Interprofessional practice and education





Introduction


Physician assistant (PA) students who train in the early 21st century are being prepared as never before for interprofessional practice (IPP) via interprofessional education (IPE) ( Box 40.1 ). IPE is a newer concept in medical education; therefore PAs who graduated a decade ago may not have had the same experience in IPE as current students and physicians. Working as part of a team with other professions is so important that the Accreditation Review Commission on Education for the Physician Assistant issued a statement that the PA curriculum must include “instruction to prepare students to work collaboratively in interprofessional patient-centered teams … [and] include opportunities for students to apply these principles.” Accrediting bodies for other health professions have similar requirements ( Box 40.2 ).



Box 40.1

Terminology


Interprofessional education (IPE) “occurs when two or more professions learn with, about, and from each other to enable effective collaboration and improve health outcomes.” IPE is intended to prepare students for interprofessional collaborative practice in the workforce.


Interprofessional practice (IPP) is often referred to as interprofessional collaborative practice. This occurs “when multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality care.” Elements of effective IPP include respect, trust, shared decision making, and partnerships.




  • Triple Aim: A three-pronged approach to optimizing health system performance created by the Institute for Healthcare Improvement. This involves simultaneous efforts to (1) improve the patient experience of care (including quality and satisfaction), (2) improve the health of populations, and (3) reduce the per capita cost of health care. The Triple Aim is a goal for new collaborative health care systems and serves as the filter or lens through which new health care models will be evaluated. (Video Resource: www.ihi.org/engage/initiatives/tripleaim and youtu.be/a_QskzKFZnI )



  • Quadruple Aim: This is the Triple Aim with one additional component: provider work-life balance. Provider burnout has been shown to decrease patient satisfaction, increase health care costs, lower empathy levels, and increase prescription errors. Overall, provider burnout affects patient health and compromises the goals of the Triple Aim. As a means of addressing this need, there are now entire conferences focused on preventing burnout, teaching evidence-based mindfulness techniques, and promoting provider self-care. ,



  • Client versus patient: Health care professionals who don’t prescribe medications, such as social workers and occupational therapists, will refer to the patient as their “client.” This may seem rather impersonal, but it is more accurate from their perspective.



Interdisciplinary versus interprofessional: Some professions may use the word “interdisciplinary” instead of “interprofessional.” There are subtle differences between these words, but they are often used interchangeably.



Box 40.2

Standards for Interprofessional Education by Health Professions





  • Physician Assistant: ARC-PA Accreditation Standard B 1.08. The curriculum must include instruction to prepare students to work collaboratively in interprofessional patient-centered teams. Such instruction includes content on the roles and responsibilities of various health care professionals, emphasizing the team approach to patient-centered care beyond the traditional physician–PA team approach. It assists students in learning the principles of interprofessional practice and includes opportunities for students to apply these principles in interprofessional teams within the curriculum.



  • Medicine: LCME Accreditation Standard 7.9, Interprofessional Collaborative Skills. The faculty of a medical school ensures that the core curriculum of the medical education program prepares medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients. These curricular experiences include practitioners and/or students from the other health professions.



  • Dentistry: CODA (Commission on Dental Accreditation) Standard 2-19. Graduates must be competent in communicating and collaborating with other members of the health care team to facilitate the provision of health care. Students should understand the roles of members of the health care team and have educational experiences, particularly clinical experiences that involve working with other health care professional students and practitioners. 2-19.1. Describe how students interact and collaborate with other health care providers, including but not limited to: a. primary care physicians, nurses, and medical students; b. public health care providers; c. nursing home care providers; d. pharmacists and other allied health personnel; e. social workers.



  • Social Work: Council on Social Work Education (CSWE) 2015 Educational Policy and Accreditation Standards Competency 1 – Demonstrate Ethical and Professional Behavior. Social workers also understand the role of other professions when engaged in interprofessional teams … Social workers value principles of relationship-building and interprofessional collaboration to facilitate engagement with clients, constituencies, and other professionals as appropriate … Social workers value the importance of interprofessional teamwork and communication in interventions, recognizing that beneficial outcomes may require interdisciplinary, inter professional, and interorganizational collaboration.



