Brenda J. Stutsky RN, PhD

1. Development and Testing of a Conceptual Framework for Interprofessional Collaborative Practice • Brenda J. Stutsky RN, PhD

2. Outline Project Background 1 Literature Review 2 Conceptual Framework 3 Methods/Procedure 4 5 Instrument 6 Results Discussion 7

3. Project Background • Post-doctoral work in Health Human Resource Optimization at UWO • September 2011 – December 2012 • Advisor: Dr. Heather Laschinger

4. Project Background • Special thanks to: • Carol Cooke, Associate Librarian, University of Manitoba • Catherine Hynes, Regional Manager Decision Support, Northern RHA

5. Literature Review • Extensive review of the interprofessional literature • Antecedents/consequences of: • Interprofessional education (IPE) • Interprofessional collaborative practice (ICP)

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

7. Literature Review • Collaborative Practice “When multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings.” (WHO, 2010)

8. Literature Review • Relationship-Centered Collaborative Care • Model developed by Tresolini & Pew-Fetzer Task Force (1994) • 3 key relationships • Patient-practitioner • Community-practitioner • Practitioner-practitioner • Used by researchers to guide ICP studies (Dix et al., 2008; Gaboury et al., 2011)

9. Conceptual Framework • Personal Factors • Interprofessional Insight • Beliefs in IPC • Flexibility • Relational Skills • 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 • 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

10. Methods/Procedure • Exploratory design • Regulated healthcare providers in Northern RHA • Involved in direct patient care planning or team decision making • 3 hospitals, 3 long-term care facilities, 4 primary healthcare centres • Manager in RHA assisted with distribution of packages • Information sheet • Informed consent • $2.00 gift card & draw ballot

11. Instrument • Interprofessional Collaborative Practice Survey (Stutsky & Laschinger, 2012) • Constructed from existing standardized measures • 55 items with 9 demographic items • 5-point scale of strongly disagree to strongly agree (1-2=low level, 3=moderate, 4-5=high level) • Pt. safety, quality, degree of collaboration (5-point scale from low to high) • 2 items measuring degree of collaboration used to validate ICP measure (r=.60 and r=.48)

12. Instrument • Exploratory Factor Analysis (Construct Validity) • ICP • Personal Antecedents • Situational Antecedents • Consequences: Work Behaviours and Attitudes • Reliability was adequate (.67 to .88)

13. 4 factors with Eigenvalues greater than 1.00, explaining 59.73% of the cumulative variance

14. 5 factors with Eigenvalues greater than 1.00, explaining 71.44% of the cumulative variance

15. 3 factors explained 67.50% of the cumulative variance

16. 4 factors explained 74.71% of the cumulative variance

17. 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

18. Results Subscale Scores • Means ranged 3.25 (SD=.81) to 4.41 (SD=.63) • Conflict 3.05 (SD=.73) • Only 34% did not have frequent conflicts over sharing of responsibilities (M=2.97, SD=1.03) • Only 25% did not believe that interprofessional relationships had winners and losers (M=3.27, SD=1.05)

19. 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

20. Results Hierarchical Multiple Regression • Influence of personal and situational antecedents on overall ICP • 37% of the variance of ICP was attributed to personal factors with an additional 12% being explained by situational factors

21. Results Hierarchical Multiple Regression • Influence of individual components of subscales of personal and situational antecedents on overall ICP • 49% of the variance of ICP was explained by personal factors with an additional 10% being attributed to situational factors

23. Results Series of Regression Analyses • Combined effect of personal and situational antecedents and overall ICP on consequences • Combination of predictors explained a significant variance in all six consequences of ICP

25. 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 • Limited power prevented more sophisticated analyses (SEM) • Psychometric properties of the ICPS are promising but continual refinement and validation is needed • Patient outcomes need to be captured in future studies

26. 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: Evidence linking personal attitudes and behaviours to effective ICP and patient safety and quality may motivate them to reflect on own behaviours and make a commitment to ICP • Further research to validate the framework