canadian interprofessional health leadership … · 6 executive summary canadian interprofessional...

CANADIAN INTERPROFESSIONAL HEALTH LEADERSHIP COLLABORATIVE

FINAL REPORTJUNE 2015

This is the Final Report of the Canadian Interprofessional Health Leadership Collaborative (CIHLC).

Individual Site Reports for each partner University and the full Appendices can be found at: www.ipe.utoronto.ca/community-engagement/cihlc-project/cihlc-final-report

ACKNOWLEDGMENTS

The CIHLC project was a consortium of five partner Canadian universities from 2011-2015 namely the University of British Columbia, University of Toronto, the Northern Ontario School of Medicine, Queen’s University, and Université Laval, and was funded by the Ontario Ministry of Health and Long-Term Care, with start-up funding from the University of Toronto and by individual contributions of the partner universities. The authors would like to take this opportunity to thank a number of people for making this work possible. Thanks to Carmela Bosco for her consulting in writing the proposal, and inaugural project management, to Cate Creede, Marcella Fiordimondo, Matthew Gertler, Jelena Kundacina, Fatima Mimoso, Jane Seltzer, Rebecca Singer, Marcella Sholdice, Benita Tam, Deanna Wu and Belinda Vilhena for supporting this project in various ways during their work in the CIHLC Secretariat. We also thank Patrick Kelley, Patricia Cuff and Megan Perez at the Institute of Medicine for their expertise and their moral support. In addition, we thank Deans Catharine Whiteside, Richard Reznick, Roger Strasser, Renald Bergeron and Gavin Stuart for their support during this project both in terms of their invaluable advice and guidance. Finally we express our deepest gratitude to Lancet Report Commissioner and President David Naylor (UofT) for his leadership, encouragement and mentorship.

http://www.ipe.utoronto.ca/community-engagement/cihlc-project/cihlc-final-report

CONTENTS

Acknowledgments ................................................................................................................................................ 2 Executive Summary / Sommaire ....................................................................................................................... 4

1. The Canadian Interprofessional Health Leadership Collaborative .................................................12A. Rationale for Formation of Collaborative ........................................................................................................ 12B. Project Vision, Goal and Objectives .................................................................................................................. 13C. Project Membership, Governance and Implementation .......................................................................... 14D. Project Foundational Documents .................................................................................................................... 15E. Funding ....................................................................................................................................................................... 15F. Implementation Process ..................................................................................................................................... 16

2. Research and Knowledge Acquisition .....................................................................................................16A. Scoping Review ....................................................................................................................................................... 17B. Key Informant Interviews...................................................................................................................................... 17C. Literature Review ..................................................................................................................................................... 17D. Inventory of Canadian Leadership Programs ................................................................................................ 18E. Social Accountability and Community Engagement .................................................................................. 19F. Evaluation .................................................................................................................................................................. 19G. Blended Learning ....................................................................................................................................................20

3. Creation and Development .........................................................................................................................20A. Program Design and Development .................................................................................................................20B. Partnership ................................................................................................................................................................21

4. The Integrated Collaborative Change Leadership Program ..............................................................22A. Program Description ..............................................................................................................................................22B. Learner Teams ..........................................................................................................................................................24C. Program Evaluation: Purpose, Methodology and Results ........................................................................24D. Conclusions of the Evaluation ............................................................................................................................26

5. Knowledge Transfer ......................................................................................................................................27A. Project Website and Other Communication .................................................................................................27B. Publications, Posters, Workshops and Presentations ................................................................................28

6. Canadian Leadership Activities ..................................................................................................................32A. Institute of Medicine Global Forum on Innovation in Health Professional Education ...................32B. Reaching the Summit: Leading the Way from Interprofessional Education to Practice ................33

7. Outcomes and Future of CIHLC ................................................................................................................34A. Beyond the Project .................................................................................................................................................34B. Impact of the CIHLC-UHN Partnership on Future Programs ..................................................................34C. Planning for Future Programs .............................................................................................................................35

