Blog Article: Interprofessional Education and Collaboration around Stockholm: A Study Trip Report

Interprofessional Education and Collaboration around Stockholm: A Study Trip Report

Heike Penner & Rita Hofheinz

Department of Staff Development, University Hospital Munich, Germany

E-mail: Heike.Penner@med.uni-muenchen.de

Introduction

As a result of demographic changes in Germany, the growing proportion of elderly people with chronic, multiple diseases is making increasingly complex demands on health care professionals. A trend analysis at the University Hospital of Munich (Klinikum der Universität München, KUM) has shown that, in recent years, the proportion of patients 65 years or older has risen, especially in intensive care. The growing number of cases with a significant reduction in the average length of stay and the increase in complex treatment and care needs (Bartholomeyczik 2007) makes it necessary to reallocate tasks as well as rethink the cooperation between health professionals in acute patient care (Kuhlmey 2011; Renz et al. 2014).

To meet these new challenges, it takes trusting collaboration within the therapeutic team (Reeves et al. 2012; Renz et al. 2014). However, professional practice and public health care assessments show that the structural conditions and the professional skills of health professionals in Germany are not promoting interprofessional cooperation (World Health Organization [WHO] 2010; Sieger et al. 2010). Doctors and nurses, the main health care professionals treating patients in the hospital, aiming to prevent errors and improve patient care (common team goal), often have difficulty working in teams: nurses sometimes blame doctors for communication deficiencies while physicians want their workload to be acknowledged by other health care professions (Hibbeler 2011). Communication problems within the health care team in turn may lead to poor patient outcome (Sachverständigenrat für Gesundheit 2007; Okuyama et al. 2011; Boev & Yinglin 2015).

From 1999 to 2002, a pilot project entitled Interprofessional Communication in the Hospital was initiated and implemented by the Federal Chamber of Physicians and the German Council of Nursing. It involved doctors, nurses and patients who focused on their communication and collaboration style(s), exploring different hospital tasks, such as patient admission and discharge and ward rounds. The results of the project showed major communication and collaboration deficiencies and a clear need for improving team cooperation (Lecher et al. 2002). In 2007, the Expert Council on Health Care also referred to these problems, noting that the current division of tasks and lack of cooperation between the health professions is not suited to meeting the demographic, structural and innovative demands (Sachverständigenrat für Gesundheit 2007).

SiHaKo Project: An Overview

In 2015, the project, Strengthening Interprofessional Collaboration through Shared Learning Seminars (Stärkung der interprofessionellen Handlungskompetenz, SiHaKo), was launched by the authors with financial support from the Robert Bosch Foundation. This project is directed at medical residents and nurses participating in the post-graduate course in intensive care. Residents and nurses examine, discuss and reflect on the treatment strategy of chronically ill patients with multiple illnesses. The overall objective of the project is to improve collaborative practice and quality of care.

The project includes 68 education units, divided into an orientation and development phase and consisting of, among others, communication seminars, demand-driven theoretical classes, and simulated interprofessional case discussions. The main focus of the seminars is on team communication and patient safety. By learning how to use various interprofessional communication tools (e.g. SBAR) and quality tools (e.g. CAM-ICU) during simulated interprofessional case discussions, the participants develop an awareness of their respective perspectives, their similarities and differences. The simulated interprofessional case discussions are held in a “protected classroom” environment where the students learn about others’roles, learn to solve problems together and thus overcome their limitations and fears within an interprofessional team. The objectives of the simulations allow students to practice and demonstrate team-based skills including communication, mutual support, leadership and “knowledge circulation” which aims to make all participants (nurses/doctors/supervisors) equal partners (DeJong 2012). Over the course of the project, an interprofessional group of lecturers/supervisors is available for all students for professional support and dialogue. The intensive project experience aims to facilitate trust and create a team that continuously reflects on and optimises its actions and communication processes and is able to design its workflows effectively and efficiently.

