Using interprofessional education
to enhance knowledge and skills for integrated and person-centred care
Dr Teresa Burdett
Facilty of Health and Social Sciences
Bournemouth University
Contact: tburdett@bournemouth.ac.uk
An
educational, person-centred initiative was designed to bring individuals from
different clinical arenas and professions together. It was intended to enhance
working collaboratively and move person-centred care forward jointly across the
organisations involved, and in the practitioner’s own clinical arenas. This
programme was designed, whilst being aware of potential implications such as
limited resources, to achieve an impact in a number of areas including on the
participants, their colleagues and their own patient populations. This
interprofessional activity was assessed before and after its implementation and
findings revealed that participants perceived it to be a valuable experience.
Strategies on interprofessional education and person-centred care resulting
from this programme are now being implemented. The programme has evolved in
response to student feedback and evaluation and aims to continue to enhance
interprofessional education, integration, workforce development and
person-centred care.
Background
Multiple
issues including resource limitations, an ageing workforce and increasing
patient populations currently face health care systems both in the United
Kingdom and internationally. Working together is often seen as a way forward
and yet interprofessional education and collaboration but repeatedly curtailed
due to modes of thinking, perceived time implications, organisational
challenges and physical resources (Barr, 2013).
This innovation was designed so that all the individuals in health and
social care would feel and be empowered so that they could learn and work
together with equality to generate new knowledge and strategies so that person
centred care could be improved through working together in a more integrated
manner (Goodwin et al., 2012). It is believed that this innovative project
could be replicated, nationally and internationally, to create new
understanding and solve issues facing public services, leading to greater
person centred care and level of services.
Implementation
Two
programmes funded by Health Education Wessex were delivered across the South of
England. Through the use of interprofessional education the aims of the
programmes included enhancing the student’s knowledge and practical skills base
through discussing and demonstrating integration in relation to seeing each
person as an individual. This is an intrinsic aspect of person-centred care
(Hewitt-Taylor, 2015). It was anticipated that this programme would lead to an
enhanced level of care being offered.
Each
participant was drawn from different professional groups, including, registered
adult and mental health nurses, social workers, social care assistants,
occupational therapists, rehabilitation therapists and health and social care
co-ordinators. This mixed cohort supported the belief in the value of
interprofessional education to enable “two or more professions to learn with,
from and about each other to improve collaborative practice and quality of
care” (CAIPE, 2002). The practitioners were drawn from primary and secondary
care and a combination of genders, ages and work locations were represented in
each cohort.
Participants
were encouraged to work together in a pro-active manner to address issues that
could potentially be enhanced by learning and working together in a more
integrated manner. A number of topics
were covered in the programme including the challenges and benefits of
integration (Ling et al., 2012) and local, national and international
perspectives of integration (Rosen et al., 2011). Ideas of how to enhance person-centred care
through integration for specific groups (e.g. mental health service users) were
also discussed.
A variety of teaching methods and strategies
were utilised including seminars, media and group participation.
Solution-focused strategies and reflective exercises including individual and
team-orientated sessions were utilised. Group work was deliberately designed to
ensure individuals from different professions worked productively together. All
participants were asked to work on an integrated, person-centred project based
in their own sphere of care. A plethora of ideas came from the students, many
of which were adopted in the clinical arenas including improving referral
systems, a greater co-ordination between services and enhancing discharge
packages. This array of approaches proved very useful for the individuals and
their practice arenas resulting in significant, positive feedback.
Assessment
This
feedback was gained by utilising pre-and post-programme questionnaires and the
participants were asked, for example, “...please identify three key points
which have had an impact on you...”
Open-ended questions were utilised in the questionnaires to gain a
deeper understanding of the participant’s perspective including, “...what are
your feelings about integration?”
Opportunities were offered have frank face-to-face discussions between
the students to obtain qualitative data. Students also had a booklet to
complete which asked a series of questions on each day of the programme
including, “...how, if at all, do you envisage this will impact on your
practice”. Students were also given the
opportunity to write and verbalise their thoughts and feelings in an
unstructured and open format, “...do you have any other comments”.
Outcomes
Initial
impressions were positive, from the qualitative data received from the students
undertaking both programmes and also from the practice arenas. This has
included written, verbal, and ad hoc feedback that enhanced integration has
been occurring, which has resulted in an improved level of workforce
satisfaction, increased workforce initiatives and an increased focus and level
of care being offered to the recipient of care. Other areas addressed included
amending services and enhancing patient access to services.