  • Occupational Therapy: Accreditation Council for Occupational Therapy Education (ACOTE®) Standard B.5.21. A graduate from an ACOTE-accredited doctoral-degree-level occupational therapy program must effectively communicate, coordinate, and work interprofessionally with those who provide services to individuals, organizations, and/or populations in order to clarify each member’s responsibility in executing components of an intervention plan.



  • Physical Therapy: Commission on Accreditation in Physical Therapy Education (CAPTE) Standard 6F. The didactic and clinical curriculum includes interprofessional education; learning activities are directed toward the development of interprofessional competencies, including, but not limited to, values/ethics, communication, professional roles and responsibilities, and teamwork. This element will become effective January 1, 2018. Standard 6L3. The curriculum plan includes clinical education experiences for each student that encompass, but are not limited to, involvement in interprofessional practice. According to these standards, the programs should provide opportunities for involvement in interprofessional practice during clinical experiences and evidence that students have opportunities for interprofessional practice.



  • Nursing: The Commission on Collegiate Nursing Education (CCNE) Standards for Accreditation of Baccalaureate and Graduate Nursing Programs and the American Association of Colleges of Nursing (ACCN) publish The Essentials of Baccalaureate Education for Professional Nursing Practice – Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes. The nursing baccalaureate program prepares the graduate to: 1) Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the health care team (i.e., scope of discipline, education and licensure requirements); 2) use interprofessional and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care. Sample content includes: interprofessional and intraprofessional communication, collaboration, and socialization, with consideration of principles related to communication with diverse cultures; teamwork/concepts of teambuilding/cooperative learning; professional roles, knowledge translation, role boundaries, and diverse disciplinary perspectives.




Why does working collaboratively require new advances in medical education? Don’t all medical professionals work in teams? Unfortunately, the concept of teams in the United States has traditionally been limited to the group of providers at a specific location or within a specific specialty practice. The team has not been defined as a group of people who work together across professional boundaries to care for one patient. Although specialists, for example, may send a letter of recommendations for the patient back to a primary care doctor, the concept of truly integrated care for the patient is rarely implemented. This fragmentation of care is potentially dangerous for the patient. As a result, policies have been implemented among some payors to provide incentives for better integration of patient care throughout the system.


This chapter is designed to introduce PA students to IPP and IPE. Because instruction in IPP and IPE is a relatively new approach, do not be surprised if you bring something new to settings that do not currently use interprofessional teams. Feel free to discuss these concepts with preceptors and employers but avoid being judgmental with them. This chapter will provide you with the basic principles of IPE and practical ways to implement the competencies in the clinical environment as a student and ultimately as a PA.


Background and rationale for interprofessional practice and interprofessional education


The population of adults over the age of 65 in the United States is estimated at more than 40 million, and this is expected to double to 83.7 million by the year 2050. Although the rates of alcohol consumption and cigarette smoking are lower in this generation of elders, overweight and obesity rates have increased. This means that PAs will be treating more chronic diseases in this group, such as diabetes, hypertension, arthritis, and impaired mobility. According to the National Institute on Aging’s Health and Retirement Study, in 2008, 41% of the older population had three or more chronic conditions, and 51% had at least one or two chronic conditions.


The traditional model of fee-for-service, referral-based care in the United States has been associated with fragmented care; dangerous outcomes; inefficient use of highly trained health professionals; and frustration among patients, particularly elderly adults. The nation cannot sustain the inefficiency and cost of the traditional fee-for-service system. These realizations spurred the development of the “patient-centered medical home” (PCMH) and other collaborative health care models.