8. Reflections and Conclusion .........................................................................................................................36A. ReflectionsoftheNationalSteeringCommittee .........................................................................................36B. Conclusion .................................................................................................................................................................37

List of Appendices ............................................................................................................................................... 38

4 Executive Summary Canadian Interprofessional Health Leadership Collaborative Project Final Report, 2015

EXECUTIVE SUMMARY

The Canadian Interprofessional Health Leadership Collaborative (CIHLC) was chosen by the U.S. Institute of Medicine’s (IOM) Board on Global Health, who then formed the Global Forum on Innovation in Health Professional Education (Global Forum), as one of four international innovation collaboratives from an international competition of academic institutions around the world. The collaboratives were intended to incubate and pilot ideas for reforming health professional education called for in the 2010 Lancet Commission report “Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World”. The CIHLC joined the Global Forum and became Canada’s visible manifestation of the reforms of the Lancet Commission, as well as a voice for increased capacity in leadership education, and an expression of success in inter-organizational partnerships across five universities. There was wide support for many of the Lancet Commission’s recommendations and the CIHLC was clear evidence of Canadian institutions taking recommendations forward.

The CIHLC was a multi-institutional and interprofessional consortium whose goal was to develop, implement, evaluate and disseminate an evidence-based program in collaborative leadership that built capacity for health systems transformation. The CIHLC lead organization was the University of Toronto (UofT), who partnered with the University of British Columbia (UBC), the Northern Ontario School of Medicine (NOSM), Queen’s University (Queen’s) and Université Laval (ULaval). The project was supported by the five universities, as well as the Ontario Ministry of Health and Long-Term Care (MOHLTC).

The IOM’s sponsorship of the CIHLC enabled the five universities to showcase the strength and innovation of the Canadian health and education systems to an international forum of policy makers, academic experts and senior health leaders. The CIHLC was successful in internationally illustrating

SOMMAIRE

Le Consortium canadien sur le leadership en matière d’interprofessionnalisme en santé (CCLIS) est l’un des quatre partenaires internationaux d’innovation sélectionnés parmi des établissements universitaires du monde entier par le conseil de santé mondiale de l’Institute of Medicine (IOM) des États-Unis, fondateur du forum mondial sur l’innovation en formation des professionnels de la santé (Forum mondial). Ces partenariats avaient pour mandat l’incubation et la réalisation de projets de réforme visant la formation des professionnels de la santé, besoins cernés par le rapport de la commission Lancet de 2010 intitulé Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World. En intégrant le Forum mondial, le CCLIS s’est fait le porte-étendard des réformes de la commission Lancet au Canada en tant que modèle de partenariat interorganisationnel fructueux regroupant cinq universités, plaidant en faveur d’un investissement accru dans la formation en leadership. Si bon nombre des recommandations de la commission Lancet ont recueilli l’approbation générale, le CCLIS a été la seule institution canadienne à entreprendre leur mise en œuvre.

Le CCLIS, un consortium multi-institutionnel et interprofessionnel, avait pour mandat de concevoir, de mettre en œuvre, d’évaluer et de diffuser un programme de leadership collaboratif fondé sur les données probantes favorisant la transformation des systèmes de santé. Il était dirigé par la University of Toronto (UofT), en association avec la University of British Columbia (UBC), l’École de médecine du Nord de l’Ontario (EMNO), la Queen’s University (Queen’s) et l’Université Laval (ULaval). Le projet bénéficiait du soutien des cinq universités et du ministère de la Santé et des Soins de longue durée (MSSLD) de l’Ontario.

Grâce au parrainage de l’IOM, les cinq universités membres du CCLIS ont pu faire valoir la force et l’innovation des systèmes de santé canadiens et des

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961854-5/fulltext?_eventId=login







Sommaire Le Consortium canadien sur le leadership en matière d’interprofessionnalisme ort finale, 2015 5

programmes de formation en la matière auprès d’un forum international de décideurs, d’universitaires et de hauts dirigeants dans le domaine de la santé. Le CCLIS a également démontré sur la scène mondiale le leadership du Canada en matière de formation interprofessionnelle (FIP), en catalysant le contenu canadien dans le cadre des ateliers publics semestriels de l’IOM, qui réunissent des participants du monde entier, en personne et par visioconférence, ainsi que dans les publications et le site Web de l’IOM.

