The HEIPS framework: Scaffolding interprofessional education starts with health professional educators

The link between interprofessional collaboration and interprofessional education has been at the centre of discourse for some time. To understand some of the challenges of interprofessional collaboration, a research study was undertaken. The study investigated the interprofessional socialisation experiences of health professional educators, across five higher education faculties in Perth, Western Australia (WA). An interpretive phenomenological framework was utilised to explore the phenomena of interprofessional socialisation. Twenty-six professional educators were interviewed from a variety of health-related disciplines and qualitative content analysis was undertaken with the aid of NVivo 10 software. Examination of the data discovered a range of barriers that were potentially preventing professionals from working together effectively, within education. Overcoming some of these obstacles were identified, such as, professional language, organizational support, time and workload and the proximity of professionals. The research also recommended a framework that would support health educators. Currently, there are conceptual frameworks that guide the professional and interprofessional socialisation of healthcare graduates within education. Whereas, there is very little guidance or frameworks to support professional educators interprofessional experiences. The heath educators’ interprofessional socialisation (HEIPS) framework is presented within this paper, and is a four-step process to encourage the interprofessional socialisation of educators within universities.     

Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration

ABSTRACT

Professionals in healthcare are increasingly encouraged to work together. This has acted as a catalyst for research on interprofessional collaboration. Authors suggest developing interprofessional collaboration is not just the job of managers and policy makers; it also requires active contributions of professionals. Empirical understanding of whether professionals make such contributions and if so, how and why, remains fragmented. This systematic review of 64 studies from the past 20 years shows there is considerable evidence for professionals actively contributing to interprofessional collaboration. Although the evidence is limited, we can show they do so in three distinct ways: by bridging professional, social, physical and task-related gaps, by negotiating overlaps in roles and tasks, and by creating spaces to be able to do so. Professionals from different professions seem to make different contributions. Moreover, differences exist between collaborative settings and healthcare subsectors. We conclude by proposing a research agenda to advance our understanding of these contributions in theoretical, methodological and empirical ways.     

Midwives’ and health visitors’ collaborative relationships: A systematic review of qualitative and quantitative studies

ObjectivesInterprofessional collaboration between midwives and health visitors working in maternal and child health services is widely encouraged. This systematic review aimed to identify existing and potential areas for collaboration between midwives and health visitors; explore the methods through which collaboration is and can be achieved; assess the effectiveness of this relationship between these groups, and ascertain whether the identified examples of collaboration are in line with clinical guidelines and policy.DesignA narrative synthesis of qualitative and quantitative studies.Data sourcesFourteen electronic databases, research mailing lists, recommendations from key authors and reference lists and citations of included papers.Review methodsPapers were included if they explored one or a combination of: the areas of practice in which midwives and health visitors worked collaboratively; the methods that midwives and health visitors employed when communicating and collaborating with each other; the effectiveness of collaboration between midwives and health visitors; and whether collaborative practice between midwives and health visitors meet clinical guidelines. Papers were assessed for study quality.ResultsEighteen papers (sixteen studies) met the inclusion criteria. The studies found that midwives and health visitors reported valuing interprofessional collaboration, however this was rare in practice. Findings show that collaboration could be useful across the service continuum, from antenatal care, transition of care/handover, to postnatal care. Evidence for the effectiveness of collaboration between these two groups was equivocal and based on self-reported data. In relation, multiple enablers and barriers to collaboration were identified. Communication was reportedly key to interprofessional collaboration.ConclusionsInterprofessional collaboration was valuable according to both midwives and health visitors, however, this was made challenging by several barriers such as poor communication, limited resources, and poor understanding of each other’s role. Structural barriers such as physical distance also featured as a challenge to interprofessional collaboration. Although the findings are limited by variable methodological quality, these were consistent across time, geographical locations, and health settings, indicating transferability and reliability.     

