Disclosures We have no conflicts to report Long second stage at St. - PDF document

10/9/13 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

  1. 10/9/13 ¡ 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 1 ¡

  2. 10/9/13 ¡ 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 2 ¡

  3. 10/9/13 ¡ 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 3 ¡

  4. 10/9/13 ¡ 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 • 23yo G4P3003…. • Complete • Clear • Brief • Timely 4 ¡

  5. 10/9/13 ¡ 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 once • Assists your colleagues and all team members in anticipating next steps 5 ¡

  6. 10/9/13 ¡ Check-Back • Closes the loop • Decreases ill will and creates camaraderie and common environment Hand Off • In person, phone, text? • Transfer of information during transitions of care • Must include opportunity to ask questions and confirm Challenges • Language barrier and/or communication styles • Distractions • Locations • Personalities • Workload • Conflict • Lack of verification 6 ¡

  7. 10/9/13 ¡ 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 7 ¡

  8. 10/9/13 ¡ 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 8 ¡

  9. 10/9/13 ¡ 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 Distinct areas of expertise – Team focused • FM – Clarity of responsibility – Expertise in management of medical conditions and – Citizenship newborn care – Acceptable case load • Midwives – Maximizing continuity of care – Expertise in managing – Frequent communication normal labor and birth – Good documentation • OB/Gyn – High efficiency – Expertise in high-risk – Evidence-based care conditions and surgical management – Excellence in education 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 9 ¡

  10. 10/9/13 ¡ 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. 10 ¡

  11. 10/9/13 ¡ 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 2012 11 ¡

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