Leadership

Interprofessional Collaboration for a Health System in Crisis

Article · May 23, 2018

Editor’s note: This article was co-authored by Prof. Reeves and Dr. Patel before Prof. Reeves suddenly passed away this month. This is one of his last fully edited works of writing and is now published in his memory. Those who have worked with Prof. Reeves hope this article provides an insight into his work and its ongoing impact. The editors have been careful to respect Prof. Reeves’ contribution and preserve his point of view.

 

Health care systems vary from being socially driven and providing universal access to having a purely for-profit infrastructure. Across the board, these systems are under considerable pressure due to a variety factors such as lack of access, cost, and an increasing health care burden. These financial pressures are accompanied by a “perpetual winter of Narnia” as demand continues to increase and a clearly overworked workforce gets less motivated by the day. This trend is seen across many health systems and is not isolated to one particular country.

The recent focus has been primarily on funding as a result of doctor contract disputes and even strikes. However, there has been very little discussion around solutions that can potentially improve work efficiency, knowledge, and motivation — namely, a greater emphasis on interprofessional collaboration and interprofessional education.

Interprofessional What?

Interprofessional education is a model in which individuals from two or more professions in health care learn together during all or part of their professional and postgraduate training, with the objective of cultivating collaborative practice. This form of education is particularly effective in subspecialties in which the need for interprofessional collaboration and learning is most acute. For instance, in the field of emergency care, in which doctors work alongside nurses, paramedics, and others, the evidence is clear that work efficiency, motivation, and patient outcomes improve when training is driven by well-founded interprofessional principles at both the undergraduate and postgraduate levels.

For example, a recent study from an academic health center in Iowa demonstrated that Emergency Department visits and hospitalizations dropped by 50%–70% in the 12-month period following the development of an interprofessional, integrated approach to mental health in which patients received care from a team of psychiatry, family medicine, and primary care health workers. Moreover, positive findings were also noted at the 6-month mark, with hospitalizations representing >5% of all before-enrolment encounters, compared with only 2% of post-enrolment encounters.

That study clearly indicated that patients had lower odds of an emergency room visit or hospitalization and a greater likelihood of an outpatient psychiatry visit or primary care visit after enrolment in an interprofessional care management program as compared with before enrolment. The findings of that study suggest that, by focusing on interprofessional training, we can increase our capacity to shift care toward the primary care and community levels, where health care delivery is well known to be more effective and more beneficial for patients.

It is clear that many health care workers have not been exposed to interprofessional learning or methods of interprofessional collaboration that are well established within the education community. Countries such as Australia, Canada, Sweden, and Japan have made some useful gains in terms of integrated interprofessional collaboration and are clearly seen as nations whose health systems are in a better state (in terms of ranking, access, and outcomes) than those of the U.S. and other countries. In Japan, for example, a rapidly aging population has resulted in a large-scale reorganization of agencies and services to work in a more collaborative manner. These reforms are supported by an established set of interprofessional competencies designed to ensure that practitioners are “fit for purpose” in terms of working effectively together in interprofessional teams.

Going Beyond the Hospital

Interestingly, just as teamwork, communication, and collaboration are essential and highly valued among athletes, work is now commencing to investigate how collaboration can be applied in the field of field of sports medicine. Our research has shown that several factors (including negotiation, confidentiality, professionalization, and professional dominance) influence interprofessional collaborative practice and, ultimately, health outcomes. The lessons that we have learned by studying interprofessional education and collaboration in the field of sports medicine can be applied to the hospital and primary care settings.

Moving Forward with Technology

Integrating this ethos of interprofessional education and collaboration is essential for systems such as the National Health Service to continue to provide quality health care. Many may question the costs of implementing such practices, but the evidence is clear that interprofessional education is an essential foundation for fair and financially stable health systems. With our society becoming more technologically driven, postgraduate interprofessional learning can create a less isolated, more motivated, and more collaborative workforce.

Two of our recently published reviews, one on the effects of interprofessional education on the health workforce and the other on the role of technology and interprofessional education in primary care, have clearly shown the benefits of interprofessional education while calling for further research in this area. These benefits include the facilitation of collaborative practice and education through e-learning — for example, learning about pathology via digital microscopy or learning about safe insulin use and diabetes via an online module. Additionally, e-learning can lead to improvements in professional competence by providing a way to overcome geographic boundaries that can lead to isolation and a lack of motivation.

Looking Ahead

Providing better health care is not just about finances and spending more of our GDP on our health systems, increasing the number of health care workers per 1,000 population, or providing access 7 days a week. It is also about the training and collaborative practice within the health workforce at the primary and hospital levels. If we are to have a stable, socially based, efficient, and safe health system, it will be necessary for all of us, as health care workers, policymakers, and educators, to implement interprofessional learning and collaboration at all levels of our health care system.

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