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Lessons in Interprofessional Practice: Communication, Collaboration, and Camaraderie

by Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP on 07/01/18

As I sat pondering what to focus on for this blog, five events from last week came to mind:

1.    The physician tweet I “liked”: ‘It’s not even 9 am and I’ve already been paged 3 times in capital letters urging me to “REVIEW ALL PATIENTS FOR POTENTIAL DISCHARGE AND INFORM WARD NUM - BEDS CRITICAL”. These messages don’t change that pts are sick and won’t make me push for discharge before it is safe.”

2.    The physician tweet I “liked” about the power of all team members using non-clinical documentation for the new ICD10 Z “stress” codes: “Don’t limit this to physicians. Social workers and case managers should also document this; social determinants of health can be coded from non-physician documentation!

3.    The physician comment to the prior tweet that infuriated me: “only MDs have the right

       to code….No, the training of Social Workers is limited and does not include this aspect.”

4.     The physician comment to the comment that empowered me: “What? They can’t identify stress from being separated from a parent and document that? Of course they can”.

5.     Attending the annual 2018 Case Management Society of America (CMSA) Conference in Chicago.

 

What’s the weave of these events? For me, it is the reminder of the power of interprofessional collaboration toward achieving quality driven and patient-centric care. The benefits for all stakeholders of this interaction should never be in doubt. 

 

What is Interprofessional Team-Based Care?

Some know the term, interprofessional as simply that latest health care industry buzz word to describe a type of team. If a walk down team memory lane is required, here is a brief terminology history:

·      Multidisciplinary: Various disciplines working with a patient, but staff members function independently of each other.

·      Interdisciplinary: Cooperation, collaboration, communication, and integration of care in teams to ensure that the care is continuous and reliable.

·      Transdisciplinary: Clinicians are enabled to implement a unified, holistic, and integrated treatment plan, with all members of the team responsible for the same patient-centered goals.

The then, Institute of Medicine (IOM) framed working in interdisciplinary teams as one of their initial five core competencies. The other four being:

1.     Provide patient-centered care

2.     Employ evidence-based practice

3.     Apply quality improvement

4.     Utilize informatics

These competencies set a foundation for where health care needed to go. The work of the IOM ultimately leveraged other entities to further delineate a more intentional team effort. The Canadian Interprofessional Health Collaborative defined the next generation of team practice, or interprofessional collaboration,as a “partnership between a team of health providers and a client in a participatory collaborative and coordinated approach to shared decision making around health and social issues.” The World Health Organization subsequently set a line in the sand for the education of this next generation, one that began at the gateway of the professional academic education journey: 

“Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”

 

Ultimately the Interprofessional Education Collaborative (IPEC) formed to further leverage this competency-based methodology to both education and patient care. The focus used a collaborative approach to develop health care students as future interprofessional team members. The work was supported and endorsed by the IOM plus a majority of accreditation entities across the industry. IPEC went on to define four competencies to ground the education effort:

1.     Teams and teamwork

2.     Values/Ethics

3.     Interprofessional communication

4.     Roles/responsibilities

 

Interprofessional practice leverages the ability of students to understand their own individual professional identity, while also gaining keen understanding of other professional roles on the health care team. Anyone involved these days on the front lines of health and/or behavioral health care knows the merits of having unique expertise of colleagues available when they need it. Our patients are far too complex and benefit greatly from the knowledge that each one of us brings to the table. No single professional can or should know all.

 

Interprofessional Practice in Action

I have been fortunate to be involved with a number of interprofessional teams over the years. The models have demonstrated strong and successful outcomes. Once you work on a true interprofessional team, you can’t imagine ever practicing another way. There is something about taking your own practice scope and merging it with the expertise of another professional; an aligned effort that achieves an optimal patient outcome. It becomes second nature to reach out to the dietician, wound care nurse, and pharmacist to co-develop treatment goals that promote wound healing. The latest generations of collaborative and integrated care that simultaneously treat physical and behavioral health are other prime examples of interprofessional models. Strong outcomes denote decreased A1C’s for those persons with co-occuring diabetes and major depression, plus enhanced pulmonary function for populations struggling with anxiety plus chronic obstructive pulmonary disease. 

 

My own profession of case management is quite interprofessional in scope, a fact I was reminded of at the 2018 CMSA conference. While a clear majority of the case management workforce continue to be nurses, a growing number are social workers and other valued members of the allied health professions. There is respect and commitment to excellence among case managers; all seeking ways to efficiently finesse care processes at their practice settings. My experiences case managing patients with my valued colleagues across disciplines have biased how I consider treatment planning and the identified care. When approached from an interprofessional lens, how rich and inspiring the critical dialogues become which drive that care. All involved are granted the opportunity to share their clinical acumen and perspective. 

 

My commitment to the interprofessional team effort is without reservation. Every presentation I make, every publication I write, and every consultation I provide comes from that lens. This effort has also fostered my communication confidence. I speak as candidly to my physician peers as I do to those in social work, nursing, and respiratory therapy. A five minute dialogue with any discipline reinforces the common challenges faced in rendering care today; untangling social determinants, managing treatment plan adherence, addressing symptoms of increased length of stay (e.g. poor team communications, bullying behaviors), dealing with disparate electronic health records and interoperability, coping with stringent reimbursement and regulatory issues, assuring cost and quality jive, or approaching ethical dilemmas. Some of these challenges fueled the initial twitter posts that triggered this blog. 

 

While the industry clearly benefits from having degreed professionals uniquely educated and trained in their discipline, great gains comes from these individuals joining forces to assure patient centered treatment goals. Even the act of agreeing to disagree becomes poetry in motion for the committed interprofessional team.

 

Interprofessional Practice is Mandatory

Our time and efforts must be maximized to effectively manage the most complex patient/family dynamics and situations to date. Here are Ten Interprofessional Team Tactics to advance your own practice:

1.     Talk to each other as opposed at or down to each other

2.     Embrace mutual respect for expertise

3.     Engage in shared decision making

4.    Use collaborative treatment planning

5.     Identify interprofessional champions to model behaviors and mentor others in the organization 

6.     Develop coalitions to maximize team focused actions (e.g. coding coalitions, huddles, collaborative practice teams)

7.     Collect Interprofessional Performance Metrics using industry defined interprofessional competencies (IPEC, COLLABORATE©)

8.     Model Interprofessional efforts across the organization

9.     Advance Evidence-based Interprofessional Teams through presentations and publications

10.   Engage in Interprofessional Initiatives across the industry


Remember, the sum of our strengths is far more valuable than a solo effort toward achieving successful outcomes for patients, populations, practitioners, and providers alike. 

 

Interprofessional Resources:

The Interprofessional Education Collaborative (IPEC)


Interprofessional Team Based Resources:

 

Centers for Interprofessional Education

 

Inteprofessional Education and Practice Resources


IPEC Supporting Members

 

IPEC Funding


#IPE #casemanagers #respect #10Teamtactics 


Until next time...Stay Resilient  

Ellen

Comments (1)

1. Molly D. said on 9/30/18 - 05:02PM
Thanks for your blog on interprofessional practice. I too believe that interprofessional practice and collaboration are a vital part of achieving good quality care and client/patient centered care. Unfortunately the training of social workers is just starting to reflect some of the core beliefs that undergird the interprofessional competencies. It has been noted by many that the education of most professions is siloed. Siloed classrooms do not support good practicum and workplace interprofessional collaboration. Change must come because we know that our clients/patients benefit most from treatment that is wholistic and reflects the collaborations of all of the parties who have a role in treatment planning. I have been supervising social work students in an interprofessional practice setting and I can say that education is significantly enhanced by the experience.


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