In response to the limitations of the traditional system, the Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA), was signed into law by President Obama on March 23, 2010. The ACA provides health care coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country and improving the affordability of private insurance with federal subsidies for other uninsured Americans. With more people now insured, there is a significantly increased need for primary care providers. Given the shortage of primary care physicians, pressure is being placed on the system to produce sufficient PAs and nurse practitioners to absorb the newly insured patients under the ACA. The U.S. Department of Health and Human Services reported in 2012 that “the number of PAs in the medical workforce (72,000) will be insufficient to meet the future primary care needs.” Even with the anticipated 72% growth by 2025, they will only be able to provide 16% of the providers needed to address the projected physician shortage in primary care. Similar increases in the number of physicians who are being trained will also not fully meet the need for new primary care providers.


In addition to providing insurance for previously uninsured patients, the ACA also enacted provisions to encourage collaborative care models. The government has provided financial support to PCMHs to allow them to accommodate the staff expansion required to improve health care coordination. Additional funds were provided to expand training for medical providers (e.g., PAs) and to increase financial reimbursement to PCMHs that provide high-quality comprehensive medical care in collaborative models. As Medicare transitioned away from the inefficient fee-for-service model, it encouraged the formation of accountable care organizations (ACOs) and has experimented with paying them a set amount per patient to encourage them to develop a collaborative model that would reduce costs. Under the old fee-for-service approach, doctors and hospitals would receive additional payment when caring for patients with preventable complications of a surgery, for example. Under the ACA, health systems are no longer financially rewarded for taking care of patients with preventable complications. Instead, doctors and health systems are rewarded for providing high-quality preventive care and for improving patient outcomes. Studies show that IPP can address the Triple Aim of increasing the quality of care while reducing costs and increasing patient satisfaction.


In contrast to the referral-based system of the past 60 years, in the team-based IPP model, the primary care provider functions as part of a multidisciplinary team. After each member of the team evaluates the patient, the team members collaborate on developing a patient care plan. When one team member discusses the plan with the patient, it becomes clear that everyone is working together in the patient’s best interest. The patient is clearly at the center of this model and viewed as an integral part of the team ( Fig. 40.1 ).




Fig. 40.1


Traditional Care Model Versus Interprofessional Team-Based Model.

In the traditional model ( A ), the primary care provider is the point-person who directs the patient to individual specialists as needed and coordinates the system of referrals. In the interprofessional team-based model ( B ), the patient and the patient’s family are the focal point of coordinated care. Each member of the team brings their unique expertise to the team with the patient being treated as an equal member of the team.


Although long-term health outcomes for interprofessional teams have not been established, studies demonstrate that interprofessional care improves short-term patient outcomes, cost efficiency, and health professional satisfaction. Quality of care is improved by reducing redundancies of medical care services, duplication of medications, medication errors, and gaps in services.


To be better prepared to function as part of interprofessional teams, students need to learn with and about other health professions during their training instead of waiting until they enter the workforce. Early exposure to IPP enables each student to develop a team mentality and the relationships needed to enact change. Universities that train health professionals use a variety of strategies and instructional methods to introduce their students to IPP.


Many universities teach interprofessional skills through student-run clinics. Student-run free clinics have proliferated in the United States, with more than 75% of accredited medical schools having at least one student-run free clinic. Many of these are run as interdisciplinary clinics for the health profession students at these universities. In some clinics, a representative of each profession sees the patient in turn; then the students huddle to share notes and develop a treatment plan, which is presented to the attending. In other clinics, students from each profession see the patient together at the same time in the same room and decide on a care plan together. Student-run clinics offer unparalleled opportunities for preclinical students to experience working in interprofessional teams with the safety of preceptor supervision.


PA students who are able to work in these clinics are encouraged to take advantage of this opportunity to speak with students from other professions. Students should ask each other about their training, what they are currently able to do, and what their scope of practice will ultimately be when they become licensed. Recognizing the roles of each profession is an important competency to master in school before going out into practice.


The most basic interprofessional team consists of a medical provider and a nurse, but with accreditation requirements in most health care professions, it is common to see teams with any combination of the following: physicians, nurses, PAs, nurse practitioners, pharmacists, occupational therapists, physical therapists, social workers, respiratory therapists, and dieticians. Because of the unique concerns in hospice, geriatrics, and the intensive care unit of a hospital, it is possible to see spiritual care providers or clergy, intensivists, rehabilitation specialists, mental health services, and informal caregivers as well. Regardless of the discipline, the need to become proficient in the core competencies is critical for team-based care.