La présence et le leadership du CCLIS à Washington D.C. lui a permis d’engager un dialogue approfondi à propos de la FIP en lien avec les soins et services en partenariat et la collaboration interprofessionnelle (CIP), de l’évaluation de la FIP, de la sensibilisation communautaire et d’autres questions liées à la réforme de la formation en matière de santé.

À titre de membres respectivement nommées et suppléantes du Forum mondial, la Dre Sarita Verma et la professeure Maria Tassone ont représenté le CCLIS auprès d’experts universitaires et de professionnels de la santé de neuf pays et de différents horizons professionnels, avec qui elles ont discuté des enjeux liés à la FIP. La participation de représentants de l’UofT, de l’UBC, de l’EMNO, de Queen’s et de l’ULaval a créé un incubateur d’expérience et d’expertise canadienne qui a grandement contribué à la conception et à la mise en œuvre des ateliers.

La présence du CCLIS en tant que collaborateur sélectionné par l’IOM a eu d’importantes retombées : ses membres ont exprimé de nouveaux points de vue et partagé l’expérience canadienne transposable à d’autres régions. L’événement était le résultat d’un partenariat entre le CCLIS, le Centre for Interprofessional Education (CIPE), le Council of Health Sciences Education Subcommittee (CHSES), l’Office of Integrated Medical Education (OIME) et le Toronto Academic Health Science Network Education Committee (TAHSNe), qui se sont unis pour commanditer un sommet en vue de poursuivre un dialogue stratégique approfondi sur la FIP et de trouver des moyens d’harmoniser les pratiques de CIP. Le Sommet, intitulé Reaching

Canada’s leadership in Interprofessional Education (IPE), through the catalyzation of Canadian content at the IOM’s bi-annual public workshops (attended internationally in person and through videoconference), in IOM publications and on the IOM website.

The presence and leadership of the CIHLC in Washington D.C. provided the opportunity for engaging in conversations to further the dialogue about IPE linked to Interprofessional Care (IPC), the assessment of IPE, community-based education and other health education reform topics.

As an appointed member and an alternate of the Global Forum, respectively, Dr. Sarita Verma and Professor Maria Tassone represented the CIHLC amongst academic experts and health professionals from nine countries and multiple professions to discuss issues related to IPE. The presence of team members from UofT, UBC, NOSM, Queen’s and ULaval enabled infusion of Canadian experience and expertise, and greatly contributed to the design and implementation of the workshops.

The ripple effect of the CIHLC’s international presence as an IOM selected collaborative was that CIHLC members brought new perspectives and national input to other venues. One such event was the partnership of the CIHLC with the Centre for Interprofessional Education (CIPE); the Council of Health Sciences Education Subcommittee (CHSES); the Office of Integrated Medical Education (OIME); and, the Toronto Academic Health Science Network Education Committee (TAHSNe), to sponsor a Summit to stimulate further dialogue on IPE and to explore strategic opportunities to align with Interprofessional Practice (IPP). The Summit entitled, “Reaching the Summit: Leading the Way from Interprofessional Education to Practice”, was held on December 2, 2014 and hosted by Dr. Verma, of the University of Toronto. Over 150 leaders, decision-makers, students and health care users, affiliated hospitals, and many from academic health science centres across Canada attended.

The Summit concluded that IPE and IPP can play a significant role in mitigating many of the challenges

http://www.iom.edu/Activities/Global/InnovationHealthProfEducation.aspx

http://www.iom.edu/Activities/Global/InnovationHealthProfEducation.aspx


the Summit: Leading the Way from Interprofessional Education to Practice et organisé par la Dre Verma, s’est tenu en décembre 2014. Il a rassemblé plus de 150 dirigeants, décideurs, étudiants, utilisateurs des services de soins de santé et représentants d’hôpitaux affiliés et de centres universitaires en sciences de la santé d’un bout à l’autre du pays.

