David Nicholas: Needs of Professionals Within An Interprofessional Environment: Emergent Findings from Sickkids Based Research

David Nicholas began with a definition of Interprofessional Practise from the Sickkids publication Advancing Interprofessional Practise (2004):
"Inter-professional practice (IPP) in a paediatric health-care setting refers to the continuous interaction of two or more professions, organized into a common effort to solve or explore common issues with the best possible participation of the child and family." (emphasis in original)
He listed some noteworthy interprofessional formations including the Multi-Disciplinary Urogential Team (MUG team) that combines multiple clinics in one spot so families can see many specialists during one visit to Sickkids and the Health Leadership Forum held in August where dozens of Sickkids staff lived and worked for a week and explored professional initiatives together, in several cases deciding to continue working together on team and family related inititatives.

He then summarized the findings of SCRIPT which can be found in the SCRIPT Annual Report Year 2 (April 2006 - March 2007).

David's main focus was sharing data on the 13 focus groups held by Sickkids to date that combine professionals, trainees and parents. The 84 participants so far average about 6.5 persons per focus group. The groups were asked about both formal communication (referrals, health care records, rounds) and informal communication (face to face discussions, telephone calls, pages and emails). While communication sometimes went well, he stated that he was pulling from the data specifically the challenges):

* communication with off-service staff was difficult and disjointed and confusion arose about who to contact leading to phone tag and communication delays

* the complexity of patient care intersects with staff turn-over, time limitations, high workload and lack of awareness or knowledge about every profession's role

Parents are concerned about: fragmentation between services, specialists who do not coordinate among themselves, how complicated it can be as a parent to navigate, and that the right hand must know what the left hand is doing.

"Parents overwhelmingly felt that the more areas that their child was seen in, the less coordinated the care and communication."

The findings speak to the need for:

* greater consideration of the breadth of health needs
* coordination of multiple services
* awareness of who else is involved
* flexibility of communication along with structures that support integrative case planning
* ways to reach off-service resources

Staff spoke to misunderstandings as to scope of practise boundaries and interprofessional boundaries (roles and responsibilities) that leads to 'slippage' with patients and families. Many felt that not recognizing boundaries was a source of stress and frustration while some felt that IPP overlap at times offered a protective factor.

The development of personal and collegial relationships which can foster respect can be supported by social and teambuilding events. Shared time is essential to get know one another and develop some bonds. Respect grows with time and experience.

David highlighted that IPP is not "rationing specialised care into a watered down mutuality" and is about "optimizing coordination, interactions, humaness and effectiveness of care." He sees the data suggesting the need for staff to experience: more IP education; more IP structures for communication (shared rounds, overlap between staff shift changes, proactive care to reduce reactive responses); more coordination between departments and the importance of social and team building events.

He introduced the family presence in IPP by reading a long quote by an adult transitioned patient who was being considered for surgery and happened to stop in at one doctors office when another doctor was there and shared how "It really helped when they were actually talking with each other in my presence." In short staff can help patients understand some of "our processes".

The key role of families in providing insight into a care plan requires effective coordination of multiple services and professionals, consistency of messaging to children and families, flexibility in communication with structures that support integrative case planning, more inclusion of families in core planning and support of parents in terms of finding their role as part of the IPP team. Inviting families to comment on care requires that staff assist families with specialised care language. He concluded by noting and supporting Dr Joshua Tepper's opening call to include the child and family integrally with the team.

"Structuring communication relationships for interprofessional teamwork (SCRIPT): a cluster randomized controlled trial" (Zwarenstein et al 2007)

RNAO Best Practice Spotlight, Supporting and Strengthening Families through Expected and Unexpected Life Events, gap analysis - summary: Partnerships with families are important but inconsistent across the hospital; An assessment of the family should be done in conjunction with the assessment of the child; While Family Centered Care(FCC) is initially discussed during staff orientation, there is a lack of ongoing educational opportunities to support family centered practice; For staff to practice FCC, they need to have the resources and support when dealing with challenging situations (e.g. adequate staffing, knowledge of conflict resolution)

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