Sustained Collaboratiion to Promote Shared Learning

Sustained Collaboration to Promote Shared Learning

Introduction

In quaternary facilities technology and new methods are continually integrated into

nursing practice. Information is presented to each professional discipline in discreet silos despite their shared patients and clinical obligation to improve quality. Opportunities to capitalize on collaborative education to enhance efficiency and quality may be overlooked. This paper will explore the educational challenge of supporting and sustaining collaborative interprofessional Rounds (IPEIPC Rounds) with a curriculum suited to the unique considerations of this surgical Division. Nursing is uniquely positioned to envision and carry forward interprofessional initiatives that enhance practice. From the nurse manager perspective sustaining interprofessional collaboration (IPC) promotes team function and ideally improves patient outcomes (Evans, 1994).

One way to incorporate collaborative practice is through shared education. The vision for the IPEIPC rounds is to expand the existing surgical Rounds that operated in a hierarchal medical model to an interprofessional collaborative format. The term IPEIPC was coined to represent a concept that acknowledges the inextricable link between interprofessional education (IPE) and collaborative practice (D'Amour & Oandasan, 2005). IPEIPC will be used to describe educational activities that extend from and result in IPC.

The revised Rounds will invite nursing, medical, and allied health professionals to present information on predetermined topics using a variety of methods. The teaching modalities will include workshops, lectures, structured dialogues, and case presentation sessions. IPEIPC Rounds will focus on sharing new information or critically examining existing issues and data to develop more robust practices (Oandasan & Reeves, 2005).

This project's goal is to facilitate, nurture, and sustain IPEIPC Rounds in order to improve teamwork, contribute to a healthy work environment, and improve patient safety. The focus on patients' needs will inspire the medical, nursing and other health professionals to come together. In reality, every patient interacts with many different health professionals and their complexity requires collaborative work. The IPEIPC Rounds project will ideally improve not only disease management and quality of the patient care and experience, but also generate savings in health care costs.

There is a definite need to incorporate more integrated and collaborative practices in the Division. Resource constraints (fiscal and health human resources) compel managers to target opportunities such as IPE or IPC to maximize program outcomes and achieve cost economies (Evans, 1994). Across the Division a communication plan was implemented to introduce the concept of IPEIPC, provide rationales for implementation (leveraging cost savings and alignment with corporate objectives as motivators), and to identify champions to participate in the strategic planning activities.

Internal support for IPEIPC was intentionally stimulated by the manager through informal dialogue and cost benefit presentations across the Division. Prior to the internal efforts the project was presented at senior leadership forums to gain feedback and leverage support. At the same time a Division IPEIPC strategic planning team was struck with inclusive representation to map out an action plan for the implementation of the new Rounds format.

External Factors

Factors external to the surgical division can directly and indirectly impact the sustainability of the IPEIPC process. Issues affecting health or health policy at the community or national level can impact the Division. Consider for example the paralyzing affect of a pandemic -no elective surgery, essential staff only, stressed patients and health care providers. This demonstrates how an externally driven imbalance could affect the flow of care and negate efforts to sustain IPEIPC as newly learned skills and practices may be abandoned under strain (Encyclopedia of Stress, 2000).

Demographics and setting can influence how effectively healthcare projects are carried forward (Iwasiw, Goldenberg, & Andrusyszn, 2009). Census data from 2006 shows that the hospital vicinity population consists of younger adults that have little bearing on the Divisions' patient base (http://www.toronto.ca/demographics/cns_profiles/2006/pdf2/cpa76.pdf). Complex surgical patients from across the region account for most of the patients. Internally gathered statistics showed: the average patient age is 58 and there is a virtually even split of males to females (personal communication, February 8, 2011). The institution is sensitive to the diverse needs of the patients it serves. Respect for differences is shown by having policies and specialized human resource staff that are responsible for actualizing the values within the workplace (institution website).

The Division is within a university affiliated institution located in a large urban North American setting. Community trends that impact the Division's work are: centralization of home care referrals, new funding allocation processes (through LHINs), and pressure from the Ministry of Health and Long Term Care (MOHLTC) to improve surgical wait times (http://www.health.gov.on.ca/en/pro/programs/waittimes/surgery/default.aspx). Additionally, based on Cancer Care Ontario research findings, the central LHIN shifted the surgical emphasis of the Division to a specific, highly technical branch of general surgery to create a centre of excellence and ensure quality outcomes (Central LHIN CEO Report, May 25, 2010). These pressures fuel Division professionals' need to have the best ongoing education to provide the necessary services to a complex patient group and ensure ongoing competence.

A summary of the IPEIPC literature reviewed yielded a variety of perspectives on how to achieve successful implementation; often papers focusing on required processes or barriers. Recurring solutions included: generating a work culture open to risk taking and change, motivating and inspiring staff to engage in IPE and collaborative activities (IPC), and the visible commitment of senior leadership to IPE (CNA, 2005; Wilson & Pirrie, 2000). Several articles focused on the necessity of the manager's ability to build teams, implement innovative methods, and incorporate shared leadership principles into their style (Health Canada, n.d.; Ginsburg & Tregunno, 2005; Freeth, 2001).

Internal Contextual Factors

Within the institution there is a working group for Interprofessional Education and Collaboration with a mandate to embed IPEIPC in the