Other
outcomes included devising an interprofessional programme that encouraged
learning and working together which has further added to the body of knowledge
about how to achieve this. Such an approach is not always viewed as the way
forward and often profession-specific training is provided. The results from
this programme do challenge this viewpoint and lessons have been also been
learned included language use and ensuring a balance of professions in groups
and individuals.
Focusing
directly on integration in an interprofessional programme has been novel. It
has resulted in creative strategies being devised and innovative projects being
implemented, which it is anticipated will result in enhanced, sustainable
patient care. As the following data extracts indicate:
“…This course has opened my mind
to how we deliver care in the future…”
“…Best outcomes for the patients with patients
being the centre…”
Teaching
the subject of integration in an interprofessional manner has raised the
profile of interprofessional learning/working and integration. This has created
a momentum and renewed vigour which can be focused on helping address the
multiple issues currently being faced by health and social care systems both
nationally and internationally:
“…I ensure I challenge attitudes
and promote integration…”
“…This course has strengthened my
belief in the importance and value of integration…”
Discussion
Working
together undoubtedly benefits the individuals we care for (World Health
Organisation, 2016) and learning together can enhance and develop our skills
with working with different disciplines (Frenk et al., 2010). Hence the usefulness of this intervention
which has gained a number of key outcomes including, providing students with
more knowledge about integration and how to utilise it, and importantly,
feeling more empowered to initiate change. Feedback has also identified that
the students believed that their patient populations have gained from an
enhanced person-focused level of services. The individuals on the programme
gained more knowledge about each other’s roles and professions which led to
increased levels of interaction and rapport which clearly continued into the
clinical or community arenas.
The
programme is now formalised as the Foundations of Integrated Care and Person
Centred Services Programme because this more clearly reflects the philosophy of
the curriculum. It is also being delivered on site at Bournemouth University
which is in response to student feedback. Although, offsite delivery is still
available if required. This is now an accredited programme and it can be
undertaken as a standalone unit. The components of leadership and change and
change management in integration have been strengthened in response to student
feedback. This is due to the evolving and challenging nature of integration, in
the UK and internationally and the need for change and leadership is inherent
in the workforce who are seeing the patient population needs first hand.
Interprofessional
education, learning and working together is one way of encouraging integration
and enhancing person centred care. This innovative, interprofessional
educational programme was designed to focus on these two issues and by bringing
different disciplines together to learn together, according to participant and
work force feedback this programme was successful. However, this was not
without its challenges. These included venue choice, the differing needs of
students, their perceived needs of specific professional roles, language use
and knowledge base. There were also differing requests from the clinical arenas
that needed to be accommodated. It was not a static programme and responded to
the evolving nature of integration and the students, workforce development, the
employer and clinical arena requirements and the patient and service user
needs. Areas of the programme have already been re-developed and this will no
doubt be an ongoing process to keep the programme relevant, up to date and
responsive to student, work force and patient population needs and maintain its
aim of being a truly interprofessional, educational programme.
References
Barr, H., (2013). Toward a theoretical framework
for interprofessional education. Journal of Interprofessional Care. 27, (1)
4-9. Doi:10.3109/13561820.2012.698328
CAIPE. (2002).
Centre for the Advancement of Interprofessional Education – a
definition. http://www.caipe.org.ik/resources/resources/defining-ipe/
Frenk J., Chen, L., Bhutta, Z.A., Cohen, J., Crisp,
N., Evans, T., … Serwadda, D., (2010). Health professionals for a new century:
transforming education to strengthen health systems in an interdependent world.
The Lancet. 376 1923-1958
Goodwin, N., Smith, J., Davies, A., Perry, C.,
Rosen, R., Dixon, A., Dixon, J., Ham, C., (2012). Integrated Care for Patients
and Populations – improving outcomes by working together: a report to the Dept.
of Health and the NHS Future Forum. London. Kings Fund
Hewitt-Taylor, H., (2015). Delivering Person
Centred Care-A Practical Approach to Quality Health Care. Palgrave, London, UK
Ling, T., Brereton, L., Conklin, A., Newbould, J.,
Roland, M., (2012). Barriers and facilitators to integrating care; experiences
of the English Integrated Care Pilots. International Journal of Integrated
Care. 12 (24) 1-12
Rosen, R. Mountford, J. Lewis, G., Lewis, R.,
Shand, J., Shaw, S., (2011). Integration in action: four international case
studies. London. Nuffield Trust
World Health Organisation (2016) Strengthening
integrated people’s health services. Resolution WHA69.24 Geneva. Switzerland.
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