Using interprofessional education to enhance knowledge and skills for integrated and person-centred care
Introduction
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.
Dr Teresa Burdett
Facilty of Health and Social Sciences
Bournemouth University
Contact: tburdett@bournemouth.ac.uk
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