This chapter traces the early history and progress of a pioneering interprofessional practice and education (IPE) program at Western University of Health Sciences (WesternU), whose growth and development can be viewed in the context of the broader IPE field, that of a nascent movement within the United States to recognize and facilitate collaborative, patient-centered healthcare. This chapter provides some of the background and details from the early design years at WesternU. The IPE movement in the U.S. worked with general principles and broad conceptual outcomes such as safety and quality but it took time to delineate more specific guidelines and practices. Over the years, frameworks and standards for education, practice, and outcomes assessment have developed that have helped to guide the program. Similarly, WesternU has developed and refined its education and assessment methods over time.
Healthcare and High-Functioning Teams
It would be hard to argue that well-functioning teams are capable of producing better outcomes than individuals working in isolation, particularly when dealing with complex tasks. This could be said for many industries, but it has special importance in health care.
Society has every right to expect that the delivery of health care should be a well-choreographed process in which all members of the health care enterprise work in concert to ensure the best possible results for the patients and populations they serve. But where does the concept of teamwork in health care come from? As students celebrate their transition to practicing professionals, they often take a pledge or oath signifying their commitment to the highest ethical and moral values and the wellbeing of their patients. Yet, there are no references to teamwork, collaboration or working with others to improve patient care or outcomes in the Hippocratic Oath, The Oath of a Pharmacist, Florence Nightingale Pledge (derived from the Hippocratic Oath and often modified for contemporary use), or the Dentist’s Pledge.
Where do we see evidence of effective interprofessional teams? Pandemics and epidemics place sudden and intense demands on health systems. Teams often respond. Natural disasters and humanitarian crises bring health professionals together in relief efforts. The key elements that make teams work in these settings is a workforce shortage, adding to the value of each contributing member; a shared situation awareness such as a hurricane, earthquake, or flood; and a common goal. Everyone knows why they are there and they know what has to be done. There will also be a less formal delineation of roles as everyone is needed to the full extent of their abilities.
The healthcare literature offers numerous examples of high functioning health care teams, particularly in interdependent care situations such as emergency rooms, trauma settings and surgical teams (Courtenay, Nancarrow & Dawson, 2019; Wilson et.al, 2005). In these settings it is of paramount importance to have a common team mental model: a shared understanding about roles, responsibilities and tasks, and the ability to anticipate teammates’ responses and adapt to situations (Mathieu, Heffner, Goodwin, Salas, & Cannon-Bowers, 2000). With these teams there is a shared situation awareness, a free flow of information and a common goal. If those are the components of high functioning teams, however, should there not be numerous examples in the literature for all practice settings? As Mitchell et al. (2012) state (p. 3):
Teams in health care take many forms, for example, there are disaster response teams; teams that perform emergency operations; hospital teams caring for acutely ill patients; teams that care for people at home; office-based care teams; geographically disparate teams that care for ambulatory patients; teams limited to one clinician and patient; and teams that include the patient and loved ones, as well as a number of supporting health professionals. Teams in health care can therefore be large or small, centralized or dispersed, virtual or face-to-face—while their tasks can be focused and brief or broad and lengthy.
Other examples of team-based health care include the field of Geriatrics (as is discussed in another chapter in this volume by Meyer and Hoffman) and the treatment of chronic illnesses and conditions requiring coordination of care and interprofessional collaboration (van Dongen et al., 2016).