TEAM BUILDING RESOURCE GUIDE FOR ONTARIO. PRIMARY HEALTH CARE TEAMS Module January 7: Enhancing 2009 Collaboration

Transcription

1 TEAM BUILDING RESOURCE GUIDE FOR ONTARIO PRIMARY HEALTH CARE TEAMS Module January 7: Enhancing 2009 Collaboration Amended December 2010 Revised December 2012 Revised December 2012

2 Purpose of the Guide This guide is designed to help you and your team better understand your processes and to help you find ways of strengthening team-based care in your primary health care (PHC) organization. The guide is divided into ten standalone modules. Each module contains background information and theory related to the topic (Part A). Some modules (i.e., 3, 4, 7, and 10) also contain companion tools and resources to address the topic (Part B). The modules are not sequential. Choose the module that addresses a specific challenge you have identified and use the tools that are most applicable to your situation. The Introduction module contains background information about interdisciplinary teams, interprofessional care and other types of teams. The Introduction module also includes acknowledgements and key references. It is recommended that before beginning any of the suggested activities, both the facilitator or group leader and the participants take the time to review the whole module. This will help to ensure that the facilitator and all participants have the information necessary to fully engage in all discussions. Each PHC organization should decide who will be responsible for overseeing team development and addressing any problems that arise. This usually falls to the existing leadership or a newlyestablished quality improvement team/leadership team. From time to time you may also involve an external consultant to facilitate team building activities, although external facilitation is not required to use these modules. Visit our website at for the complete set of modules including: Introduction Module 1: What Is an Effective Team? Module 2: Building a Team Module 3: Clarifying Roles and Expectations Module 4: Making the Most of Meetings Module 5: Evaluating Team Performance Module 6: Understanding Change Module 7: Enhancing Collaboration Module 8: Improving Communication Module 9: Leadership and Decision-Making Module 10: Conflict Management Primary health care (PHC) organization refers to a group of providers, allied health professionals and other staff, etc. within a FHT, CHC, NPLC or other practice model with multiple providers. A number of teams may function within one organization. In the case of solo-provider practice models, organization may refer to an individual provider and staff. 2

3 Part A Enhancing Collaboration There are many definitions of collaboration, but the common elements include two or more individuals working together in a partnership that is characterized by: a) Common goals or common purpose b) Recognition and respect for strengths and differences c) Equitable and effective decision-making d) Clear and regular communication to improve access to a comprehensive range of services delivered by the right person, in the right place, at the right time (IPC definition) Way, Jones and Busing 1 have defined collaboration as: an interprofessional process of communication and decision-making that enables the separate and shared knowledge and skills of health care providers to synergistically influence the client/patient care provided. A clear understanding of others is the basis of respect, which underlies all successful collaborative endeavours. The need to establish the trust and respect of other team members is a central feature of collaboration in healthcare, i.e., no individual is responsible for all aspects of a patient s care and therefore, each member must have confidence that other team members are able to fulfil their responsibilities. Collaboration is improved through strong personal relationships and team-building activities such as exercises, retreats, social/recreational activities and training sessions. These help build personal as well as professional relationships. However, an often overlooked member of the health care team is the patient, their families, and the community. Collaborative partnerships need to consider how to incorporate the patient and their family into the care plan. Assessing Collaboration in a Team A number of tools are included in Part B of this module to help your team. Choose the ones that are most applicable to what you want to achieve. As with other tools, the findings from these instruments should be collated by the team leader and the results shared with the team. Team members may discuss their responses to the questions asked openly, or the leader may summarize the findings. However, these tools are designed to facilitate discussion through questions like: Are the responses a surprise? Do these findings seem valid? What do we need to change? Where do we start? Often an open discussion can substantially improve collaboration. Part B of this module contains the following exercises and activities, which address the themes we have already discussed Attitudes in Teams Knowledge and Skills in Interprofessional Collaboration Assessing Current Collaborative Efforts 7.4 Measuring the Level of Satisfaction in Collaborative Teams 1 Way D, Jones L, Busing N. (2000) Implementation strategies: Collaboration in primary care - family doctors & nurse practitioners delivering shared care [Discussion paper for the Ontario College of Family Physicians] Available from: 3

