BACKGROUND The Institute of Medicine recommends shifting from prelicensure classroom interprofessional education (IPE) to workplace learning and interprofessional continuing professional development (IPCPD). Despite the growth of collaborative practice (CP) education, further exploration is needed on the impact of IPE and IPCPD on collaborative behavior, patient outcomes, safety, and organizational change. A systematic review highlights the effectiveness of interprofessional training but notes a lack of understanding about context, mechanisms, implementation processes, and outcomes. SUMMARY OF WORK From 2020-2024, seven virtual modules and two three-day in-person competency-based courses were delivered to 293 healthcare professionals (105 physicians, 81 nurses, 69 allied health professionals, 38 administrators). This IPCPD program was a collaboration between a Canadian university interprofessional centre and a Singaporean academic hospital network. Participants learned through small/large group dialogue, simulations, tools and practice. They co-designed IPE and CP knowledge-to-action projects in interprofessional teams. A Train the Trainer model developed local interprofessional facilitators, ensuring program sustainability and ongoing support. The program was evaluated through a multi-method quantitative and qualitative case study. SUMMARY OF RESULTS The IPCPD programs showed strong quantitative (facilitator/program rating scales) and qualitative (learner/faculty thematic analysis) outcomes. Over 60 project proposals emerged, resulting in 13 completed knowledge-to-action projects. The modified Kirkpatrick evaluation framework mapped completed project outcomes at upper levels of impact: knowledge, skills, and attitudes (1 project), collaborative behavior change (9), and patient benefits and organizational practice change (3). DISCUSSION AND CONCLUSION: In order to support collaborative environments for our learners and patients, IP CPD can be effective to develop not only professionals and teams but learning organizations. Integration of physicians and other health professionals as local facilitators supported integration and role modeling across teams. Collaborative competencies is a useful conceptual framework to frame curriculum and Kirkpatrick framework to explore impact and outcomes within and following IPCPD program. Cultural awareness of international healthcare system’s similarities/differences and concurrent capacity building through train the trainer is crucial for successfully adapting an established IPCPD program. TAKE HOME MESSAGE IPCPD programs enhance teamwork processes, patient/organizational outcomes. Collaborative competencies are effective for IPCPD codesign. Kirkpatrick framework is valuable for evaluating program impacts. Successful factors include understanding international healthcare system differences and Train the Trainer models.

Principles-focused evaluation reflects on the change process itself through examination of its underlying principles. The Centre for Advancing Collaborative Healthcare & Education (CACHE) worked to build interprofessional education programs and tools that attended to the Team Primary Care (TPC) principles. Our internally directed principles-focused evaluation, presented here, asks how CACHE adhered to these principles in the programs and tools it delivered to the TPC project. The article's main contribution is the creation of a new concept, organizational critically reflective practice, which describes an approach health leaders can use to mitigate the limitations of short-term initiatives while pursuing transformational change. We propose specific tools and steps that will help health leaders attempting to enact organizational critically reflective practice.

Lack of access, system inequities, and inefficiencies plague our current healthcare system. With a challenge this complex, no one intervention is sufficient; all will be necessary. The primary care system needs a strong health workforce prepared in bold new ways. Students represent an important voice, given their role as future leaders of health education and healthcare. For students to lead, educators must leverage education paradigms that position current students as leaders of transformation. Yet, in current health education systems, students are often seen as passive recipients of knowledge and skill. Transformative education seeks to foster critical reflection (an ongoing process of questioning unhelpful assumptions and power relations) and informed action in students to enable them to challenge and change norms and change practices, structures, and society. This article highlights the value of transformative education in cultivating thoughtful change agents and provides one tangible example of a new education/practice model that puts this paradigm into action.