Inclusive early childhood education and care: a longitudinal study into the growth of interprofessional collaboration

ABSTRACT

Inclusive early childhood education and care (ECEC) requires interprofessional collaboration between professionals with diverse professional backgrounds. Following developments in human services, there is a growing interest in the role of interprofessional teams in community-based settings for young children. In a three-year longitudinal study, we investigated interprofessional collaboration (IPC) between staff from childcare, education and youth care. At the individual level, a survey was used for the analysis of IPC competences. At the network level, we investigated professional relationships between individuals using social network analysis. Results of a multilevel mixed linear model showed an increase in interdependence and reflection on process of individual staff, followed by the progressive development of perceived team performance. Smaller networks with higher density and professionals’ centrality predicted more positive perceptions of inclusive ECEC. We discuss our findings in the context of growing interest in interprofessional teams in ECEC.     

Leading interprofessional practice: a conceptual framework to support practitioners in the field of learning disability

One of the key challenges for practitioners in present day health and social care has been responding effectively in the interprofessional teamwork setting, where collaboration is at the centre of professional activity. For whilst practitioners are expected to work interprofessionally there often remains limited attention to the actual process of interprofessional practice itself, within organizational strategy, local workforce development planning and individual continuing professional development. These concerns were a driver for this research with practitioners in the field of learning disability which resulted in the development of a conceptual framework for interprofessional practice. This paper sets out the process of conceptual framework development, underpinned by the concepts of knowledge of learning disabilities, contextual socialisation, empowerment, conflict management, transforming capability and interprofessional reflection on action. The researcher suggests that the framework may offer clinical leaders in learning disabilities and a range of other practice settings a tool to facilitate individual practitioner development, enabling as it does, the identification of a range of critical factors which impact on the outcomes of interprofessional practice intervention.     

Interprofessional education on a training ward for older people: students' conceptions of nurses, occupational therapists and social workers

Collaboration between professionals in health and social care is essential to meet the needs of the patient. The collaboration is dependent on knowledge and understanding of each other's roles. One means of improving communication and collaboration among professionals is interprofessional education. The aim of this study was to describe the variation in how students in nursing, occupational therapy and social work perceived their own and the other professions. Over a three-week period two interviews were conducted with each of 16 students who were on an interprofessional training ward for older people in a municipal setting in Sweden. A phenomenographical approach was used in the analysis of the interviews. The findings showed great variation in how the students perceived the professions, from simplistic in terms of tasks to a more complex conception in terms of knowledge, responsibility and values. Differences in the ways professions were described concerning their professional stance towards the patients were especially accentuated. The findings indicate that the students need opportunities for reflection on and scrutiny of each other's beliefs and knowledge. The influence of interprofessional education involving reflection on the different health-care professions needs to be explored in future research.     

Interdisciplinary health care training in the USA: lessons learned from a rural training grant program

Abstract

For almost half a century, research has identified that effective teamwork is essential in order to enhance care provision and health outcomes for patients. Although the value of teamwork is well-recognized in healthcare, the historically rooted dynamics of workplace relationships create a myriad of challenges to creating collaborative teams. Understanding the history of interpersonal dynamics between health professionals can provide direction for future interprofessional education and collaboration strategies. The aim of this paper is to provide a historical overview of the social positioning of nursing and medicine in the context of interprofessional collaboration. Few professions work as closely as nursing and medicine. Despite the well-recognized benefits of interprofessional collaboration, these two professions are often socially positioned in opposition to one another and depicted as adversarial. This analysis will seek to advance our understanding of the historical roots between these two professions and their relationships with and among each other in relation to career choice, early socialization and patient care delivery. An exploration of the historical social positioning of nursing and medicine can provide an enhanced understanding of the barriers to interprofessional collaboration and inform future successes in interprofessional education and practice among all health and social care professions.     

A comparative study of professional and interprofessional values between health professional associations

Abstract

The need for effective interprofessional collaboration to ensure safe patient care is crucial. However, health professions are guided by separate professional codes of conduct. To examine whether professional codes are consistent across professions, this review examines 13 key health professional associations in the United States and compares their values to the guiding principles of interprofessional practice defined by the Interprofessional Professionalism Collaborative (IPC). Findings indicate that all six of the IPC’s principles (altruism/caring, excellence, ethics, respect, communication, and accountability) were shared by the majority of professions, with many emphasizing two additional attributes, integrity and justice, suggesting there is room to expand the IPC’s core principles. Few associations included interprofessional communication and collaboration in their professional codes. There is potential for associations to promote greater interprofessional collaboration by reshaping their professional frameworks. With many shared values across professions, establishing a common framework of interprofessional professionalism is feasible.     

