The Collaborative Learning Environment for Health Professionals (CLE) assesses the methodologies that nurture and support interprofessional delivery of health services by health care providers. For purposes of this CLE project, interprofessional competencies are defined as:
- conflict resolution
- role clarity
- team functioning
- collaborative leadership
The CLE project was designed by the Atlantic Advisory Committee on Health Human Resources (AACHHR) and funded by Health Canada through the “Health Care Policy Contribution Program” until March 31, 2012. The CLE project arose from the commitment of federal, provincial and territorial governments to enhance teamwork in the delivery of health services. This teamwork approach would serve as a basis to address human resource shortages and improve system efficiency and effectiveness. Through CLE, the following products and processes were developed:
- a tool to identify gaps in interprofessional skills;
- learning modules;
- evaluation of various approaches to skills development;
- methodologies to review cases and align administrative policies.
The CLE has three components: demonstration, research and evaluation .
Demonstration sites were selected at four locations:
- Miramichi City, New Brunswick: Advisory Committee for the Healthy Baby and Me program: The committee directs and guides the delivery of this program at the Miramichi site. Committee Members are community representatives from various professions and areas of expertise. CLE Project Report Miramichi NB site
- St. Martha’s Hospital, Antigonish, Nova Scotia: Maternal Child Clinic. The clinic serves the population of Antigonish and surrounding areas which includes parts of Cape Breton, Pictou County, and First Nations communities. The clinic staff includes a manager, two midwives, a lactation consultant, a registered nurse, a public health nurse; social worker, a family physician; the Chief of medical staff; and three obstetricians. CLE Project Report on Antigonish NS site;
- James Paton Memorial Regional Health Centre, Gander, Newfoundland & Labrador: Obstetrical Clinic. The mandate for the Maternal Child team is to provide holistic care for the maternal child population. The team serves a population of about 45,000 throughout multiple rural communities where Healthy Baby Clubs (HBC) and satellites of HBCs are found. There are approximately 350 deliveries per year at the clinic. Family physicians and nurse practitioners provide early prenatal and postnatal care to this population. CLE Project Report on Gander NL site;
- Victorian Order of Nurses (VON) New Brunswick: Provincial facilitators for the Healthy Baby and Me program. These facilitators are from various disciplines and work in eleven separate locations in NB to coordinate activities for the HB&M sites. CLE Project Report on VON NB site.
CLE research activities included assessment of staff skills at the four sites and implementation of learning activities aimed to address gaps in interprofessional competencies. Based on a literature review, CLE project staff identified two skills assessment models, namely the Collaborative Practice Assessment Tool (CPAT) and the Readiness for Interprofessional Learning (RIPLS). Elements of these models were used to design a new questionnaire, the CLE-Needs Assessment Questionnaire. It allowed individuals to assess their skills in communication and negotiation as well as their working relationship(s) with colleagues.
At the NS site, a member of the CLE project staff participated as an observer at meetings of the clinical team. This observation process provided additional insights into the interpersonal behaviours and communication skills of the participants.
At each site, healthcare providers participated in pre-existing programs and new learning activities designed by the CLE project team. The delivery and timing of the activities varied from site to site in response to the identified needs of the participants. The interventions at each CLE site were designed to both respect and accommodate the contextual factors.
Learning modules based on the needs assessment were designed and delivered to staff at both the VON NB and Miramichi City sites. These included: conflict management, environmental scanning, managing stress, negotiation skills and working effectively together.
Established programs that supported learning needs were also implemented. The MOREOB/AMPROOB Program created by the Society of Obstetricians and Gynecologists of Canada was implemented at the NS site. Michael Leiter and Associates’ Civility, Respect, and Engagement at Work (CREW) Program was offered at the NL and NS sites.
Policy review activities took place at the sites in NS and NL. CLE project staff worked with participants to complete policy review for both administrative and clinical organizational policies. Through the review they identified barriers and enablers of interprofessional collaboration.
A case review process was introduced in NS using mock scenarios that addressed recognized barriers to interprofessional collaboration with new and/or existing collaborative teams. The case review process combined clinical learning and facilliatation of competencies and relationships that supported interprofesional practice.
Multiple approaches were used to facilitate learning. These ranged from face-to-face workshops, on-line seminars, case vignette videos, simulations, role-playing, presentations, observation, group and one-on-one meetings.
An evaluation plan was developed for the CLE. Process evaluations were undertaken at each site to assess the participation and continuity of activities. Both the CREW and MOREOB / AMPROOB programs include assessment processes to identify impacts and changes in the skills of the staff group.