Introduction: Globally, health systems are moving toward better integrated care organization and delivery. A current example within the Canadian context is the restructuring of care delivery in Ontario, in alignment with the Quadruple Aim. The vision for reorganizing care into Ontario Health Teams (OHTs) was announced by the government in early 2019 and this has prompted care providers across sectors to choose priority patient populations and engage in collaborative governance to achieve desired outcomes. The early implementation of OHTs was “low rules:” each OHT assembled its own leadership and governance infrastructure to meet local needs. This was (and remains) a significant task, requiring strategic thinking and inter-organizational collaboration. In response, a team of faculty at the University of Toronto developed the ADVANCE program to guide shared leadership, decision-making and accountability for leaders of OHT partner organizations. The program, designed as a virtual constellation of educational supports included two main streams of activity: (1) a six-module series of interactive webinars to support leadership council members, and (2) adaptive support to local coaches embedded in the leadership teams. Methods: The Coaching Academy was intentionally designed with a responsive and adaptive curriculum, underpinned by the Collective Impact framework. OHT leadership teams nominated local coaches, based on specified coaching competencies and characteristics. We onboarded coaches through an intake interview which allowed us to better understand the collaborative culture/norms of their OHT, and their individual learning needs. These insights also informed the Coaching Academy curriculum which included virtual synchronous and asynchronous engagement methods. Monthly synchronous sessions included a blend of expert lectures and open-ended coach discussion. To encourage asynchronous engagement, we posted discussion questions and learning resources on an external collaborative platform. At regular intervals, we elicited feedback from coaches (via Google forms) and adapted our content and delivery format accordingly. Results: The coach participants were diverse in terms of their educational backgrounds, years of experience, position on the leadership council (e.g., CEO, Patient/Family Advisor, etc.) and willingness to participate (e.g., volunteered or ‘voluntold’). We learned that coaches functioned in a variety of contexts, dependent on the culture and the processes adopted by individual OHTs. We observed that coaches’ needs evolved throughout the program, likely due to the dynamic intersection of OHT implementation and the ongoing management of the COVID-19 pandemic. In early 2022, coach feedback indicated that less frequent touchpoints were needed, and coaches valued learning from other coaches and receiving asynchronous materials. We adapted the curriculum for the final cohort to include coach touchpoints every 2-3 months. Conclusion and Next Steps: When planning the Coaching Academy, our team anticipated the need to be flexible and adaptable in terms of the program format and content to meet the needs of a diverse participant group. These insights could be helpful for others who are engaged in health care system transformation and considering varying approaches for building a culture of collaborative governance.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Quality improvement (QI) teams typically consist of membership from many roles and professions working together to improve care. However, despite the growing number of interprofessional (IP) teams involved in QI education and projects, carrying out successful improvement remains challenging. IP competency frameworks have been used as an enabler in practice, education and research to expand understanding of collaboration beyond team dynamics. Building on literature and practices in QI and interprofessional care (IPC), this paper identifies specific team tools and practices relevant to IP competencies. By connecting IP competencies to these practical QI tools, we examine the synergistic relationship between QI tools and IP competencies. There is an opportunity to explicitly integrate IP competencies with QI tools, education and programs to enhance IPC. Future research should include application of IP competencies across different QI team structures and sectors and the impact of integration of IP competencies in QI tools and programs.

Evidence is mounting regarding the positive effects of Interprofessional Education and Collaborative Practice (IPECP) on healthcare outcomes. Despite this, IPECP is only in its infancy in several Australian rural healthcare settings. Whilst some rural healthcare teams have successfully adopted an interprofessional model of service delivery, information is scarce on the factors that have enabled or hindered such a transition. Using a combination of team surveys and individual semi-structured team member interviews, data were collected on the enablers of and barriers to IPECP implementation in rural health settings in one Australian state. Using thematic analysis, three themes were developed from the interview data: IPECP remains a black box; drivers at the system level; and the power of an individual to make or break IPECP. Several recommendations have been provided to inform teams transitioning from multi-disciplinary to interprofessional models of service delivery.