Le Sommet s’est conclu sur le constat que la FIP et la CIP peuvent grandement contribuer à aplanir bon nombre des difficultés auxquelles font face les systèmes de santé et à renforcer ces derniers, améliorant du même coup la santé publique.

Les travaux de recherche fondamentale du CCLIS visaient essentiellement à définir l’orientation du projet et à concevoir, à mettre en œuvre et à évaluer le programme de formation. Le Consortium a produit les études et les rapports ci-dessous :

• une recension exploratoire des écrits (scoping review) sur le leadership collaboratif à l’égard de la transformation du système de santé;

• des entrevues auprès d’informateurs clés de divers pays au sujet du leadership collaboratif;

• une vaste évaluation et compilation de programmes de leadership en santé dans les écoles et facultés canadiennes de médecine, de sciences infirmières, de santé publique et de gestion;

• une recension systématique des écrits scientifiques démontrant l’efficacité et les retombées des programmes de leadership en soins de santé;

• une étude de l’engagement des communautés et de la responsabilité sociale dans le contexte des programmes de formation en leadership;

• un cadre de référence pour l’évaluation développementale pour structurer le processus évaluatif accompagnant le projet pilote;

• une recension des écrits sur l’enseignement utilisant une approche hybride.

faced by health systems and enable forward movement towards strengthened health systems, and ultimately, improved health outcomes.

As a key deliverable of its work, the CIHLC conducted foundational research to inform project direction and the education program design, delivery and evaluation. The research and reports produced included:

• A scoping review of the literature on collaborative leadership for health system change;

• International key informant interviews on collaborative leadership;

• An extensive assessment and compilation of an inventory of Canadian health leadership programs in Schools of Medicine, Nursing, Public Health and Business;

• A rigorous, systematic review of the scholarly evidence related to the efficacy and impact of leadership programs in health care;

• A review of community engagement and social accountability in the context of a leadership curriculum;

• A review of evaluation frameworks for process and pilot program evaluation; and

• A review of the literature on blended learning education.

Based on results of this research, the CIHLC was able to identify needs and address education gaps in leadership across the health professions. What emerged were the unique elements of collaborative leadership, the curriculum that integrated the principles of community engagement and social accountability, a Capstone initiative design, a blended learning approach and a customized evaluation framework, as well as the realization that it would be advantageous to partner with an existing leadership program to increase impact and cost effectiveness. In addition, the CIHLC research was the subject of over 32 presentations, workshops, and publications in Canada, South Africa, Thailand, Hungary, Japan, Brazil and the United States.


À la lumière des résultats de ces recherches, le CCLIS a défini les besoins et les lacunes en matière de formation en leadership dans l’ensemble des professions de la santé. Il a ainsi mis en relief les éléments uniques du leadership collaboratif et produit un programme intégrant les principes l’engagement des communautés et de la responsabilité sociale, un projet de pédagogie dans l’action, une approche d’enseignement hybride et un cadre d’évaluation adapté. Il a également pris conscience des avantages de s’associer à un programme de leadership existant, c’est-à-dire une portée plus large et des coûts réduits. En outre, les travaux du CCLIS ont fait l’objet de plus de 32 présentations, ateliers et publications au Canada, en Afrique du Sud, en Thaïlande, en Hongrie, au Japon, au Brésil et aux États-Unis.

Dans la foulée, le programme intégré CCL a été créé, mis en œuvre et évalué grâce au partenariat entre le CCLIS et le University Health Network à Toronto (UHN). Ce programme élaboré de leadership collaboratif, ciblant les hauts dirigeants et les leaders doués d’un fort potentiel, est fondé sur la responsabilité sociale et l’amélioration de la visibilité en ligne et de l’évaluation de type développemental. Les équipes d’apprenants des établissements membres du CCLIS ont soutenu le déploiement pancanadien dans le cadre de projets pilotes locaux et régionaux qui répondent aux besoins prioritaires et intègrent le contenu du programme.

