Improving Patient Care by Using Simulation to Empower Health Professional Preceptors and Mentors to Practice Collaboratively:

A Health Workforce Action Plan InitiativeIrina Charania RRT, BSc(Hons), Alyshah Kaba MSc, Resident PhD(c),

Mirette Dube RRT, MSc, Jennifer Loken RN, BN, Marlene Donahue RN, MN,Ian Wishart MD, Steven Lopushinsky MD, MSc, FRCSC

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Defining the Gap

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Across Alberta healthcare providers report they lack the skills related to interprofessional competencies to be effective preceptors and mentors.

In order to move towards collaborative care delivery, healthcare teams must be collectively competent. Team members must move from thinking and acting as individuals to thinking and acting as a team.

Dr. Lorelei Lingard - Collective Competence, TEDxBayfield

A simulation based intervention was designed to help achieve this.

Patients receive care from interprofessional teams in a variety of settings.

Unfortunately there is a paucity of opportunities for practicing healthcare professionals to gain proficiency in Interprofessional Collaboration through deliberate practice followed by reflection, especially outside of critical care areas.

Interprofessional teams of preceptors and mentors were recruited from three Medical/Surgical Units across AHS to participate in this intervention.

Our Goal

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Unit 201 Pediatric Rehabilitation - Glenrose Rehabilitation Hospital

Unit 44 Adult Trauma -Foothills Medical Centre

Pincher Creek Hospital

Simulations Activities Debriefing

The Intervention

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• Invested Interest in Collaborative Practice

• Preceptors and Mentors • Simulation Expertise• One Unit per Zone

Post-Intervention IP Skills

Pre-Intervention IP Skills

Higher Order Thinking Skills

Lower Order Thinking Skills

eLearning Module(pre-learning)

Simulations and

Activities

Debriefing Post-testPre-test

1 Baker, D.P, Krokos, K.J., Amodeo, A.M. (2008). TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) Manual. Washington, DC, U.S. Department of Defense, Tricare Management

2 Malec, J.,Torsher, L., Dunn, W. et al. (2007). The Mayo high performance teamwork scale (MHPTS): reliability and validity for evaluating key crew resource management skills. Simul Healthc, 2, 4–10

3 Marshall D., Hall P., Taniguchi A., Boyle A. (2008). Team OSCEs: Evaluation Methodology or Educational Encounter? Medical Education, 42(11):1129-30.

66 preceptors and mentors, representing 15 professions (17% Physicians, 47% Nurses, 36% Allied Health) completed all components of the intervention.

Results

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MD

PTOT SW RRTPsychologyPharmacyEMTEMT-PRec TherapySLP

RN NPLPN

Knowledge Attitudes: T-TAQ1 Behaviours: MHPTS2 and TOSCE3

A significant change was seen in participants’ knowledge, attitudes and behaviour performance related to collaborative teamwork competencies (p< 0.05)

1 Baker, D.P, Krokos, K.J., Amodeo, A.M. (2008). TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) Manual. Washington, DC, U.S. Department of Defense, Tricare Management2 Malec, J.,Torsher, L., Dunn, W. et al. (2007). The Mayo high performance teamwork scale (MHPTS): reliability and validity for evaluating key crew resource management skills. Simul

Healthc, 2, 4–103 Marshall D., Hall P., Taniguchi A., Boyle A. (2008). Team OSCEs: Evaluation Methodology or Educational Encounter? Medical Education, 42(11):1129-30.

We were able to demonstrate not only a change in behaviours, we were also able to change underlying attitudes about patient safety:

Patient Safety

“Without this experience I would have just kept doing what I have been doing, without learning from it.”

“It has increased my ability to question, clarify and report back on medication orders.”

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Teams that show a high degree of collective competence are able to more safely and efficiently address patient care needs and mitigate adverse events.

Dr. Lorelei Lingard - Collective Competence, TEDxBayfield

(Rudolf et al., 2007)

The role of the patient as part of the collaborative team was emphasized throughout the intervention:

Partnership

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“I now have increased confidence to speak up and advocate for patients in difficult

situations.”

“If patients see you working together as a team it increases their trust in you.”

“I am more inclined to follow-up about missing orders, leading to timely treatment and decreased length of stay.”

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Our intervention suggests that a targeted IPE simulation based intervention results in a changes in attitudes, knowledge, and behaviours, specific to collaborative practice.

Central to our mandate is aligning this initiative with the stakeholders. Plans are currently underway to develop a sustainability plan for this initiative, including dissemination of educational resources.

Lessons Learned

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