Development and Testing of a Conceptual Framework for Interprofessional Collaborative Practice

1. Development and Testing of a Conceptual Framework for Interprofessional Collaborative Practice Brenda J. Stutsky RN, MScN, EdS, PhD University of Manitoba brenda.stutsky@med.umanitoba.ca Heather K Spence Laschinger RN, PhD, FAAN, FCAHS University of Western Ontario hkl@uwo.ca

2. Objectives Describe a conceptual framework for interprofessional collaborative practice. 1 2 Describe the preliminary empirical testing of the framework. 3 Determine potential application for the framework.

3. Literature Review • Problem • Interprofessional literature: Atheoretical • Terms are poorly conceptualized • Consistent framework for research is missing (Reeves et al., 2011)

4. Conceptual Framework • ANTECEDENTS • Personal Factors • Beliefs in IPC • Flexibility • Trust • Cooperation • Communication Skills • Situational Factors • Leadership • Empowerment • Support Structures Antecedents • Interprofessional • Collaborative • Practice • Collective Ownership of Goals • Understanding of Roles • Interdependence • Knowledge Exchange Interprofessional Collaborative Practice • CONSEQUENCES • Work Behaviours & Attitudes • Personal • Work Satisfaction • Intent to Stay • Team • Perceived Team Effectiveness • Conflict • Organizational Outcomes • Patient Safety • Quality of Patient Care • Patient Outcomes • Patient Biopsychosocial Outcomes • Patient Satisfaction • Patient Empowerment • Length of Stay Consequences

5. Method • Descriptive correlationaldesign • Regulated healthcare providers in Northern Health Authority in Manitoba, Canada • 3 hospitals, 3 long-term care facilities, 4 primary healthcare centres • Interprofessional Collaborative Practice Survey • Constructed from existing standardized measures • 55 items with 9 demographic items • Reliability was adequate (.67 to .88) and .78 for overall ICP scale • Construct validity confirmed via exploratory factor analysis (Stutsky & Laschinger, 2012)

6. Results Demographics • Response rate 32% (N=117) • 95 females, 21 males, 1 not indicated • 23-68 yrs. of age (M=43.30, SD=11.77) • 0.5-40 yrs. of experience (M=15.51, SD=12.45) • 75% nurses, 17% allied health, 8% physicians • 59% acute care, 34% community care, 7% long-term care • 72% full-time, 24% part-time, 4% casual • 78% direct patient care

7. Results Means Overall mean for ICP was moderate (M=3.76, SD=.43) ICP dimensions were moderate to moderately high: • Understanding of Roles (M=3.15, SD=.75) • Interdependence (M=4.24, SD=.47) • Knowledge Exchange (M=3.98, SD=.50) • Collective Ownership of Goals (M=3.43, SD=.69)

8. Results Correlations • Correlations between ICP and its antecedents and consequences • All factors were significantly correlated with overall ICP (r=.33-.65, p<.01) except for flexibility Path Analysis Reasonably adequate fit for a newly developed framework: • Comparative Fit Index (CFI) .81 • Normed Fit Index (NFI) .77 • Root Mean Square Error of Approximation Index (RMSEA) .14

9. Results

10. Discussion • Encouraging preliminary empirical support for the conceptual framework • Results were consistent with findings in the literature including the importance of relationship-centered collaborative care • Limitations include small sample size and response rate • Psychometric properties of the ICPS are promising but continual refinement and validation is needed • Patient outcomes need to be captured in future studies

11. Discussion • Use of the framework • Healthcare leaders: Guide for facilitating ICP to enhance patient safety and quality of care • Educators: Strengthen IPE curricula • Healthcare professionals: Share the framework with their colleagues to promote ICP and remind all those involved in caring for patients of the importance of individual attitudes and behaviours and interprofessional interactions to improving patient safety and quality • Further research to validate the framework

12. References • Atwal, A., & Caldwell, K. (2002). Do multidisciplinary integrated care pathways improve interprofessional collaboration? Scandinavian Journal of Caring Sciences, 16(4), 360-367. • Blewett, L. A., Johnson, K., McCarthy, T., Lackner, T., & Brandt, B. (2010). Improving geriatric transitional care through inter-professional care teams. Journal of Evaluation in Clinical Practice, 16(1), 57-63. • Bronstein, L. R. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297-306. • Canadian Health Services Research Foundation (2006). Teamwork in healthcare: Promoting effective teamwork in healthcare in Canada - Policy synthesis and recommendations. Retrieved from http://www.chsrf.ca/Migrated/PDF/teamwork-synthesis-report_e.pdf • Canadian Interprofessional Health Collaborative. (2010). A national interprofessional competency framework. Retrieved from http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf • Clark, P. G. (2011). Examining the interface between interprofessional practice and education: Lessons learned from Norway for promoting teamwork. Journal of Interprofessional Care, 25(1), 26-32. • Cowan, M. J., Shapiro, M., Hays, R. D., Afifi, A., Vazirani, S., Ward, C. R., & Ettner, S. L. (2006). The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs. The Journal of Nursing Administration, 36(2), 79-85. • D'Amour, D., Goulet, L., Labadie, J., San Martín-Rodriguez, L. S., & Pineault, R. (2008). A model and typology of collaboration between professionals in healthcare organizations. BMC Health Services Research, 8, Online. • Dix, L., Steggles, E., Baptiste, S., & Risdon, C. (2008). A process-oriented approach to enhancing interprofessional education and collaborative relationship-centered care: The PIER project. Journal of Interprofessional Care, 22(3), 321-324.