Barriers to interprofessional education


For the IPP model to succeed, exposure to IPP must begin when practitioners are still students. Each profession must provide opportunities for students to receive joint training. Unfortunately, health profession educators have found it more difficult than expected to provide IPE. Attempting to blend among different professions reveals practical and philosophic barriers that can make IPE challenging to implement. Some of the barriers include:




  • Structure of traditional education: Students from each profession are taught in “silos,” unaware of the content of the education and the role of each health profession. These silos promote isolation and inhibit collaboration among the professions. In clinical practice, siloes can create gaps in communication and compromise patient safety. As the health care needs of the community change, each profession adapts to meet those needs. This results in evolving roles and often an overlap of skills among professions. In many cases, health care professionals are unaware of this “role blurring” until they have the opportunity to work side-by-side with each other. For example, many clinical pharmacists are able to perform a basic physical examination and prescribe under protocol, and many occupational therapists are trained in assessing stages of childhood development, anxiety, and depression.



  • The first step to overcoming this barrier is to make the effort to learn about the roles and responsibilities of each profession on the student team. You may learn this as part of your curriculum, but you should take advantage of extracurricular opportunities to volunteer in interprofessional clinical environments and learn directly from other health professionals about their training and scope of practice.



  • Interprofessional accreditation standards: Although the inclusion of IPE standards in accreditation procedures is intended to promote the development of IPE, implementation of IPE training is stifled by the variety of standards among each profession and the lack of guidance from accrediting agencies about what fulfills this requirement. For example, some standards may permit a school to simply provide one lecture on roles and responsibilities of different professions or provide a one-time clinical opportunity for students to interact with another health professional. Other standards may expect clinical training to be conducted interprofessionally, either in special clinics for patients with complex conditions, daily interprofessional interactions, or regular interprofessional case conferences. With each profession trying to meet the standards set for them in the context of already overcrowded curricula, it becomes difficult for different professions to agree on how to implement IPE activities.



  • Complexity of academic scheduling: Arranging time for IPE is an extremely difficult task because of the differences in content, complexity of schedules, and logistics of transportation to a common location. Most students are already in classes 35 to 40 hours per week. Trying to create a common time for a course for students from different professions is extremely difficult. For this reason, programs have to be creative, typically incorporating short IPE activities within existing courses. Some common IPE activities include a panel of speakers from different professions, an IPE day where students from different professions participate in workshops and simulated clinical activities, and student-run clinics, which are often scheduled in the evening hours.



  • Attitudes of faculty and administration: Merging IPE content into existing courses requires time, effort, and changes to the way things have always been done. These changes sometimes meet with resistance from faculty or administrators who do not believe in the viability of IPE or who are simply overwhelmed with the demands of running their existing programs. As IPE becomes an accreditation requirement for each profession, faculty will adjust to the new expectations, and IPE will become an accepted part of the curriculum.



Barriers to interprofessional practice


Even as the barriers to IPE seem difficult to overcome, barriers to true IPP are likely even more substantial:




  • Traditional silo structure of health professionals: The silos that exist in education result in silos in practice. In any given health care environment, doctors talk to doctors, nurses talk to nurses, social workers talk to social workers, and so on. Through experience, they become self-reliant and tend to refer out any questions that they perceive to be beyond their scope of practice. The reality is that even the conditions that they believe are within their scope can be better cared for by an interprofessional team.



  • Fee-for-service reimbursement structure: Fee for service refers to the system whereby a health care provider, after seeing a patient, bills either an insurance carrier or the patient for services rendered. The traditional system is not set up to receive invoices for consultations from multiple providers or a team. The ACA created an infrastructure that made way for a novel reimbursement system that not only reimburses a medical group based on the number of individuals assigned to its site but also provides bonuses based on performance, improving health outcomes. In other words, there can be financial rewards for offering high-quality health care and preventing disease. Team-based care will be one of the keys to success for this new system.



