Building Team Intelligence (TI) — the capacity of people to learn, think,reflect, and act together — has been a major focus of my research for several years now. In fact, I am writing a book with an airline pilot and medical educator on the aviation safety movement and how it changed aviation culture. The book – Come Fly With Me — considers what those working on quality and safety in health care can learn from the aviation safety movement.
As my colleagues and I have been working on our book, we have been looking at examples of similar transformations in health care settings. We now know that safety –whether in an airplane or an operating room — depends not simply on technical proficiency but on team work and the development of team intelligence. Last week, I saw an impressive example of Team Intelligence in action at the University of Toronto, in Ontario where I had the privilege of learning about the work being done by the University of Toronto’s (U of T) Faculty of Medicine’s Wilson Centre for Research in Education and its Centre for Interprofessional Education . The work these two centres are doing both on their own and in collaboration is fascinating.
Although many Canadian health care researchers had long been interested in promoting inter-professional education and practice, their efforts got a huge boost after the Romanow Report on Building on Values: The Future of Health Care in Canada that was released in 2002 . The Romanow Commission, led by Roy J. Romanow, considered the future health of Canada’s Medicare System. One of its key recommendations was creation of initiatives that would promote Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP). The Canadian federal government took on this challenge by setting aside millions of dollars to fund Interprofessional Education and Practice in Canadian schools of medicine, nursing, pharmacy, dentistry and other health professions. In Ontario, the government added to that federal effort by setting aside money to fund both inter-professional education and practice .
The University of Toronto, with its Wilson Centre and Centre for Interprofessional Education, is at the heart of these efforts. The director of Wilson Centre is Brian Hodges, a psychiatrist who wrote the clinical commentary for Chloe Atkins amazing book My Imaginary Illness: A Journey into Uncertainty and Prejudice in Medical Diagnosis published by our series The Culture and Politics of Health Care Work at Cornell University Press.
Hodges and his colleagues at the Wilson Centre are producing important scholarship on inter-professional education and practice. Maria Tassone, is the director of the Centre for Interprofessional Education where she and her colleagues are putting theory into practice in more ways than one.
The programs that have begun at the U of T offer many lessons to offer those interested in teamwork in health care in the US and elsewhere. All health care faculties at the U of T are now working together to introduce all 1400 of their students to inter-professional education. Each and every student has some contact with students in other schools as well as with interdisciplinary and collaboration in the practice setting. Although the Centre for IPE is working to build capacity so that students can gain inter-professional experience in a serious and sustained way, initial efforts are promising. For example, some students are brought into the hospital and other health care settings in structured placements in which they interact with students from different health care faculties as well as with professionals from different disciplines. Thus, a student in speech language pathology (SLP) told me how she and an occupational therapist collaborated to help a wheel chair bound patient. As the SLP student watched the OT student adjust the patient’s wheel chair, she realized that the patient’s problems with swallowing were eased. She confessed that, without this hands on interdisciplinary experience, she would never have thought of calling on an OT to help with a swallowing problem.
While students engage in activities outside of the practice setting, one of the most interesting aspects of this program is how they interact within it. Bringing students together in an interdisciplinary group within the practice setting has a ripple effect on the setting itself. That’s because Tassone and her colleagues are trying to make sure that what students see in practice doesn’t contradict — or even erase — the lessons they learn in theory.
We all know how the hidden — or not so hidden — curriculum in nursing and medicine and other health disciplines can completely eradicate more positive lessons students may have gotten in the classroom. Thus an RN student will be told that they have a great deal of skill and knowledge only to be confronted by a physician who treats them like little more than a handmaiden. Or a medical student will be told that teamwork is now the mantra in health care only to watch an attending physician bad mouth pharmacists or disregard the contributions of the dietician in the treatment of diabetic patients. To make sure this happens as little as possible, The Centre for Interprofessional Education also targets the faculty whom students will meet in the practice setting. Indeed, the Centre for IPE hosts a five day session each June to help faculty learn how to teach in a way that enhances rather than defeats teamwork and collaborative practice.
All of this attention to team intelligence in action (TIA) helps to produce greater awareness and attention to teamwork in the practice setting. As students are educated so are working professionals as well as those who work in other health care occupations. Indeed, a number of the teaching hospitals in the U of T system have launched serious collaborative practice efforts into which students can be integrated after they have graduated.
Although I plan to post on this more, I want to conclude with something Maria Zhang, a student at the Leslie Dan Faculty of Pharmacy wrote to me about her experiences in her inter-professional placement. It illustrates the promise of genuine efforts to move students out of their silos (or really, fortresses) and to teach them greater regard for those with whom they will be working in as they enter practice. I would like to thank Maria for sending this.
From November 2010 to December 2010, I completed an inter-professional education placement at Toronto Rehab, a teaching hospital that provides complex care and specializes in adult rehabilitation. I worked with a group of students from other health care professions including occupational therapy, physical therapy and nursing. Our group was co-facilitated by two very knowledgeable and helpful Toronto Rehab staff members, both with nursing backgrounds.
We met on a weekly basis to work through case studies of patients in the Geriatric Psychiatry ward and through these case studies, we delved deeper in understanding each other’s roles and our own. For example, for the communication barriers case study, a Speech Language Pathologist (SLP) working on the floor, joined us for our discussion and offered her insight. This was extremely valuable as we did not have an SLP student within our group. On a weekly basis, I also met with my pharmacist preceptor who is a clinical pharmacist at Toronto Rehab and she briefed me on all of the patients and provided profound clinical knowledge and insight on the specialized role pharmacists take while working in the Geriatric Psychiatry ward along with her personal experience with practicing pharmaceutical care as part of a team of healthcare professionals.
Overall, this was an invaluable experience that has made me excited to learn and do more in my clinical practice. Just collaborating with students and learning about what their entry to practice process is like, the future of their profession and the roles they play in different settings, was eye-opening.
The importance of collaborative care cannot be underscored enough. One example that demonstrates this for me would be when our discussion was around a patient on the floor who was a concentration camp survivor. He had been admitted for reasons similar to most patients on the floor; sexual disinhibition and aggressive behaviour. Our inter-professional team gave insight on how the team approach has helped our patient.
The social worker kept in contact with the family, gave them regular updates on the patient’s progress and asked for consent for procedures, medications and more. If the patient is unable to provide us with their opinions, then we enlist that from the family as they are critical to any team approach as well. The occupational therapist and assistant worked with him and found out that he enjoyed music and singing and that this calmed him. The nurse found that he was agitated in the morning when medications were administered. Based on his history, we discussed that his may be related to him reliving his experiences at the concentration camp where he may have been forced to awaken suddenly and had his blankets ripped from him. As a team, we brainstormed that perhaps warm towels can be used to ease the blanket removal process or whether medication regimens could be altered so that he could take the medications at a time later in the day. These processes would have to be discussed between the nurse, pharmacist and doctor working with the patient.
This experience has been enlightening and enriching. It has helped me understand much more about my own profession’s role in healthcare provision along with a few other professions. It has helped me learn more about the importance of collaborative care and how we all play integral parts in the overall picture of maintaining and/or improving a patient’s health and quality of life. Most of all, it has fuelled my passion to learn and participate more in inter-professional experiences.