As Canadian health care takes steps to restructure and improve, I am regularly reminded of the importance of interprofessional collaboration (IPC) and the incorporation of interprofessional education (IPE) into health discipline curriculums.
IPC, the integrated practice of two or more professional disciplines, has been recognized by the World Health Organization (WHO) as an innovative strategy for mitigating global health crises (including ongoing health workforce shortages) and addressing increasingly complex health challenges (Grymponpre et al., 2021; World Health Organization [WHO], 2010). More than just multiple disciplines in a shared space, IPC strengthens patient experience and improves individual and population outcomes through the development of shared goals, consistent and standardized measurement and evaluation, provider willingness to engage and consult (both with patients and across disciplines) and fostering of mutual respect (Green & Johnson, 2015; WHO, 2010). IPC presents many benefits to health and broader sectors, including a reduction in rates of rehospitalization, improved self-management of chronic and complex conditions, and overall reduction in health spending and cost of care (Grymonpre et al., 2021; WHO, 2010). At an individual level, patients report higher satisfaction, better acceptance of care, and positive perception of outcomes and future health trajectory following the provision of care in an IPC-supported environment (Green & Johnson, 2015; WHO, 2010). Additionally, IPC opens the door to move beyond a biomedical focus in primary and hospital care – allowing for the input and time of multiple disciplines to explore and address patient experiences of the broader social determinants of health (Green & Johnson, 2015).
To move towards a fuller integration of IPC in health care, restructuring of the current health system as well as support from other sectors will be necessary (Green & Johnson, 2015; WHO, 2010). WHO provides a framework of steps to be taken, shown in the table below:
A critical first step is the integration of IPE into the curriculums and ongoing professional development of health disciplines (Grymonpre et al., 2021). IPE involves multiple professional backgrounds learning about, with, and from one another in effort to improve collaboration and quality of care and create a workforce for whom collaboration on interprofessional teams is the standard rather than the exception (Grymonpre et al., 2021; WHO, 2010). The integration of IPE has been shown to foster respect and eliminate harmful stereotypes and power struggles between professions and evoke greater patient-centeredness in care (WHO, 2010). However, lacking accreditation and standardization, IPE can become a health curriculum afterthought for many disciplines, with its inclusion often being the result of individual champions and subject-matter experts (Grymonpre et al., 2021). Additionally, IPE (and more broadly IPC) is often criticized in medical fields as being values based (rather than outcomes based) which makes support, change, and adherence difficult to achieve and sustain (Grymonpre et al., 2021).
In my research I have discovered that, in response to the concern for affordability and sustainability of the health system, Canada has been a leader in IPE and IPC (Grymonpre et al., 2021). Multiple levels of government have been known to reward IPE and IPC initiatives with greater resources, funding, and weight given to presented findings (Green & Johnson, 2015). Included in these initiatives has been the Accreditation of Interprofessional Health Education Project which seeks to legitimize and secure IPE across health education disciplines in support of future, sustained health system reform and improvement (Grymonpre et al., 2021). An additional initiative that hits a little closer to my physical and professional home is the introduction by the Ontario Government of Ontario Health Teams (OHTs).
In an effort to restructure the provincial health system to provide better integrated and collaborative care, the Ontario Government introduced OHTs in 2019. At maturity, OHTs are expected to incorporate patient care across disciplines and care environments (including, but not limited to, primary care, hospitals, palliative care, mental health and addictions, long-term care, and other social and community services) to allow for a seamless care experience and minimized duplication as it relates to investigations, treatments, and referrals (Government of Ontario, n.d.). OHTs are expected to better coordinate individual care and assist with health system navigation, referral management, and use of and access to digital health (Government of Ontario, n.d.). These teams should, once fully established, offer collaborative health care service to 95% of Ontarians (Government of Canada, n.d.). Admittedly, I find details on OHTs to be a bit unclear at this time. Provincial descriptions sound promising, and I applaud the use of IPC towards health improvement in the province, but there exists much to be done in terms of implementation, evaluation, and outcome measurement before this Ontarian will be fully convinced. Specifically, clarity is needed surrounding how each OHT will address, prioritize, and manage locally identified needs (no overarching governance structure is being mandated at this time), and how the needs of traditionally marginalized and underserved populations will be addressed within the OHT framework (as an example, will specific attention be paid to Indigenous care, and will support that is Indigenous-designed and led be integrated within each OHT geography?) (Government of Ontario, n.d.).
OHTs excluded (for now), the integration of IPC and IPE into health care and related curriculums is an exciting approach to future health. I am hopeful that, with continued championing of these processes within and across the health system, existing practices and provider attitudes will transform, and legislation be enacted, that supports a more social and collaborative model of care delivery and understanding of health as more than absence of disease.
References
Government of Ontario (n.d.). Improving health care in Ontario. https://www.ontario.ca/page/improving-health-care-ontario?_ga=2.115460038.1967318726.1642890982-1928674246.1642618499
Green, B. N., & Johnson, C. D. (2015). Interprofessional collaboration in research, education, and clinical practice: Working together for a better future. Journal of Chiropractic Education, 29(1), 1–10. https://doi.org/10.7899/jce-14-36
Grymonpre, R. E., Bainbridge, L., Nasmith, L., & Baker, C. (2021). Development of accreditation standards for interprofessional education: A Canadian case study. Human Resources for Health, 19(1). https://doi.org/10.1186/s12960-020-00551-2
World Health Organization (2010). Framework for action on interprofessional education & collaborative practice. https://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf?sequence=1&msclkid=a12c6250ab8611eca239aed3bfbe9e16
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