Purpose This scoping review examines what is known about the processes of quality improvement (QI) teams, particularly related to how teams impact outcomes. The aim is to provide research-informed guidance for QI leaders and to inform future research questions. Data sources Databases searched included: MedLINE, EMBASE, CINAHL, Web of Science and SCOPUS. Study selection Eligible publications were written in English, published between 1999 and 2016. Articles were included in the review if they examined processes of the QI team, were related to healthcare QI and were primary research studies. Studies were excluded if they had insufficient detail regarding QI team processes. Data extraction Descriptive detail extracted included: authors, geographical region and health sector. The Integrated (Health Care) Team Effectiveness Model was used to synthesize findings of studies along domains of team effectiveness: task design, team process, psychosocial traits and organizational context. Results of data synthesis Over two stages of searching, 4813 citations were reviewed. Of those, 48 full-text articles are included in the synthesis. This review demonstrates that QI teams are not immune from dysfunction. Further, a dysfunctional QI team is not likely to influence practice. However, a functional QI team alone is unlikely to create change. A positive QI team dynamic may be a necessary but insufficient condition for implementing QI strategies. Conclusions Areas for further research include: interactions between QI teams and clinical microsystems, understanding the role of interprofessional representation on QI teams and exploring interactions between QI team task, composition and process.

The importance of interprofessional education in health professions training is increasingly recognised through new accreditation guidelines. Clinician teachers from different professions may find themselves being asked to teach or supervise learners from multiple health professions, focusing on interprofessional dynamics, interprofessional communication, role understanding, and the values and ethics of collaboration. Clinician teachers often feel prepared to teach learners from their own profession but may feel ill prepared to teach learners from other professions. In this guide, we draw upon the collective experience from two countries: an institution from the United States with experience in guiding faculty to teach in a student-run interprofessional clinic and an institution from Canada that offers interprofessional experiences to students in community and hospital settings. This guide offers teaching advice to clinician educators in all health professions who plan to or already teach in an interprofessional clinical setting. We anticipate that clinician teachers can learn to fully engage learners from different professions, precept effectively, recognise common pitfalls, increase their confidence, reflect, and become role models to deliver effective teaching in interprofessional settings.

The purposes of this exploratory study were to investigate the attitudes of radiation oncology professionals regarding interprofessional (IP) teaching and interprofessional education (IPE), to identify the challenges faced by radiation oncologists who teach within an IP context, and to discover new strategies to aid professionals teaching IP students. A questionnaire was developed through the review of existing literature on IPE using Medline. The proposed group of questions was selected by educators from different professions actively involved in IPE. The final revised questionnaire consisted of three main domains assessing the understanding of IP concepts, attitudes toward IP teaching and learning environments, and attitudes toward health-care teams. An open-ended comment section was included. The questionnaire was administered to health-care professionals (physicists, radiation oncologists, and radiation therapists) nationally through SurveyMonkey® (electronic survey). A total of 220 respondents provided demographic information. Half of these respondents indicated that they previously received education relating to IPE. A high level of agreement was received for nearly all the questions. There were no significant statistical differences among the three different professional respondent groups for any question. Overall, most of the respondents demonstrated a good knowledge and understanding of IP concepts and advocated IP training and collaboration.

Successful implementation of new extended practice roles which transcend conventional boundaries of practice entails strong collaboration with other healthcare providers. This study describes interprofessional collaborative behaviour perceived by advanced clinician practitioner in arthritis care (ACPAC) graduates at 1 year beyond training, and relevant stakeholders, across urban, community and remote clinical settings in Canada. A mixed-method approach involved a quantitative (survey) and qualitative (focus group/interview) evaluation issued across a 4-month period. ACPAC graduates work across heterogeneous settings and are on teams of diverse size and composition. Seventy per cent perceived their team as actively working in an interprofessional care model. Mean scores on the Bruyere Clinical Team Self-Assessment on Interprofessional Practice subjective subscales were high (range: 3.66-4.26, scale: 1-5 = better perception of team's interprofessional practice), whereas the objective scale was lower (mean: 4.6, scale: 0-9 = more interprofessional team practices). Data from focus groups (ACPAC graduates) and interviews (stakeholders) provided further illumination of these results at individual, group and system levels. Issues relating to ACPAC graduate role recognition, as well as their deployment, integration and institutional support, including access to medical directives, limitation of scope of practice, remuneration conflicts and tenuous funding arrangements were barriers perceived to affect role implementation and interprofessional working. This study offers the opportunity to reflect on newly introduced roles for health professionals with expectations of collaboration that will challenge traditional healthcare delivery.

