1.5: Interprofessional collaboration- transforming public health through team work
At the end of this case, students should be able to:
- Describe the Interprofessional Education Collaborative core competencies
- Discuss the importance of interprofessional collaboration in public health practice
- Identify different models or frameworks to build community partnerships and interprofessional collaborations in addressing public health needs
- Apply components of various models in creating and sustaining community partnerships to public health prevention initiatives
Introduction
Research has identified effective healthcare teams as a factor in improved patient outcomes and reduction in medical errors. 1 In order for health professions to learn to work together optimally, health profession higher education has placed increased emphasis on interprofessional education (IPE). The World Health Organization (WHO) defines IPE as the process in which “two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.” 2 The Interprofessional Education Collaborative (IPEC), which consists of national health education organizations, has identified the following four core competencies common to healthcare professions that support effective team development and function.
- Values/ethics for interprofessional practice To work with individuals of other professions to maintain a climate of mutual respect and shared values
- Roles/responsibilities To use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of patients and to promote and advance the health of populations
- Interprofessional communication To communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease
- Teams and teamwork To apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver and evaluate patient population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable 3
In regard to public health, building partnerships across health professions and community organizations is an important step in addressing complex health issues. Effective interprofessional collaboration is both necessary and critical, given the complexity of public health issues and the multiple stakeholders involved. Additionally, interprofessional collaboration in relation to public health often includes more disciplines than pharmacists typically see in clinical practice.
While these interprofessional teams can tackle complex public health issues, it is important that the team be moving in the same direction. A first step is conducting a community health needs assessment to identify and prioritize health issues. 4 Once a need has been selected, the team can utilize various models that provide a blueprint for creating and sustaining partnership, 5-7 such as the Creating and Maintaining Partnerships toolkit and the Developing a Framework or Model of Change toolkit from Community Toolbox. 6,8 The Creating and Maintaining Partnerships toolkit provides an outline of questions and resources to consider when building partnerships across professions and with community-based organizations. The Developing a Framework or Model of Change toolkit helps in developing an overarching framework for the program, activities, and intended outcomes. Once a partnership has been forged between health systems and community-based organizations, useful resources, such as the Partnership Assessment Tool for Health (PATH), can assist collaborators in working together effectively to maximize the impact of the partnership. 9 Further guidance is available on approaches to consider for successful health partnerships. 10
Case
It’s finally happened—you have your license to practice pharmacy! You’ve recently moved and accepted a residency position at a large teaching hospital downtown. On your first day at work, the residency director assigns a project she wants you to complete by the end of your one-year residency: developing a hypertension primary prevention interprofessional initiative in the surrounding community. The previous resident’s project was a community health needs assessment that found hypertension to be a prevalent and growing issue in the community. The community you now work and live in is underserved and located in an urban setting with low socioeconomic status, low health literacy, a high disease burden, and a high crime rate. Although the community has its struggles, it also has a strong community presence, including many people, organizations, and institutions that want to help. Being at an academic medical center located in a heavily populated community lends itself to many diverse and creative opportunities for collaboration.
Case Questions
- Interprofessional/IPEC Which professional healthcare groups do you want represented on the team to help with the project? Why?
- Interprofessional/IPEC How would the team identify and communicate about each member’s functions or roles, responsibilities, and accountabilities? How will the team communicate about the project’s goals and progress?
- Stakeholders/partners Using the Creating and Maintaining Partnerships toolkit, which stakeholders and partners (other than healthcare professionals) do you want to include in this project? Why? How will you include them?
- Shared goal/vision Using the Creating and Maintaining Partnerships toolkit, create an overall shared goal/vision for the project.
- Initiative Using the Developing a Framework or Model of Change toolkit, develop a feasible initiative concerning hypertension primary prevention in your community.
Author Commentary
The multifaceted nature of public health requires a sound, interprofessional approach in addressing issues. Tackling public health issues requires a team-based approach, often with disciplines pharmacists are not typically familiar with. Such collaborations are necessary but are also difficult to establish and maintain. Taking the time to carefully and purposefully choose an interprofessional team, where each member brings unique connections, knowledge, and/or skills, is critical for success. Once you have your team, it is equally important that you are all on the same page, so as to promote open communication and engagement among members. Ensuring that your initiative is clear, impactful, and feasible can help team members fully engage in the project and prevent unnecessary barriers from impeding progress. Utilizing tools (such as those included herein) aimed to create impactful initiatives, establish and maintain interprofessional teams, and establish a shared vision among teams, can be extremely helpful when pursuing public health initiatives.
Patient Approaches and Opportunities
When developing an interprofessional team, it is important to be both creative and critical, so as to include a wide range of professionals who can contribute in unique, meaningful ways. Establishing relationships with stakeholders, especially those from the community, is critical toward building trust and a strong foundation for resulting initiatives. Following a patient-centered paradigm of seeking to include patients (or, in this case, “community members”) in the design, implementation, and closure of a project, will lead to better-designed and, likely, more impactful programs. Utilizing toolkits and models (such as those included here) can help practitioners create and implement, in a logical, step-by-step fashion, an interprofessional public health initiative.
