[PDF] - Disclosures We have no conflicts to report Long second stage at St. PDF Document

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Beyond alphabet soup: Collaborative practice in the age of quality and the epoch of patient centered care

Melissa Avery, PhD, CNM, FACNM, FAAN Nicole Chaisson, MD, MPH Carrie Ann Terrell, MD, FACOG

Disclosures

We have no conflicts to report

Long second stage at St. Elsewhere

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Objectives

Describe national objectives for

interprofessional education and practice

Identify elements of functional collaborative

communication

Identify models of interprofessional practice

in maternity care

Not a new idea

1972 – IOM
1998 – Pew Health Professions Commission
2001 – IOM, Crossing the Quality Chasm
2003 – IOM, Health Professions Education:

Bridge to Quality

2011 – IOM, Core Competencies for

Interprofessional Collaborative Practice

Interprofessional competency domains

Values and ethics
Roles and responsibilities
Interprofessional communication
Teams and teamwork

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10/9/13 ¡ 3 ¡ Values and ethics

Mutual respect
Patient centered care
Respect for dignity,

privacy and culture

Ethical conduct
Quality care
Professional

competence

Roles and responsibilities

Knowledge about each

team member

Patients and families

informed of roles

Team approach to

maximize skills of each

Approach to benefit

patients

Interprofessional communication

Responsible

communication among all aspects to team including community

Tools to provide and

exchange information

Effective

communication that is respectful, resolve conflicts

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10/9/13 ¡ 4 ¡ Teams and teamwork

Team approach that

provides care that is safe, timely, efficient, effective, and equitable

Collaboration, shared

accountability, environment of continuous improvement

JOINT COMMISSION

Ineffective communication is a root cause for

nearly 66% of all sentinel events recorded.*

*JCAHO Root Causes and Percentages for Sentinel Events January 1995-

December 2005

Standards of Effective Communication

Complete
Clear
Brief
Timely
23yo G4P3003….

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Information Exchange Strategies

SBAR
Call-Out
Check-Back
Handoff

SBAR

Situation, Background, Assessment,

Recommendation

Provides a framework for communication

Call-Out

Codes, emergency or urgent situations
Informs all members about a situation at
nce
Assists your colleagues and all team

members in anticipating next steps

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Check-Back

Closes the loop
Decreases ill will and

creates camaraderie and common environment

Hand Off

Transfer of information

during transitions of care

Must include
pportunity to ask

questions and confirm

In person, phone, text?

Challenges

Language barrier and/or communication

styles

Distractions
Locations
Personalities
Workload
Conflict
Lack of verification

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Building the Collaborative Team

Barriers

– Current climate of separate training programs – Hierarchical health care system – Different approaches to patient care – Dominance of the medical profession in the health care system – Traditional model of independence vs interdependence – Differences in social status

Stapleton S. 1998, J Nurse-Midwifery

Building the Collaborative Team

Benefits/Attributes

– Open, honest communication – Mutual trust/mutual respect/mutual support – Valuing each other’s perspectives

And willingness to discuss differences

– Valuing each other’s practice style – Shared power and shared accountability – Professional competence – Shared values, goals, vision

Stapleton S. 1998, J Nurse-Midwifery

Models that Work

University of Michigan

– FM/OB collaborative consultation and privilege guidelines

University of North Carolina at Chapel Hill

– FM/CNM collaboration in support of a freestanding birth center

Boston University

– OB/FM/CNM collaboration around intrapartum and postpartum care

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University of Michigan, 1994

Recognizing that the historic relationship

between OB and FM had been “controversial and intense”

– Developed a structured method of obstetric privilege for FM faculty – Provided guidelines for FM/OB “interaction” and consultation

Resulted in resolution of prior conflicts,

increased collaboration around teaching and increased rates of FM graduates practicing OB

Berman DR et al. 2000, Obstet Gyneco

University of North Carolina, 1996

Synchronous developments led to a

partnership between the Dept of FM at UNC and Piedmont Women’s Health Center

– FM wanted to expand and improve their OB training to increase rates of graduates providing OB care after graduation – PWHC built a free-standing birth center in closer proximity to surgical and neonatal back up and needed buy in from UNC

Payne PA & King VJ. 1998, J Nurse-Midwifery

University of North Carolina, 1996

Benefits

– Consistency of philosophy and approach to patient and family care – Richer training environment for FM residents

Provided a “cultural experience” working with and being

taught by APNs

– Shared understanding of “scope of practice” – Smooth transitions for clients requiring transfer to UNC Hospitals

FM acted as advocate for the whole family and as a liaison

to other services when needed

Payne PA & King VJ. 1998, J Nurse-Midwifery

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Boston University, 2005

Prior to collaboration – “3 silos of care”

– Individual professional practices – Interdisciplinary mistrust – Inconsistent communication – Variable skill sets

After collaboration – “maternity care team”

– Clearly defined practice structure – Sustainable system promoting a culture of safety – Interdisciplinary and interprofessional educational environment

Pecci CC et al. 2012, Obstet Gynecol Clin N Am

Boston University, 2005

Collaborative Model of Excellence on L&D

Ten guiding principles

– Team focused – Clarity of responsibility – Citizenship – Acceptable case load – Maximizing continuity of care – Frequent communication – Good documentation – High efficiency – Evidence-based care – Excellence in education

Distinct areas of expertise

FM

– Expertise in management

f medical conditions and

newborn care

Midwives

– Expertise in managing normal labor and birth

OB/Gyn

– Expertise in high-risk conditions and surgical management

Pecci CC et al. 2012, Obstet Gynecol Clin N Am

Boston University, 2005

Benefits of the interdisciplinary team model

– Culture of safety

Team training initiatives, uniform competency

requirements, mandatory skill evaluation for all

– Patient-focused care

Significant increases in patient satisfaction and

development of patient-education materials

– Interdisciplinary and interprofessional education

Both inpatient and outpatient

Pecci CC et al. 2012, Obstet Gynecol Clin N Am

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Success in Development

Leadership commitment
Regular meetings with accountability
Reassessment of hierarchy
Development of shared vision
Exploration of financial sustainability
On-going attention to guiding principles
Presence and accessibility
Commitment to education

Thank you References

Berman DR, Johnson TRB, Apgar BS, Schwenk TL.

Model of family medicine and obstetrics-gynecology collaboration in obstetric care at the Univeristy of

Michigan. Obstet Gynecol 2000;96:308-313.
Chang CC, Mottl-Santiago J, Culpepper L, Heffner L,

McMahan T, Lee-Parritz A. The birth of a collaborative model: obstetricians, midwives, and family physicians. Obstet Gynecol Clin N Am 2012;39:323-334.

Payne PA, King VJ. A model of nurse-midwife and family

physician collaborative care in a combined academic and community setting. J Nurse-Midwifery 1998;43:19-26.

Stapleton SR. Team-building: making collaborative

practice work. J Nurse-Midwifery 1998;43:12-18.

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References

http://www.ahrq.gov/professionals/education/

curriculum-tools/teamstepps/instructor/ fundamentals/module6/igcommunication.html

http://www.ahrq.gov/professionals/education/

curriculum-tools/teamstepps/instructor/ fundamentals/module6/ igcommunication.html#refs

Obstetrics & Gynecology, September 2011
OB/GYN Clinics of North America, Sept/Oct