2008 HEALTH SERVICES &2008 HEALTH SERVICES &POLICY RESEARCH DAYPOLICY RESEARCH DAY

SINCLAIR LECTURESINCLAIR LECTURE

New Vision, New Journey, New New Vision, New Journey, New Promise:Promise:

Interdisciplinary Health Care in a New Interdisciplinary Health Care in a New TimeTime

26 November 200826 November 2008

Crucial to finding the way is Crucial to finding the way is this: this:

there is no beginning or end.there is no beginning or end.

You must make your own map.You must make your own map.

Joy Harjo Joy Harjo

Map to the Next World: Map to the Next World: PoemsPoems

Barred Spiral Milky Way: - Credit: R. Hurt (SSC), JPL-Caltech, NASA Survey Credit: GLIMPSE Barred Spiral Milky Way: - Credit: R. Hurt (SSC), JPL-Caltech, NASA Survey Credit: GLIMPSE Team Team

DR. DUNCAN G. SINCLAIRDR. DUNCAN G. SINCLAIRMAKER OF NEW MAPSMAKER OF NEW MAPS

DR. DUNCAN G. SINCLAIRDR. DUNCAN G. SINCLAIRMAKER OF NEW MAPSMAKER OF NEW MAPS

Veterinary College, Ph.D. in Physiology at Queen'sVeterinary College, Ph.D. in Physiology at Queen's Markle Scholar in Academic Medicine at Queen'sMarkle Scholar in Academic Medicine at Queen's Dean of the Faculty of Arts and Science at Queen’sDean of the Faculty of Arts and Science at Queen’s Vice-Principal (Institutional Relations) at Queen’s Vice-Principal (Institutional Relations) at Queen’s Director General of Program Operations at MRCDirector General of Program Operations at MRC Honorary Fellowship in the RCPSCHonorary Fellowship in the RCPSC Ontario MOH Committee for Review of the Public Ontario MOH Committee for Review of the Public

Hospitals Act Hospitals Act Premier's Council on Health, Well-Being and Social Premier's Council on Health, Well-Being and Social

Justice Justice Ontario Cancer Treatment and Research Board Ontario Cancer Treatment and Research Board National Forum on Health National Forum on Health Chair of Ontario's Health Services Restructuring Chair of Ontario's Health Services Restructuring

Commission Commission Founding Chair of the Board of Canada Info HighwayFounding Chair of the Board of Canada Info Highway Committee on Collaborative Health Professional Committee on Collaborative Health Professional

Education and Research – Memorial UniversityEducation and Research – Memorial University

At the end of the first decade of this At the end of the first decade of this twenty-first century, we are called twenty-first century, we are called

to see with new eyes to see with new eyes

to hear with new ears to hear with new ears

to dare with new thinking to dare with new thinking

to act with new passion to act with new passion

if we are to help create a truly strong, if we are to help create a truly strong, safe and responsive health system in safe and responsive health system in Canada.Canada.

OVERVIEW OF OVERVIEW OF REFLECTIONSREFLECTIONS Context in changing societyContext in changing society New vision = interdisciplinary New vision = interdisciplinary

health carehealth care New journey = transformation of New journey = transformation of

culture culture New promise = leaders and New promise = leaders and

championschampions New hope = readiness to New hope = readiness to

respondrespond

CHANGES IN CHANGES IN WESTERN SOCIETYWESTERN SOCIETY

Demographic shiftsDemographic shiftsCultural diversityCultural diversityFinancial uncertainty/volatilityFinancial uncertainty/volatilityIncreasing urbanizationIncreasing urbanizationImpact of technologyImpact of technologyChanging face of familyChanging face of familyReality of poverty and violenceReality of poverty and violencePollution of the environmentPollution of the environmentRole of womenRole of womenExpectations of public serviceExpectations of public service

CHANGING PROFESSIONSCHANGING PROFESSIONS Move from traditional inward-looking, Move from traditional inward-looking,

reactive culture to outward-looking, reactive culture to outward-looking, proactive culture proactive culture

Shift from profession-centred to patient-Shift from profession-centred to patient-centred culturecentred culture

Blurring professional boundariesBlurring professional boundaries Changes in law re scope of practice and Changes in law re scope of practice and

responsibilitiesresponsibilities Increased expectations of inter-professional Increased expectations of inter-professional

collaboration in education and practicecollaboration in education and practice Focus on evidence-informed practiceFocus on evidence-informed practice Increasing demands for accountability and Increasing demands for accountability and

transparencytransparency InternationalizationInternationalization Loss of control over working conditionsLoss of control over working conditions