13. References • Gaboury, I., Bujold, M., Boon, H., & Moher, D. (2009). Interprofessional collaboration within Canadian integrative healthcare clinics: Key components. Social Science and Medicine, 69(5), 707-715. • Gaboury, I., Lapierre, L.,M., Boon, H., & Moher, D. (2011). Interprofessional collaboration within integrative healthcare clinics through the lens of the relationship-centered care model. Journal of Interprofessional Care, 25(2), 124-130. • Hall, P., Weaver, L., Gravelle, D., & Thibault, H. (2007). Developing collaborative person-centred practice: A pilot project on a palliative care unit. Journal of Interprofessional Care, 21(1), 69-81. • Havens, D. S., Vasey, J., Gittell, J. H., & Lin, W. T. (2010). Relational coordination among nurses and other providers: Impact on the quality of patient care. Journal of Nursing Management, 18(8), 926-937. • Kanter, R. M. (1977). Men and women of the Corporation. New York, NY: Basic Books. • Kanter, R. M. (1997). Rosabeth Moss Kanter on the Frontiers of Management. Boston, MA: Harvard Business Review Book. • Laschinger, H. K. S., Finegan, J., Shamian, J., & Wilk, P. (2001). Impact of structural and psychological empowerment on job strain in nursing work settings. Expanding Kanter’s model. Journal of Nursing Administration, 31, 260-272. • Laschinger, H. K. S., Gilbert, S., Smith, L. M., & Leslie, K. (2010). Towards a comprehensive theory of nurse/patient empowerment: Applying Kanter’s empowerment theory to patient care. Journal of Nursing Management, 18(1), 4-13. McGrail, K. A., Morse, D. S., Glessner, T., & Gardner, K. (2009). "What is found there": Qualitative analysis of physician-nurse collaboration stories. Journal of General Internal Medicine, 24(2), 198-204. • Oandasan, I., & Reeves, S. (2005). Key elements of interprofessional education. Part 2: Factors, processes and outcomes. Journal of Interprofessional Care, 19(Suppl. 1), 39-48.

14. References • Ottawa Hospital (n.d.). The Ottawa Hospital Inter-Professional Model of Patient Care Staff Survey. Author. • Parker Oliver, D., Wittenberg-Lyles, E. M., & Day, M. (2007). Measuring interdisciplinary perceptions of collaboration on hospice teams. American Journal of Hospice & Palliative Medicine, 24(1), 49-53. • Reeves, S., Goldman, J., Gilbert, J., Tepper, J., Silver, I., Suter, E., & Zwarenstein, M. (2011). A scoping review to improve conceptual clarity of interprofessional interventions. Journal of Interprofessional Care, 25(3), 167-174. • Safran, D. G., Miller, W., & Beckman, H. (2006). Organizational dimensions of relationship-centered care. theory, evidence, and practice. Journal of General Internal Medicine, 21 (Suppl. 1), S9-15. • San Martín-Rodriguez, L., D'Amour, D., & Leduc, N. (2008). Outcomes of interprofessional collaboration for hospitalized cancer patients. Cancer Nursing, 31(2), E18-27. • Sicotte, C., D’Amour, D, & Moreault, M. (2002). Interdisciplinary collaboration within Quebec community health care centres. Social Science & Medicine, 55, 991-1003. • Temkin-Greener, H., Gross, D., Kunitz, S. J., & Mukamel, D. (2004). Measuring interdisciplinary team performance in a long-term setting. Medical Care, 42(5), 472-481. • Tresolini, C. P., Pew-Fetzer Task Force. (1994 [reprinted 2000]). Health professions education and relationship-centered care. Retrieved from http://rccswmi.org/uploads/PewFetzerRCCreport.pdf • World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice (WHO/HRH/HPN/10.3). Retrieved from http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf • Zwarenstein, M., Goldman, J., & Reeves, S. (2009). Interprofessional collaboration: Effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 3(3), CD000072.