ARCHIVED - Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP): Research Workshop Final Summary Notes [Health Canada, 2006]

Research Workshop Final Summary Notes

May 2006

Table of Contents

• 1. Context
  • Purpose
  • Objectives
  • Attendees
  • Overview of the Workshop
  • Summary Report
  • Evaluation Results
• 2. Identifying Research Priorities
  • Common Definitions
  • Small Group Work
  • Selection Criteria
  • Initial List of Research Priorities
• 3. Establishing a Research Agenda
  • Creating Priority Categories
  • Key Research Questions
• 4. Moving Forward
  • Guiding Principles
  • Target Audiences
  • Research Capacity
  • Sharing Research Results
  • Funding
  • Next Steps
• 5. Participant List

1. Context

Purpose

The primary purpose of the Research Workshop was to delineate research topics and questions that address knowledge gaps, and to further the work in the area of interprofessional education for collaborative patient-centred practice.

Objectives

1. To understand the context and landscape in which research planning is taking place.
2. To reach a common understanding of key definitional concepts.
3. To generate important research topics and identify those that are deemed a priority.
4. To begin to plan strategies and actions in relation to priority research topics.
5. To learn about the formation of the Canadian Interprofessional Health Collaborative (CIHC).
6. To network with colleagues who have a similar interest in this research.

Attendees

The Research Workshop, held May 28 - 29 2006, in Ottawa, Ontario, was facilitated by an external consultant and attended by over 45 individuals from across Canada. The research and evaluation leads for both Cycle 1 and Cycle 2 projects funded by Health Canada's Interprofessional Education for Collaborative Patient-Centred Practice initiative were in attendance as were individuals from the Complementary Projects and other key stakeholders. Please see page 10 for a list of attendees.

Overview of the Workshop

The Workshop consisted of one evening and one day.

• The evening included dinner and an opportunity for participants to network with their research colleagues. It focused on providing background and contextual information about IECPCP and the current research landscape, and included information about the CIHC. The evening was designed to set the stage for research planning and to facilitate thinking about priority research topics.
• The next day focused on identifying and reaching consensus on research priorities and creating an initial plan of action with respect to advancing the agreed-upon research agenda.

Summary Report

The summary report reflects the highlights of the Research Workshop and is not intended to capture all the discussions or comments generated throughout the day. It starts with a synopsis of the discussions around common definitions and initial research priorities and moves to a summary of the agreed-upon future research agenda. The final section outlines how the participants saw the Research Agenda moving forward.

Evaluation Results

A formal evaluation was not conducted but an informal show of hands clearly indicated that the Research Workshop was productive and worthwhile. Using a 10-point scale -- where 10 was productive and worthwhile and one was not -- all participants rated the workshop 7 or higher.

2. Identifying Research Priorities

Common Definitions

Participants believed it was important to have a common understanding of core definitions and concepts prior to identifying research priorities. Definitions previously utilized by Health Canada were presented for comment. The intent of the discussion was not to reach consensus or to change the existing definitions. Rather, the discussion allowed participants to share their viewpoints and to identify important concepts, definitional gaps, and areas of controversy. The discussion highlighted the need to facilitate a common language around interprofessional education and collaborative patient-centred practice.

• Interprofessional education: "Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care." (CAIPE, 1997 revised)

The current definition from the Centre for the Advancement of Interprofessional Education was deemed acceptable.

• Collaboration: "An interprofessional process of communication and decision making that enables the separate and shared knowledge and skills of health care providers to synergistically influence the client/patient care provided." (Way & Jones 2000)

There is a need to distinguish between collaboration and interprofessional collaboration and to note the difference between interdependence and collaboration as well as between interprofessional and interdisciplinary. There were also several comments to embrace individuals beyond the providers and to include non-professionals in the definition.

• Interprofessional Teams: "Medical and health professionals from at least three different disciplines or professions, who share a common purpose and work together collaboratively and interdependently to serve a specific patient/client population and achieve the team's and organization's goals and objectives."

There were comments about whether it was important to identify a minimum number of persons in a team. Other comments included concern about the difference between medical and health and the need to embrace health as a broad concept that includes social determinants of health

• Quality of Care: Donabedian...structure, process, outcome.

There needs to be a more fulsome or illustrious definition that includes the dimensions of quality.

Participants also identified other terms or concepts that would benefit from a common definition:

• preceptor
• patient-centred
• power
• patient / client / consumer / person
• shared decision making
• scope of practice
• conceptual models
• research methodologies

Small Group Work

In eight pre-assigned groups ranging in size from five to seven people, participants were given approximately 90 minutes to carry out three tasks:

1. Create a list of possible research questions or knowledge areas.
2. Identify criteria for prioritizing questions / knowledge areas.
3. Reach consensus and report on 3-5 priority questions/ knowledge areas.

Below, are the results arising from the morning's group discussions. They are not presented in any order of priority although key selection criteria are presented first as they guided decision making about the most important research questions / topics.

