So Long, Silos Interprofessional care benefits patients, but teaching future clinicians how to provide it can be challenging. Follow these guidelines to “de-silo” your academic program. Features
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Features  |   June 01, 2013
So Long, Silos
Author Notes
  • Jack Pickering, PHD, CCC-SLP, is professor of communication science and disorders at the College of St. Rose in Albany, N.Y., and co-director of the department’s Transgender Voice and Communication Program. He is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders. pickerij@mail.strose.edu
    Jack Pickering, PHD, CCC-SLP, is professor of communication science and disorders at the College of St. Rose in Albany, N.Y., and co-director of the department’s Transgender Voice and Communication Program. He is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders. pickerij@mail.strose.edu×
  • Erin Embry, MS, CCC-SLP, is the associate director of the communicative sciences and disorders graduate program at NYU Steinhardt School of Culture, Education, and Human Development. ee28@nyu.eduv
    Erin Embry, MS, CCC-SLP, is the associate director of the communicative sciences and disorders graduate program at NYU Steinhardt School of Culture, Education, and Human Development. ee28@nyu.eduv×
Article Information
Professional Issues & Training / Features
Features   |   June 01, 2013
So Long, Silos
The ASHA Leader, June 2013, Vol. 18, 38-45. doi:10.1044/leader.FTR1.18062013.38
The ASHA Leader, June 2013, Vol. 18, 38-45. doi:10.1044/leader.FTR1.18062013.38
Fred Astaire and Ginger Rogers. Wilbur and Orville Wright. Lewis and Clark. Steve Jobs and Steve Wozniak. King George VI and Lionel Logue.
What do these names have in common? We may recognize some of these people and their individual accomplishments, but it is their success as part of a dynamic collaboration that we remember most. The results of creative, interprofessional collaboration are all around us: a Pixar movie, pictures from Mars, a cochlear implant, an iPad app, a laryngeal transplant. These accomplishments are possible only because of the efforts of multiple disciplines working together to create art, expand knowledge, solve a problem or help others.
As communication sciences and disorders professionals, it’s not enough to demonstrate the value of interprofessional collaboration to future clinicians—we need to teach them how to work with other professionals to achieve better outcomes for patients.
Why collaborate?
In her book “Creative Collaboration,” Vera John-Steiner writes that most meaningful artistic and scientific achievements result from creative interprofessional collaborations, rather than solitary acts from great, individual minds. Positive outcomes emerge from joint thinking, passionate conversations, emotional connections, and shared struggles common in meaningful relationships. The late Mark Ylvisaker, then College of Saint Rose professor of communication sciences and disorders, revolutionized services for people with traumatic brain injury, in large part because of his philosophy of collaboration in assessment and intervention. In 2007, in an interview conducted as part of the International Brain Injury Association’s 25th anniversary, he said that in an exceptional rehabilitation team for people with traumatic brain injury, the team members:
  • Learn from one another and share skills.

  • Do not function in a pecking order or hierarchy.

  • Understand that many critical client needs are not discipline-specific.

  • Are willing to blur professional boundaries, respecting one another.

In the context of health care, these powerful ideas are gaining momentum in clinical education.
Research in health care indicates that interprofessional collaboration enhances patient care by increasing efficiency, improving continuity of service, reducing errors, and providing a context for sharing increasingly scarce resources (see sources list online). Interprofessional collaboration in health care mirrors the real world in many ways and, given technological advances, global learning and economic pressures, interprofessional collaboration is becoming the societal norm. The World Health Organization discusses the global significance of interprofessional collaboration in the 2010 document, “Framework for Action on Interprofessional Education and Collaborative Practice” (bit.ly/WHOframework). It points out the critical need to educate the next generation of health care providers in principles of interprofessional collaboration to support health care around the world.
Learning to collaborate across disciplines
As the U.S. health care system strives to become more interprofessional and collaborative, policy makers are urging higher education institutions to teach students how to work in teams. We are seeing significant changes in medical and nursing education to address this need. Recently, eight professional organizations that represent educators of health care providers came together to generate core competencies that can facilitate interprofessional collaboration in the classroom, clinic and community (bit.ly/ipecreport). This collective, the Interprofessional Education Collaborative, generated the competencies to help future doctors, nurses, dentists, pharmacists and other providers gain the skills needed to work in an increasingly collaborative, team-based, health care arena. The competencies are arranged around four domains: values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork.
The framework for implementing these competencies and responding to calls for action is interprofessional education. IPE requires students in multiple disciplines to learn together with intention, mutual respect and commitment. (For an update on ASHA’s IPE efforts, visit www.asha.org/leader.) It requires continuous interaction, coordinated effort and knowledge sharing, activities consistent with person-centered clinical practice, and Mark Ylvisaker’s characteristics of an exceptional team. As appealing as these principles sound, activities that promote this type of learning typically are not found in the clinical education of speech-language pathologists or audiologists.
Difficulties implementing IPE
Ample evidence supports interprofessional collaboration. To provide this collaboration effectively, we need to educate future health care providers in team-based service delivery and to establish a framework for teaching interprofessional collaboration. However, inherent tendencies in higher education pose barriers to its implementation. Broadly speaking, these barriers include the tendency to reward individual achievement, insufficient funding for interprofessional activities, and, importantly, differences in terminology and professional cultures among disciplines. Further, academic programs are usually organized in silos, independent of other disciplines in administrative function and curriculum. Coursework is often disorder-specific, with an awkward separation between academic knowledge and clinical skills.
These challenges make it difficult to expose students to meaningful interprofessional collaboration during their course of study. But overcoming them yields many benefits. Exposure to interprofessional partnerships broadens students’ knowledge and experiences in our increasingly team-based, collaborative health care system; faculty members have opportunities for meaningful, contextualized scholarship that can enhance program viability and visibility; and, most important, the implementation of team-based, interprofessional collaboration improves the care we provide in clinical practice.
We can take 10 steps to cultivate interprofessional collaboration in our classrooms, clinics and communities.
  1. Scan the internal and external environment to see what is available. There may be collaborative opportunities within your department or unit with colleagues you know, and you may be able to capitalize on affiliations already established. However, partnerships that extend outside your unit—whether on campus or beyond—also may provide unique chances for interprofessional collaboration. Community-based organizations that serve our clients may be worth considering, particularly if such projects would fill unmet needs in your clinic, hospital, local schools and community. One example is the Rockcastle project, a collaboration among a rural hospital in Eastern Kentucky and students and clinical supervisors in occupational therapy, physical therapy and speech-language pathology from two Kentucky universities (on.asha.org/rockcastle).

