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 conflicts to report Long second stage at St. Elsewhere 1 ¡

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 ¡

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 ¡

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 ¡

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 ¡

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 ¡

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 ¡

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 ¡

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 ¡

10/9/13 ¡ 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 ¡

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 ¡