  • Physical space in health care facilities: Medical facilities in the traditional system are designed for optimal patient flow for a health care professional from a single discipline (e.g., a family medicine practice, physical therapy clinic, social work office). This physical setup works well in the “referral system” model but is not conducive to IPP. Many new provider offices are being constructed with a more inclusive design that may include onsite facilities for multiple disciplines at the same time, such as dentistry, physical therapy, occupational therapy, and social work in addition to primary care. How much better might the care that the patient receives be when a health care team is in close proximity to each other, actively informing each other of the patient’s progress and revising patient care plans together? This is the current direction of health care.



  • Lack of training and experience in IPP: To a health care provider who is accustomed to working autonomously and directing care for his or her patients, it can be a large adjustment to work on a team, especially when others now have input into your decisions. Functioning as part of a team does not come naturally for many providers. It requires training and experience. In the IPP model, the team leader role may be given to the one with the most team experience rather than always being assigned to the physician, as has been the tradition. PAs should be prepared to both lead these teams and know how to be a responsible supporting member of a team.



Interprofessional education competencies


Creating health care reform begins at the root, educating students from multiple professions to learn the interprofessional competencies and graduate with experience in interprofessional care. The World Health Organization recommends that health care students and medical providers become proficient at the following interprofessional skills or competencies:



  • 1.

    Teamwork: Acquisition of the knowledge and skills linked to interprofessional collaboration and networking and building trust


  • 2.

    Role recognition: Understanding one’s own roles, responsibilities, and boundaries, as well as those of other health and social care professionals


  • 3.

    Communication: Effective communication, listening, negotiation, and conflict resolution and facilitation


  • 4.

    Learning and reflection: Transferring interprofessional learning to the clinical setting; learning about team development; and reflecting critically on one’s role in the team


  • 5.

    The patient: The central focus of the interprofessional team should be the patient and their family; cooperation is in the best interest of the patient; and the patient should be treated as a partner within the team


  • 6.

    Ethics and attitudes: Ethical issues relating to teamwork; respect; awareness of stereotyping; and tolerating differences and misunderstandings



Teamwork


Team characteristics


Health professionals may work on teams, but that does not necessarily mean that they are engaging in teamwork. The traditional patient referral system is often mistaken for interprofessional collaboration. Referring to specialists and other health care workers does not require teamwork and involves gaps in communication. In many cases, it could take weeks or months before a report is received about how a patient or client is progressing. In a true IPP, each discipline collaborates in the evaluation and management of the patient’s condition in real time.


It took 15 years of studies for the National Institutes of Health to identify the following seven team characteristics required for primary care practice improvement:



  • 1.

    Trust: Being vulnerable and collaborative


  • 2.

    Mindfulness: Being highly aware of details and open to new ideas


  • 3.

    Heedfulness: Paying attention to tasks belonging to one’s self and others


  • 4.

    Respectful interaction: Showing honesty, self-confidence, and appreciation of others


  • 5.

    Diversity: Respecting differences in the perspectives and worldviews of individuals


  • 6.

    Social and task relatedness: Maintaining a balance of social and work issues


  • 7.

    Rich and lean communication: Communicating ambiguous information face to face and less ambiguous information using lean channels, such as emails or memos ,



Research shows that IPP involves more than just teamwork. It requires interprofessional collaboration, communication, coordination, and networking to improve outcomes, increase patient satisfaction, and reduce medical errors. , , The University of Virginia developed the Academic Strategic Partnerships for Interprofessional Research and Education (ASPIRE) Model for implementing and assessing interprofessional training in the core competencies. This model has been shown to work in “real-world” settings with health care providers and faculty.


Putting team theory into practice


Many students will have the opportunity to work on interprofessional teams during the course of their studies, possibly at a health fair or student-run clinic. When assigned to work with a new group of students, there are a few issues that the newly formed team should manage together:




  • Leadership: The physician or medical student assumes leadership in the traditional model. In an interprofessional team, however, leadership is shared, and the team leader takes on the role of a facilitator. It is a good idea for the individual with the strongest facilitation skills to be selected as the leader of the group. The leader is responsible for keeping the discussion on track, allowing everyone’s voice to be heard, and for following up.