EXAMPLES OF EXAMPLES OF HEALTH DISCIPLINESHEALTH DISCIPLINES

Audiology Audiology

Clinical PsychologyClinical Psychology

Counseling Counseling

DentistryDentistry

Dental HygieneDental Hygiene

Diagnostic ImagingDiagnostic Imaging

Healthcare Healthcare ManagementManagement

Human KineticsHuman Kinetics

Laboratory ServicesLaboratory Services

MedicineMedicine

MidwiferyMidwifery

NutritionNutrition

NursingNursing

PharmacyPharmacy

PhysiotherapyPhysiotherapy

Occupational therapyOccupational therapy

Recreation TherapyRecreation Therapy

Respiratory TherapyRespiratory Therapy

Speech Language Speech Language

Social workSocial work

Spiritual CareSpiritual Care

Veterinary SciencesVeterinary Sciences

NEW VISIONNEW VISION

COLLABORATIONCOLLABORATION

Collaborative patient-centered practice is Collaborative patient-centered practice is designed to promote the active designed to promote the active participation of several health care participation of several health care disciplines and professions. It enhances disciplines and professions. It enhances patient-, family-, and community-centred patient-, family-, and community-centred goals and values, provides mechanisms for goals and values, provides mechanisms for continuous communication among health continuous communication among health care providers, optimizes staff care providers, optimizes staff participation in clinical decision making participation in clinical decision making (within and across disciplines), and fosters (within and across disciplines), and fosters respect for the contributions of all respect for the contributions of all providers.providers.

Health Canada, 2003Health Canada, 2003

FINDING THE BALANCEFINDING THE BALANCENEW PARADIGMNEW PARADIGM

All health professionals retain their All health professionals retain their high degree of competence and high degree of competence and individual professional identities individual professional identities

All health professionals develop the All health professionals develop the capacity tocapacity towork happily and productively work happily and productively

together together be knowledgeable about and confident be knowledgeable about and confident

in one another’s contributions to in one another’s contributions to health and community service teamshealth and community service teams

Committee on Collaborative Health Committee on Collaborative Health Professional Professional

Education and Research – MUNEducation and Research – MUN

SPECTRUM OF INTER-SPECTRUM OF INTER-PROFESSIONALISMPROFESSIONALISM

PRESENT IN MOST HEALTH PRESENT IN MOST HEALTH ORGANIZATIONSORGANIZATIONS

Climate of mutual respect and trustClimate of mutual respect and trust CooperationCooperation = formal communication, = formal communication,

independent decision-makingindependent decision-makingShared information Shared information ConsultationConsultation

CoordinationCoordination = defined roles, some = defined roles, some shared decision-makingshared decision-making

Shared vision, goals and planningShared vision, goals and planningShared resourcesShared resources

SPECTRUM OF INTER-SPECTRUM OF INTER-PROFESSIONALISMPROFESSIONALISMABSENT IN MOST HEALTH ORGANIZATIONSABSENT IN MOST HEALTH ORGANIZATIONS

CollaborationCollaboration = defined roles, = defined roles, frequent communication, shared frequent communication, shared decision-making, one systemdecision-making, one system

Teamwork – specific tasks, patient-Teamwork – specific tasks, patient-centeredcentered

Collective responsibility – Collective responsibility – organizational integration organizational integration

Shared leadership, control, risk Shared leadership, control, risk and accountabilityand accountability

OUTCOMES SOUGHTOUTCOMES SOUGHT

Health professional graduates, Health professional graduates, comfortable and experienced in working comfortable and experienced in working together, who will create and staff together, who will create and staff collaborative teamscollaborative teams

New knowledge, skills and attitudes that New knowledge, skills and attitudes that transcend traditional disciplinary and transcend traditional disciplinary and professional boundaries, derived from professional boundaries, derived from collaborative research and inter-collaborative research and inter-professional education and practiceprofessional education and practice

Exemplary practice models by which Exemplary practice models by which teams of health and community service teams of health and community service professionals provide a range of services professionals provide a range of services

Committee on Collaborative Health Committee on Collaborative Health Professional Education and Research – MUNProfessional Education and Research – MUN

IMPLICATIONS FOR IMPLICATIONS FOR UNIVERSTY PLANNINGUNIVERSTY PLANNING

Articulation of new direction in values Articulation of new direction in values statements, strategic priorities and statements, strategic priorities and explicit goalsexplicit goals

Faculties and Schools collaboratively Faculties and Schools collaboratively offering programs of professional study offering programs of professional study