4 Part B Enhancing Collaboration Activity Attitudes in Teams Preparation: Review Part A, Module 7 Time Required: minutes, with follow-up at the next meeting Materials: Handouts Pens This activity requires the following handouts for participants: Attitudes Toward Health Care Teams Scale Description: This activity is a survey of team member attitudes towards collaboration. The survey identifies differences in attitudes between team members about the importance of team functioning and collaboration, and the place of collaboration in a PHC organization. Steps: 1. Use this survey to discover participants attitudes towards the value and efficiency of interprofessional collaboration. 2. Have everyone on the team complete the scale anonymously and return it to one person. 3. Have a small group of people representing different components of your team analyze and summarize the data. 4. Report the findings of the survey to the team at the next meeting. 5. Follow this with a brainstorming discussion about the benefits of collaboration in your team, across teams, or within the whole organization. Consider questions such as: What are the benefits to our clients? What are the benefits to us as providers? How do different team members approach collaboration? What are the advantages of collaboration? What are the disadvantages? 4

5 Activity 7.1: Attitudes in Teams Attitudes Toward Healthcare Teams Scale 2 Check the number for each statement that best describes your attitude toward the value and efficiency of interprofessional collaboration. Rating System: 1= strongly disagree, 2 = disagree, 3 = neither agree or disagree, 4 = agree, 5 = strongly agree Working in teams unnecessarily complicates things most of the time. The team approach improves the quality of care for patient/clients /families. Team meetings foster communication between different professions. Patient/clients receiving team care are more likely than other patient/clients to be treated as whole persons. Working on a team keeps most health professionals enthusiastic and interested in their jobs. Developing a patient/client care plan with other team members avoids errors in the delivery of care. Health professionals working on teams are more responsive than others to the emotional and financial needs of patient/clients/ families. Developing an interprofessional patient/client care plan is excessively time consuming. The sharing of information and best practices between team members helps them make better patient/client care decisions. The time required for team meetings could be better spent in other ways. Hospital patients/clients who receive team care are better prepared for discharge that other patients/clients. The team approach makes the delivery of care more efficient. The team approach permits health professionals to meet the needs of family caregivers as well as patients/clients. Having to report observations to the team helps team members better understand the work of other health professionals Heinamann et al 1999, Development of an Attitudes toward Health Care Teams Scale, Eval Health Prof.1999; 22: : Sage Publications 5

6 Activity 7.2: Knowledge and Skills in Interprofessional Collaboration Preparation: Review Part A, Module 7 Time Required: minutes Materials: Handouts Pens This activity requires the following handout for participants: Current Knowledge and Skills Related to Interprofessional Collaboration Description: o o Steps: This activity helps participants appreciate not only their readiness for participation in collaborative teams, but also those individuals who may be able to assist with leading the process. Each team member will complete the survey, which assesses their understanding of the principles and practices of collaboration 1. Use this survey to discover participants confidence in their knowledge of and skills related to interprofessional collaboration. 2. Have everyone on the team complete the scale anonymously and return it to one person. 3. Have a small group of people representing different components of your team analyze and summarize the data. 4. Report the findings of the survey to the team at the next meeting. 5. Follow this up with a brainstorming discussion about the team s shared knowledge and skills. Consider questions such as: What steps could we take as a team to enhance our collective knowledge and skills related to interprofessional collaboration? What current expertise can we build upon? What natural opportunities for success already exist? 6

