Overview
Population aging presents
significant challenges to the health care system in
Ageing demographics will have a
significant impact on human resource planning and development in all
professions working in many health care contexts across the circle of
care
(McKnight et al. 2003). Providing care to the expanding population of
frail
seniors requires an both an increase in the numbers of care providers
and development
of our skill sets. Our skill sets require expertise in three broad
competencies - geriatrics,
inter-professional practice and inter-organizational collaboration.
Competence
in geriatrics is required because the clinical presentations of frail
seniors
are unique and include the ‘geriatric giants’ of dementia, delirium,
falls,
continence and poly-pharmacy often co-occurring in complex ways. Competence in inter-professional practice is
required because the complexities of these clinical presentations are
such that
optimal care requires an interdisciplinary team. Inter-professional
teamwork,
as outlined in the recently published Health Force
On the
need for training in the core competencies
Repeated surveys demonstrate that curriculum time devoted to geriatrics in the academic preparation of health professionals is insufficient. In our own surveys, for example, frailty-focused service ‘specialists’ in all disciplines tell us that they when they graduated they lacked the confidence and skill sets to care for frail seniors. They tell us that they required extensive continuing education that was acquired through informal ‘on the job’ processes, specific time-limited educational events and pilot projects though groups such as the RGPs of Ontario. These findings from the inter-professional geriatric ‘specialists’ appear independent of year of graduation (Ryan & Kirst, 2005). Limitations on geriatrics training are a challenge to the health systems capacity to meet the needs of an aging population.
The
need for renewed focus on preparing health professionals for
inter-professional
practice has recently been documented in the Health Force
The
Inter-professional Care: Blueprint for Action and the emergence of
Local Health
Integration Networks in
Between Specialized Geriatric Service providers affiliated with the Regional Geriatric Programs of Ontario, Community Health Centres and Family Health Teams who are and will increasingly be the primary source of care for the growing population of frail seniors, there exits a combination of skill sets and needs that can respond to the issues of human resource scarcity for geriatric care and the need to provide practice based training in inter-professional practice and inter-organizational collaboration as outlined in the Blueprint for Action.
Goals
and objectives
Through this initiative we
propose the development of a network of excellence in practice based
interprofessional education and interorganizational collaboration in
primary
care that will support the academic initiatives outlined in the Health
Force
The primary outcomes arising from this initiative are as follows:
1) The consolidation of a team of GIIC resource consultants situated within the RGPs of Ontario,
the Centre for Education and Research on Aging and Health at Lakehead University and the North East Specialized Geriatric Services Group in Sudbury to train coach and mentor a provincial network of GiiC facilitators.
2) The development of a province-wide network of 200 GiiC facilitators situated in Family Health
Teams (FHT) and Community Health Centers (CHC) to assist their teams and organizations in
the delivery of collaborative shared care to frail seniors.
3) A set of GIIC teaching
resources and
facilitation tools with an online repository
4) An intersectoral and province-wide health services workforce with enhanced awareness and
knowledge of each other and higher levels of skill in the three competencies
6) A sustainability plan for each network hub consistent with each group’s specific needs and
leveraging existing resources and skill sets
7) Improved shared health care for seniors and especially frail seniors
Table 1. A framework of
competencies for health human resource development
The Geriatric clinical
core
competencies
for frailty focused services
1.
The nature of frailty
2.
Dementia, delirium, depression, falls, continence, polypharmacy – the
Geriatric
Giants
3.
Context specific geriatric assessment tools
4. Specialized geriatric services and their processes
5.
Senior friendly environments and seniors safety.
6. Geriatrics and models of geriatric care giving
The
Inter-professional core competencies
Assessment competencies include
the ability to:
1. Assess the culture of a working
team
2. Assess the characteristics of a
team’s development
3. Understand the formal and
informal influence processes on teams
4. Understand individual styles of
behavior and problem solving
5 Assess team meeting
behavior
6. Identifying
the correct locus of decision-making
Intervention
competencies include:
1. Create consensus on a
best practice
2. Engage formal and informal
opinion leaders
3. Small group facilitation
4.
Communication, confrontation and conflict resolution
5. Manage task and process needs
6 Edumetrics – measurement
procedures that teach
7 The ability to
engage patients/clients and their families
as team
members
8. Inter-professional
mentoring and coaching
9.
Inter-professional ethics
Developing
inter-organizational core competencies
Inter-organizational
assessment competencies include:
1. Recognizing
teams within teams
2. Network
analysis and system pragmatics
3. Assessment
of boundary functions
4. Organizational
culture and power analysis
5. Understanding
expectancy dynamics
6. Privacy, confidentiality
and
inter-organizational collaboration
7. The colleges,
the skill sets and cognitive maps of the health professions
Inter-organizational
intervention competencies
include:
1.
Network building and support
2.
Managing change in a networked environment
3.
Inter-organizational human resource facilitation
4.
Diversity management
5.
Inter-organizational negotiation and issues management
Selected
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