MANAGERS QUESTIONING HOW THEY WORK TO IMPROVE INTERPROFESSIONAL COLLABORATION AND CLINICAL GOVERNANCE Australian Institute of Health Innovation Greenfield, D; Nugus, P; Braithwaite, J Centre for Clinical Governance Research in Health Australian Institute of Health Innovation Email: d.greenfield@unsw.edu.au
Background Interprofessional collaboration (IPC), a fluid mix of interprofessional learning (IPL) or education (IPE) and interprofessional practice (IPP), is advocated as being a driver to improve health care and address patient safety issues.
Significance of IPC Factors contributing to sentinel events in Australian hospitals 2004 2005. Equiptment 6% Staff factors 11% Coordination 3% Work Patient environment assessment 7% 4% Patient factors 9% Rules, policies and procedures 27% Information, documentation 17% Communication 16%
Significance of IPC
Research team Professor Jeffrey Braithwaite Professor Bill Runicman Professor Johanna Westbrook A/ Professor Ruth Foxwell Dr Rosalie Boyce Professor Timothy Devinney A/ Professor Marc Budge Ms Karen Murphy Dr Mary-Ann Ryall Ms Elisabeth Renton Dr Peter Nugus Dr David Greenfield Dr Joanne Travaglia Ms Robyn Clay-Williams Ms Tania Lawlis Ms Judy Stone Ms Rebecca Vanderheide Research funded by the Australian Research Council Linkage funding scheme (project number LP0775514)
Research partner organisations
Research framework Intersection of project objectives and domains:
Purpose of initiatives Ideas were generated by ACT Health staff following participation in the audit activities. UNSW research team offered to work with individuals/ teams on projects which had an interprofessional focus. Purpose of initiatives: to guide and promote practice change to enhance IPC.
Breakdown of initiatives Proposed initiatives N (I) = 111 Concept only N (CO) = 42 Activity N (A) = 69 Completed N (ACm) = 28 Progressing N (APr) = 41
Breakdown of proposed initiatives Focus of initiative At the boundary between health and university domains Progress outcome Concept only Completed Progressing Total 3-1 4 Within the health service 33 26 29 88 - Acute services 3 6 1 10 - Sub-acute services 3 6 4 13 - Community health 16 8 1 25 - Mental health 3 4 4 11 - Across divisions 8 2 19 29 Within universities 3 2 9 14 Within professional 3-2 5 associations Total 42 28 41 111
Interprofessional initiatives Examples of interprofessional improvement initiatives Developing an interprofessional pediatrics induction pathway Enhancing interprofessional teamwork in palliative care Improving interprofessional recovery planning in mental health care Integrating IPL into a new simulation centre Evaluating doctor-nurse collaboration in Corrections Health Evaluating the role of the Aboriginal Health Worker in health care teams Curriculum map of IPL activities across four tertiary education providers Evaluating IPL in university clinics Analysis of IPL themes in 3rd-year medical students reflective journals
What drives improvements? Quality improvement - most effectively achieved by combining the skills of both managers and frontline clinicians. Engaging and maintaining the focus of staff on improvement initiatives is challenging. Investigations into programs have shifted focus from appreciating how improvement initiatives manifest to investigating the determinants of their effectiveness.
What drives improvements? We need greater understanding of the impact of the social context, that is, the interpersonal, team and organisational factors, and strategies that engage staff.
Study purpose The project investigated how a senior managers' meeting could be improved to enhance IPC and clinical governance.
The dilemma?
Research process Action research cycle? IPC meeting Plan Managers, Continuing Care Program, Community Health, Australian Capital Territory Health Reflect A-R cycle Observe Action
Research process Action research cycle Plan Developed survey: 28 questions Reflect A-R cycle Observe Action Survey to examine: Efficiency Accountability Value Participation IPC Improvements to enhance governance.
Survey questions, examples A1 The Continuing Care Allied Health Managers meeting is an effective forum that meets my needs. A2 I believe that I have a good understanding of the purpose of the meeting. A3 The decision making process of the meeting is open and transparent. A4 In the meeting I have an opportunity to express my opinions and be heard.
Survey questions, examples A5 The meeting is a consultative forum. A6 The meeting has a democratic decision making process. A7 The meeting is a friendly, non confrontational yet confidential environment in which to raise and discuss sensitive issues. A8 The meeting provides the opportunity to hear different viewpoints which are respected. A9 The meeting facilitates communication of updates relating to the organisations policies and initiatives.
Action research cycle Research process Plan Reflect A-R cycle Action Administered survey July 2010 Observe
Action research cycle Research process Plan Reflect A-R cycle Action Descriptive and thematic analysis Observe
Research process Action research cycle Plan? Next Reflect A-R cycle Action Observe
Action research cycle Research process Reflect Plan A-R cycle Action Re Re-do survey Reflection Reflection- activity with managers Observe
Action research cycle Research process Plan Reflect A-R cycle Action Administered survey February 2011 Observe
Action research cycle Research process Plan Reflect A-R cycle Action Compariso n of 2010 and 2011 results Observe
Research process Action research cycle Plan Team Reflection Activity Reflect A-R cycle Action Observe
Team Reflection Activity Positive responses reported across all 28 items surveyed. Scores improved for 25 items across the two surveys. Improvements identified in organisational and collective accountability domains.
5.0 Allied Health Managers Survey 2009 and 2011 4.5 2009 2011 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 A1 A2 A3 A4 A5 A6 A7 A8 A9 A10 A11 A12 A13 A14 A15 A16 A17 A18 A19 A20 A21 A22 B1 B2 B3 B4 B5 B6 Question number
Team Reflection Activity Organisational improvements: Revising agenda to incorporate participants interests and professional needs; Promoting consistency across different professional services; Time to reflect on issues; and, Decision making to be more open and inclusive.
Team Reflection Activity Collective accountability improvements: To promote an collaborative team environment; To contribute to a positive learning environment; Improving individual organisation; and, Encouraging participation and leadership.
How does your work improve patient care? The success of the action research activity prompted participants, all of whom were managers of services, to replicate it with their respective teams.
Conclusion The great healthcare challenge is identifying and implementing similar leadership strategies and interprofessional forums, that enable shared governance to be enacted, and collaborative problem-solving to be addressed.
Contact details David Greenfield, PhD Senior Research Fellow Centre for Clinical Governance Research Australian Institute of Health Innovation Faculty of Medicine University of New South Wales Email: d.greenfield@unsw.edu.au Web: http://www.aihi.unsw.edu.au/