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2008 HEALTH SERVICES & POLICY RESEARCH DAY SINCLAIR LECTURE. New Vision, New Journey, New Promise: Interdisciplinary Health Care in a New Time 26 November 2008. Crucial to finding the way is this: there is no beginning or end. You must make your own map. Joy Harjo - PowerPoint PPT Presentation
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2008 HEALTH SERVICES &2008 HEALTH SERVICES &POLICY RESEARCH DAYPOLICY RESEARCH DAY
SINCLAIR LECTURESINCLAIR LECTURE
New Vision, New Journey, New New Vision, New Journey, New Promise:Promise:
Interdisciplinary Health Care in a New Interdisciplinary Health Care in a New TimeTime
26 November 200826 November 2008
Crucial to finding the way is Crucial to finding the way is this: this:
there is no beginning or end.there is no beginning or end.
You must make your own map.You must make your own map.
Joy Harjo Joy Harjo
Map to the Next World: Map to the Next World: PoemsPoems
Barred Spiral Milky Way: - Credit: R. Hurt (SSC), JPL-Caltech, NASA Survey Credit: GLIMPSE Barred Spiral Milky Way: - Credit: R. Hurt (SSC), JPL-Caltech, NASA Survey Credit: GLIMPSE Team Team
DR. DUNCAN G. SINCLAIRDR. DUNCAN G. SINCLAIRMAKER OF NEW MAPSMAKER OF NEW MAPS
DR. DUNCAN G. SINCLAIRDR. DUNCAN G. SINCLAIRMAKER OF NEW MAPSMAKER OF NEW MAPS
Veterinary College, Ph.D. in Physiology at Queen'sVeterinary College, Ph.D. in Physiology at Queen's Markle Scholar in Academic Medicine at Queen'sMarkle Scholar in Academic Medicine at Queen's Dean of the Faculty of Arts and Science at Queen’sDean of the Faculty of Arts and Science at Queen’s Vice-Principal (Institutional Relations) at Queen’s Vice-Principal (Institutional Relations) at Queen’s Director General of Program Operations at MRCDirector General of Program Operations at MRC Honorary Fellowship in the RCPSCHonorary Fellowship in the RCPSC Ontario MOH Committee for Review of the Public Ontario MOH Committee for Review of the Public
Hospitals Act Hospitals Act Premier's Council on Health, Well-Being and Social Premier's Council on Health, Well-Being and Social
Justice Justice Ontario Cancer Treatment and Research Board Ontario Cancer Treatment and Research Board National Forum on Health National Forum on Health Chair of Ontario's Health Services Restructuring Chair of Ontario's Health Services Restructuring
Commission Commission Founding Chair of the Board of Canada Info HighwayFounding Chair of the Board of Canada Info Highway Committee on Collaborative Health Professional Committee on Collaborative Health Professional
Education and Research – Memorial UniversityEducation and Research – Memorial University
At the end of the first decade of this At the end of the first decade of this twenty-first century, we are called twenty-first century, we are called
to see with new eyes to see with new eyes
to hear with new ears to hear with new ears
to dare with new thinking to dare with new thinking
to act with new passion to act with new passion
if we are to help create a truly strong, if we are to help create a truly strong, safe and responsive health system in safe and responsive health system in Canada.Canada.