7 Activity 7.2: Knowledge and Skills in Interprofessional Collaboration Current Knowledge and Skills Related to Interprofessional Collaboration 3 Check the number for each statement that best describes your confidence in your skills and knowledge related to interprofessional collaboration. Rating System: 1= not at all, 2 = somewhat, 3 = moderately, 4 = very, 5 = extremely I am confident that I have the knowledge and/or skill to: Accurately define what is meant by collaborative practice. 2. Discuss collaborative practice with my interprofessional colleagues using language and terms that are commonly understood. 3. Identify the steps a team should follow to ensure effective collaboration. 4. Explain the benefits and purpose of collaboration to my colleagues. 5. Define the elements essential for effective collaboration. 6. Describe my professional role/functions, responsibilities and competencies to other professions. 7. Recognize and respect the separate and shared roles/functions, responsibilities and competencies of other professions in relation to my own. 8. Negotiate roles/functions and responsibilities within my team. 9. Communicate assessments and recommendations related to a patient/client situation in a clear, concise and relevant manner to facilitative interprofessional decision making. 10. Communicate in a manner that ensures each team member feels valued, respected and understood. 11. Determine the need for and appropriately consult, refer or transfer care to other professions. 12. Determine the need for and appropriately initiate ongoing interprofessional care delivery. 13. Engage in shared leadership and consensus decision-making within a team. 14. Effectively implement and co-ordinate an interprofessional plan of care for a patient/client/family 15. Recognize interpersonal, organizational and/or systemic factors that can enable or inhibit interprofessional collaboration. 16. Work with others professions to effect change and resolve conflict in the provision of interprofessional care. 3 Jones, L. Way, D. (2006) Collaborative Practice Learning Guide. Developed for Supporting Interdisciplinary Practice: the Family Physician/Nurse Practitioner Educational and Mentoring Program. Ontario Ministry of Health Long-Term Care Primary Health Care Transition Fund Grant # G

8 Activity Assessing Current Collaborative Efforts Preparation: Review Part A, Module 7 Time Required: minutes Materials: Handouts Pens This activity requires the following handout for participants: Assessment of Collaboration worksheet Description: Steps: This survey evaluates the satisfaction of team members with the current state of collaboration. Each team member may have different perceptions about how well the team is functioning. This survey may identify individuals who are having difficulty with the way things are developing or their own place in the care team/organization. It may be helpful to use this worksheet in conjunction with the assessment of the efficacy of collaboration. 1. Use this survey to discover participants perceptions about the actions of team members related to collaboration. 2. Have everyone on the team complete the Assessment of Collaboration form anonymously and return it to one person. 3. Have a small group of people representing different components of your team analyze and summarize the data. 4. Report the findings of the survey to the team at the next meeting. 5. Follow this up with a brainstorming discussion about the team s assessment of its actions related to collaboration. Consider the following questions: What actions are moving us closer to being more effective team collaborators? What are we doing really well? Where do we need to improve our efforts? What are our goals moving forward? 8

9 Activity Assessing Current Collaborative Efforts Assessment of Collaboration 4 Rate the extent to which you agree or disagree with each of the following statements about the actions of people in your team, teams or organization. Use the following scale to indicate your level of agreement or disagreement. Strongly Agree 5 Agree 4 Neither Agree nor Disagree 3 Disagree 2 Strongly Disagree 1 In this team, people Act in a trustworthy and trusting manner. Ask others for help and assistance when they need it. Treat others with dignity and respect. Talk openly about their feelings and opinions. Listen attentively to the opinions of others. Are able to clearly express the group s goals. Make personal sacrifices to meet the group s goals. Can rely on one another. Pitch in to help when others are busy and absent. 10. Give credit to others for their contributions. 11. Interact with each other on a regular basis. 12. Treat every relationship as if it will last for a lifetime, even if it won t. 13. Make it their business to introduce their colleagues to people who can help them succeed. 14. Freely pass along information that might be helpful. 15. Relate well to people of diverse backgrounds and interests. 4 Kouzes, J., Posner, B. (2002) The Leadership Challenge (3rd ed.) Published 2003 Jossey-Bass - A Wiley Imprint, 989 Market Street, San Francisco, CA

10 Activity Measuring Satisfaction Levels in Collaborative Teams Preparation: Review Part A, Module 7 Time Required: minutes, plus follow-up at the next team meeting Materials: Handouts Pens This activity requires the following handouts for participants: Collaborative Practice Questionnaire Provider Satisfaction with Current Collaboration Description: Steps: This provides information on how well the team is doing at any point in time. It can also be used periodically (every six months, for example) to measure progress in team performance. Two questionnaires assess how the effectiveness and efficiency of the team s collaborative efforts. This survey (the second questionnaire) may be used in conjunction with the personal satisfaction questionnaire. 1. Use the two questionnaires to discover a) the current level of collaboration within your team and b) team satisfaction with the collaboration. 2. Have everyone on the team complete the questionnaire anonymously and return it to one person. 3. Have a small group of people representing different components of your team analyze and summarize the data. 4. Report the findings of the survey to the team at the next meeting. 5. Follow this up with a brainstorming discussion. Consider the following questions: Were we surprised by the results of the questionnaires? If so, why? Have we made progress since the last time we assessed the level of collaboration and/or satisfaction with collaboration? What are the reasons we have or have not made progress? What is our vision for moving forward? What are opportunities for success? *Note: these tools do not need to be used at the same time. During a meeting you may choose to use only one tool, which would require less time. 10

