Achieving Quality and Improved Outcomes Through Interprofessional Collaboration

November 2015

Loretta Nunez

It is 2015. You have just completed a case history on a person referred to you for a hearing and balance assessment. The patient reports falling forward when she is performing tasks such as gardening or tying her shoes. She is being treated for diabetes and anxiety by other health professionals. What assessments will you complete? What referrals may be necessary? As other care providers are also seeing this individual for assessment or treatment, who is facilitating the coordination of care and sharing of information? What is the risk to the patient and family as care is provided in professional silos?

It is 2025. Let's drop in on a conversation among a team of health care providers discussing this same case. The patient and family member—along with you as the audiologist, a physical therapist, primary care physician, otolaryngologist, and psychiatrist—are present in the room or are connected remotely. The team is developing a plan of care and agrees to reconvene in 2 weeks to share further information, assess progress, and determine next steps. Is this scenario feasible? Will administrative and reimbursement systems support such an approach for collaborative, reflective care? What values and skills are necessary for these professionals to effectively collaborate as a nonhierarchical, synergistic team in order to provide individual and family-centered holistic care?

Now, imagine similar 2015 and 2025 scenarios in a K–12 school setting to address the educational needs of a child with moderate sensorineural hearing loss. How will the educational audiologist, other education specialists, the student, and the parent(s) work collaboratively to develop an individualized education program (IEP) and sustain that collaboration over time? Will administrative systems that are in place support opportunities for ongoing collaboration to maximize progress and continuity of services? What values and skills are necessary for these professionals to effectively collaborate as a nonhierarchical, synergistic team?

Driving Forces for IPE/IPP

It is understandable that there are questions about how we will achieve interprofessional education and interprofessional collaborative practice (IPE/IPP) as the norm whenever two or more professionals are learning together or providing services to an individual and family. However, factors are in play driving us toward IPE/IPP approaches of education and service delivery. Consider that our current method of health care service delivery and payment (fee-for-service model) is unsustainable (Whittington, Nolan, Lewis, & Torres, 2015), leading in recent years to innovative service delivery models (Porter & Lee, 2013) and legislation such as the Affordable Care Act (Patient Protection and Affordable Care Act, 2010). Aging populations and increased longevity—coupled with chronic health problems—have become a global challenge, putting new demands on medical and social services (including audiology; CDC, 2009; Stam et al., 2014). Similarly, advances in science and technology have resulted in great strides in pediatric care and the viability of infants and children—accompanied by the need for and benefit of early identification and intervention services (Karoly, Kilburn, & Cannon, 2005).

In K–12 education settings, the demand for increased accountability will continue to drive the need for IPE/IPP in the schools. Response to Intervention (RTI) or other multitiered systems of support (MTSS) work best when professionals with diverse experience and expertise coalesce to develop and provide supports and services to students. Likewise, state education standards (either Common Core State Standards (National Governors Association & Council of Chief State School Officers, 2012) or standards specific to your state) are best achieved when all professionals integrate their services, communicate, evaluate, and train together to support student success.

Leading Change

Several organizations are providing direction to transform both education and practice toward more interprofessional collaboration. The Institute of Medicine (IOM) (2001, 2003, 2009, 2013), the World Health Organization (WHO, 2010), and the Institute for Healthcare Improvement (IHI)—through its Triple Aim (IHI, 2015)—have articulated the vision, rationale, and benefits for IPE/IPP. Entities such as the Interprofessional Education Collaborative (IPEC, 2011) and the Interprofessional Professionalism Collaborative (Hammer et al., 2012) have each proposed, respectively, desired core competencies and a means for assessment of interprofessional values and behaviors in students and professionals.

The Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, funded the National Center for Interprofessional Practice and Education (or Nexus), housed at the University of Minnesota. Nexus functions as a clearinghouse on interprofessional education, practice, and research, providing a wealth of information and resources (e.g., articles, videos, webinars, and discussion groups) to assist educators, practitioners, and students in learning about IPE and IPP. In concert with the efforts of these and other groups, ASHA has committed significant resources as part of ASHA's Envisioned Future: 2025 and Strategic Pathway to Excellence to advance IPE/IPP.

