safety, and Innovations Committee of the WRHA Board Hosted regional leadership forum to further inform regional action plan and identify possible sites for upcoming research projects

6 Key Milestones 2009/2010 Participated in MHHL funded Interprofessional Student Clinical Placement Project with University of Manitoba 2010/2011 PAC approved an updated Action Plan for Collaborative Care Interprofessional education and collaborative practice embedded in regional strategic directions Release of regional guiding principles for Collaborative Care

7 1. Define structure and leadership Regional Action Plan for Collaborative Care 2. Develop awareness and common understanding 3. Identify and further develop collaborative practice and learning environments 4. Promote enablers and reduce barriers 5. Build a robust infrastructure for continuing clinical education 6. Evaluate and measure impact

8 Regional Guiding Principles for Collaborative Care Effective communication, mutual respect, and trust are required for true team collaboration, and must occur both within and between teams. Quality care results from an integrated plan of care provided through the shared contributions of the person receiving care and all the health providers within a given team. The person receiving care will be respected and supported as an equal member of the health care team at all points in his/her care journey.

9 Regional Guiding Principles for Collaborative Care The care delivery model and subsequently the team composition and leadership must be determined by the needs of the people served. Successful implementation of Collaborative Care maximizes the opportunities for health providers to work to their full scope of practice. Health providers must be able to articulate their own scope of practice and identify and respect areas of shared competencies with other health providers.

10 Regional Guiding Principles for Collaborative Care In incorporating assessment and evaluation of person, team and system outcomes to allow for ongoing improvement and the creation of new benchmarks. All health leaders and managers have a responsibility to champion and shape interprofessional education and Collaborative Care. Regional, site and program policies and processes must support and facilitate interprofessional education and Collaborative Care.

11 Academic Partnerships University of Manitoba IPE Initiative: Cross appointments on IP related committees Joint research studies Development of joint curriculum blueprint for interprofessional education at pre-licensure and post-licensure levels

12 Research Project Developing Interprofessional Collaborative Practice and Learning Environments (ICP&LE) Across the Continuum of Care in Western and Northern Canada

13 Project Vision To establish and implement interprofessional collaborative practice and learning environments (ICP & LEs) in a variety of multijurisdictional sites across the continuum of care. The ICP & LEs will serve as capacity centres to provide the essential tools, resources, processes and learning opportunities to facilitate replication of the successful interprofessional and change management practices for other clinical sites and settings in the future, as well as to provide the opportunities for learning for future students and healthcare practitioners.

14 Project Overview Total of 9 teams across 4 western provinces Project timeline of 6-9 months depending on jurisdiction Oversight provided by interprovincial steering committee and jurisdictional steering committee Full project report available at

15 The Manitoba Experience

16 Community Stroke Care Service A community based centralized, interprofessional service Provides case coordination from hospital to home, home care support and home based rehabilitation to adults who have recently suffered a stroke Staff include a team manager, case coordinator, occupational therapist, resource coordinator, physiotherapist, speech language therapist, and rehabilitation assistants (12 staff in total).

17 CSCS Accomplishments CSCS Action Plan Develop information materials for patients/families/referral sources Develop Interprofessional Student Placements Improve access to assessment tools Improve information sharing/access to educational materials for all staff Use of technologies to provide feedback to the clients Utilize technology to allow staff with remote access to files Include other disciplines i.e. social worker, recreational therapist, psychologist, dietician Expand services to be able to accept referrals from other facilities Completed during Pilot Ongoing Action Item

18 Mature Women s Centre Referral-based, nurse-managed centre that provides comprehensive management of health issues related to menopause and aging with an emphasis on health promotion, and disease and disability prevention from a physical, cultural, emotional and spiritual perspective. Staff includes clerical staff, RN s, a pharmacist, dietitian, kinesiologist (11 staff in total) and a Medical Director.

