Living up to Our Expectations: Do We Need to Go Back to Go Forward?

Blog post by InspireNet Leadership Council member, David Byres, and Marion Briggs

As leaders in healthcare, we have high expectations. We expect that patients will receive care of the highest quality, care that is meaningful to them, and care where they are engaged as full partners. We expect that staff will work together collaboratively and we remind each other that there is no “I” in “team”.

We expect that we can expect a great deal and that somehow it will all happen. We expect that care paths are followed, assessments and charting are done, rounds and huddles are attended, equipment and supplies are found, meetings are attended, plans are made, point-of-care staff are excited about quality improvement work, AND we expect that nurses and allied staff will increase time in direct care at the bedside. In this blog, we want to consider how we, as leaders and researchers, are preparing and supporting staff who are doing their best to meet our expectations.

Let’s take teamwork as an example. The evidence appears to be in. Teamwork – interprofessional collaboration - is not just a ‘nice to have’, it is essential to safe and effective patient care (the evidence is strongest in this domain), it improves workplace quality and provider satisfaction, and influences employment choice (Suter and Deutschlander, 2010). Yet, while 96% of health care academics agree that interprofessional education (IPE) is important, only 42% include some element of IPE in their curriculum, and while 91% have been exposed to IPE themselves, 54% have never facilitated an IPE learning experience (CNA Meeting, February 2011). In our clinical sites, team-based educational opportunities are rare compared to the resources applied to discipline-specific education; students are (naturally) placed with discipline-specific preceptors, and rarely have the opportunity to interact with students or graduates from other disciplines during their education. If as academics and clinical leaders we are not vigorously supporting opportunities for interprofessional learning, how can we expect teams to successfully practice together?

Practising together collaboratively isn’t as easy as saying, “Practice together collaboratively”! The Canadian Interprofessional Health Collaborative published the National Interprofessional Competency Framework in 2010 (you can download it from http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf ). It was surprisingly difficult for the group working on this document to come to consensus about these competencies. Health care academics and clinicians continue to wonder whether the competency frameworks that all disciplines, and now interprofessional collaborative teams, have are actually helpful – or at least whether how we use them is helpful.

Reeves et al (2009) ponder the question of professional competencies: “While there are a number of benefits derived from clearing defining scope of practice and identifying appropriate indicators of acceptable performance, the competency movement may also be viewed as a trend that reproduces conventional practice, limits innovation and interferes with interprofessional practice” (2009: 451). Talbot (2004) agrees. He suggests that the competency approach: “… has a tendency to limit the reflection, intuition, experience and higher order competence necessary for expert, holistic or well developed practice”. This argument seems to us to have merit (notwithstanding the irony that he critiques the ‘competency approach’ by claiming the need for a ‘higher order competence’). He argues that the tendency to focus on task and outcome under-represents the complex processes needed for professional practice where members of any discipline so often find themselves in deeply interdependent relationships with other disciplines. Have we really prepared healthcare providers through our education, practice structures and processes to be able to navigate through the complexities of any given patient and the groups of patients that we are collectively caring for? Have we really understood how new practices emerge? Do we prioritize the development of key relationships that will be “big enough” to cultivate the kind of fluidity in the practice environment that is demanded by how quickly clinical demands can change?

We suggest there is work to do! Perhaps we need to consider whether we have provided the right support and focus so that staff have an even chance of meeting our expectations – which are unquestionably also their own expectations. There is no doubt that everyone starts their career, and then starts each day of their career, with the intention to make a positive difference. We all share in the disappointment when making a difference becomes too difficult and we slip into expecting less of ourselves. It is no different for academics, leaders, or point of care staff. So, in the title of this blog we suggested that maybe we have to back to go forward; if we were to ‘back up’ our expectations, what would we need to do? Surely we would have to attend to relationships. Effective healthcare is all about relationships – the relationships we have with our patients, with each other, our ability to include directly in our thinking and practice more of what is now in our peripheral vision. The successful organizations of the future will be those who have intentionally invested in and attended to relationship. We must understand that patient-centred care is more than just including patients on committees and decision-making bodies (as helpful as that is) – it is about how we serve, not just include, but how we serve the goals and aspirations that our patients have and how their health supports or impedes them. And we would need to understand that working together collaboratively is tough but vital for good patient care, for healthy work environments, and for sustaining the workforce. Nothing less than the future of our healthcare system is at stake.

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David Byres
Vice President Acute Clinical Programs & Chief of Professional Practice and Nursing
Providence Health Care
dbyres@providencehealth.bc.ca

Marion Briggs
Practice Consultant
Interprofessional Practice, Education and Research
Providence Health Care

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