Clarifying IPE/IPP

ASHA adapted the WHO (2010) definitions of IPE and IPP to describe their application to both educational and health care settings. That is, IPE occurs when two or more professions learn about, from, and with each other to enable effective collaboration and health or education outcomes. IPP occurs when multiple service providers from different professional backgrounds provide comprehensive health or education services by working with individuals, their families, caregivers, and communities to deliver the highest quality of care across settings. Collaborating on IPE/IPP teams does not mean that audiologists or other professionals relinquish their professional identity, scope of practice, or autonomy. Rather, it means that they are called upon to coalesce their and others' expertise to jointly develop and implement the best plan of care and to sustain continuity of care through ongoing collaboration, communication, and reflection as a team. Such collaboration is expected to transform care to be more person-/family-centered, resulting in improved outcomes, satisfaction, and safety as well as cost efficiencies (IHI, 2015). However, although a growing body of research has shown that IPE enhances IPP and IPP positively impacts treatment outcomes, more research is needed to clarify any cause-and-effect relationship between IPE and patient, population, and systems outcomes (IOM, 2015).

Establishing a Common Interprofessional Vision

A key component of IPE/IPP is fostering a transdisciplinary professionalism (IOM, 2013; Holtman, Frost, Hammer, McGuinn, & Nunez, 2011)—that is, acculturating students and professionals across disciplines to a common vision, including adopting professional values that align with collaborative, team-based care. This common understanding or social contract for care becomes the foundation on which professionals are prepared to serve on collaborative teams. Transdisciplinary professionalism encompasses principles of altruism, excellence, caring, ethics, respect, communication, and accountability. This "new professionalism" implies that, in addition to our individual expertise, we must also bring to the table a common understanding of how we will interact and apply our expertise as a team.

Beyond a common vision and core set of values, there are also certain skills and characteristics that high-functioning, synergistic teams demonstrate (Hooper, 2010; Center for Interprofessional Education, University of Toronto, n.d.). Skills such as collaborative leadership, team facilitation, role clarification, conflict resolution, and reflective practice (i.e., examining our work to improve how we work)—and qualities such as mutual respect and trust—are critical for effective collaboration. As professionals, we must consider how we can hone our individual and team capabilities through professional development. As educators, we must consider how these skills and qualities can be fostered among students preparing to enter the professions.

Building Capacity for IPE/IPP

Transitioning our health care and school systems to a true IPE/IPP environment is quite an undertaking, one that requires both systems-level change and change in how we educate students and design professional development opportunities. Such a movement has been gaining traction in recent years through the efforts of the IOM's Global Forum on Innovation in Health Professional Education, the Global Interprofessional Networks' All Together Better Health conferences, and IPEC workshops targeting academic and clinical teams—to name a few. Many health professions, often through their professional organizations, are engaging in similar discussions. Efforts are advancing at leadership levels within organizations, colleges, health care, education, insurers, and payment systems—and also at the grassroots level through patients, clients, families, students, practitioners, educators, and researchers.

As an audiologist, audiology student, educator, or administrator, there are opportunities for you to engage in and advance IPE/IPP knowledge, understanding, practice, and research. There are many examples being shared on websites, in the literature, at conferences, and in discussion forums. These examples describe not only how to become better collaborators but also how to overcome personal and system barriers and challenges associated with moving our education and practice environments from silos to collaborative entities.

Key Steps to Take Now

  1. Design or seek out opportunities to "learn about, from, and with" other professions. If you can't find it, found it!
  2. Foster transdisciplinary professionalism among students and professionals.
  3. Acquire and foster teaming skills consistent with high-functioning, synergistic, teams.
  4. Communicate and collaborate with other professionals in a way that capitalizes on everyone's expertise.
  5. Engage in individual and team-based reflective practice.
  6. Work to build IPE/IPP capacity in academic programs, practice settings, and in professional development offerings.
  7. Initiate or collaborate on IPE/IPP research (see IOM 2015 report for IPE/IPP research needs and study design recommendations).
  8. Get connected, and engage in IPE/IPP!

The future of service delivery and reimbursement is evolving. Interprofessional collaboration in education and practice is one component of an envisioned future for both health care and education settings. Helpful tools are available for audiologists to acquire the knowledge and skills necessary to successfully adapt. Make a choice today to get started or to scale up your engagement in IPE/IPP.

About the Author

Loretta Nunez, MA, AuD, CCC-A/SLP, is director of Academic Affairs & Research Education for the American Speech-Language-Hearing Association (ASHA). She directs activities that support academic, clinical, and research education; student preparation and faculty development; and higher education trends and forecasting in communication sciences and disorders. Nunez leads ASHA's Envisioned Future 2025 strategic objective to advance interprofessional education and interprofessional collaborative practice (IPE/IPP), and she represents ASHA on the Interprofessional Professionalism Collaborative, a national group comprising 12 health professions that is working to develop an IPE/IPP assessment and educational toolkit. She is a Distinguished Practitioner and Fellow of the National Academies of Practice in Speech-Language Pathology.

References

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World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Geneva, Switzerland: Author. Retrieved from http://www.who.int/hrh/nursing_midwifery/en.

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