19 MWC Accomplishments Conduct daily morning meetings MWC Action Plan Present case rounds more regularly/consistent weekly rounds Completed during Pilot Ongoing Action Item New orientation manual - Physician section and Role of Clinician Include a patient representative on Advisory Committee Increase satisfaction survey to patients Expand MWC team to include Psychiatric Health service Improved efficiencies through reorganization of chart storage Expand opportunities for Interprofessional Student Placements

20 River Park Gardens 80 bed Personal Care Home in South Winnipeg Provides 24 hour professional nursing services and care 80 staff including registered nurses, licensed practical nurses, health care aides, a physician, administrative staff, housekeeping, and dietary staff

21 Appreciative Inquiry sessions RPG Team Interventions Interprofessional Collaborative Organizational Map & Preparedness Assessment (IP-COMPASS) 6 team members Collaborative care education session CIHC Competency Framework 6 core team competencies

22 RPG Accomplishments RPG Action Plan Work force optimization maximizing the role of the nurse Enhance effective communication between Victoria General Hospital emergency department and River Park Gardens. Remain open to new ideas Use of PIECES (physical, intellectual, emotional, capabilities, environment, and social assessment tool) Continue to hire staff with empathy and high work ethics; reflect IP principles in position descriptions Extended practice prescribing pharmacist on site daily Completed during Pilot Removed from Action Plan as NP was to be added to team Ongoing Action Item

23 RPG Unique Challenges 80 plus staff Large interprofessional team and multiple unit/shift based teams 24/7 operation (compared to M to F service) Changes in leadership during course of project

24 Knowledge Transfer WRHA webpage for interprofessional education and collaborative care resources Snapshots/summaries of key WRHA and national/international collaborative practice documents Collation of national and international interprofessional resources and tools Success Stories and photos of the three teams in the pilot project Education and facilitator materials

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26 Evaluation Questions To what degree is implementation of a model of ICP & LE associated with changes in current staff attitudes, roles, relationships, and team functioning & skills? To what degree have learning and change management strategies helped sites to achieve collaborative patient centred care and expected outcomes?

27 Methods Qualitative (document review, observations, key informants, focus groups, interviews) and Quantitative (questionnaires, tracking and collating of administrative data) data collection

28 Provider (staff) Short Term Objectives Increased knowledge, skills, and abilities related to the core competencies of interprofessional practice Satisfaction with facilitated change management practices Workforce Optimization Improved enactment of full scope of practice Improved understanding of team members respective roles

29 Success The project accomplished its short term objectives. That is, based on the outcomes of Appreciative Inquiry (engaging the site), IP COMPASS (action planning), a collaborative care education session, brochure development, and other team based activities, participants awareness, knowledge and abilities related to working collaboratively has increased.

30 Evaluation Findings All sites felt that the ICP project had a good impact on their team and, on the individuals participating. The project: reinforced and echoed staffs belief of being a strong collaborative team increased awareness, knowledge and skills/abilities related to ICP concepts assisted with the drafting of action items to work on to achieve collaborative patient centered care and to strengthen on going team work.

31 Evaluation Findings ICP projects would be enhanced by: having client & family perspectives on the effectiveness of ICP undertaking periodic evaluations (6 months to 1 year post completion of ICP implementation) to explore ICP sustain-ability: progress/completion of action items planned re visiting the Appreciative Inquiry (AI) and IP COMPASS action plan processes to formulate a new wish list and action items the status and effectiveness of interprofessional student placement

32 Evaluation Findings Defining the components/aspects/competencies of ICP so that staff with different educational preparedness can easily grasp what ICP means to clients and what the team s practice would look like if ICP was fully developed throughout a site.

33 Lessons Learned Commitment of the ENTIRE team required Need for dedicated time to work on teaming Value of linking such work to quality and safety improvement projects External facilitator (coach) critical Need for strategies to ensure physician engagement

34 Next Steps Based on findings and lessons learned from this experience: Briefing note presented to Senior Management for resourcing to support expansion to other teams Role descriptions for site champions, team champions and facilitators developed

35 Next Steps Based on findings and lessons learned from this experience: Collaborative care competencies being embedded in regional role descriptions Team development framework and online toolkit of resources linked to the framework developed

36 WRHA Collaborative Care Team Development Model

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