Interprofessional Collaboration 

 Interprofessional collaboration occurs when multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality of care.

Driven by necessity, rural practitioners build strong collaborations with other providers to better care for their communities.

Interprofessional collaboration has many benefits:

• Improved communication, coordination, and partnerships between health providers, patients and their families, and less risk for patients to ‘fall through the cracks’.  
• Better care for patients with complex and/or chronic conditions because joint expertise can address the broader factors that influence health (i.e. social determinants of health) in the care plan.
• Better patient experience and higher satisfactions with their care. 
• Supportive health-care practice through meaningful contact with other health professionals.
• Improved access to services and more effective use of health resources.  

There are many great examples of inter-professional collaboration in rural areas.

While the benefits of collaboration to patients are clear, effective collaboration is not always easy to achieve. First, it requires trust and respect between providers and the sense that each member is valued. Traditional hierarchies in the health-care system can sometimes get in the way of sharing decisions for care. Not understanding each other’s scope of practice can lead to efforts to protect professional ‘turf’. The work environment might not always facilitate collaboration. 

Health professionals need to learn and practice special competencies to become good collaborators.

 Competencies are the knowledge, skills and abilities health care provider need for better patient outcomes.

There are many initiatives that help health sciences students and professionals to become more proficient in collaboration:

• In some medical and health sciences programs, students have an opportunity to do an interprofessional clinical placement. These experiences help students to understand the roles of other health providers, practice collaboration, and potentially influence the choice for rural practice. 
• The University of Alberta has created an Interprofessional Learning Pathway that links a series of courses and practice experiences into a comprehensive collaboration curriculum.  
• Through RhPAP’s ‘Let’s Go Rural!’ program, post secondary students can team up to get early exposure to rural health-care practice. Feedback from participants suggest that these collaborative events are great opportunities to learn with others about rural practice. They may also spark an interest in rural practice. 
• RhPAP offers several programs for rural health-care teams to train together, such as the Emergency Department Echo (EDE) program and the Financial Incentive for Rural Staff Training (FIRST).

Interprofessional collaboration is a way to achieve better patient care while at the same time having a happier and more effective workforce.  

In the past, much of the education for health sciences and medical students occurred in their own professional departments. Students had little opportunity to learn about other health professions. It became clear, that if collaboration in health care was the goal, universities and colleges needed to change the way they educate their health sciences students.  

 All of these diverse members of the health team should be brought together during their undergraduate years, taught by the same teachers, in the same classrooms and on the same patients. – McCreary, 1964

This is not a new idea, but it took more than 40 years for Dr. John McCreary’s vision to become reality in Canada.

In 2004, Health Canada launched the initiative on Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP). The initiative funded over 20 projects across Canada. The goal was to demonstrate the benefits of educating health sciences students for collaborative practice and to increase the number of health professionals trained in collaboration.  

The initiative resulted in curriculum changes in many health sciences programs to better prepare students for their collaborative role. It also produced the National Interprofessional Competency Framework. 

These competencies capture the knowledge, skills, and abilities that all health providers need to be successful collaborators in health care.  

Many health professions regulatory bodies (e.g., Canadian Nurses Association) support inter-professional collaboration as an essential way to care for patients and they have adopted the National Inter-professional Competency Framework. Similarly, Alberta Health Services has a strong focus on collaborative practice and promotes the use of the interprofessional competencies.

Many health professionals love their rural practice because of the positive, collaborative work-environment. This became very evident in a RhPAP study of successful health provider attraction and retention strategies. Many clinics in the 12 rural communities that participated promote interprofessional practice models where physicians, nurse practitioners, pharmacists, nurses and allied health-care professionals work very closely alongside billing and referral staff.

Being able to work with a range of health-care providers is an attractive practice feature.  

 Being in a small facility, we know all the nursing staff and all the physicians by first name; you are really able to collaborate with other professionals; people actually know who you are and know a little bit about you”. – RhPAP 2018, ‘Building on Success’ project

Strong interprofessional collaboration has a range of benefits for health providers: 

• They can work to their full scope of practice by delegating to appropriate providers
• They feel less isolated and have more social interaction 
• They can quickly access colleagues for questions and support and to jointly plan patient care

In rural clinics and hospitals, we find various elements that foster collaboration, such as open communication, considering everybody equal, and appreciating each other’s skill. Teams also train together to support stronger collaboration.

The RhPAP study found that some clinics encourage interprofessional collaboration through workplace design. For example, in one clinic, all physicians, nurses and learners work at one communal desk all day. This makes it easy to ask questions and offer support.  

Many health providers interviewed in the study referred to their colleagues as their families – they don’t just work together but they also have fun together and support each other outside of work. A positive, collaborative work environment helps to keep health providers in the community and creates stable medical communities. It also makes it easier for new health-care providers to join and stay for the long term.  

Professional isolation describes a situation where health providers feel they lack support in their role or professional opportunity, and are not recognized or praised for achievements. Professional isolation can be a challenge for rural health providers. They often miss peers from the same profession or mentors that could help with difficult care decisions. They may not have easy ways to interact with others, such as during professional development workshops.

Studies have shown that professional isolation is a barrier to recruitment of health care providers to rural areas. It can also prompt a health-care provider to leave.

Rural health providers use many strategies to feel less professionally isolated. Collaborating with other health providers can create a feeling of support and shared responsibility. They can also build professional support through virtual relationships with urban health-care centers through telephone contacts, telemedicine and specialist access.  

Participating more fully in the community can make health providers feel more at home overall and create a better work-life balance. Many communities host regular appreciation events to show that they care about their health providers. This is an important retention strategy that can help keep health providers in the community. 

Explore interesting reads on interprofessional collaboration by clicking the links below:

• Short report: The importance of interprofessional collaboration in health care in rural and northern settings
• Blog post: Have investments in interprofessional education led to changes in practice?
• Editorial: Interprofessional education: A college perspective
• Academic article: Interprofessional education for collaborative patient-centred practice
• Academic article: Effective teamwork in healthcare: research and reality
• Academic article: Leading collaboration among the providers of primary health care
• Canadian Nurses Association: Collaborative practice in nursing
• Physiotherapy Alberta: Collaborative practice standards for physiotherapists
• Alberta College of Speech-Language Pathologists and Audiologists: FAQs on professional considerations for collaborative practice for SLPs & Audiologists