brenda j. stutsky rn, phd development and testing of a conceptual framework for interprofessional...
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Brenda J. Stutsky RN, PhD
Development and Testing of a Conceptual Framework for Interprofessional Collaborative Practice
Outline
Project Background1
2
3
4
5
6
Literature Review
Methods/Procedure
Instrument
Results
Conceptual Framework
7 Discussion
Project Background
• Post-doctoral work in Health Human Resource Optimization at UWO
• September 2011 – December 2012• Advisor: Dr. Heather Laschinger
Project Background
• Special thanks to:– Carol Cooke, Associate Librarian, University
of Manitoba– Catherine Hynes, Regional Manager Decision
Support, Northern RHA
Literature Review
• Extensive review of the interprofessional literature– Antecedents/consequences of:
• Interprofessional education (IPE)• Interprofessional collaborative practice (ICP)
Literature Review
• Problem– Interprofessional literature: Atheoretical– Terms are poorly conceptualized– Consistent framework for research is missing
(Reeves et al., 2011)
Literature Review
• Collaborative Practice“When multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings.” (WHO, 2010)
Literature Review
• Relationship-Centered Collaborative Care– Model developed by Tresolini & Pew-Fetzer
Task Force (1994)– 3 key relationships
1. Patient-practitioner
2. Community-practitioner
3. Practitioner-practitioner
– Used by researchers to guide ICP studies (Dix et al., 2008; Gaboury et al., 2011)
ConsequencesInterprofessional
Collaborative
Practice
Conceptual Framework
Antecedents
Personal Factors
Interprofessional Insight• Beliefs in IPC• Flexibility
Relational Skills• Trust• Cooperation• Communication Skills
Situational Factors
Leadership
Empowerment
Support Structures
Interprofessional
Collaborative
Practice
• Collective Ownership of Goals
• Understanding of Roles
• Interdependence• Knowledge Exchange
Work Behaviours & Attitudes
Personal• Work Satisfaction• Intent to Stay
Team• Perceived Team
Effectiveness• Conflict
Organizational Outcomes• Patient Safety• Quality of Patient Care
Patient Outcomes• Patient Biopsychosocial
Outcomes• Patient Satisfaction• Patient Empowerment• Length of Stay
Methods/Procedure
• Exploratory design• Regulated healthcare providers in Northern RHA
– Involved in direct patient care planning or team decision making
• 3 hospitals, 3 long-term care facilities, 4 primary healthcare centres
• Manager in RHA assisted with distribution of packages– Information sheet– Informed consent– $2.00 gift card & draw ballot
Instrument
• Interprofessional Collaborative Practice Survey (Stutsky & Laschinger, 2012)
– Constructed from existing standardized measures– 55 items with 9 demographic items– 5-point scale of strongly disagree to strongly agree
(1-2=low level, 3=moderate, 4-5=high level)
– Pt. safety, quality, degree of collaboration (5-point scale from low to high)
– 2 items measuring degree of collaboration used to validate ICP measure (r=.60 and r=.48)
Instrument
• Exploratory Factor Analysis (Construct Validity)
– ICP– Personal Antecedents– Situational Antecedents– Consequences: Work Behaviours and Attitudes
• Reliability was adequate (.67 to .88)
Rotated Factor Loadings for Interprofessional Collaborative Practice
Scales/Question # Ownership of Goals
Understanding of Roles
Interdependence Knowledge Exchange
Goals 37 .880 Goals 39 .789 Goals 40 .674 Goals 38 .522 .451 Roles 32 .794 Roles 35 .744 Roles 33 .623 Interdependence 31 .788 Interdependence 34 .633 Interdependence 30 .475 .584 Knowledge 44 .828Knowledge 41 .705Knowledge 43 .466 .473
4 factors with Eigenvalues greater than 1.00, explaining 59.73% of the cumulative variance
Rotated Factor Loadings for Antecedents: Personal Factors
Interprofessional Insight
Relational Skills
Scales/Question # Beliefs in ICP Trust Communication Flexibility Cooperation
Belief 2 .903 Belief 4 .859 Belief 3 .830 Belief 1 .760 Trust 10 .795 Trust 11 .782 Trust 9 .770 Trust 8 .756 Trust 14 .563 .470 Communication 15 .825 Communication 16 .706 .329Communication 17 .381 .634 Flexibility 5 .856 Flexibility 6 .737 .324Cooperation 12 .865Cooperation 13 .321 .346 .628
5 factors with Eigenvalues greater than 1.00, explaining 71.44% of the cumulative variance
Rotated Factor Loadings for Antecedents: Situational Factors
Situational Factors
Scales/Question # Support Leadership Empowerment
Support 24 .763 Support 25 .708 Support 23 .659 .425 Support 27 .557 .370Support 26 .398 .599Leadership 21 .876 Leadership 20 .799 Leadership 22 .359 .702 Empowerment 29 .880Empowerment 28 .315 .858
3 factors explained 67.50% of the cumulative variance