Selection Criteria

Participants gave preference to research topics that met one or more of the following:

• Is grounded in theory.
• Has an immediate ability to affect practice.
• Models the principles of interprofessional education for collaborative patient-centred practice.
• Advances knowledge in both the learner and patient circles of the IECPCP framework and show the interactions between the two.
• Involves multiple perspectives.
• Addresses immediate knowledge gaps, and urgently needed information .
• Has the ability to affect the greatest number of people / students.
• Increases partnership capabilities.
• Has scientific testability.
• Is considered a foundational concept or element upon which other research can be conducted.
• Is the next logical step in knowledge.
• Facilitates or encourages conversations and discussions on difficult topic areas that need to take place.

Initial List Of Research Priorities

Group A

• Definitions for quality of care and patient-focused.
• Theory of change for the IECPCP framework.
• Role and participation of the client / patient / person in interprofessional education.
• Evaluating / examining the process of change - leadership, management, individual.
• Emergent Practice Models - ' learning on the run'.

Group B

• Testable models and outcomes across different practice contexts - Canadian and interprofessional.
• Characteristics of high functioning (Canadian and interprofessional) health and social service / wellness teams.
• Continuum of learning required for optimal collaboration in practice.
• Optimal learning conditions for IPE.

Group C

• Characteristics of an effective interprofessional leader and how we prepare these leaders.
• Places or settings where collaboration / IPC is essential or not necessary
• Educational interventions that impact behaviour change and attitudes - measured around patients and other professionals.
• Longitudinal cohort study of the acquisition of professional identity and its impact on interprofessional interactions.
• Characteristics of a collaborative practice / site that positively influences collaboration and patient outcomes - who needs what, when, where & how?

Group D

• Patient-centredness: factors affecting patient involvement in interprofessional education for collaborative patient-centred practice decision making, levels of involvement; indicators of functioning of teams from the patient's perspective.
• Approaches to evaluation of pre-licensure IPE versus post licensure interprofessional education for collaborative patient-centred practice.
• Strategies in team learning (i.e., norms of practice) to facilitate interprofessional education for collaborative patient-centred practice in practice for both pre- and post-licensure (professionals).
• Effective methods (conventional versus innovative) in learning interprofessional education for collaborative patient-centred practice.

Group E

• Using narratives of practice and interactivity to: reflect on daily experiences, identify and amplify teaching moments, track changes in attitudes and behaviours, focus attention on what happens / what is desired, the 'good enough' story - recognition and resonance.
• Understanding development of professional identity - openness to others, when/how/why does fortress mentality set it.

Group F

• Contextual factors that influence patient involvement and patient desire for involvement in interprofessional care.
• Measurement of long-term impact of interprofessional education for collaborative patient-centred practice - use of immediate positive outcomes and follow-up with common measures.
• Effective ways to measure outcomes of behavioural interventions.
• Nature of team composition and effect on health care outcomes.

Group G

• Most effective and reliable tools to measure collaborative practice outcomes
• Early exposure to interprofessional education and affect on attitudes toward team work and collaboration.
• Students learning from working within an interprofessional practice team versus student-level teams - role modeling.
• Sustaining / maintaining a culture of collaboration - what - how - when?
• How to develop / create an exemplary environment to sustain collaborative practice - leadership, process, principles.

Group H

• Establish and evaluate collaborative practice attitudes, knowledge and skills development in pre- and post-licensure education programs.
• Greater consensus on ways to measure the components of evaluation of education programs.
• Systematic review of the existing measures of collaborative practice
• Studies to demonstrate the difference between team work and collaborative practice.
• Research program to gain an understanding of collaborative practice within organizations and systems.

Other

• Public education.
• Teaching versus learning.
• Faculty development.
• Process of team development.
• Core competencies for the individual.
• Methodologies and tools for analysis.
• Policies.
• Outcomes of interest.

3. Establishing A Research Agenda

Creating Priority Categories

The initial list of priorities generated by the small groups was grouped into five priority research categories and reviewed by the participants. Upon reflection, the additional category - Outcomes - was identified. Each category was deemed equally important, and all were to be included in an Interprofessional Education for Collaborative Patient-Centred Practice Research Agenda:

Participants were asked which research category they wanted to work on further, and the resulting self-selected groups ranged in size from 5 to 10 individuals. They were given approximately 90 minutes to address six tasks:

1. What knowledge gaps are being addressed?
2. What are the specific questions that should be addressed in this area?
3. Who is the target population or setting?
4. What strategies should be considered for knowledge dissemination?
5. What are possible funding sources?
6. What are the strategies for ongoing stakeholder discussions?

Not all groups had sufficient time to respond to all six tasks and there were several different approaches used to present the results of their discussions, including notes, conceptual pictures and charts. A summary of the key research areas or questions in each category is highlighted in the subsequent sections.

Key Research Questions

Interprofessional Teams

• How does a highly functioning team form?
• What are the norms of practice for the team and do they include incorporating the patient/family?
• What is the range of models of practice in a particular context or setting and what are the implications for health care outcomes?
• What are the norms used by a team to establish leadership and / or change leadership. Is it a constant or a variant?
• How do you move a collection of people (i.e. team) to a synergistic group (i.e., collaborative)?
• How does a leader develop and how do we teach effective leadership?