OVERVIEW OF OVERVIEW OF REFLECTIONSREFLECTIONS Context in changing societyContext in changing society New vision = interdisciplinary New vision = interdisciplinary
health carehealth care New journey = transformation of New journey = transformation of
culture culture New promise = leaders and New promise = leaders and
championschampions New hope = readiness to New hope = readiness to
respondrespond
CHANGES IN CHANGES IN WESTERN SOCIETYWESTERN SOCIETY
Demographic shiftsDemographic shiftsCultural diversityCultural diversityFinancial uncertainty/volatilityFinancial uncertainty/volatilityIncreasing urbanizationIncreasing urbanizationImpact of technologyImpact of technologyChanging face of familyChanging face of familyReality of poverty and violenceReality of poverty and violencePollution of the environmentPollution of the environmentRole of womenRole of womenExpectations of public serviceExpectations of public service
CHANGING PROFESSIONSCHANGING PROFESSIONS Move from traditional inward-looking, Move from traditional inward-looking,
reactive culture to outward-looking, reactive culture to outward-looking, proactive culture proactive culture
Shift from profession-centred to patient-Shift from profession-centred to patient-centred culturecentred culture
Blurring professional boundariesBlurring professional boundaries Changes in law re scope of practice and Changes in law re scope of practice and
responsibilitiesresponsibilities Increased expectations of inter-professional Increased expectations of inter-professional
collaboration in education and practicecollaboration in education and practice Focus on evidence-informed practiceFocus on evidence-informed practice Increasing demands for accountability and Increasing demands for accountability and
transparencytransparency InternationalizationInternationalization Loss of control over working conditionsLoss of control over working conditions
EXAMPLES OF EXAMPLES OF HEALTH DISCIPLINESHEALTH DISCIPLINES
Audiology Audiology
Clinical PsychologyClinical Psychology
Counseling Counseling
DentistryDentistry
Dental HygieneDental Hygiene
Diagnostic ImagingDiagnostic Imaging
Healthcare Healthcare ManagementManagement
Human KineticsHuman Kinetics
Laboratory ServicesLaboratory Services
MedicineMedicine
MidwiferyMidwifery
NutritionNutrition
NursingNursing
PharmacyPharmacy
PhysiotherapyPhysiotherapy
Occupational therapyOccupational therapy
Recreation TherapyRecreation Therapy
Respiratory TherapyRespiratory Therapy
Speech Language Speech Language
Social workSocial work
Spiritual CareSpiritual Care
Veterinary SciencesVeterinary Sciences
NEW VISIONNEW VISION
COLLABORATIONCOLLABORATION
Collaborative patient-centered practice is Collaborative patient-centered practice is designed to promote the active designed to promote the active participation of several health care participation of several health care disciplines and professions. It enhances disciplines and professions. It enhances patient-, family-, and community-centred patient-, family-, and community-centred goals and values, provides mechanisms for goals and values, provides mechanisms for continuous communication among health continuous communication among health care providers, optimizes staff care providers, optimizes staff participation in clinical decision making participation in clinical decision making (within and across disciplines), and fosters (within and across disciplines), and fosters respect for the contributions of all respect for the contributions of all providers.providers.
Health Canada, 2003Health Canada, 2003
FINDING THE BALANCEFINDING THE BALANCENEW PARADIGMNEW PARADIGM
All health professionals retain their All health professionals retain their high degree of competence and high degree of competence and individual professional identities individual professional identities
All health professionals develop the All health professionals develop the capacity tocapacity towork happily and productively work happily and productively
together together be knowledgeable about and confident be knowledgeable about and confident
in one another’s contributions to in one another’s contributions to health and community service teamshealth and community service teams
Committee on Collaborative Health Committee on Collaborative Health Professional Professional
Education and Research – MUNEducation and Research – MUN
SPECTRUM OF INTER-SPECTRUM OF INTER-PROFESSIONALISMPROFESSIONALISM
PRESENT IN MOST HEALTH PRESENT IN MOST HEALTH ORGANIZATIONSORGANIZATIONS
Climate of mutual respect and trustClimate of mutual respect and trust CooperationCooperation = formal communication, = formal communication,
independent decision-makingindependent decision-makingShared information Shared information ConsultationConsultation
CoordinationCoordination = defined roles, some = defined roles, some shared decision-makingshared decision-making
Shared vision, goals and planningShared vision, goals and planningShared resourcesShared resources
SPECTRUM OF INTER-SPECTRUM OF INTER-PROFESSIONALISMPROFESSIONALISMABSENT IN MOST HEALTH ORGANIZATIONSABSENT IN MOST HEALTH ORGANIZATIONS
CollaborationCollaboration = defined roles, = defined roles, frequent communication, shared frequent communication, shared decision-making, one systemdecision-making, one system
Teamwork – specific tasks, patient-Teamwork – specific tasks, patient-centeredcentered
Collective responsibility – Collective responsibility – organizational integration organizational integration
Shared leadership, control, risk Shared leadership, control, risk and accountabilityand accountability
OUTCOMES SOUGHTOUTCOMES SOUGHT
Health professional graduates, Health professional graduates, comfortable and experienced in working comfortable and experienced in working together, who will create and staff together, who will create and staff collaborative teamscollaborative teams