Background The Advanced Clinician Practitioner in Arthritis Care (ACPAC) program prepares expereinced physical therapists and occupational therapists for extended practice roles. Objectives This study assessed the practice behaviour and perceptions of ACPAC program-trained extended role practitioners (ERPs) and relevant members of their teams. Analysis evaluated the extent to which this new human health resource in arthritis care is perceived to function in the context of Interprofessional Patient-centred Collaborative (IPC) practice in Ontario, Canada. Methods Mixed-methods were used. Three focus groups (n=20 ACPAC ERPs) and 18 interviews (n=18 clinical colleagues and administrators) were conducted. All were digitally audio-recorded, transcribed and coded for anticipated and emergent themes. Themes related to IPC were analysed using components of the evaluation of interprofessional education (IPE) initiatives framework (Barr et al., 2005) to evaluate behavior and modification of attitudes and perceptions, readiness for change in organizational practice and any benefit to patient. 24 ACPAC ERPs completed the Bruyère Clinical Team Self-Assessment on Interprofessional Practice (Patrick, 2010) and a single-item rating of their team’s readiness for IPC practice. Results Qualitative data suggests that ACPAC program-trained ERPs are effective at promoting and contributing to IPC within arthritis care settings. Varying degrees of IPC exist within their arthritis care teams. Barriers such as institution-specific lack of medical directives, remuneration conflicts, and role recognition issues were barriers to role implementation. Quantitative survey: Seventy percent of respondents felt their team was actively working in an IPC practice model, 5% were prepared for action and 25% felt their team was in the precontemplation or contemplation phase. Mean Bruyère subjective subscale scores were high (all >3 [1-5=better perception of team’s IPC practice]) and objective scale scores were lower (mean 4.6 [0-9=more team practices associated with IPC actually in place]). Conclusions ACPAC program graduates are effective participants in, and contributors to IPC care at select sites. Their presence appears to promote organizational change and impart general benefit to the collaborative care of patients with arthritis. ACPAC graduates are working on teams that are at varying stages of readiness for IPC practice. They appear to understand what is needed for IPC while fewer actual IPC team practices are in place. Intensive IPC components were recently added to the ACPAC curriculum to address this gap. References Patrick, L. Transitioning Clinical Teams to an Interprofessional Model of Care (IPC): A “How To” Manual. Appendix B. Clinical Team Self-Assessment on Interprofessional Practice. Ottawa: Bruyère Continuing Care, 2010. Barr H, et al. Effective Interprofessional Education - Argument, Assumption, and Evidence. Centre for Advancement of Interprofessional Education (CAIPE). London: Blackwell Publishing, 2005. Disclosure of Interest None Declared

Purpose Despite the importance of leadership in interprofessional health care teams, little is understood about how it is enacted. The literature emphasizes a collaborative approach of shared leadership, but this may be challenging for clinicians working within the traditionally hierarchical health care system. Method Using case study methodology, the authors collected observation and interview data from five interprofessional health care teams working at teaching hospitals in urban Ontario, Canada. They interviewed 46 health care providers and conducted 139 hours of observation from January 2008 through June 2009. Results Although the members of the interprofessional teams agreed about the importance of collaborative leadership and discussed ways in which their teams tried to achieve it, evidence indicated that the actual enactment of collaborative leadership was a challenge. The participating physicians indicated a belief that their teams functioned nonhierarchically, but reports from the nonphysician clinicians and the authors’ observation data revealed that hierarchical behaviors persisted, even from those who most vehemently denied the presence of hierarchies on their teams. Conclusions A collaborative approach to leadership may be challenging for interprofessional teams embedded in traditional health care, education, and medical-legal systems that reinforce the idea that physicians sit at the top of the hierarchy. By openly recognizing and discussing the tensions between traditional and interprofessional discourses of collaborative leadership, it may be possible to help interprofessional teams, physicians and clinicians alike, work together more effectively.