Views from the field: Medical student experiences and perceptions of interprofessional learning and collaboration in rural settings

Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning and collaboration, (c) experiencing the importance of social connections to interprofessional collaboration and learning, and (d) realisations that interprofessional collaboration is a means of overcoming barriers in rural areas. We discuss our findings using the socio-material perspective of complexity theory. These findings may be used to inform undergraduate programs in re-defining, re-creating, developing, and fostering interprofessional learning opportunities for medical students in rural communities as well as to support clinical faculty through ongoing professional development.     

Leadership characteristics for interprofessional collaboration in China

AimTo explore the perceptions of health professionals and educators regarding the characteristics of leadership that they believed were required for successful interprofessional education and interprofessional collaboration initiatives in China.BackgroundLeadership is a key competency in the successful implementation of any collaborative initiative in healthcare. However, there are few studies about leadership characteristics how these facilitate interprofessional collaboration in health care, especially in China.MethodsData for this secondary analysis came from a qualitative study of Interprofessional Team Development in China. Grounded theory methods were used to analyze fifteen semi-structured interviews from the original study.FindingsThe three leadership characteristics extracted that facilitated interprofessional collaboration were: 1) serving as a role model of Junzi (according to Confucianism the idea person); 2) initiating and maintaining collaboration; and 3) showing benevolence to all team members during interprofessional collaboration. One overarching category that surfaced throughout the interviews was that leaders who behaved in ways congruent with typical Chinese cultural expectations for leadership would be most effective.ConclusionThis study describes the characteristics of leadership for interprofessional collaboration, providing directions for training and cultivation of healthcare professionals and workers so that they are better prepared for and work more effectively in interprofessional collaborative practice.     

Interprofessionalism and ethics: consensus or clash of cultures?

The ethical arguments which underpin the call for interdisciplinary collaboration are analysed. In particular, the concept of 'teamwork' is considered as well as the organisational, professional, personal and cultural obstacles that constitute the barriers to the effective development of interdisciplinary relationships.     

Physicians’ perceptions of the role of the dental hygienist in interprofessional collaboration: a pilot study

ABSTRACT

Shifts in healthcare models, and greater numbers of patients seeking care, has encouraged professional organizations to recommend collaborative healthcare teams. In the realm of oral health, the American Dental Hygienists’ Association (ADHA) and the Commission on Dental Accreditation (CODA) have set recommendations that interprofessional collaboration (IPC) be emphasized in the profession. The purpose of this study was to determine physicians’ perceptions of the role of the dental hygienist in IPC. A pilot study utilizing a nonprobability sampling method which included a purposive sample of 30 licensed physicians was conducted. The survey addressed: personal experiences with a dental hygienist, dental hygienists’ roles working in collaboration with physicians, experiences with IPC, benefits of working with dental hygienists, barriers, and demographics. The majority (77.7%) supported the concept that dental hygienists have the necessary education and are important in IPC. Over 77.7% indicated dental hygienists would add value to a medical practice. Time and transfer of data were identified as primary obstacles in working collaboratively with dental hygienists. Findings revealed dental hygienists have the necessary education to be valuable members of IPC teams. Future research is needed to broaden the scope of studies among dental hygienists and other members of IPC teams.     

Understanding the barriers to multiprofessional collaboration

Multiprofessional collaboration is key to delivering quality patient care. Many developments in health care such as supplementary prescribing or the single assessment process rely on the premise that such collaboration already exists. This article focuses on barriers to interprofessional collaboration and explores whether 'new ways of working' in health care can survive in an environment with a long history of independent disciplines.     

How the past influences interprofessional collaboration between obstetricians and midwives in the Netherlands: Findings from a secondary analysis

Collaborations between groups of professionals often have a long history, which can still influence contemporary practice. If problems in the collaboration occur, the search for effective interventions for these problems may be informed by analysing current practice as well as the historical development of the collaboration. The study focused on the collaboration between obstetricians and midwives in the Netherlands. We performed a secondary analysis of questionnaire data focusing on midwives evaluating the collaborative performance of obstetricians in the Netherlands. Template analysis was used to analyse the questionnaires. The initial template was based on a model for interprofessional collaboration. As a final step, we reflected on the results in light of the historical development of the collaboration. The midwives experienced a power imbalance and a lack of trust and mutual acquaintanceship in their collaboration with obstetricians. They also reported a need for interprofessional governance and formalization. Most of these reported problems in the collaboration have their origin in the historical development of both professions and in the development of the collaboration between both professional groups. Combining an exploration of contemporary interprofessional practice with a historical perspective on interprofessional collaboration is fruitful for understanding problems in collaboration between professional groups, and provides guidance for improving collaboration.     

