VCH Interprofessional Collaboration Project Staff Component

VCH Interprofessional Collaboration Project
Staff Component
FINAL REPORT
January 8, 2008
Kim Dougherty, RN, M.A., Director – Professional Practice, Nursing VA
Marcia Choi, M.Sc. SLP (C), Project Coordinator
Acknowledgements
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Interprofessional Education for Collaborative Patient-Centred Practice ( IECPCP)
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Health Canada
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Interprofessional Network of British Columbia
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College of Health Disciplines, University of British Columbia
§
Memorial University of Newfoundland’s Centre for Collaborative Health Professional
Education
This project would not have possible without the generosity and interest of staff, students and
leaders at G. F. Strong Rehabilitation Centre, Vancouver, B.C especially;
Karin Alzner, Gail Allison, Karen Anzai, Rida Baruni, Jo-Anne Burleigh, Robyn Butler, Sonia
Calayan, Jean Carr, Caren Carlaw, Darryl Caves, Carol Chao, Patricia Cifuentes, Marion
Clauson, Hilary Cole, Dawn Coney, Linda Denham, Colleen Fallon, Alyson Ford, Naomi Franks,
Cynthia Fraser, Mary Gagnon, Gina Galway, Lesley Grant, Jenna Haylock, Erin Hartnett, Lara
Heller, Barbara Henn-Pander, Bev Hills, Jonathan Ho, Lesley Houle, Anne Houseman, Barb
Hughes, Jeannie James, Helena Jung, Christiane Kilpatrick, Anna Krzyzanowski, Annette
Lange, Marilyn Laplante, Walt Lawrence, Aaron Li, C.S. Ling, Susan Louie, Catherine McAuley,
Mary McKinnon, Kathy MacPherson, Richard Macklin, Dianna Mah-Jones, Caroline Marcoux,
Hilary Matson, Jane Millard, Trevor Moizumi, Cathy Nevens, Rosemary Ng, Kelly Oliver, Cathy
Petry, Avchen Pinkard, Debbie Pugh, Kathy Puri, Jenny Puterman, Summer Reveley, Douglas
Ritchie, Kailey Ross, Sarah Rowe, Anne Salumay, Ina Snaterse, Delia Tan, Elsie Tan, Janet
Warren, Carol Wilson, Katherine Wright, Jennifer Yao, Jody Yuzik
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Contents
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
VCH Interprofessional Collaboration Project . . . . . . . . . . . . . . . . . . . . . . . 5
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Improvement Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Follow-up Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Project Learnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Appendix A Description of Occupational Groups . . . . . . . . . . . . . . . . . . . 12
Appendix B Project Activities and Participation . . . . . . . . . . . . . . . . . . . . 13
Appendix C References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
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Background
Practice environment is defined as the organizational characteristics of a practice setting
that support professional clinical practice and the provision of quality patient care. Critical
components of healthy practice environments include empowerment of staff, quality of
leadership (Lowe, 2002; Anderson, Issel, McDaniel, 2003; Requena, 2003) and trusting
relationships between managers and staff (Cohen et al 2003). Teamwork and collaboration
have also been shown as important to patient safety and positive health outcomes
(Zwarenstein and Bryant, 2000; Lundstrom et al., 2002). In addition to benefits to patient
care, healthy practice environments have the capacity to recruit and retain staff during severe
staff shortages, (Kramer, 1990).
Since 2002, Vancouver Coastal Health has conducted four Practice Environment Projects
(PEP) aimed at improving practice environments in Vancouver Acute’s ICU, ASU, Richmond
Perioperative, and UBCH 1A, 1D, 2B, 2C. The purpose of these PEP projects was to assess the
impact of employee-designed interventions on practice environment and client outcomes.
These projects collected baseline and follow-up data on practice environment and institutional
indicators and provided interim support for staff-generated improvement initiatives, staff
education and when indicated, leadership coaching. This report is an overview of the staff
portion of the VCH Interprofessional Collaboration Project at G.F. Strong.
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VCH Interprofessional Collaboration Project
VCH Interprofessional Collaboration Project
The Vancouver Coastal Health Interprofessional Collaboration Project is one of several projects
across British Columbia funded by Health Canada’s initiative, “Interprofessional Education for
Collaborative Patient-Centred Practice” (IECPCP). Hosted by G.F. Strong Rehabilitation Centre,
this project represented an active partnership between the Interprofessional Network of B.C.,
Vancouver Coastal Health, G. F. Strong Rehab Centre and the College of Health Disciplines.
