Collaborative patient-centred practice delivered by interprofessional (IP) teams has been linked to positive patient, provider, and system level outcomes. However, the composition and implementation of these IP teams has not been consistent across Primary Care Networks (PCNs). There is a gap in knowledge about what works well, what does not work well, and what improvements are needed to facilitate effective IP team functioning within the PCN context.

Objectives:

1. To better understand the structure and functioning of interprofessional teams in PCNs in Alberta

2. To use evidence from the research to inform the effective and efficient use of interprofessional teams in primary care

A case study of the Chinook PCN will be presented due to its history as an exemplar of interprofessional teamwork.

A highly effective team:

• Understands and addresses health needs of local populations

•Provides better care through staff education and shared decision-making

• Have structures and processes to support governance, guiding principles, and quality improvement roles

Advantages to the team approach:

•Capacity to serve the patient population is much better

•Patients feel listened to

•Providers are able to utilize each other’s expertise

•Time to educate and plan care in a way that is convenient and effective

Barriers to effective team functioning in the Chinook PCN include:

Physician Compensation Models

Patients •Challenges related to patient populations: language barriers, difficulty getting Aboriginal populations into the clinics, and patient compliance

Staff •Challenge for rural clinics to find appropriate staff for clinics

•“Us” versus “them” perception among PCN and non-PCN team members due to difference with how clinical and non-clinical staff members are paid

1. Establishing explicit guiding principles for governance

2. Implementing quality improvement roles to support clinical and operational advances to offer the best patient experience

3. Using patient panels and registries to proactively align population health needs with staff mix and team based services

The Chinook PCN serves:

•Rural (12) and urban (1) communities in south

•On-Reserve First Nations, urban Aboriginal peoples, approximately 50 Hutterite colonies, Kanadier Mennonite immigrants, and a significant post-secondary student population

•46% males and 54% females

•Main health issues: obesity, hypertension, and diabetes

•80% of PCN budget must be spent on hiring and building of IP teams

A qualitative approach was used to capture data:

•1 rural and 1 urban team interviewed

•Semi-structured individual and group interviews were conducted with clinical and non-clinical staff and clinical leaders (n=23)

•Thematic and iterative process was used to analyze the data

•The Chinook PCN Business Plan was also reviewed

Shelanne Hepp

Alberta Health Services

Workforce Research & Evaluation

Telephone: (403) 943-1177

Email: Shelanne.hepp@albertahealthservices.ca

Funded by Alberta Health

Alternative Relationship

Plan

• Although not used, an Alternative Relationship Plan (ARP) model was mentioned to be more conducive to developing teams.

Capitation Model

• Capitation model was an improvement from the fee-for-service model (allows other team members to see the patient without the physician being penalized.). Model does not necessarily help physicians work with teams.

Fee-for-Service

• Fee-for-service model is problematic and impedes team functioning. A different payment model would allow physicians to be more proactive rather than “just trying to make a living.”

•Two funding models for physicians were used: fee-for-service and a population-based funding model (also known as capitation model)

Factors that influence effective team functioning in the Chinook PCN include:

Co-location

•Providers found it helpful to be co-located not only with other team members but also with community services

Governance

•The majority of money generated through the PCN is spent on IP teams. Expenditures that fall outside the principle of value-added requires governing body recommendation

•Legally changing the joint venture so that money comes directly to the PCN (improves accountability and the reporting structure)

•Good representation within board governance

Education

•Team education is encouraged and central office supports a number of information-sharing events for professionals to discuss issues and share learnings

•CME-accredited Family Practice Summits are attended by physicians and IP teams Culture •Improvement culture supported, but change is not easy

•Pride in working for the physicians

PCN

•Team members take on more responsibility in smaller settings with overlap among providers

•Pilot clinic for IP teams has a lot of early experience

•Visioning for the PCN and clinics matured over time (very beneficial in order to establish goals and objectives)

•Clear mission statement from staff, not top-down, allowed the group to build a strong foundation and adjust roles and responsibilities

Relationships

•Openness, helpfulness, and trust in each other and knowledge of each other’s skills

•Structures bring staff together (eg. Family Practice Summits)