Measurement & Tools

• What are the measurable characteristics, competencies, and abilities of interprofessional education for collaborative patient-centred practice?
• How can we conceptualize, formulate, construct and develop instruments for measuring interprofessional education for collaborative patient-centred practice - (areas of emphasis, instruments, reliability / validity)?
• What new or alternative methods or models can be used for evaluating interprofessional education for collaborative patient-centred practice development?

Patient

• Terminology related to patients requires a comprehensive description.
• Where are the patients in the discussion of interprofessional education for collaborative patient-centred practice development - terminology, the inclusion of family and community, and the evolution of the interprofessional education for collaborative patient-centred practice development framework?
• What are the frameworks or concepts related to interprofessional education that maintain or seek to improve health status?
• What is the impact of terminology - relationship between provider and recipient, view of self and expectations of care?
• What are the contextual factors (i.e., personal characteristics) that influence patient involvement in interprofessional education for collaborative patient-centred practice development?
• What are the relationship management issues related to IECPCP (e.g., personal characteristics)?

Organizations

• What are the benefits of interprofessional education for collaborative patient-centred practice to an organization?
• How does an organization support interprofessional practice?
• How do you apply existing business theories of organizational development, design methodology, leadership, change theory, etc. to IP practice?
• What are the moments in day-to-day work that foster IP and/or an interactive engagement?

Learner

• Does early exposure to IPE affect knowledge, behaviour, attitude, and skills toward teamwork and collaboration?
• Where and when is the most appropriate time for competencies related to knowledge, behaviour, attitude, and skills to be introduced along the continuum of learning?
• Do students who have early exposure to clinical practice develop different knowledge, behaviour, attitude, and skills than others who have later experiences?
• What combination of learning experiences / approaches is most effective in developing knowledge, behaviour, attitude, and skills pre- and post-licensure?

Outcomes

4. Moving Forward

Guiding Principles

Participants outlined principles that they believed important in advancing an Interprofessional Education for Collaborative Patient-Centred Practice Research Agenda:

• Interactive engagement whereby all interested researchers are actively involved in creating and sustaining the Research Agenda.
• Shared whereby the Research Agenda is disseminated in such a manner that all stakeholders are informed.
• Collaborative whereby the ongoing work related to an Interprofessional Education for Collaborative Patient-Centred Practice Research Agenda models the very principles it seeks to achieve.
• Iterative whereby fine tuning of the Research Agenda occurs by those who seek to further the work in the area of interprofessional education for collaborative patient-centred practice.
• Advanced by champions whereby all those involved in research seek to educate and influence leaders who can help advance interprofessional education for collaborative patient-centred practice.

Target Audiences

The small working groups identified a range of audiences to target interprofessional education for collaborative patient-centred practice research . Since many audiences are common across research categories, they are presented collectively rather than in relation to each research category:

• System level whose audience is policy makers, regional health authorities, funders, and regulators.
• Professional: practice settings, practitioners, management, staff, patients/ families.
• Educational: researchers, teachers, students, patients/ families.

Research Capacity

There was general agreement that building and sustaining research capacity in interprofessional education for collaborative patient-centred practice is important. Initial ideas included:

• Researcher career development.
• Research programs.
• Influencing leaders, funders and policy decision-makers.
• Creating a critical mass of researchers.
• Establishing a training process for the next generation of interprofessional education for collaborative patient-centred practice researchers.

Sharing Research Results

The importance of sharing and disseminating research results was deemed important so as to build on rather than duplicate interprofessional education for collaborative patient-centred practice knowledge. To this end, several strategies emerged:

• A database of current research including existing tools.
• Employing research techniques that embraced ongoing feedback / iterations,
• Scientific meetings.
• Websites / Internet.
• Publishing.

Funding

A number of organizations were identified by participants as being viable funding sources for future interprofessional education for collaborative patient-centred practice research initiatives:

• Canadian Institutes of Health Research (CIHR)
• Canadian Health Services Research Foundation (CHSRF)
• Canadian Patient Safety Institute (CPSI)
• Canadian Council on Learning (CCL)
• Health Canada
• Health Council of Canada
• Social Sciences and Humanities Research Council of Canada (SSHRC)
• Training grants
• Disease-related organizations
• Ministries of health
• Philanthropic foundations of learning
• Consumer groups
• Emergency preparedness organizations
• Alberta Heritage Foundation
• Family foundations
• Regional Health Authorities

A point was made that funding should be sufficient to facilitate reasonable participation of the patient / family.

Next Steps

There was consensus that the positive results of the Research Workshop should be advanced in a variety of ways:

• The Canadian Interprofessional Health Collaborative (CIHC) can continue to move the Research Agenda forward and facilitate the sharing of lessons learned, resources and information with interested persons and groups.
• Develop a position paper under CIHC and publish it in a peer-reviewed journal. It can contain general principles to guide researchers, such as building theory, testing concepts, embracing change theory and facilitating 'linkages' within the IECPCP framework. The paper may also address the need for common definitions important to IECPCP.
• Researchers can share projects' results with colleagues, provincial leaders and funding sources.
• Health Canada can consider the research priorities identified above, when they are developing their future funding strategy.

IECPCP Research Workshop: Participant List