Team Resources

The "wish list" section of this report testifies to the importance of team resources for both IPE and IPC. Resources can take the form of time, human, space and financial. Compelling cases can be made for all of these resources, with the bottom line argument being that investment in IPE and IPC will likely improve patient care in a cost efficient manner. While each IPE and IPC setting would have different resource allocation priorities, some generalizations are as follows:

Time

With the busy, often hectic, schedules of many health care professionals, there is sometimes not enough time in the day to engage in IPE and/or holistic IPC. Designated time is needed for holistic care (home visits and outreach), team meetings, IPE opportunities (like grand rounds, student/peer mentoring, team orientation), and reflection, evaluation and dissemination. It was felt that Nurses, who because of the sheer size of the profession, would be the key profession to buy into IPC as this would start an "avalanche" of support. Unfortunately though, it is the Nurses who may have the greatest time constraints in attending IP education sessions.

Human

Human resource management in the health care/education sector is a major concern for NW Ontario. To make IPC and IPE work you need the "right person for the right job". Not only is there a shortage of many professionals and qualified support personnel, there is also concern with stability/sustainability of the health workforce. Human resources are linked to time or money resources as more than one participant shared sentiments similar to:

On the bright side, there is anecdotal evidence that IPC models, like the family health teams, maternity centre and community health centres, are effective components of a recruitment and retention strategy (see also care provider benefits of IPC on page 17). Workers appreciate the team atmosphere and support and belief in the end goal. For example one staff member noted:

Another counselor commented:

Space

There is a lack of space to fully integrate IPE with IPC. For example there should be meeting rooms big enough to accommodate the whole team and examining rooms large enough for multiple learners or other care providers. When patient centredness is added to the mix the list of space needs grows (see wish list section). Nonetheless, in the settings interviewed teams were making do with what was available. One of the keys was simply collocation of the various professionals so that communication, both formal and informal, was facilitated. Communication mechanisms will be discussed later.

Financial

Financial resources have been alluded to with the other resources as a lack of any resource often comes down to financial limitations. It is important to note though, that more often than not, the frustrations related to financial resources had less to do with total money in the system, but inflexibility of financial resources. Silo'd funding at the system level often means inflexible financial resourcing at the health care organization's level. The silos we build (due to educational system, social system, professional system, etc.) is a cross cutting theme and will be noted many times throughout this paper. The success stories cited in this review are usually examples of individuals navigating around the system. For example:

Payment plans can create either an incentive or disincentive for IPC. It was noted by many that the fee for service is a barrier to IPC as it incents procedures and billable consults instead of holistic care management. While it is beyond the scope of this environmental scan to do an assessment of different payment plans, the patient panel (the unique, unduplicated, discrete patient population for which the physician/team is responsible) appears to incent holistic and population based care, while holding the team accountable, Jubber, 2009. The patient panel is being used in Alberta and would define the work (demand) by the physician/team and would be adjusted to account for patient characteristics (i.e. diabetes, depression, elderly, etc.).

At St. Joe's we always plan noon hour education sessions. Fabulous, fabulous sessions, teleconferenced, video conferenced but you never got the nurse down there and the reason you don't get the nurse down there is that they are too busy up on the floor feeding the patients, and doing things for the patients so after a while the hostility and resentment comes from the nursing, who sees all of the other disciplines going to these things coming back all enthused and excited and here is Cinderella upstairs on the floor doing all the work.

Other (non-nursing) participant: we have the luxury of being able to schedule our clients.

…back to that efficiency piece is that sometimes we are just so bare bones, it is not that we are resistant to change, but how do you back fill that direct care person to do grant proposals and do all those things so you can do the innovation.

I don't think money is the motivator. Until you have worked in a really collaborative model, I don't know for myself anyways if I truly appreciated collaboration…until I was doing it all these years. And once you have done it, and that is what I say when I look back on my career and look to the future, I wouldn't want to do it any other way. It is just better care; less patients falling through the cracks.

One of the reasons our health centre is doing so well is that we have found a way, like [other participant] to bypass the system in many situations. We have found a way to bend the rules, to twist the guidelines, to make it work for us. That takes a lot of energy. Most people won't do that which is why a lot of organizations are stuck in paperwork.