New knowledge, skills and attitudes that New knowledge, skills and attitudes that transcend traditional disciplinary and transcend traditional disciplinary and professional boundaries, derived from professional boundaries, derived from collaborative research and inter-collaborative research and inter-professional education and practiceprofessional education and practice
Exemplary practice models by which Exemplary practice models by which teams of health and community service teams of health and community service professionals provide a range of services professionals provide a range of services
Committee on Collaborative Health Committee on Collaborative Health Professional Education and Research – MUNProfessional Education and Research – MUN
IMPLICATIONS FOR IMPLICATIONS FOR UNIVERSTY PLANNINGUNIVERSTY PLANNING
Articulation of new direction in values Articulation of new direction in values statements, strategic priorities and statements, strategic priorities and explicit goalsexplicit goals
Faculties and Schools collaboratively Faculties and Schools collaboratively offering programs of professional study offering programs of professional study
Practice experience in model Practice experience in model environments representative of the environments representative of the people and communitiespeople and communities
Curriculum elements (modules, courses, Curriculum elements (modules, courses, and programs) to prepare students to and programs) to prepare students to derive the greatest benefit from their derive the greatest benefit from their collaborative practice experiences collaborative practice experiences
IMPLICATIONS FOR IMPLICATIONS FOR UNIVERSTIESUNIVERSTIES
Environment that draws together students, Environment that draws together students, professional staff, faculty members, and health professional staff, faculty members, and health and community service professionals and and community service professionals and facilitates their engagement in basic and applied facilitates their engagement in basic and applied collaborative inter-professional researchcollaborative inter-professional research
Non-hierarchical environment of “learning Non-hierarchical environment of “learning together” in which students in the participating together” in which students in the participating professional programs will learn from one professional programs will learn from one another: another: the value of collaborative inter-professional the value of collaborative inter-professional
contributions and inter-dependencies in the provision of contributions and inter-dependencies in the provision of services and programs both to individuals and to services and programs both to individuals and to communities communities
knowledge of and respect for the particular knowledge of and respect for the particular competencies of each professioncompetencies of each profession
Committee on Collaborative Health Committee on Collaborative Health Professional Education and Research – MUNProfessional Education and Research – MUN
BARRIERSBARRIERS Silo structures and long-standing disciplinary Silo structures and long-standing disciplinary
boundaries among and across the professions boundaries among and across the professions Differences in history and culture, language and Differences in history and culture, language and
jargon, schedules and professional routinesjargon, schedules and professional routines Historical inter-professional and intra-Historical inter-professional and intra-
professional rivalries professional rivalries Varying levels of preparation, qualifications and Varying levels of preparation, qualifications and
statusstatus Differences in requirements, regulations and Differences in requirements, regulations and
norms of professional education norms of professional education Fears of diluted professional identity Fears of diluted professional identity Differences in accountability, payment and Differences in accountability, payment and
rewards rewards Concerns regarding clinical responsibilityConcerns regarding clinical responsibility
Headrick, Wilcock & Batalden (1998)Headrick, Wilcock & Batalden (1998)
CHALLENGESCHALLENGES
Lack of funding to review curriculum and teaching Lack of funding to review curriculum and teaching methods and to make needed changes methods and to make needed changes
Lack of funding for student placement, transportation, Lack of funding for student placement, transportation, and model site expansionand model site expansion
Overly crowded curricula and competing demands Overly crowded curricula and competing demands Lack of an evidence base assessing the impact of Lack of an evidence base assessing the impact of
changes in teaching methods or curriculum changes in teaching methods or curriculum Fragmented responsibilities for undergraduate and Fragmented responsibilities for undergraduate and
graduate education graduate education Little integration across oversight processes, including Little integration across oversight processes, including
accreditation, licensing, and certification accreditation, licensing, and certification Unsupportive culture and norms in health professions Unsupportive culture and norms in health professions
education education Emphasis on research and patient care in many Emphasis on research and patient care in many
academic settings, with little reward for teachingacademic settings, with little reward for teaching Insufficient channels for sharing information and best Insufficient channels for sharing information and best
practices practices Lack of faculty and of faculty developmentLack of faculty and of faculty development
NEW JOURNEYNEW JOURNEY
CULTURE CHANGECULTURE CHANGE
Culture is dynamic and changing Culture is dynamic and changing over timeover time
