Collaborative care receives stamp of approval in CMA, CNA study involving HIV/AIDS

David Walters, MA, MD, CCFP; Donald Morgan, MD, FRCSC; Mary Colbran-Smith, DPOT, MPA

Canadian Medical Association Journal 1996; 154: 21-27

David Walters is director of the CMA's Department of Health Care and Promotion, while Donald Morgan chairs the Council on Health Care and Promotion. Mary Colbran-Smith is senior project manager in the department.

In Brief

The CMA wants to work with national health care groups, such as the Canadian Nurses Association (CNA), to explore ways providers can work collaboratively to provide quality health care. A joint working group of the CMA and the CNA recently examined collaborative care, focusing on examples provided in HIV/AIDS care. The group developed principles to help people work collaboratively in a variety of settings.

En bref

L'AMC souhaite explorer avec d'autres organisations nationales du secteur de la santé, telles que l'Association des infirmières et des infirmiers du Canada (AIIC), des façons pour les fournisseurs de collaborer à la prestation de soins de santé de qualité. Un groupe de travail mixte de l'AMC et de l'AIIC s'est penché récemment sur les soins en collaboration, plus particulièrement dans le contexte des soins prodigués aux patients atteints du VIH/SIDA. Le groupe a formulé des principes pour favoriser la collaboration dans divers milieux de soins.

A rapidly changing environment is presenting new challenges to health care providers. As governments critically examine the health care system to control costs, providers must explore ways to strengthen and further develop partnerships with one another. Last summer, after receiving a grant from the AIDS Care, Treatment and Support Unit at Health Canada, the CMA and Canadian Nurses Association (CNA) undertook a joint project to explore and address the challenges presented by collaborative practice. A working group of four physicians and four nurses was formed to look at collaborative care in general; HIV/AIDS care was chosen as the focus because of the complexity of the disease process, the number of care providers involved and the importance of a continuum of coordinated care.

The result of that work is a background paper, published in booklet form and now available through the CMA's Member Service Centre 1867 prom. Alta Vista Dr., Ottawa ON K1G 3Y6; tel.: 800 663-7336 ext. 2307, fax: 613 731-9102, email: cmamsc@cma.ca or through the CNA. The working group conducted a comprehensive literature review, identified broad principles for collaborative practice, highlighted examples of excellence in HIV/AIDS collaborative practice across Canada and recommended future actions for decision makers.

The generic principles developed by the working group are intended to help professionals working in a variety of settings. The CMA and CNA hope they will foster a better understanding of the advantages and opportunities that exist when professionals work together to provide care.

Collaborative practice is attracting increasing attention. Specialization of services and the growing complexity of care make interdependency and support among professionals essential. Collaboration provides a framework for strengthening interprofessional communication and increasing the efficient use of resources.

Collaborative practice means sharing in planning, decision making, problem solving and goal setting. There is also shared responsibility for coordinating activities, communicating openly and understanding other points of view. The argument in favour of collaborative practice is simple: a team effort will usually be more effective in meeting a patient's needs than care provided independently by a number of people. The working group strongly believes that the main element for successful collaborative practice is positive and open communication. Communication must consistently respect the patient's central role on the team and the expertise and responsibilities of all team players.

The group reviewed all levels of decision making: macro (societal and system); meso (facility and community); and micro (patient and provider). To be effective, the group concluded, principles for collaboration must address factors at all decision-making levels.

Successful collaborative relationships have been demonstrated in many clinical areas: palliative care, rehabilitation, geriatrics, mental health and, most recently, in HIV/AIDS care. These examples provide a sound foundation for the future development of collaborative-practice models. They also provide important information and experience for people and groups examining the need for better planning, coordination and delivery of health care and support services.

The working group chose to highlight four models of collaborative practice used in the treatment of HIV/AIDS patients; these offer examples of collaborative care provided by physicians, nurses and other providers in different settings.

One important factor was the limited amount of evidence concerning collaborative practice, whose benefits are often argued rather than demonstrated. However, several studies discovered during the literature review pointed to increased patient and provider satisfaction in interdisciplinary team settings. The working group believes that more research on the potential benefits of collaboration is essential.

Despite the lack of concrete evidence, the group examined the potential value of collaboration to patients, organizations, facilities and professionals. It also explored several barriers to collaborative practice, including the issues of team leadership, the need for active patient participation, organizational challenges, time and cost considerations, educational gaps and problems in group dynamics.

The working group developed a set of general principles that is intended to guide and support the development of collaborative-practice models in different settings. This type of practice involves:

patient-centred care with a minimum of two caregivers from different disciplines working together with the patient to meet assessed health care needs;
development of a shared or common vision, values and philosophy focused on meeting care needs;
clear definition and understanding by all of team-member roles and responsibilities;
a climate of respect, trust, mutual support and shared decision making;
effective communication among all team members;
empowerment of all team members;
respect for autonomous professional judgement; and
respect for autonomous choices and decisions of the patient. The working group also made several recommendations for decision makers at all levels:
patients should be included in the development, implementation and evaluation of collaborative-practice models;
educational curricula for health care professionals should include theory and clinical experience in collaborative practice;
health care organizations, agencies and practices should be encouraged to explore pilot projects that focus on the effectiveness of the collaborative-practice approach in changing health outcomes and on patient and provider satisfaction; these groups should also seek funding to investigate, research and evaluate collaborative models; and
discussion of collaborative care should be encouraged within the primary care and specialty groups of the CNA and CMA.

The CMA recognizes the importance of and need for leadership that will develop, promote and facilitate collaborative efforts at the practice level. To that end, the Board of Directors has made it a priority to work with other national professional groups, such as the CNA, to explore ways providers can work collaboratively to ensure that all Canadians receive quality care in the future.

| CMAJ June 15, 1996 (vol 154, no 12) / JAMC le 15 juin 1996 (vol 154, no 12) |