Practice experience in model Practice experience in model environments representative of the environments representative of the people and communitiespeople and communities

Curriculum elements (modules, courses, Curriculum elements (modules, courses, and programs) to prepare students to and programs) to prepare students to derive the greatest benefit from their derive the greatest benefit from their collaborative practice experiences collaborative practice experiences

IMPLICATIONS FOR IMPLICATIONS FOR UNIVERSTIESUNIVERSTIES

Environment that draws together students, Environment that draws together students, professional staff, faculty members, and health professional staff, faculty members, and health and community service professionals and and community service professionals and facilitates their engagement in basic and applied facilitates their engagement in basic and applied collaborative inter-professional researchcollaborative inter-professional research

Non-hierarchical environment of “learning Non-hierarchical environment of “learning together” in which students in the participating together” in which students in the participating professional programs will learn from one professional programs will learn from one another: another: the value of collaborative inter-professional the value of collaborative inter-professional

contributions and inter-dependencies in the provision of contributions and inter-dependencies in the provision of services and programs both to individuals and to services and programs both to individuals and to communities communities

knowledge of and respect for the particular knowledge of and respect for the particular competencies of each professioncompetencies of each profession

Committee on Collaborative Health Committee on Collaborative Health Professional Education and Research – MUNProfessional Education and Research – MUN

BARRIERSBARRIERS Silo structures and long-standing disciplinary Silo structures and long-standing disciplinary

boundaries among and across the professions boundaries among and across the professions Differences in history and culture, language and Differences in history and culture, language and

jargon, schedules and professional routinesjargon, schedules and professional routines Historical inter-professional and intra-Historical inter-professional and intra-

professional rivalries professional rivalries Varying levels of preparation, qualifications and Varying levels of preparation, qualifications and

statusstatus Differences in requirements, regulations and Differences in requirements, regulations and

norms of professional education norms of professional education Fears of diluted professional identity Fears of diluted professional identity Differences in accountability, payment and Differences in accountability, payment and

rewards rewards Concerns regarding clinical responsibilityConcerns regarding clinical responsibility

Headrick, Wilcock & Batalden (1998)Headrick, Wilcock & Batalden (1998)

CHALLENGESCHALLENGES

Lack of funding to review curriculum and teaching Lack of funding to review curriculum and teaching methods and to make needed changes methods and to make needed changes

Lack of funding for student placement, transportation, Lack of funding for student placement, transportation, and model site expansionand model site expansion

Overly crowded curricula and competing demands Overly crowded curricula and competing demands Lack of an evidence base assessing the impact of Lack of an evidence base assessing the impact of

changes in teaching methods or curriculum changes in teaching methods or curriculum Fragmented responsibilities for undergraduate and Fragmented responsibilities for undergraduate and

graduate education graduate education Little integration across oversight processes, including Little integration across oversight processes, including

accreditation, licensing, and certification accreditation, licensing, and certification Unsupportive culture and norms in health professions Unsupportive culture and norms in health professions

education education Emphasis on research and patient care in many Emphasis on research and patient care in many

academic settings, with little reward for teachingacademic settings, with little reward for teaching Insufficient channels for sharing information and best Insufficient channels for sharing information and best

practices practices Lack of faculty and of faculty developmentLack of faculty and of faculty development

NEW JOURNEYNEW JOURNEY

CULTURE CHANGECULTURE CHANGE

Culture is dynamic and changing Culture is dynamic and changing over timeover time

Most individuals are able to adapt: Most individuals are able to adapt: some have a greater facility to some have a greater facility to accommodate otherness in their accommodate otherness in their internal meaning structure than internal meaning structure than othersothers

The need for change may be The need for change may be driven by survival or passiondriven by survival or passion

NATURE OF NATURE OF CULTURAL ISSUESCULTURAL ISSUES SystemicSystemic: Pervasive throughout the : Pervasive throughout the

organization usually based in polices, organization usually based in polices, procedures, and organizational procedures, and organizational structures structures

LocalLocal: As cultures within cultures : As cultures within cultures naturally form, practices, traditions, and naturally form, practices, traditions, and norms emerge that are unique to a work norms emerge that are unique to a work group (e.g., profession, program, group (e.g., profession, program, facility) facility)

IndividualIndividual: persons bring their own : persons bring their own values, philosophies, and biases to the values, philosophies, and biases to the organizationorganization

The Winters Group, Inc. (2001)The Winters Group, Inc. (2001)