À l’évaluation finale, les apprenants ont jugé le programme de très haute qualité, axé sur de nombreuses notions et stratégies pédagogiques très utiles. Ils ont estimé que le programme atteint les objectifs d’apprentissage définis. Ils reconnaissent en outre au programme divers avantages : transformation, apprentissage d’un nouveau langage, acquisition de nouvelles connaissances et de différentes façons d’être, renforcement de la confiance en soi et sentiment d’être galvanisé. Le programme semble avoir mis les apprenants sur la bonne voie pour transformer avec succès les systèmes de santé. En plus des effets individuels, on observe des retombées considérables au niveau des équipes et des organisations qui favorisent et

As a result, the Integrated Collaborative Change Leadership (CCL) Program was created, implemented, and evaluated, in a partnership of the CIHLC and the University Health Network (UHN). This advanced collaborative leadership program targeting senior and high potential leaders, was anchored in social accountability, and had additional enhancements of an online presence and a developmental evaluation. The learner teams from the CIHLC sites supported a pan-Canadian presence, with local and regional pilot projects that reflected priority needs, and that integrated the Program content.

The final evaluation showed that learners rated the CCL Program to be of very high quality with many valuable concepts and pedagogical strategies. Learners reported the program to be highly successful in meeting its Program and learning outcomes. They further reported a variety of impacts including being transformed, learning a new language, acquiring new knowledge and ways of being, increased confidence, and feeling energized. This Program appeared to have set the learners on the right path for achieving transformative changes in health systems. In addition, there was evidence of considerable impact at the team and organizational level beyond the individual that would enable and catalyze health system change. The Program, in its enhanced form, will continue to offer collaborative leadership education to health leaders across the country.

The CIHLC disbanded in June 2015, however, its member organizations continue to demonstrate the impact of their work through extensive knowledge transfer activity, and to dialogue on collaborative leadership as a means to enable complex system change.

The Lancet Commission called for a new breed of collaborative leader to truly transform health systems at a global level. The CIHLC responded to this call for action through its partnership of five universities to explore a much needed, and less traditional type of leadership as an effective approach for complex system transformation. Through its research on leadership, the delivery


catalysent le changement dans les systèmes de santé. Le programme, dans sa formule enrichie, continuera d’enseigner le leadership collaboratif aux dirigeants des systèmes de santé d’un bout à l’autre du pays.

Le CCLIS a été dissous en juin 2015, mais ses membres continuent de promouvoir les résultats de leurs travaux dans le cadre d’activités de transfert des connaissances à grande échelle et entretiennent le dialogue sur le leadership collaboratif comme moteur de changement des systèmes complexes.

La commission Lancet recommandait l’adoption d’une nouvelle approche du leadership collaboratif afin de réaliser une véritable transformation des systèmes de santé à l’échelle mondiale. En réponse à son appel, les cinq universités membres du CCLIS se sont unies afin de définir un style de leadership moins traditionnel dont les systèmes de santé ont un besoin criant pour réussir leur transformation. Grâce à ses travaux, à la mise en œuvre et à l’évaluation de son programme de formation évolué en partenariat avec UHN, et à ses activités prolifiques de transfert des connaissances, le CCLIS a fait valoir l’importance du leadership collaboratif, mais aussi de l’engagement des communautés et de la responsabilité sociale, comme principaux leviers de la réforme des systèmes de santé et de la formation en la matière.

and evaluation of its advanced education program in partnership with the UHN, and its prolific knowledge transfer activities, the CIHLC has raised the profile and importance of collaborative leadership, together with community engagement and social accountability, as a key lever for health system and education reform.


CIHLC ACHIEVEMENTS RÉALISATIONS DU CCLIS

Phase 1: Set-Up Phase 1 : Mise sur pied

• Selected by IOM as North American Innovation Collaborative

• Createdandexecutedafiveuniversitypartnershipagreement

• Established the National Steering Committee, site teams, a secretariat

• Secured funding for $2.7M over three years from MOHLTC

• Sélectionné par l’IOM comme partenaire d’innovation nord-américain

• Création et exécution d’une entente de partenariat entre cinq universités

• Établissement du Comité directeur national, des équipes universitaires et d’un secrétariat

• Obtention d’une enveloppe du MSSLD totalisant 2,7 millions de dollars échelonnés sur trois ans.