Interprofessionalism and ethics: consensus or clash of cultures?

The ethical arguments which underpin the call for interdisciplinary collaboration are analysed. In particular, the concept of 'teamwork' is considered as well as the organisational, professional, personal and cultural obstacles that constitute the barriers to the effective development of interdisciplinary relationships.     

Revealing tacit knowledge used by experienced health professionals for interprofessional collaboration

ABSTRACT

With the current interest in interprofessional collaboration in health care as a response to ever-increasing complexity of health issues and scarcity of resources, many higher education institutions are developing interprofessional education (IPE) programs. However, there has been little empirical work on what. With the current interest for interprofessional collaboration in health care ever-increasing knowledge and skills are required to work collaboratively between health professions. We have undertaken to describe interprofessional collaboration as a practice largely underpinned by tacit knowledge acquired by experienced clinicians. Clinicians from all health professions in a large francophone university in Eastern Canada were invited to participate in explicitation interviews. Explicitation interviews require participants to freely recall an interprofessional collaboration event (e.g., team meeting or joint care delivery) and describe specific actions they personally enacted. An experienced health professional encounters many interprofessional situations over time; the actions they describe reflect their personal theories about the practice. Hence, it is highly probable that they use them frequently when working with colleagues in clinical settings. Unveiled tacit knowledge was divided into four themes: the importance of a sense of belonging to a team, the imperative to meet face-to-face, the practice of soliciting the working hypotheses of colleagues, and the art of summarizing meeting discussions.     

Enablers and barriers to the development of interprofessional collaboration between physicians and osteopaths: A mixed methods study

Osteopathy is a complementary and alternative medicine (CAM) that is growing in popularity. Increasing numbers of parents are seeking pediatric osteopathic care in addition to conventional medical care. Information about the development of interprofessional collaboration (IPC) between these practitioners is scarce. This explanatory sequential mixed methods study aimed to explore enablers of and barriers to the development of IPC between physicians and osteopaths involved with pediatric patients in primary care in Quebec, Canada. Postal questionnaires about collaborative practices were first sent to all physicians and osteopaths working with pediatric patients in Quebec. Semi-structured individual interviews were then conducted with a subset of 10 physicians and 11 osteopaths. A total of 274 physicians (14%) and 297 osteopaths (42%) completed the survey. Forty-five percent (n = 122) of physicians reported that they referred at least one pediatric patient per month to an osteopath. Thirty-six percent (n = 96) of physicians and 41% (n = 122) of osteopaths indicated having professional relationships. Personal consultation, professional relationship, perceived utility of osteopathy and community practice were positively associated with osteopathic referrals. According to participants, the strongest enabler of the development of collaboration was positive clinical results reported by parents. Additional enablers included the osteopath having previous health professionals training such as physiotherapist, pediatric experience, mutual respect for professional boundaries and complementarity, perceived safety of osteopathy, and parents’ requests for collaboration. Barriers were the absence of a common language, the organizational and legal context, uncertainty regarding one another’s roles, lack of interprofessional interactions, and limited scientific evidence. These results related to enablers of and barriers to collaboration between physicians and osteopaths and the illustration of their dynamic interaction could be used to guide efforts to promote productive collaboration and safe patient-oriented care.     