Rotated Factor Loadings for Consequences: Work Behaviours and Attitudes
Work Behaviours & Attitudes:
Team
Work Behaviours & Attitudes: Team
Scales/Question # Conflict Team
EffectivenessIntent to Stay Work Satisfaction
Conflict 59 .767 Conflict 57 .722 .475Conflict 60 .715 Conflict 58 .691 .378Team Effectiveness 55
.870
Team Effectiveness 54
.768 .364
Team Effectiveness 56
.728 .356
Stay 49 .884 Stay 51 .870 Stay 50 .306 .587 .581Work Satisfaction 52 .783Work Satisfaction 53 .363 .369 .681
4 factors explained 74.71% of the cumulative variance
Results
Demographics• Response rate 32% (N=117)• 95 females, 21 males, 1 not indicated• 23-68 yrs. of age (M=43.30, SD=11.77)• 0.5-40 yrs. of experience (M=15.51, SD=12.45)• 75% nurses, 17% allied health, 8% physicians• 59% acute care, 34% community care, 7% long-term care• 72% full-time, 24% part-time, 4% casual• 78% direct patient care
Results
Subscale Scores• Means ranged 3.25 (SD=.81) to 4.41 (SD=.63)• Conflict 3.05 (SD=.73)
– Only 34% did not have frequent conflicts over sharing of responsibilities (M=2.97, SD=1.03)
– Only 25% did not believe that interprofessional relationships had winners and losers (M=3.27, SD=1.05)
Results
Correlations• Correlations between ICP and its antecedents and
consequences• All factors were significantly correlated with overall ICP
(r=.33-.65, p<.01) except for flexibility
Results
Hierarchical Multiple Regression • Influence of personal and situational antecedents on
overall ICP• 37% of the variance of ICP was attributed to personal
factors with an additional 12% being explained by situational factors
Hierarchical Multiple Regression for Personal and Situational Factors on ICP R2 ∆R2 B SE β P
Personal Factors .366** .400 .076 .405 .000**Situational Factors .123** .250 .048 .403 .000**Total ICP R2 .489** **p<.001
Results
Hierarchical Multiple Regression • Influence of individual components of subscales of
personal and situational antecedents on overall ICP• 49% of the variance of ICP was explained by personal
factors with an additional 10% being attributed to situational factors
Hierarchical Multiple Regression for Personal and Situational Subscales on ICP
R2 ∆R2 B SE β PPersonal Factors .485**
Beliefs in IPC
.029 .047 .043 .542
Flexibility -.051 .043 -.078 .242Trust .091 .044 .165 .043*
Cooperation .151 .052 .207 .005*
Communication .205 .049 .333 .000**
Situational Factors .098**
Leadership .004 .048 .006 .942
Empowerment .013 .037 .032 .723
Support Structures
.174 .043 .330 .000**
Total ICP R2 .583** *p<.05, **p<.001
Results
Series of Regression Analyses• Combined effect of personal and situational antecedents
and overall ICP on consequences• Combination of predictors explained a significant variance
in all six consequences of ICP
Hierarchical Multiple Regression for the Entire Model
Work Behaviours & Attitudes: Personal
Work Behaviours &
Attitudes: Team
Organizational
Outcomes
Work Satisfaction
Intent to Stay
Team Effectiveness
Conflict PatientSafety
QualityPatient Care
Standard Coefficients BetaPersonal Factors
Beliefs in IPC
.068 -.008 .018 .279* .120 .024
Flexibility -.055 .061 -.152 -.073 -.113 -.103Trust -.049 .055 .100 .357** .087 -.018Cooperation .087 -.073 -.092* -.049 -.038 -.075
Communication-.080 .033 .171 -.002 -.018 .230*
Situational Factors Leadership .050 .127 .050 .092 -.025 .015
Empowerment.570** .364* .144 -.040 .091 .195
Support Structures
-.131 -.235* .078 -.076 .020 .064
ICP ICP Overall .305* .305* .405** .329* .450** .283*
R2 and ∆R2
Personal Factors R2 .200** .178** .377** .417** .207** .270**Situational Factors ∆R2 .232** .096* .090** .007 .042 .076*ICP ∆R2 .039* .039* .069** .045* .085** .033*Total Model R2 .472* .313* .537** .469* .334** .380**p<.05, **p<.001
Discussion
• Encouraging preliminary empirical support for the conceptual framework
• Results were consistent with findings in the literature including the importance of relationship-centered collaborative care
• Limitations include small sample size and response rate• Limited power prevented more sophisticated analyses
(SEM)• Psychometric properties of the ICPS are promising but
continual refinement and validation is needed • Patient outcomes need to be captured in future studies
Discussion
• Use of the framework– Healthcare leaders: Guide for facilitating ICP to enhance patient
safety and quality of care– Educators: Strengthen IPE curricula– Healthcare professionals: Evidence linking personal attitudes and
behaviours to effective ICP and patient safety and quality may motivate them to reflect on own behaviours and make a commitment to ICP
• Further research to validate the framework
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