Study Trip to Stockholm (Sweden)

During the project planning phase, the authors searched for interprofessional education (IPE) and interprofessional practice (IPP) programmes in health care, both nationally and internationally. In Stockholm, we found a project that we thought could serve as an example for the SiHaKo project. Active networking between the education departments in Munich and Stockholm began in 2014. As a result, a speaker from Stockholm was invited to Munich to give a presentation on IPE at the 19th Munich Intensive Care Day in March 2015. Our study trip to Stockholm took place in October 2016. We planned the trip in cooperation with one supervisor of the IPE Södersjukhuset Utbildningscenter and one supervisor of the IPEICU at Karolinska University Hospital Stockholm. A representative of the Robert Bosch Foundation joined us on our study trip. We visited six different IPE locations in and around Stockholm, which are connected to each other through the Södersjukhuset Utbildningscenter.

Days 1 to 3. We began our tour at the Education Centre of the Stockholm South General Hospital (Södersjukhuset). Here, we were introduced to the Utbildningscenter, receiving information about the history and concept of IPE and IPP in Sweden and the larger Stockholm area.  

During our stay in Stockholm, we were able to observe the employment of the SBAR communication tool with different training teams on different interprofessional training wards. We were given the information that all health care professionals involved in the IPE training (students/supervisors/facilitators) were taught the SBAR concept. According to the IPE learning objectives of the Karolinska Institutet and depending on the level of (interprofessional) education (undergraduate/postgraduate courses), we noted differences in supervising styles: If undergraduate students required professional assistance, supervisors tended to be pro-active, while for students in the postgraduate education programme supervisors were waiting patiently in the background until the students asked for their assistance. On the interprofessional training ward, supervisors (doctors/nurses with pedagogical training) and interprofessional students form a team within each shift’s health care team, meeting for reflection at midday. Clinical assessments of patients take place at the patient’s bedside. The student teams perform the clinical assessment and discuss their findings among themselves before they present them and the therapy goal to the supervisors in the so-called “protected classroom”. After each shift a reflection unit takes place, using, for example, Gibbs’ Model of reflection. This cyclic generic framework is a general approach to reflection and novices may find it too vague requiring further guidance (Thompson & Pascal 2012).

Day 4: To find out how IPE works in an intensive care unit, we visited the Utbildnings Unit ICU at Karolinska Huddinge (IPEICU) because of its similarities to our own project. This IPEICU is open 18 weeks per year for one to two IPE teams per week. We were able to join the IPE teams for one shift on 6 October 2016. Each team is responsible for the care of one patient and coordinates its work with other health care professions. An important part of the IPE training is the joint clinical assessment of the patient followed by the IPE team’s reflection on the therapy plan. The IPE training team consists of students (nurses and residents in ICU training), supervisors (specialist nurses/doctors ICU with pedagogical training) and head supervisors (specialist nurses) facilitating the interprofessional activities and encouraging the participants to remain faithful to the IPE learning concept (Conte et al. 2015).

At the beginning of the shift, we observed the clinical assessment of the patient at the bedside by the IPE student team. The supervisors were quietly standing in the background, observing the students and taking notes. Later, the entire IPE training team retired to the seminar room where the students presented their observations and findings on the patient in accordance with the SBAR concept to reflect collaboratively on the therapy plan. The supervisors used a hermeneutic approach and did not respond directly to the students’ questions, but asked further specific questions that prompted the students to reflect on and, if necessary, rethink their decisions (V= Vorverständnis, or prior understanding, T= text or context understanding; V¹= enlarged understanding, T¹= enlarged context understanding, etc.).

This approach gave the students the space and time to think about and discuss the therapy plan, giving them a feeling of ownership. The learners had enough time to present and re-evaluate their own professional perspectives. In the seminar room, students found a stress-free and safe atmosphere where they could learn from each other in order to arrive at a collaborative therapy decision.  Conte et al. (2015) found that students in the IPE programme in Stockholm indicated that being provided this space and time was a major motivating factor for them. If health care students, from the beginning, are (made) aware of their own professional roles and the roles and perspectives of other health care groups, they may find it much easier to contribute to and focus on collaboration between health care professionals. However, interprofessional communication and collaboration in health care does not happen on its own, it should be offered early and practiced as a lifelong process. The need for life-long learning in IPE is also shown by the WHO (2010).