11 Activity Measuring the Level of Satisfaction in Collaborative Teams Collaborative Practice Questionnaire 5 Please answer the following, two-part questionnaire by indicating the number that best applies to you for each statement. There are no right or wrong answers. It is important that you respond to each statement. If you work with more than one collaborative partner, consider the collaboration overall and not your collaboration with a specific individual. Part 1: Measure of Current Collaboration Consider your overall experience with collaboration between you and your partners (the provider(s), the allied health professional(s), the administrative staff and other team members within your practice). Please place a check mark under the number that best represents your opinion on each statement. Rating Scale Strongly Disagree Disagree Somewhat Disagree Neutral Somewhat Agree Agree Strongly Agree My collaborating partner(s) and I: Plan to work together when making decisions about patient/client care (when appropriate) 2. Communicate openly as decisions are made about patient/client care 3. Share responsibility for decisions regarding patient/client care 4. Cooperate in making decisions about patient/client care 5. Consider the concerns of all professions when making decisions about patient/client care 6. Coordinate implementation of a shared plan for patient/client care 7. Demonstrate trust in each other s decision making abilities when it affects patient/client care 8. Respect one another s knowledge and skills in making shared decisions about patient/client care 9. Fully collaborate in making decisions about patient/client care 5 Jones, L. Way, D. (2006) Collaborative Practice Learning Guide. Developed for Supporting Interdisciplinary Practice: the Family Physician/Nurse Practitioner Educational and Mentoring Program. Ontario Ministry of Health Long-Term Care Primary Health Care Transition Fund Grant # G

12 Activity Measuring the Level of Satisfaction in Collaborative Teams Part 2: Provider Satisfaction with Current Collaboration 6 Consider your experiences with the collaboration between you and your partners (provider(s), allied health professional(s), administrative staff and other team members within your practice). Please place a check mark under the number that best represents your opinion on each statement. Rating Scale Strongly Disagree Disagree Somewhat Disagree Neutral Somewhat Agree Agree Strongly Agree Indicate your current level of satisfaction with: The planning that occurs between you and your partner(s) when making decisions about patient/client care 2. The communication that takes place between you and your partner(s) 3. The responsibility that is shared between you and your partner(s) for decisions about patient/client care 4. The level of cooperation between you and your partner(s) when making decisions about patient/client care 5. The consideration of all professional concerns as decisions are made about patient/client care 6. The coordination between the you and your partner(s) when implementing a shared plan for patient/client care 7. The trust shown in one another s decision making ability when making shared decisions about patient/client care 8. The respect shown by the you and your partner(s) in each other s knowledge and skills 9. The amount of collaboration that occurs in making decisions about patient/client care 10. The way that decisions are made about patient/client care; (regarding the decision making process, not necessarily with the decisions) 11. The decisions that are made about patient/client care 6 Ibid. 12

13 References Heinamann et al 1999, Development of an Attitudes toward Health Care Teams Scale, Eval Health Prof.1999; 22: : Sage Publications Jones, L. Way, D. (2006) Collaborative Practice Learning Guide. Developed for Supporting Interdisciplinary Practice: the Family Physician/Nurse Practitioner Educational and Mentoring Program. Ontario Ministry of Health Long-Term Care Primary Health Care Transition Fund Grant # G Kouzes, J., Posner, B. (2002) The Leadership Challenge (3rd ed.) Published 2003 Jossey-Bass - A Wiley Imprint, 989 Market Street, San Francisco, CA Way D, Jones L, Busing N. (2000) Implementation strategies: Collaboration in primary care - family doctors & nurse practitioners delivering shared care [Discussion paper for the Ontario College of Family Physicians] Available from: edicine 13