  • Hierarchy: It is good practice for members of a new team to decide on the following team roles based on interests and abilities: facilitator, scribe, and timekeeper. This may sound very basic, but a team functions more efficiently when one person is responsible for taking minutes and another for keeping track of the time. Clarity of responsibilities is vital to the success of a team.



  • Ground rules: To be an effective team, the group should begin by agreeing on ground rules. For example, the team may decide that all members will be given the opportunity to express their opinions on every issue. They may also decide that cell phones should not be answered during discussions or that no one is allowed to interrupt the person who is speaking, except for maybe the timekeeper.



  • Diversity: Is diversity a strength or hindrance for this group? For example, differences in scopes of practice and overlapping roles can enhance or complicate the patient encounters. When two members of the team have differing approaches to a health care problem (e.g., complementary and alternative medicine vs. medication), how will the team resolve these issues? When multiple members of the team are capable of taking a social history or performing a depression screen, who will the team elect to perform those functions? Answering these questions prospectively minimizes frustration for both the students and the patients.



  • Assumptions: What underlying assumptions do the team members have about other team members regarding gender, status, seniority, age, and education? Is it safe to assume that the ideal person to lead the team is the eldest, the physician, or the one with the most seniority? The team must take some time early in its formation to identify members with strong facilitation skills and to learn about each other’s education and professional abilities.



  • Jargon: Avoid using profession-specific jargon that other team members may not recognize, such as CHF (congestive heart failure), EOM (extraocular muscle), and ADLs (activities of daily living). Jargon causes rifts in communication and relationships. It can make other team members feel ignorant or as if they are an outsider to the group. Be aware of how members of the team are responding to your language, and if they appear confused, take time to explain any terms that may not be commonly used in their profession.



Requirements for a good team leader or facilitator


Being a good team leader requires that you have the appropriate knowledge base, skills, and attitudes. The team leader has to have a clear understanding of the roles of other health professionals. Although basic knowledge can be learned from class, it is ideal if the team leader has also had experiential knowledge about the roles by actually working with other professions. Essential leadership skills not only require an ability to communicate clearly with others but also the personal ability to reflect and the ability to facilitate group reflection. The attitudes required of the leader or facilitator include the fostering of mutual respect, a willingness to collaborate, and an openness to others’ views.


Role recognition


Being aware of each other’s roles, responsibilities, and limitations sets the climate for effective teamwork. One of the first steps in forming a team is to discuss roles and allow each member to have an equal opportunity to educate teammates about their role. During this process, misperceptions are typically clarified, and assumptions are corrected. Developing a common vocabulary can help the team to avert potential conflicts.


PAs often discover that other health professionals are surprised to learn that PAs can perform surgical procedures and prescribe controlled substances. At the same time, PAs may not realize that many pharmacists can examine patients or that occupational therapists can perform cognitive assessments and depression screenings. Learning from each other can be enlightening. Sharing about our roles is an essential part of interprofessional learning and helps solidify the team.


Conflict management


Conflict should be expected when a new team is forming. It is not a stage to be avoided but rather welcomed and addressed. Conflict offers a team the opportunity to overcome a challenge and grow stronger in the process. It is a stage that brings out new ideas and creativity within the group. Knowing to expect conflict gives the team the opportunity to take a proactive approach and to create a plan of action rather than form a reactive approach that generates additional stress.


Psychologist Bruce Tuckman proposed the forming-storming-norming-performing model for team development in 1965, which identifies the stages of development necessary for team growth and for the team to produce positive results. If you want to be a strong team leader, you should be aware of the stages of team development and what your role is at each stage.


In the forming stage, team members learn about each other and try to find safe patterns for interacting. The team leader’s role is to set a climate in which each member fully participates, roles and tasks are clarified, and communication is encouraged. This stage builds the group identity.


