Improving Continuity of Care: An Innovative Primary Care Role in an Acute Care Hospital.

This article describes an innovative organization-spanning collaboration between primary care and acute care in Calgary to support continuity of care for patients with complex needs. Mosaic Primary Care Network provides funding for a primary care navigation nurse to work at the Peter Lougheed Centre, an Alberta Health Services hospital. This role supports hospital in-patients with discharge planning, linking to family physicians and connecting to programs that provide support in the community to vulnerable populations. The commitment of leadership from both organizations was critical for getting this unique role implemented.

Organizational factors influencing inter-professional team functioning in primary care networks.

This study examined organizational factors influencing the functioning of inter-professional teams in select primary care networks (PCNs) in Alberta. Seven PCNs participated, each identifying two teams to be interviewed. The study used an exploratory qualitative approach to collect information from 118 physicians, managers and other clinical and non-clinical staff. Organizational factors affecting these teams included leadership and workplace culture, physical infrastructure, information technology infrastructure, organizational supports and employment models. The authors offer organizational strategies that enhance inter-professional team functioning based on interviewee recommendations and the existing literature. Further research is needed to link the strategies to measureable outcomes.

The status of accreditation in primary care.

BACKGROUND: One method utilised to improve the quality of health care is accreditation. Although accreditation has been extensively used in the acute care sector, its presence in primary care is limited and so is our understanding of its nature, uptake and associated outcomes. Because acute care and primary care environments are vastly different, our understanding of acute care accreditation cannot simply be translated to primary care. AIM: The purpose of this paper was to explore the current state of primary care accreditation. METHODS: An extensive search was completed examining peer-reviewed and grey literature. In addition, interviews with key stakeholders involved in primary care accreditation were undertaken. RESULTS: From the 501 reviewed abstracts, 62 papers were used in this review in addition to 72 sources from grey literature. Eight interviews were also held with key informants. CONCLUSIONS: In this review of the available literature of accreditation within primary care, it was found that accreditation in this sector is generally non-government funded and voluntary with some countries offering financial incentives. It was evident that there is a dearth of research on the nature and uptake of accreditation in this sector, along with how accreditation affects outcomes of care, whether it is an effective method to improve quality, perceptions of care, healthcare utilisation and costs. These findings imply that further research is required to examine the possible impact accreditation may have on health care within primary care.

Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis.

Many studies examine the impact of interprofessional (IP) interventions on various health practice and education outcomes. One significant gap is the lack of research on the effects of IP interventions on health human resource (HHR) outcomes. This project synthesized the literature on the impact of IP interventions at the pre- and post-licensure levels on quality workplace, staff satisfaction, recruitment, retention, turnover, choice of employment and cost effectiveness. Forty-one peer-reviewed articles and five IECPCP project reports were included in the review. We found that IP interventions at the post-licensure level improved provider satisfaction and workplace quality. Including IP learning opportunities into practice education in rural communities or in less popular healthcare specialties attracted a higher number of students and therefore may increase employment rates. This area requires more high quality studies to firmly establish the effectiveness of IP interventions in recruiting and retaining future healthcare professionals. There is strong evidence that IP interventions at the post-licensure level reduced patient care costs. The knowledge synthesis has enhanced our understanding of the relationships between IP interventions, IP collaboration and HHR outcomes. Gaps remain in the knowledge of staff retention and determination of staffing costs associated with IP interventions vis-à-vis patient care costs. None of the studies reported long-term data on graduate employment choice, which is essential to fully establish the effectiveness of IP interventions as a HHR recruitment strategy.

Strategic approach to building research capacity in inter-professional education and collaboration.

The purpose of this paper is to describe the process used to initiate research capacity building in a community of practice (CoP) focused on the research and evaluation of inter-professional education and collaboration. This CoP, composed of members from across Canada, is a committee of the Canadian Interprofessional Health Collaborative (CIHC), a national collaborative that aims to advance inter-professional education and collaboration in healthcare. The committee mapped recommendations that emerged from a number of CIHC reports onto a research capacity building framework. The expertise of the diverse members in conjunction with this unique mapping process allowed the committee to identify its long-term research and evaluation objectives and strategies. This resulted in the formation of three working groups, each tasked with activities that contribute to the committee's overall goal of building research capacity in inter-professional education and collaboration. A framework provides a structured approach to identifying research and evaluation priorities and objectives. Furthermore, the process of applying the framework engages the committee members in determining the course of action. The process can be easily transferred to other areas in need of research capacity building.

How can frontline managers demonstrate leadership in enabling interprofessional practice?