Pharmacists play an important role in public health. As medication experts, we understand the nuances associated with the ramifications of widespread medication use in our society, including issues of nonadherence, medication safety, adverse events, overdoses, and pharmacoeconomics (costs). Your value as part of the interprofessional team is crucial. However, it can be difficult at times to integrate your knowledge and opinions in an interprofessional setting and/or team and, ultimately, show your value. Becoming a more effective team member takes practice. As you improve leadership and communication skills, your ability to work with others will improve. In addition to hands-on practice, resources are available to improve interprofessional teamwork skills. These resources are diverse and include articles, toolkits/models, surveys, reflections, modules, and curricula.
Related chapters of interest:
- Communicating health information: hidden barriers and practical approaches
- The ‘state’ of things: epidemiologic comparisons across populations
- More than just diet and exercise: social determinants of health and well-being
External resources:
Websites:
- IPEC Core Competencies. https://www.ipecollaborative.org/ipec-core-competencies
- IPEC Resources. https://www.ipecollaborative.org/resources
- Interprofessional Education Collaborative, “Resources,” https://www.ipecollaborative.org/resources.html .
- National Center for Interprofessional Practice and Education, home page, https://nexusipe.org .
- US Department of Labor, Bureau of Labor Statistics, “Occupational Outlook Handbook,” https://www.bls.gov/ooh/healthcare/home.htm .
Publications
- Robert Wood Johnson Foundation, “Lessons from the Field: Promising Interprofessional Collaboration Practices,” white paper, 2015.
- Stergios T. Roussos and Stephen B. Fawcett, “A Review of Collaborative Partnerships as a Strategy for Improving Community Health,” Annual Review of Public Health 21 (2000): 369–402.
- Steven A. Schroeder, “We Can Do Better—Improving the Health of the American People,” New England Journal of Medicine 357 (2007): 1221–28.
- Matthew K. Wynia, Isabelle Von Kohorn, and Pamela H. Mitchell, “Challenges at the Intersection of Team-Based and Patient-Centered Health Care: Insights from an IOM Working Group,” Journal of the American Medical Association 308 , no. 13 (2012): 1327–28.
Models
- Center for Health Care Strategies, Inc., “Partnership Assessment Tool for Health,” https://www.chcs.org/resource/partnership-assessment-tool-health/ .
- Centers for Disease Control and Prevention, “Assessment & Planning Models, Frameworks & Tools,” https://www.cdc.gov/stltpublichealth/cha/assessment.html .
- Centers for Disease Control and Prevention, “Community Health Assessments & Health Improvement Plans,” https://www.cdc.gov/stltpublichealth/cha/plan.html .
- Community Tool Box, “Creating and Maintaining Partnerships,” https://ctb.ku.edu/en/creating-and-maintaining-partnerships .
- Community Tool Box, “Developing a Framework or Model of Change,” https://ctb.ku.edu/en/4-developing-framework-or-model-change .
- Robert Wood Johnson Foundation, “The Secret to Successful Health Partnerships,” https://www.rwjf.org/en/blog/2015/02/the_secret_to_succes.html.
- National Association of County and City Health Officials, “Mobilizing for Action through Planning and Partnerships (MAPP),” https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp .
- Practical Playbook, “Building a Partnership,” https://www.practicalplaybook.org/section/building-partnership .
References
- Roussos ST, Fawcett SB. A review of collaborative partnerships as a strategy for improving community health . Annu Rev Public Health. 2000 ;21:369 -402.
- World Health Organization. (2010) Framework for action on interprofessional education & collaborative practice . Geneva. World Health Organization.
- Interprofessional Education collaborative Expert Panel. (2011) . Core competencies for interprofessional collaborative practice: Report of an expert panel . Washington, D.C.: Interprofessional Education Collaborative.
- Centers of Disease Control and Prevention. Community Health Assessments & Health Improvement Plans . https://www.cdc.gov/stltpublichealth/cha/plan.html . Accessed October 15, 2018.
- National Association of County and City Health Officials. Mobilizing for Action through Planning and Partnerships (MAPP) . https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp . Accessed October 15, 2018.
- Community Tool Box. Creating and Maintaining Partnerships. https://ctb.ku.edu/en/creating-and-maintaining-partnerships . Accessed October 15, 2018.
- Practical Playbook. Building a Partnership. https://www.practicalplaybook.org/section/building-partnership . Accessed October 15, 2018.
- Community Tool Box. Developing a Framework or Model of Change . https://ctb.ku.edu/en/4-developing-framework-or-model-change . Accessed October 15, 2018.
- Center for Health Care Strategies, Inc. Partnership Assessment Tool for Health. https://www.chcs.org/resource/partnership-assessment-tool-health/ . Accessed October 15, 2018.
- Robert Wood Johnson Foundation. The Secret to Successful Health Partnerships. https://www.rwjf.org/en/blog/2015/02/the_secret_to_succes.html . Accessed October 15, 2018.