Problems stemming from health care silos and hierarchies are, by now, well known: Avoidable errors. Duplicative services. Missed referrals. Overuse, misuse and underuse of services. Many of these problems are likely due to shortcomings in interprofessional education and collaborative practice, and the toll on patients' outcomes is steep, as noted in the 2003 Institute of Medicine report "Health Professions Education: A Bridge to Quality". These problems fuel support for interprofessional education and practice (see glossary online) across all health care areas, including communication sciences and disorders, as health care leaders recognize that it takes the expertise of multiple disciplines to craft effective solutions and deliver comprehensive, non-duplicative care.
Bolstering what other professionals know about speech-language pathology and audiology is a welcome opportunity, as it will facilitate more timely and efficient services being provided to those likely to benefit from our expertise. Also, with the shift from a singular focus on "sick care" to a broadened emphasis on "health promotion," we may need to expand or rethink professional silos. In fact, one of the major drivers of health care reform is the need to better align monetary incentives with patient-centered care by, for example, basing reimbursement on outcomes and the value of services, as described in the recent Access Academics and Research article "Mapping the Emerging Landscape in Health Care."
Interprofessional practice and interprofessional education also open up many opportunities, including the chance for professionals to understand more fully one another's roles to enhance teamwork, to collaborate better to improve outcomes, and to develop coordinated approaches to education and service delivery to improve efficiencies. However, there are also several potential barriers to implementing IPP, most of which directly contrast with its key dimensions, as outlined by Scott Reeves and his co-authors in their 2010 book "Interprofessional Teamwork for Health and Social Care" (see chart [PDF]).
So, as interest in interprofessional teaming grows, with ASHA and other professional associations pushing to move it forward, programs grapple with how to surmount these challenges and actually make it happen. How do you change an entrenched system and culture? Where do you even start? We suggest reaching across departmental lines and starting the conversation, with a view to developing a joint plan. Meanwhile, you can engage in the preliminary work of assessing the challenges and seeking solutions.
Challenges and questions
One of the biggest challenges to interprofessional practice is the fee-for-service reimbursement model, which perpetuates professional silos. With fee-for-service, professionals receive payment for performing procedures and for the volume of services they provide to patients. Time allotted to team meetings and interprofessional collaboration is uncompensated. Accordingly, fee-for-service reimbursement models create competition among health professionals who might otherwise collaborate, often to the detriment of patient care. With changes such as pay-for-performance, value-based purchasing and Accountable Care Organizations, providers will receive payment for the value that is created by their combined efforts over the full cycle of care. These relatively new reimbursement models are expected to promote collaborative practice.
There are also challenges associated with implementing interprofessional education—some are particular to communication sciences and disorders, and others are more universal.
- In CSD and perhaps most disciplines, adding coursework and clinical experiences may seem impossible, given the already jam-packed curriculum and limited timeframe for completing degrees. It may also be difficult to coordinate learning opportunities with other disciplines because interprofessional requirements and course sequencing may vary across professions.
- Critical administrative support for IPE can be hard to secure. And without strong top-down support, departments may struggle to work out scheduling and other logistical issues, such as how to assign course credit across faculty teams providing IPE and how to assess faculty for promotion and merit, given that these decisions are typically based on individual achievements within one's discipline.
- Even with good intentions, faculty members may have limited experience with IPE and IPP and little knowledge of other professions' culture and practices. Accordingly, for IPE to successfully promote expertise in IPP, it may be necessary for faculty to step up their knowledge of other related professions.
These challenges raise questions about the implementation of IPE and about what changes may be needed.
- Should accreditation standards include preparation about how to work interprofessionally?
- Should preparation or demonstrated competencies with interprofessional skills be a part of certification and/or licensure?
- When and how should IPE be provided? How much time is required for interprofessional socialization? When is a learner ready to be an effective member of the interprofessional team?
Action and tools
Rather than waiting for all of these challenges and questions to be sorted out, departments and clinical programs may decide to charge ahead. Some preliminary steps could include:
- Identifying aspects of the program that already support the goals of IPE and IPP or could be easily adapted to do so.
- Familiarizing faculty and students with IPP through colloquia and seminars, ideally with faculty and students from related professional disciplines.
- Engaging colleagues and key stakeholders in discussions about potential barriers and promising approaches to IPE and improving interprofessional teamwork.
- Gathering a comprehensive list of opportunities and potential barriers to successful implementation of IPE or IPP in your setting.
- Exploring the need and possibility of changing local policies and procedures that might impede IPE and IPP.
- Developing a strategic plan to integrate IPE into the curriculum and clinical experiences, or into the work setting.
Programs looking for guidance on IPE development can use a number of tools developed for that purpose; other tools can help with evaluation of interprofessional teamwork. Additionally, ASHA has collaborated with 10 other professional associations to develop the Interprofessional Professionalism Assessment. Clinical educators use this 26-item behavioral assessment—created as part of the Interprofessional Professionalism Collaborative—to rate supervisees on their professionalism when interacting with other health professionals. A pilot study of this assessment through June 2014 will determine its validity and usefulness. To learn more about what ASHA and its Board of Directors are doing to further IPE and IPP, see the sidebar online.
There is little doubt that interprofessional collaboration is needed to reduce duplication of effort, enhance safety and deliver higher quality health care. Therefore, despite the many challenges to implementing IPE and IPP, we must embrace this trend. If we don't, we will find ourselves truly alone in our silos, with our contributions diminished and possibly unnoticed. Through interprofessional teamwork, we have an opportunity to truly demonstrate the value of our services and, most important, to improve our patients' functional outcomes.