Building an Interprofessional Collaborative Education and Practice Model (ICEPM)

Background: A new Internal Medicine residency program in a community hospital challenged the existing team structure and how providers (e.g., nursing, pharmacists, and current medical staff) interacted and collaborated. To achieve the goals of the Nursing Faculty Leadership Academy (NFLA), a leadership project was developed to address team communication and collaboration to develop effective working relationships among frontline health care providers at the point of care. An interprofessional (IP) team from academia was formed to partner with this practice setting to improve IP competencies.

Purpose: The focus of this project was to conduct a mixed method assessment of team culture to develop interventions that foster living the IP competencies in practice by faculty, students and front line providers and build a sustainable Interprofessional Collaborative Education and Practice Model (ICEPM).

Methods: The initial baseline assessment was completed in two phases using a mixed methods approach. In Phase I, focus group and individual interviews over eight months examined perceptions about the organization’s culture, beliefs about existing attitudes towards team concepts, and communication patterns as a prelude to promoting this ICPM. The interviews were audio recorded and transcribed. The IP research team independently read the transcripts using conventional content analysis to code the data and identify themes. In Phase II, a pre and post-test design is being implemented to evaluate strategies to strengthen working relationships, communication, and team collaboration. Gittell’s Relational Coordination Scale, a validated and reliable instrument has measured team work pre implemention of ICEPM interventions, and will be administered post interventions. Relational Coordination (RC) is a mutually reinforcing process of communicating and relating for the purpose of task integration measured between workgroups and/or individuals.

Results: Analysis of Phase I focus groups (N=19) and individual interviews (N=26) provided insights from pharmacists, nurses, case managers, new residents, hospitalists and community physicians. Emerged themes included Disjointed Communication, Desire for a Shared Mental Model, Impact of Residency Presence and Call for Mechanisms that Foster Interprofessional Collaboration.  These findings were shared with the hospital leadership and university faculty followed by brainstorming how to promote IP practice. As a result the project team chose to structure the 7 domains of Relational Coordination (RC) on patient needs for discharge. Pre interventional RC Scores were reviewed by the project team for their reflection on patterns of behavior that impact the patient discharge process. Overall, RC among the discharge process team was moderate, driven by strong Frequent Communication ties and weak Timely Communication and Shared Knowledge ties. Frequent communication among team members was identified as a strength the team can leverage as they embark on their effort to improve the patient discharge process. Weak timely communication and shared knowledge among team members currently limits the effectiveness of the patient discharge process. Similar patterns were also borne out at the role level.

Conclusions: Results of the organizational assessment are guiding the team as they integrate and hardwire IP communication. In turn, the team plans to produce a discharge video featuring IP perspectives, implement IP discharge rounds, and develop Faculty and Practice Champions to create a sustainable IP environment that impacts patient outcomes.