Purpose
While based on previous PEPs, this project’s purpose was to enhance the practice environment
in four GFS Programs (Acquired Brain Injury, Arthritis, Neuromusculoskeletal, Spinal Cord Injury)
to specifically improve collaborative client -centred practice, foster a clinical learning environment
for interprofessional collaboration for students, and determine whether enhancing the IPC
environment can have an impact on staff and client outcomes.
Activities
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baseline and follow-up ‘point in time’ assessment of practice environment and client
satisfaction
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planning and implementation of staff-generated initiatives
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planning, implementation and evaluation of student interventions
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provision of communication workshops to enhance collaborative competency
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facilitation of cross-program learning
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Methodology
Sample
A voluntary convenience sample of inpatient staff including Nursing, Medicine, Allied Health
and Health Care Support was used at both baseline and follow-up (Appendix A: Description
of Occupational Groups). Discharged patients were recruited for voluntary participation in a
client satisfaction survey.
Assessment
Staff perception of practice environment was assessed with a self-administered 108 to 116item questionnaire survey, the “Clinical Practice Environment Assessment Tool” (CPEAT),
compiled by Van Der Wal & Globerman, VCH 2002. The project-relevant areas assessed by
this tool included Values, Decision-making Support, Workload, Resources, Communication
with Leaders, Team Collaboration, Team Conflict and Professional Practice.
At baseline, assessment occurred over 5 months and included focus groups and interviews. At
follow up, assessment was conducted by survey only and occurred over 1 month. Consenting
clients completed the validated “Client Perspectives of Rehabilitation Tool”. This tool surveyed
client perspectives on Client Participation, Client-Centred Education, Evaluation of Outcomes,
Family Involvement, Emotional Support, Continuity and Transition, and Physical Comfort.
Design
This project used a participatory action approach. Staff reviewed baseline data (survey results,
focus and interview results), and identified top priorities for improvement initiatives. Staff
generated initiatives to improve practice environment occurred over 10 months with facilitator
support. After the final report is reviewed, staff and leaders will determine next steps for these
initiatives.
Project timeframe
Project activities occurred over two years spanning October 2005 – December 2007. Staff
members were engaged from October 2006 to November 2007 with follow-up assessment
occurring in October 2007.
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Improvement Initiatives
A facilitator supported staff initiatives and coordinated project communication for staff and
leadership. This role provided support, modelling and leadership for processes involving
frontline interprofessional collaboration.
Top staff priorities for intervention as determined by voting were Workload, Adequate Staffing
(exception of Arthritis), Team Collaboration and Quality of Care.
Based on these priorities, each program’s staff clarified issues and generated initiatives
resulting in the formation of working groups. Initiatives targeted effective interprofessional
collaboration and communication during current/new team meetings and around client
routines, and the development of strategies for managing client role and expectations in
rehabilitation. Staff were also engaged to clarify, problem solve and develop improvements to
team systems and client-centred care.
In addition to these activities, GFS staff and leaders attended communication training around
motivational values and conflict. Disciplines participating included Nursing, Health Care
Support (HCS), Allied Health, Medicine, and Centralized Staff from all programs.
Informal and formal leaders and staff champions were also supported in interprofessional
collaborative practice and a formal leadership session was facilitated on the topic of
supporting staff. Regular project meetings with GFS leaders also served as an important venue
for cross program learning and leadership peer support during the project.
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Follow-up Assessment
At follow-up, staff were again surveyed with the CPEAT during October 2007. Discharged
clients were surveyed with the assistance of Volunteer Resources over three months at project
end.
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Results
For a summary of project activities and participation, see Appendix B.
Overall, GFS staff responders rated their practice environment neutrally or positively at
baseline with the exception of Workload. At follow-up, Allied Health and Medicine reported
more positive ratings of Workload, with Nursing rating it unchanged and Health Care Support
rating it at less positive than at baseline. Allied Health ratings also indicated lower levels of
conflict between team members.
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Project Learnings
10
Staff identified issues related to Workload and Adequate Staffing were beyond project
resources and scope to impact. In retrospect, project strategy should include clarification
of PEP scope and involvement should these emerge as primary staff issues. This same
clarification should be applied when a practice environment project is engaged at the same
time as other large-scale organizational initiatives, as was the case during this project.
The use of the CPEAT as the pre-post assessment tool was time-consuming in administration
and analysis, and valid conclusions were contingent on higher sample rates than achieved at
GFS. A lighter assessment phase may free project resources for greater utilization and impact
during the improvement initiatives phase.
The facilitator role was important for staff support when initiating and ensuring continuity for
staff committees, and communication with leadership.
While staff and clinical educators were actively involved in the project’s Student
Interprofessional Collaboration Placement Experience, future initiatives should incorporate
more opportunities for formal and informal interaction between student and staff
interprofessional activities.