  2. Find a willing colleague. Planning and implementing interprofessional partnerships require considerable effort and time, so it’s important to share the experience with a colleague. This colleague is not necessarily someone with whom you always agree or share a style. Rather, a working relationship that can facilitate open dialogue and debate can lead to creative problem solving. Critical conversations may be necessary to move your ideas forward. Explore opportunities to share ideas and leadership roles with other team members to maintain a sense of empowerment, trust and respect by all involved.

  3. Identify a shared vision and tap into individual strengths. Each person brings strengths to the process of developing and implementing a collaborative partnership. Use those strengths to identify a shared vision for the project. These two ideas go hand in hand. Successful interprofessional teams appreciate, understand and accept the individual contributions of their collaborative efforts and goals, and then re-envision them as part of a collective. Regardless of the discipline, ask: What do you hope to accomplish on behalf of the people being served by the collaboration?

  4. Enhance core competencies for collaboration. To explore ideas that enhance collaboration among students, consider using the Interprofessional Education Collaborative’s core competencies as a guide. Each of the four domains in the document includes specific objectives that can be applied to the collaboration. Include these ideas, as well as the discipline-specific content that team members need to share to make the collaboration successful.

  5. Plan carefully. One of the main pitfalls of developing and implementing a successful interprofessional collaboration is rushing to start. The collaborating faculty/clinical supervisors need time to develop a curriculum, consider space and learn the language of one another’s disciplines. Trust and respect take time to cultivate, but are essential in promoting shared decision making in the collaborative process.

  6. Engage stakeholders in planning and evaluation. Do not do the work on your own. Encourage feedback from others—including students and clients—who will make the project better. A focus group or evaluation team can consider critical features of the collaboration; ideal team members would include professionals in the field who could support and be supported by such collaborations.

  7. Get administrative support. Administrative support goes beyond finances. A department chair or college dean who supports your project can open the door for creative ways to maximize time and departmental resources. In addition, the positive public relations generated by administrators often can garner positive attention to the partnership. Keep your chair and dean apprised of the project to help sustain the collaboration.

  8. Seek funding and share resources. We have each received internal professional development funding to initiate, assess, and/or improve our collaborations. Additional support, including access to other professionals and various medical settings and community centers, followed in response to our successes. Health care and education settings require professionals to share resources—including space and time—and the same is true for interprofessional education. Institutions that provide clinical services can generate income. Translational research supported by the National Institutes of Health or the National Science Foundation often includes the expectation of collaboration, so creative partnerships can be folded into grant opportunities (see ASHA’s information on collaboration in research, on.asha.org/inter-collab), yielding a great way to integrate academic and clinical education.

  9. Share what you are doing. Let others know of your collaborative efforts, through public relations and scholarship. Well-planned collaborations with an evaluation component facilitate research that can be shared in conference presentations and scholarly articles. The potential for student research is great, and there are avenues for sharing creative interprofessional collaboration beyond our discipline. Also, successful collaborations that support real people in the real world make good stories in an alumni newsletter, internal correspondence, local newspapers and professional association news.

  10. Follow up, evaluate, improve. Do not rest on success! Constantly evaluate the partnership with a focus on the individuals served. At the end of the class, semester or treatment period, sit down with your collaborators and discuss the project outcomes and strengths and weaknesses. Think big and outside the box when considering next steps. Involve students, clients and professionals in your follow-up and modify goals for the next opportunity, if necessary.

  11. Collaborative work in clinical education takes vision, time, effort and creativity, but if done effectively, has far-reaching impacts that may exceed your initial expectations. When we present information about interprofessional collaboration, we often refer to the original “Saturday Night Live” as a quintessential creative collaboration that ultimately changed the face of late-night television. The cast, partnered with the talents of the writers, musicians, technicians and directors, made us look differently at entertainment.

In an increasingly complex, global professional environment, we give our students a distinct advantage when we cast them in interprofessional teams that mirror the interprofessional clinical services they will provide. Helping them become part of a creative team of professionals allows them to see their work in a different, client-centered way.
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June 2013
Volume 18, Issue 6