Leading Change Collaboratively: Enhancing Interprofessional Practice

and Patient-Centred Care

National Health Leadership Conference June 10, 2013

Collaborative Leadership Initiative

• Background

• Overview

• Evaluation

– Outcomes

– Critical Success Factors

• Next Steps

• Parting Thoughts

Background

• Interprofessional Practice (IPP) has positive impacts on the health care system and those in it

• Health care professionals working in teams does not necessarily ensure collaborative practice

• With this in mind the Collaborative Leadership Initiative (CLI) was developed and piloted at St. Joseph’s Care Group (SJCG), Thunder Bay, ON

Interprofessional Practice

Occurs when practitioners from two

or more professions work together with a

common purpose, commitment and mutual respect

(World Health Organization, 2010)

CLI Overview – Purpose

For clinical teams to discover "the best of

what is" around interprofessional

practice and create opportunities to

enable it to occur more frequently

Goals

CLI Goals

Improve team

function & processes

Improve patient-

centred care

Improve staff satisfaction

Achieve project

sustainability

Participants

• Three clinical teams:

– Acquired Brain Injury

– Adult and Older Adult Rehabilitation

– Day Hospital

• All teams consisted of six or more professions, and included the manager

Clinical Team Sessions

• Each team, including the manager, participated in three sessions, facilitated by the project leads

• Sessions were

– Three hours in length

– Occurred over 3-5 months

– Designed and delivered using Appreciative Inquiry and emergent change methodology

Appreciative Inquiry (AI)

Is a group process that inquires into, identifies, and further develops the best of ‘what is’ in

organizations in order to create a better future

(Preskill & Tzavaras Catsambas, 2006)

Appreciative Inquiry

• Purposely positive / generative

• Builds on past successes

• Grass roots and top down

• Highly participative

• Nurtures a positive inner dialogue

• Stimulates vision and creativity

• Accelerates change (Cooperrider et al, 2008)

Appreciative Inquiry – 4 D Model

Discover

Dream

Design

Destiny

(Preskill & Tzavaras Catsambas, 2006)

Emergent Change Theory

• Change that unfolds in an apparently spontaneous and unplanned way

• Flexible and adaptive to re-navigate

• Usually a grass roots change

(Collaborative Change Leadership Faculty, 2009)

Overview – Clinical Team Sessions

Session 1

Reflected on IPP at its

best

Session 2

Envisioned ways to

enhance IPP

Session 3

Designed goals and action

plans based on emerging themes

Post-sessions

Teams collaboratively led meaningful and sustainable

change

IPP – Interprofessional Practice

Evaluation

• Qualitative data collection was completed six months

following the final facilitated session, and consisted of:

– Team interviews

– Paired interviews

– Managers’ interview

– Individual anonymous questionnaire

• Design – considered if there was a difference as well as

how the difference had been achieved

Evaluation

All teams led change collaboratively, developing and implementing goals that enhanced

interprofessional practice while achieving the project goals to:

Improve team function & processes

Improve patient-centred care

Improve staff satisfaction

Achieve project sustainability

Outcomes

Improved patient-centred care

– Enhanced patient and family involvement in care plans and program development

– Follow-up clinic created

– Interprofessional documentation developed

– Patient pamphlets revised

– Improved environment

“The follow-up clinic is allowing us to see clients that we normally

wouldn’t be able to... the ones that live out of the region.”

Outcomes

Improved team function, processes and engagement

– Increased trust, pride, collaboration, communication and understanding of roles and responsibilities

– Employee orientation revised

– Team norms established

– Daily huddles created

“The CLI has been incredibly valuable in supporting team growth and development, with a closer, more respectful team; with improved

communication, client care has greatly improved. We now have more skills to further develop as a team and continue to improve.”

Outcomes

Improved staff satisfaction

• Increased:

– Morale

– Respect

– Pride

– Excitement

– Energy

“The CLI enhances job satisfaction, flow of programs, client care… you

feel like you want to come to work… you make positive changes.”