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Conclusions
GF Strong Rehabilitation Centre is a unique environment for practicing and providing
interprofessional collaborative client-centred care. However, this environment, like all health
care environments, is subject to independent organizational and social variables that pose
challenges for staff and leaders
While staff engaged in improvement activities which were aimed at increasing efficiency in
interprofessional contexts and clarifying processes and communication directly or indirectly
impacting clients, quantitative and qualitative results indicate that perception of workload
remains a primary focus for staff.
Communication and managing client expectations emerged as priorities for staff, as
demonstrated in level of interest in formal support, education and facilitation to develop
these areas. It was also apparent that the facilitator role was key towards ameliorating barriers
commonly experienced by front-line staff committees and coordinating communication for
staff and leaders around project activities.
While project activities were shown to enhance the interprofessional collaborative practice
learning environment and outcomes for students (see Final Report : VCH Interprofessional
Collaboration Student Placement Experience), this did not occur with a change in GFS staff
perception of overall practice environment or GFS client satisfaction outcomes. In addition,
enhancement of the interprofessional collaborative-practice learning environment did not
impact already positive staff perceptions of team collaboration at GFS.
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11
Appendix A
Description of Occupational Groups
When referenced in this report, these occupational groups include the following:
Category
12
Occupational Groups Included
Licensed Practical Nurses
Nurse Educators
Nursing
Patient Service Coordinators
Registered Nurses
Liaison Therapists
Music Therapists
Occupational Therapists
Peer Mentors
Physiotherapists
Recreation Programmers and Therapists
Rehab Assistants
Allied Health
Rehab Consultants
Respiratory Therapists
Social Workers
Social Work Assistants
Speech Language Pathologists
Speech Language Pathology Assistants
Artworks
Assistive Technology & Seating Services
Chaplains
Driver Rehab Coordinators
Equipment Specialists
Library Technicians
Neuropsychologists
Centralized Staff Orthotists
Orthotic Assistants
Patient Transport Drivers
Pharmacists
Psychology Testing Technicians
Registered Dieticians
Sexual Health Clinicians
Vocational Rehab Counsellors
Administrative Assistants
Health Care
Patient Care Aides
Support (HCS)
Unit Clerks
Physiatrists, Rheumatologists
Medicine
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Appendix B
Project Activities and Participation
Project Activity
Number
of staff
participating
% of eligible
participants
Dates
Baseline Staff Assessment
149
64.2
Feb–Jun 2006
Baseline Client Satisfaction Survey
59
19.0
Apr 2006–Apr 2007
Facilitator Support
Not Applicable
Not Applicable
Sept 2006–Nov 2007
Communication of Baseline Results
4 Programs
4 Programs
Sept–Oct 2006
Staff Voting on Priorities
103
44.4
Oct 2006
Staff generated initiatives planning
132
56.9
Nov 2006–Jan 2007
Student Interprofessional Placements
(n =33)
11
NA
Jan–Apr 2007
Working Group activities
92
39.7
Jan– Nov 2007
Communication Workshops
135
58.2
Feb–Nov 2007
Leadership Session
19
Not available
May 2007
Follow-up Client Satisfaction Surveys
32
27.3
Aug–Oct 2007
Follow-up Staff Survey
86
37.1
Oct 2007
Closing event
75
32.3
Oct 2007
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13
Appendix C
References
Anderson, RA., Issel, LM., & McDaniel, RR. (2003). Nursing homes as complex adaptive systems: Relationship
between management practices and resident outcomes. Nursing Research, 52(1):12-21
14
Cohen M, Yassi A, Ostry A, Ratner PA, Village J, (OHSAH) OhaSAfH, et al. (2003). Reducing injuries in intermediate
care. Risk factors for musculoskeletal and violence-related injuries among care aides and licensed practical
nurses in Intermediate care facilities. Community Alliance for Health Research (CAHR) project #3.
Kramer, M. (199). The magnet hospitals: Excellence revisited. J. Nurs. Adm, 20, 35-44
Lowe, GS. (2002). High-quality healthcare workplace: A vision and action plan. Hospital Quarterly, 5(4):49-56
Lundstrom T., Pugliese G., Bartley J., Cox J., & Guither C. (2002) Organizational and environmental factors that
affect worker health and safety and patient outcomes. Am. J. Infect. Control 30, 93-106
Requena, F. (2003). Social capital, satisfaction and quality of life in the workplace. Social Indicators Research, 61: 331336
Zwarenstein M. & Bryant W. (2000) Interventions to promote collaboration between nurses and doctors. Cochrane.
Database.Syst.Rev. CD000072
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