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1. Interprofessional Practice Multiple health workers from different professional backgrounds providing comprehensive health services working with patients, their families, caregivers and communities to deliver the highest quality of care across settings. Framework for Action on Interprofessional Education & Collaborative Practice WHO, 2010.

2. Interprofessional Collaboration “… the process of developing and maintaining effective working relationships with learners, practitioners, patients/clients/families and communities to enable optimal health outcomes. Elements of collaboration include respect, trust, shared decision-making, and partnerships.”

3. Interprofessionality is not Simply sharing electronic health records Sole profession teams (neurologist, pulmonologist, radiologist) Learners hearing a talk about another profession Reporting out at interdisciplinary team meetings Co-location without intentional collaboration Decision-making without client/patient input

4. Why IP Teamwork? Why Now? Since 1999 the Institute of Medicine (IOM) has urged the practice of IP team-based care to prevent medical errors. In 2013 the Journal of Patient Safety reported that between 210,000 and 440,000 patients each year suffer some type of preventable harm when receiving hospital care. If the Centers for Disease Control included preventable medical errors as a category, these conclusions would make it the third leading cause of death in America . James, J. T. (2013) . A new, evidence-based estimate of patient harms associated with hospital care. JPS, 9(3), 122-128. Demographic Changes, aging population Chronic health conditions needing complex care Technological advances Specialization in healthcare Patient Safety & Quality agenda Workforce pressures and gaps Healthcare and payment reforms

5. Evidence for Teamwork Better continuity of care, access to care, and patient Satisfaction* Higher patient-perceived quality of care† Superior care for diabetes patients‡ Improved blood pressure control Reduction in medication side effects and improved adherence+

6. Core Competencies

7. Roles & Responsibilities Know one’s own role and those of team members Communicate team roles and responsibilities Engage diverse healthcare professionals to meet the needs of patients Use the full scope of knowledge, skills, and abilities of available health professionals and health care workers to provide safe, timely, efficient, effective, and equitable care Use respectful health care practices

8. Values & Ethics Recognize and respect the unique cultures, values, roles/responsibilities and expertise of other health professions Work in cooperation with those who receive care, those who provide care, and those who contribute to or support the delivery of prevention and health care services Place the interests of patients and populations at the center of interprofessional health care delivery

9. Communication Use respectful and appropriate communication in all situations Organize and communicate information with patients, families, and health care team members in a form and format that is understandable, avoiding jargon Listen actively and encourage ideas and opinions of all team members.

10. Teams & Teamwork Work with others to deliver patient-centered, community-responsive care Engage when possible in shared patient-centered problem solving Integrate knowledge and experience of other professions to inform effective/ethical decisions Apply leadership and facilitation practices that support collaboration and team effectiveness

11. Group Discussion What do we know about Pat? What role would your profession play on Pat’s team? What role will the other professions play on the team? Describe the role of the following professions on Pat’s team: Pharmacist Social Worker Physical Therapist Occupational Therapist

12. Interprofessional Competencies

13. Collaborative Leadership Value contributions of all team members Include patient, family, and community Facilitate contributions from all team members Build support for working together Purposefully work towards ending health disparities and improving access and quality

14. Interprofessional Facilitation Interprofessional learning is interactive and takes place when individuals from two or more professions learn about, from and with each other to enhance practice and improve the quality of patient care. Are two or more professions involved? Are you capitalizing on learning moments? Is the session interactive? Are contributions of different team members acknowledged? Are IP communication strategies discussed? Who’s doing most of the talking, you or the learners?

15. IP Facilitation Skills Open to multiple perspectives Value people and their ideas Think quickly and logically Excellent and comfortable communicators Groupwork skills: patience, comfort with silence, focus, redirection, conflict management Product and process oriented

16. Role Modeling Role model collaborative competencies in everyday practice Share your own process – what were your misperceptions of other professions Orient learners to interprofessional principles and values Facilitate introductions Clarify your role and have learners identify theirs

17. Facilitate IP Team Meeting Orient learners to goals of the session Prompt learners to discuss their observations Encourage a non-judgmental environment Make interprofessional learning explicit (e. g. let’s get the [discipline] view of Pat’s needs) What do we know about Pat? What information is missing and where might we find it? Capture teachable moments Prompt self-reflection - model Encourage closure and final case determinations

18. TeamSTEPPS & Primary Care Evidence for Positive Teamwork Outcomes: Significant improvement in communication and supportive behavior Increases in patient satisfaction and adherence Improved perceptions of teamwork* Reductions in worker turnover rate Increases in employee satisfaction† * Weaver, SJ, Rosen MA, DiazGranados D, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf 2010 Mar;36(3):133-42. † Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13 Suppl 1:85-90.

19. What is TeamSTEPPS™ A teamwork system designed for healthcare professionals and workers. Provides attitudes, knowledge and skills for improving patient safety and quality within health and health-related settings. Informed by evidence-based research aimed at improving communication and teamwork skills among healthcare professionals and workers.

20. A Shared Mental Model Is... The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication. "Teams that perform well hold shared mental models." (Rouse, Cannon-Bowers, and Salas 1992)

21. ISBAR A Shared Mental Model for Communication

22. 23 Briefs, Huddles & Debriefs

23. Situation Monitoring Process of actively scanning behaviors and actions to assess elements of the situation or environment Fosters mutual respect and team accountability Provides safety net for team and patient Includes cross-monitoring …Remember, engage the patient whenever possible.

24. Check-Back Is when Practitioners…

25. Teach-Back Is… Confirmation of understanding Opportunity to correct miscommunication Comprehensive “Tell me in your own words how you will take this medicine when you get home…”

26. Team-based Leaders: Motivate people to work together to accomplish common goals Model facilitation and collaboration Share information and listen Offer constructive and timely feedback Include patients and families as decision-makers

27. Patient- and Family-Centered Care Hear the patient’s stories Be open and honest Respect the patient and family as the central hub of the care team Make sure patients share fully in decision making Speak to patients in a way they can understand and enable them to feel empowered to be in control of their care

28. Equipping Patients & Families Quality care is a team effort Patients and families can improve their care by taking active roles in the process Invite patients to ask questions, and evaluate their option Be culturally responsive to patients Encourage shared decision-making in their health care Questions Your Patients Should Ask What is the test for? When will I get the results? Why do I need this treatment? Are there any alternatives? What are the possible complications? Which hospital is best for my needs? How do you spell the name of that drug? Are there any side effects?

29. Racial & Ethnic Disparities Language barriers are less well documented The root causes of patient safety events for non-English speaking patients in are: (1) p oor communication and (2) insufficient use of qualified medical interpreters and cultural navigators