Discussion

We were able to experience and observe IPE in several training centres in the Stockholm area. In all centres, we met highly committed and enthusiastic Swedish colleagues who welcomed us warmly and work hard to promote an interprofessional spirit in health care. It takes people like them to bring the idea of IPE to (practice) life. Without their hard work and the government’s decision to include IPE in the curricula, the journey would not have been this successful. However, it has taken the Swedish health care system more than twenty years to come this far.

While we can learn a lot from the Swedish model, it will be necessary to adapt it to the German context. Our project is one of a few IPE projects in Germany. The health care system is undergoing constant reforms, and many projects have never gone beyond pilot project level. The Swedish IPE model, however, gives us hope that our vision will become a reality. How to design healthcare education as to meet the needs of the future remains a crucial question. Whether IPE and teamwork are one answer to this question will have to be the subject of further studies.

Acknowledgments

Special thanks to Rene Ballnus, Helen Conte, Sara Fouraux, Anna Magdsjö, Erika Thorwaldsdotter, Linda Arundson, Eva Barkestad, Anders Nilsson and other Swedish colleagues for their warm welcomes and insights into their professional worlds.

References

Bartholomeyczik, S. (2007): Kurze Verweildauer im Krankenhaus – die Rolle der Pflegenden. Pflege & Gesellschaft; 2:135–149.

Boev, C. & Yinglin, X. (2015): Nurse-Physician Collaboration and Hospital Acquired Infections in Critical Care. Critical Care Nurse; 35:66-72.

Conte, H., Jirwe, M., Scheja, M. & Helmqvist, H. (2015): Get it together: Issues that facilitate collaboration in teams of learners in intensive care. Medical Teacher; 38:491-497.

DeJong, A. (2012). Veränderungen zum Alltag werden lassen – Stabilisierung von Erneuerungen; Universität Witten/Herdecke, Department für Pflegewissenschaft. Available at: http://www.g-plus.org/sites/default/files/deJong_Praesentation_Symposium.pdf

Kuhlmey, A. (2011): Die Idee des Memorandums – Kooperation der Gesundheitsberufe – Einleitung, in: Memorandum Kooperation der Gesundheitsberufe – Qualität und Sicherstellung der zukünftigen Gesundheitsversorgung, Robert Bosch Stiftung. Available at: http://www.bosch-stiftung.de/content/language1/downloads/Memorandum_Kooperation_der_Gesundheitsberufe.pdf

Lecher S., Klapper B., Schaeffer D. & Koch U. (2002): Endbericht zum Modellprojekt Interprofessionelle Kommunikation im Krankenhaus. Available at:http://bundesaerztekammer.de/downloads/EndberichtInterKiK.pdf

Okuyama, A., Martowirono, K. & Bijnen, B. (2011). Assessing the patient safety competencies of healthcare professionals: a systematic review. BMJ Quality & Safety; doi:10.1136/bmjqs-2011-000148.

Reeves, S., Tassone, M., Parker, K., Wagner, SJ., Simmons, B.(2012): Interprofessional education: An overview of key developments in the past three decades. Work; 41:233–245.

Renz, P., Luntz, J., Mollenhauer, A. & Doll, N. (2014):Teamkompetenztraining am Universitätsklinikum Tübingen – Eine neue Form der Personalentwicklung, in R. Tewes and A. Stockinger (eds.), Personalentwicklung in Pflege- und Gesundheitseinrichtungen. Berlin and Heidelberg: Springer-Verlag.