CHALLENGE OF CULTURE TRANSFORMATION

OTT Management Consultants

KEYS TO CULTURAL KEYS TO CULTURAL TRANSFORMATIONTRANSFORMATION

ScanningScanning the environmentthe environment DeterminingDetermining implications implications RevisitingRevisiting the missionthe mission BanningBanning the old hierarchy and building the old hierarchy and building

flexible, fluid structures and systemsflexible, fluid structures and systems Challenging Challenging – – questioning every policy, questioning every policy,

practice, procedure, and assumptionpractice, procedure, and assumption CommunicatingCommunicating with a few powerful, with a few powerful,

compelling messagescompelling messages DispersingDispersing the responsibilities of the responsibilities of

leadership leadership Frances HesselbeinFrances Hesselbein

NEW PROMISENEW PROMISE

LEADERS ACT WISELYLEADERS ACT WISELY

With KnowledgeWith Knowledge At all LevelsAt all Levels

StrategicallyStrategicallyTacticallyTacticallyOperationallyOperationally

CollaborativelyCollaboratively

LEADERS ACT LEADERS ACT PASSIONATELYPASSIONATELY

IntentionallyIntentionally PersistentlyPersistently RelationallyRelationally

LEADERS ACTLEADERS ACTCOURAGEOUSLYCOURAGEOUSLY

As catalystsAs catalysts Knowing vulnerabilityKnowing vulnerability Caring for self and othersCaring for self and others

LEADERS AS CATALYSTSLEADERS AS CATALYSTS

Manage diversity, be inclusive Manage diversity, be inclusive Respond within changing social realitiesRespond within changing social realities Understand globalization and health Understand globalization and health

care reformcare reform Reintroduce values of flexibility, Reintroduce values of flexibility,

discovery and innovation – stretch into discovery and innovation – stretch into new ways of thinking, allow creativity, new ways of thinking, allow creativity, questions, riskquestions, risk

Interconnect practice, education, Interconnect practice, education, research and administrationresearch and administration

Tell storiesTell stories Re-inspire spiritRe-inspire spirit

NEW HOPENEW HOPE

READINESS TO RESPONDREADINESS TO RESPOND

Awareness of complexityAwareness of complexity Skills developmentSkills development Strengths of traditionStrengths of tradition Emotional preparednessEmotional preparedness ReflectionReflection Ceremonies and celebrationCeremonies and celebration SymbolsSymbols Confidence/convictionConfidence/conviction

IMAGE OF COLLABORATIONIMAGE OF COLLABORATION

I’m sittin’ on my stage-head lookin’ out at I’m sittin’ on my stage-head lookin’ out at where Skipper Joe Irwin’s schooner is where Skipper Joe Irwin’s schooner is ridin’ at her moorin’ … thinkin’ about ridin’ at her moorin’ … thinkin’ about how weak are the things that try to pull how weak are the things that try to pull people apart – differences in colours, people apart – differences in colours, creeds and opinion – weak things like creeds and opinion – weak things like the ripples tuggin’ at the schooner’s the ripples tuggin’ at the schooner’s chain. And thinkin’ about how strong chain. And thinkin’ about how strong are the things that hold people together are the things that hold people together – strong, like Joe’s anchor, and chain, – strong, like Joe’s anchor, and chain, and the good holdin’ ground below.and the good holdin’ ground below.

Ted Russell, Ted Russell, The Holdin’ GroundThe Holdin’ Ground

A BLESSING FOR EQUILIBRIUMA BLESSING FOR EQUILIBRIUM

Like the joy of the sea coming home to shore,Like the joy of the sea coming home to shore,May the music of laughter break through your May the music of laughter break through your soul.soul.

As the wind wants to make everything dance,As the wind wants to make everything dance,May your gravity be lightened by grace.May your gravity be lightened by grace.

Like the freedom of the monastery bell,Like the freedom of the monastery bell,May clarity of mind make your eyes smile.May clarity of mind make your eyes smile.

As water takes whatever shape it is in,As water takes whatever shape it is in,So free may you be about who you become.So free may you be about who you become.

As silence smiles on the other side of what’s said,As silence smiles on the other side of what’s said,May a sense of irony give you perspective.May a sense of irony give you perspective.

As time remains free of all that it frames,As time remains free of all that it frames,May fear or worry never put you in chains.May fear or worry never put you in chains.

May your prayer of listening deepen enoughMay your prayer of listening deepen enoughTo hear in the distance the laughter of God.To hear in the distance the laughter of God.

John O’Donohue, Benedictus – A Book of BlessingsJohn O’Donohue, Benedictus – A Book of Blessings