Most individuals are able to adapt: Most individuals are able to adapt: some have a greater facility to some have a greater facility to accommodate otherness in their accommodate otherness in their internal meaning structure than internal meaning structure than othersothers
The need for change may be The need for change may be driven by survival or passiondriven by survival or passion
NATURE OF NATURE OF CULTURAL ISSUESCULTURAL ISSUES SystemicSystemic: Pervasive throughout the : Pervasive throughout the
organization usually based in polices, organization usually based in polices, procedures, and organizational procedures, and organizational structures structures
LocalLocal: As cultures within cultures : As cultures within cultures naturally form, practices, traditions, and naturally form, practices, traditions, and norms emerge that are unique to a work norms emerge that are unique to a work group (e.g., profession, program, group (e.g., profession, program, facility) facility)
IndividualIndividual: persons bring their own : persons bring their own values, philosophies, and biases to the values, philosophies, and biases to the organizationorganization
The Winters Group, Inc. (2001)The Winters Group, Inc. (2001)
CHALLENGE OF CULTURE TRANSFORMATION
OTT Management Consultants
KEYS TO CULTURAL KEYS TO CULTURAL TRANSFORMATIONTRANSFORMATION
ScanningScanning the environmentthe environment DeterminingDetermining implications implications RevisitingRevisiting the missionthe mission BanningBanning the old hierarchy and building the old hierarchy and building
flexible, fluid structures and systemsflexible, fluid structures and systems Challenging Challenging – – questioning every policy, questioning every policy,
practice, procedure, and assumptionpractice, procedure, and assumption CommunicatingCommunicating with a few powerful, with a few powerful,
compelling messagescompelling messages DispersingDispersing the responsibilities of the responsibilities of
leadership leadership Frances HesselbeinFrances Hesselbein
NEW PROMISENEW PROMISE
LEADERS ACT WISELYLEADERS ACT WISELY
With KnowledgeWith Knowledge At all LevelsAt all Levels
StrategicallyStrategicallyTacticallyTacticallyOperationallyOperationally
CollaborativelyCollaboratively
LEADERS ACT LEADERS ACT PASSIONATELYPASSIONATELY
IntentionallyIntentionally PersistentlyPersistently RelationallyRelationally
LEADERS ACTLEADERS ACTCOURAGEOUSLYCOURAGEOUSLY
As catalystsAs catalysts Knowing vulnerabilityKnowing vulnerability Caring for self and othersCaring for self and others
LEADERS AS CATALYSTSLEADERS AS CATALYSTS
Manage diversity, be inclusive Manage diversity, be inclusive Respond within changing social realitiesRespond within changing social realities Understand globalization and health Understand globalization and health
care reformcare reform Reintroduce values of flexibility, Reintroduce values of flexibility,
discovery and innovation – stretch into discovery and innovation – stretch into new ways of thinking, allow creativity, new ways of thinking, allow creativity, questions, riskquestions, risk
Interconnect practice, education, Interconnect practice, education, research and administrationresearch and administration
Tell storiesTell stories Re-inspire spiritRe-inspire spirit
NEW HOPENEW HOPE
READINESS TO RESPONDREADINESS TO RESPOND
Awareness of complexityAwareness of complexity Skills developmentSkills development Strengths of traditionStrengths of tradition Emotional preparednessEmotional preparedness ReflectionReflection Ceremonies and celebrationCeremonies and celebration SymbolsSymbols Confidence/convictionConfidence/conviction
IMAGE OF COLLABORATIONIMAGE OF COLLABORATION
I’m sittin’ on my stage-head lookin’ out at I’m sittin’ on my stage-head lookin’ out at where Skipper Joe Irwin’s schooner is where Skipper Joe Irwin’s schooner is ridin’ at her moorin’ … thinkin’ about ridin’ at her moorin’ … thinkin’ about how weak are the things that try to pull how weak are the things that try to pull people apart – differences in colours, people apart – differences in colours, creeds and opinion – weak things like creeds and opinion – weak things like the ripples tuggin’ at the schooner’s the ripples tuggin’ at the schooner’s chain. And thinkin’ about how strong chain. And thinkin’ about how strong are the things that hold people together are the things that hold people together – strong, like Joe’s anchor, and chain, – strong, like Joe’s anchor, and chain, and the good holdin’ ground below.and the good holdin’ ground below.
Ted Russell, Ted Russell, The Holdin’ GroundThe Holdin’ Ground
A BLESSING FOR EQUILIBRIUMA BLESSING FOR EQUILIBRIUM
Like the joy of the sea coming home to shore,Like the joy of the sea coming home to shore,May the music of laughter break through your May the music of laughter break through your soul.soul.
As the wind wants to make everything dance,As the wind wants to make everything dance,May your gravity be lightened by grace.May your gravity be lightened by grace.
Like the freedom of the monastery bell,Like the freedom of the monastery bell,May clarity of mind make your eyes smile.May clarity of mind make your eyes smile.
As water takes whatever shape it is in,As water takes whatever shape it is in,So free may you be about who you become.So free may you be about who you become.
As silence smiles on the other side of what’s said,As silence smiles on the other side of what’s said,May a sense of irony give you perspective.May a sense of irony give you perspective.
As time remains free of all that it frames,As time remains free of all that it frames,May fear or worry never put you in chains.May fear or worry never put you in chains.
May your prayer of listening deepen enoughMay your prayer of listening deepen enoughTo hear in the distance the laughter of God.To hear in the distance the laughter of God.
John O’Donohue, Benedictus – A Book of BlessingsJohn O’Donohue, Benedictus – A Book of Blessings