Interprofessional practice has been proposed to address many of the current health system challenges. Little attention has been paid to the role of frontline managers in supporting effective interprofessional practice. Qualitative interviews suggest that frontline managers can demonstrate leadership in enabling interprofessional practice by creating an organizational culture for interprofessional practice, eliminating barriers to collaboration, and acting as role models and facilitators. New management approaches may be needed to meet these demands.

Collaborative Clinical Placements: Interactions Among Students From Different Programs.

BACKGROUND: Shortages of clinical placements for health care students in Canada have led education and health care organizations to explore innovative ways to increase placement capacity. One way to increase capacity is to bring together students from various programs for their placements, which also allows students to learn about each other's roles and how to work collaboratively. This article describes shared placements for students from bachelor of nursing, practical nurse, and health care aide programs. METHOD: Qualitative interviews were used. RESULTS: Students benefited from this approach by learning about the roles of other providers and how to coordinate care with others. The challenges of the approach were competition among students for opportunities to practice clinical procedures and concerns about how to communicate with other students when sharing the care of patients. CONCLUSION: The objectives of increasing student placement capacity and expanding collaboration opportunities were partially achieved through this approach to clinical education.

Incentives for improving human resource outcomes in health care: overview of reviews.

OBJECTIVES: To review the effectiveness of financial and nonfinancial incentives for improving the benefits (recruitment, retention, job satisfaction, absenteeism, turnover, intent to leave) of human resource strategies in health care. METHODS: Overview of 33 reviews published from 2000 to 2012 summarized the effectiveness of incentives for improving human resource outcomes in health care (such as job satisfaction, turnover rates, recruitment, and retention) that met the inclusion criteria and were assessed by at least two research members using the Assessment of Multiple Systematic Reviews quality assessment tool. Of those, 13 reviews met the quality criteria and were included in the overview. Information was extracted on a description of the review, the incentives considered, and their impact on human resource outcomes. The information on the relationship between incentives and outcomes was assessed and synthesized. RESULTS: While financial compensation is the best-recognized approach within an incentives package, there is evidence that health care practitioners respond positively to incentives linked to the quality of the working environments including opportunities for professional development, improved work life balance, interprofessional collaboration, and professional autonomy. There is less evidence that workload factors such as job demand, restructured staffing models, re-engineered work designs, ward practices, employment status, or staff skill mix have an impact on human resource outcomes. CONCLUSIONS: Overall, evidence of effective strategies for improving outcomes is mixed. While financial incentives play a key role in enhancing outcomes, they need to be considered as only one strategy within an incentives package. There is stronger evidence that improving the work place environment and instituting mechanisms for work-life balance need to be part of an overall strategy to improve outcomes for health care practitioners.

Models in interprofessional education: the IP enhancement approach as effective alternative.

OBJECTIVE: This article discusses the strategies and challenges of implementing interprofessional education interventions with students from different disciplines. It reviews two models of interprofessional education in academic prelicensure curricula including the extra-curricular and the crossbar models by considering ease of implementation, program reach and sustainability. It also introduces the interprofessional enhancement approach as an additional curriculum development strategy. RESULTS: The Alberta Interprofessional Education for Collaborative Patient-Centred Practice project used the Interprofessional Enhancement Approach by integrating course content into existing placement courses for nursing, respiratory therapy, pharmacy, and physiotherapy students. The students conducted their regular discipline-specific placements at various clinical sites in southern Alberta, Canada that were supplemented by three interprofessional strategies: mentoring, workshops and online discussions. The intervention reached over sixty individuals including students, preceptors and faculty. CONCLUSION: As compared to other approaches (extra-curricular and crossbar models), this approach shows that IP course content can be added to placement courses without restructuring complete curricula. This article intends to initiate further discussions about different IP education models in prelicensure education.

Interprofessional mentoring: enhancing students' clinical learning.

Interprofessional (IP) collaboration is recognized as critical for patient-centred care. The clinical setting is an ideal environment for students to learn the competencies required to effectively work with providers from other professions. To enhance traditional clinical placements, we propose an IP mentoring approach, defined as learning that takes place between providers and students who are from different disciplines or health professions. In IP mentoring, students have primary relationships with their preceptors, but also have interactions with providers from other professions. We implemented IP mentoring with the support of two faculties of nursing in Alberta, Canada who provided an IP clinical focus for interested fourth year students. We emphasized to providers and students that there are no prescribed interactions that comprise IP mentoring; experiences between providers and students are context-specific and often informal. Through our evaluation we demonstrated that in IP mentoring, provider commitment was important, students engaged in IP activities of varying complexity, and students learned about roles of other professions and how to work together to provide patient-centred care. IP mentoring is an effective learning strategy to enhance students' knowledge and skills in IP collaboration without radical changes to the structure of the placements or to the educational curricula.