Physicians’ attitudes about interprofessional treatment of chronic pain: family physicians are considered the most important collaborators

Scand J Caring Sci; 2013; 27; 303–310 Physicians’ attitudes about interprofessional treatment of chronic pain: family physicians are considered the most important collaborators Aims and objectives: Interprofessional collaboration is the process in which different professional groups work together to positively impact health care. We aimed to explore physicians’ attitudes toward interprofessional collaboration in the context of chronic pain management with the implication that if attitudes are not positive, appropriate interventions could be developed. Design: A quantitative attitudes study. Ethical issues: The ethical committee approved the study. Methods: A web‐based survey about interprofessional treatment of chronic pain was administered to physicians. Outcome measures were as follows: physicians’ demographic and workplace information, previous experience of working within an interprofessional team, and attitudes towards interprofessional collaboration in chronic pain management. Results: There were 90 physicians who responded to the survey. Physicians had positive attitudes towards team work in the context of chronic pain, but they were undecided about sharing their role within an interprofessional team. The family physician was singled out as the most important as well as the most common collaborator in chronic pain treatment. Interprofessional educational seminars and workshops were suggested as methods for improving interprofessional collaboration. Conclusions: Interprofessional collaboration may be enhanced with continuing medical education that will bring together different healthcare professionals, enable them to exchange experiences and learn about their potential roles within a team.     

Spreading the concept: an attempt to translate an interprofessional clinical placement across a Danish hospital

Abstract

In a Danish Interprofessional Training Unit (ITU), the clinical tutors have succeeded in developing a safe learning environment combined with challenging the students by giving them responsibility for the patient’s care and rehabilitation. In the ITU, students improved their uniprofessional and interprofessional knowledge and capability while strengthening their professional identity. It was, therefore, decided to make an attempt to transfer these interprofessional learning and teaching methods to another setting. The aims of this study were to evaluate whether the students learned about interprofessional collaboration and strengthened their professional identity and whether the clinical tutors could create a safe and challenging learning environment. Clinical tutors from the professions occupational therapy, physiotherapy, and nursing together planned the pedagogical approach and practical organization of two pilot studies in an orthopedic ward. After the intervention, focus group interviews of students and clinical tutors were performed and analyzed. The findings indicated that a one-week interprofessional clinical placement can contribute to students learning about interprofessional collaboration and to their development of professional identity. The data from the clinical tutors indicated that they needed to create a safe and challenging learning environment but emphasized that a thorough planning and continuous monitoring and adjusting of the clinical placement is necessary for success. The study documents that it is possible to create successful interprofessional learning opportunities in a normal ward environment in a restricted time frame. This knowledge can be applied to other ward settings where interprofessional clinical training is a natural possibility.     

Transforming Preprofessional Health Education Through Relationship-Centered Care and Narrative Medicine

Issue: The Institute of Medicine identified health care education reform as a key to improving the error prone, costly, and unsatisfying U.S. health care system. It called for health care education that no longer focuses exclusively on the mastery of technical skills but teaches students the human dimensions of care and develops their ability to collaborate with patients and colleagues to alleviate suffering and improve health. When should this educational reform begin, by what frameworks should it be guided, and which methods should it employ are important questions to explore. Evidence: There is increasing evidence that practitioners' relational skills, such as empathy and reflection, improve patients' health outcomes. Efforts to shift education toward patient-centered care in interprofessional teams have been made at the professional level, most notably in medical schools. However, reform must begin at the preprofessional level, to start cultivation of the habits that support humane care as early as possible and protect against empathic decline and the development of counterproductive attitudes to collaboration. The conceptual basis for reform is offered by relationship-centered care (RCC), a framework that goes beyond patient-centered care and interprofessional teamwork to focus on the reciprocal human interactions at the micro, mezzo, and macro levels of care. RCC identifies practitioners' relationships with patients, colleagues, community, and self as the critical interpersonal dimensions of healthcare and describes a foundation of values, knowledge, and skills required for teaching each dimension. The teaching of these foundations can be facilitated with techniques from narrative medicine, a compatible care model that conceptualizes health care as a context in which humans exchange stories and thus require narrative competence. Implications: We suggest beginning the educational reform at the preprofessional level with the implementation of a formal curriculum based on the 4 RCC dimensions with students expected to gain beginner levels of competency on these dimensions in addition to evidence-based principles of health sciences. This requires interprofessional collaboration among health professions, social science, and liberal arts faculty and training of health professions faculty in narrative medicine. Next, we suggest engaging in incremental change in the organizational culture with professional development and team-building activities. Although we need systematic research on the efficacy of the components of the transformation, their impact on students' learning, and their costs, it is important to engage in efforts to prepare professionals who are able to respond to the complex health needs of individuals and society in the 21st century.