The storming stage is characterized by a storm or conflict among team members as they test their roles as part of the group. If the storm is too violent, some teams will never get past this stage. During this time, it is vitally important for the team to keep the goals the team is trying to achieve in mind. This is a time when the team needs to come together to decide how to move forward. It is important to remember that conflict is an opportunity for growth. The team leader’s roles at this stage are to focus the team, encourage respect for each other’s viewpoints, and facilitate a plan to resolve the conflict.


Norming refers to the stage during which the team collaborates well and becomes a cohesive unit. Everyone understands the mission of the team, and respect grows. The team leader facilitates good communication by being open about issues, encouraging feedback, building consensus, and delegating new tasks.


In the performing stage, the team is fully functioning, with each member aware of his or her specific tasks and producing results. The team leader may assess the team, recognize each member’s contributions, and assist each member in reaching his or her full potential on the team.


The transforming stage is the point at which the team achieves its goal. It’s a time for the team leader to honor the team’s accomplishments, celebrate personal growth, and determine future directions for the team.


To optimize team performance, these are the recommended steps that a team leader should take:



  • 1.

    Build trust. Take time to hear each other’s personal stories and develop an understanding of their personal motivation.


  • 2.

    Establish a “conflict culture.” Profile the team and its members, anticipating conflict and preparing for conflict norming.


  • 3.

    Manage meetings. Protect your team from too many meetings. When you must meet, address the issues quickly and encourage everyone’s voice to be heard.


  • 4.

    Get commitment. Do not assume that everyone thinks the way you do. Speak with the team and make issues and tasks very clear. Use cascading communication to ensure that everyone is aware of messages and decisions.


  • 5.

    Establish accountability. Both the team leader and peers are responsible for holding each other accountable for tasks. An effective leader keeps track of team accomplishments and milestones.



Reflection and team assessment


Reflection is an essential part of developing an effective team. It gives meaning and focus to the team, fosters a habit of appreciating each other, creates a sense of closure after an emotional or stressful encounter, develops the ability to learn from both positive and negative experiences, creates shared understanding and improved communication, and provides a broader perspective on the experience.


The ideal time to reflect is at the end of the session or end of the day to discuss how everything went. During this time, team members should be encouraged to share about team strengths and weaknesses they observed that day, whether ground rules were observed, situations that enabled effective collaboration, and potential areas of improvement.


When giving feedback to the team, it is recommended that the team leader begin with team self-assessment based on direct observation. The team leader should encourage all to be clear, specific, and balanced with feedback and to use “teach-back” to ensure that the feedback was received as intended.


Centrality of the patient


The interprofessional model places the patient at the center and considers the patient a part of the team, to be included in the decision-making process. The patient’s improved health is the goal of the team, and every action should be performed in the patient’s best interest.


Ethics and attitudes


Ethics is at the core of the practice of medicine. It includes the principle of primum non nocere , which means “Above all, do no harm.” The fee-for-service model was easily susceptible to abuse and breaches of ethics because providers were financially rewarded for providing potentially unnecessary care. Paying teams for delivering high-quality care and better outcomes aligns the financial interests of the providers with the good of the patient. Ethics in this new delivery system will involve respecting the other team members, being cautious not to stereotype them or the patients, and exhibiting tolerance toward the team members with different opinions. It is important to understand that misunderstandings may occur, and in these situations, communication is key to resolving differences among team members.


Summary


IPE occurs when members of “two or more professions learn with, about, and from each other to enable effective collaboration and improve health outcomes.” As the result of inefficiencies in the traditional fee-for-service or referral system model, the government has restructured health care reimbursement, allowing for more a comprehensive team-based approach conducive to interprofessional care. Health care professions have traditionally been educated in silos; however, with increased accreditation standards requiring IPE, further integration of education and learning activities will be seen.


Interprofessional competencies must be learned as part of health care education to adequately prepare students for IPP. These competencies include teamwork, role recognition, communication, learning and reflection, the centrality of the patient, and ethics and attitudes. PA students should make every effort to develop these competencies and to prepare themselves for potential leadership of interprofessional teams.



Jun 15, 2021 | Posted by in MEDICAL ASSISSTANT | Comments Off on Interprofessional practice and education
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