Outcomes

Project sustainability

• Team members:

– Valued IPP

– Expressed a strong interest in and commitment to engage in ongoing quality improvement

– Were empowered and recognized themselves as change leaders

“I think we have more skills and strategies to use now going forward, but

just that awareness of change and the opportunity of change I think is greater

in this group… and you know, the willingness to change... we can look to

be better and ultimately for our clients.”

Critical Success Factors

1. Clear, common team direction – by developing realistic team goals collaboratively

2. Sense of accomplishment – by achieving team goals together

3. Engagement – to create change leaders within and beyond the project

4. Effective change model – Appreciative inquiry and emergent change

5. Facilitators 6. Time to meet

Critical Success Factors

1. Clear, common team direction – by developing realistic team goals collaboratively

“It’s a much stronger process when we can do it as a team, when everybody’s on board, when everybody’s working

towards the same goal”

Critical Success Factors

2. Sense of accomplishment – by achieving team goals together

“I felt it was certainly a ‘team’ effort; working

together to reach goals was very rewarding”

Critical Success Factors

3. Engagement – to create change leaders within and beyond the project

“Attitudes towards change (have improved)…we’re taking better advantage of opportunities that present themselves for change”

Critical Success Factors

4. Effective change model – Appreciative inquiry and emergent change

“…the focus is on the solutions,

not on the issues”

“(AI) recognizes that we’re not approaching change as a

remediation or deficit”

Critical Success Factors

5. Facilitators

“…in the room when everybody was talking and the way the facilitation was happening, it was amazing to see the team work together as this moving

unit… It doesn’t just happen, it needs to be fostered and it needs

to be worked at”

Critical Success Factors

6. Time to meet

“It got everyone together in the same place, at the same time, and

for a single purpose – It created the space in an otherwise

scheduled work day, to reflect and brainstorm something new”

Next Steps – Program Expansion

• 9-12 clinical and non-clinical teams in 2013-14 • Purpose: For teams to enhance collaborative teamwork

and create opportunities to enable it to occur more frequently

• Approach: Appreciative Inquiry and emergent change • Structure: One manager prep session; Three half day

team sessions (including managers), once monthly, over three consecutive months

• Evaluation – Quantitative – Pre/Post (6 months post) staff satisfaction

survey and Bruyѐre Team Self-Assessment Scale – Qualitative – Questionnaire (immediately and 6 months

post)

Parting Thoughts

When looking to lead change, consider the following:

• All staff, regardless of title, have the potential to contribute to and become leaders of change

• The organizational development methodology / change model matters… and will affect success

• Natural facilitators exist within organizations and can be highly effective in advancing change

• Creating the time and opportunity for key stakeholders to collaborate towards change in a meaningful way can improve ownership and sustainability of change

Audacity to imagine helps push the boundaries of possibility

Success will be great if we dare to overcome fear and take a risk

Bertrand Picard

Adora Svitak

Questions…

Thank you

Michelle Addison Professional Practice Leader, Physiotherapy St. Joseph’s Care Group, Thunder Bay, ON

addisonm@tbh.net

Special Thanks Linda Belcamino, Manger Learning and Professional Practice

Meaghan Sharp, VP Complex Care and Physical Rehabilitation Services & CNO Acquired Brain Injury Program

Adult and Older Adult Rehabilitation Programs Day Hospital Program

Interprofessional Working Group

References Collaborative Change Leadership Faculty, Centre for Interprofessional

Eduction, University of Toronto, 2009.

Cooperrider, D., Whitney, D., Stavros, J. (2008). The Appreciative Inquiry Handbook: For Leaders of Change. Brunswick, OH, USA: Crown Custom Publishing.

Preskill, H. & Tzavaras Catsambas, T. (2006). Reframing Evaluation Through Appreciative Inquiry. Thousand Oaks, CA, USA: Sage Publications

World Health Organization. (2010). Framework for Action on Interprofessional Education & Collaborative Practice. Health Professions Networks Nursing and Midwifery Human Resources for Health. Retrieved March 27, 2012 from http://www.cihc.ca/files/Framework%20for%20Action%20on%20Interprofessional%20Education%20and%20Collaborative%20Practice.pdf