Sachverständigenrat für Gesundheit (2007): Begutachtung der Entwicklung im Gesundheitswesen: Kooperation und Verantwortung: Voraussetzungen einer zielorientierten Gesundheitsversorgung, Kurzfassung. Available at:http://www.svr-gesundheit.de/fileadmin/user_ upload/Gutachten /2007/ Kurzfassung_2007.pdf

Sieger, M., Ertl-Schmuck, R. & Bögemann-Großheim, E. (2010): Interprofessionelles Lernen als Voraussetzung für interprofessionelles Handeln – am Beispiel eines interprofessionell angelegten Bildungs- und Entwicklungsprojektes für Gesundheitsberufe. Pflege & Gesellschaft; 15:197-216.

Thompson, N. & Pascal, J. (2012): Reflective Practice: International and Multidisciplinary Perspectives - Developing critically reflective practice, Reflective Practice; 13:311–325.

World Health Organization (WHO) (2010): Framework for Action on Interprofessional Education & Collaborative Practice. Available at: http://www.who.int/hrh/nursing_midwifery/en/

Book Review: Interprofessional Teamwork in Health and Social Care: Key Tensions and Future Possibilities.



Interprofessional Teamwork in Health and Social Care: Key Tensions and Future Possibilities. In, The Power of Distributed Perspectives (2016)
Günter Abel & Martina Plümacher (Editors)Walter De Gruyter Inc, 2016, 364 pages, hardcover, $140 USD, ISBN-10: 3110482649 ISBN-13: 978-3110482645

This recent volume, edited by Günter Abel and Martina Plümacher, compiles sixteen articles (four of which are written in German) that explore the dynamics of change within institutions. Topics largely centre on the interplay between individual and institutional perspectives, challenges with communication and cooperation between people and institutions, and creative solutions for targeting such challenges. The volume is organized into five sections: structures, interplays, organization, dynamics, and conflicts.

   A chapter of interest to readers, written by Scott Reeves and Ruth Harris, is placed within the organization section. Here, the authors present a review of the literature on teamwork between various health and social professions and link these empirical findings to theory. Noting the global rise in interdisciplinary approaches to patient care, the authors attempt to clarify the complex dynamics of interprofessional teamwork and offer suggestions for practice. As they account for both social and contextual dynamics, as well as build upon previous theories with their own contributions, this chapter serves its purpose well.
   Beginning with an explanation of foundational principles underlying the interprofessional teamwork literature, Reeves and Harris highlight the key aims of the research. These include the importance of diverse skills and knowledge, sharing information to promote organized care, continuity of care, communication, collaborative resource planning, and effective coordination of service provision. The authors summarize the literature’s suggestions for achieving these aims and then link them to relevant theories, including those devised by the authors themselves as well as by other contributors.
   Next, the authors discuss recent developments in the practice and study of interprofessional teamwork. They thematically organize this section in terms of quality and safety, patient centred care, chronic care, rising costs, education and training, and media coverage. They follow this discussion by noting the challenges to this approach, touching on issues at both the patient and systems level. After offering potential solutions to meet those challenges, the authors culminate their review with an empirical case example that draws from previous studies. In doing so, they help the reader to translate findings and theory into practical application.
   This chapter is comprehensive yet succinct. Cited sources are both older and newer, ensuring a balanced review of seminal ideas with recent developments, and the inclusion grey literature adds to the array of information. At the same time, the authors do not overwhelm the reader with too much information, and the chapter’s breadth and depth is appropriate for an edited collection. In the end, Reeves and Harris provide an organized review of original research, describe these findings within a theoretical framework, and then apply their discussion to a “real-world” context. The reader is left with a clear summary of the key issues, dynamics, and developments of interprofessional teamwork. Those working in this type of setting, whether in research, management, or on the frontline, will find this chapter to be a useful resource and guide to further exploration.
   Overall, an interesting collection of chapters which provide a rich exploration of communication, cooperation and change issues from the perspectives of both individuals and institutions.
  Reviewed by
  Rosita Sabzevari