Phase 2: Reviews and Scans Phase 2 : Examens et analyses

• Conducted literature reviews and environmental scans and prepared reports

• Scoping review of collaborative leadership, key informant interviews, leadership education programs, leadership program inventory, community engagement, evaluation frameworks, blended learning

• Recensions des écrits, analyses de contexte et rédaction de rapports

• Examen de délimitation de la documentation sur le leadership collaboratif, entrevues avec des sources d’information clés, programmes de formation en leadership, liste des programmes de formation en leadership, mobilisation communautaire, cadres d’évaluation, enseignement hybride

Phase 3: Creation and Development Phase 3 : Création et mise au point

• Created a competency framework

• Established CIHLC-UHN partnership

• Developed advanced Integrated Collaborative Change Leadership (CCL) Program 2014-2015

• Developed Program evaluation plan

• Création d’un référentiel de compétences

• Établissement d’un partenariat entre le CCLIS et le RUS

• Mise au point du programme intégré Collaborative Change Leadership (CCL) 2014-2015

• Élaboration du plan d’évaluation du programme

Phase 4: Implementation and Evaluation Phase 4 : Mise en œuvre et évaluation

• Heldfivesessions,10-dayCCLProgram

• Applied ongoing developmental evaluation and utilized findingstomodifytheCCLProgram

• Programme CCL en cinq séances, d’une durée totale de dix jours

• Évaluationdéveloppementaled’élaborationetmodificationdu programme CCL à la lumière des constatations

Phase 5: Production Phase 5 : Production

• Created community engagement/social accountability framework and monograph, IPE assessment exemplars, Collaborative Leadership model

• Created Learning Management Systems for CCL Program

• Produced workbook for participants

• Created and maintained CIHLC website

• Developed and implemented marketing plan

• Production d’un cadre et d’une monographie concernant l’engagement des communautés et la responsabilité sociale, de documents de référence sur l’évaluation de la FIP, et modèle sur le leadership collaboratif

• Création de systèmes de gestion de l’apprentissage pour le programme CCL

• Production d’un guide du participant

• Création et tenue à jour du site Web du CCLIS

• Élaboration et mise en œuvre d’un plan de marketing


CIHLC ACHIEVEMENTS RÉALISATIONS DU CCLIS

Ongoing Knowledge Transfer and Leadership Transfert de connaissances continu et leadership

• Provided Canadian experience and expertise at six IOM public workshops and planning forums

• Contributed to design of IOM Forum workshops

• Led and facilitated international World Café at the IOM workshop

• Coordinated meetings with the three international innovative collaboratives at the IOM

• Participated in debates, café discussions, facilitated the four collaboratives to work together and gave international and national invited talks

• Partnered with four other organizations for interprofessional education Summit

• Gave 11 oral presentations, nine workshops, eight posters in seven countries

• Created articles/book chapters of which four were published and two are in the publication process

• Partage de l’expérience et de l’expertise canadiennes dans le cadre des ateliers publics (six) et des forums de planificationdel’IOM

• Participation à la conception des ateliers du forum de l’IOM

• Animation du volet international World Café de l’atelier de l’IOM

• Coordination des réunions du groupe international de trois partenaires d’innovation à l’IOM

• Participation aux débats et aux discussions du volet World Café, animation de séances de travail collectives des quatre partenaires et conférences au Canada et à l’étranger

• En partenariat avec quatre autres organisations, commandite du Sommet sur la formation interprofessionnelle

• Présentation de onze exposés et de neuf ateliers et présentationsparaffichesdansseptpays

• Rédaction d’articles et de chapitres, dont quatre publiés et deux soumis

Final Report: June 2015 11

1. INTRODUCTION

The Canadian Interprofessional Health Leadership Collaborative (CIHLC) was a multi-institutional and interprofessional partnership with the goal to develop, implement, evaluate and disseminate an evidence-based program in collaborative leadership that built capacity for health systems transformation. The CIHLC lead organization was the University of Toronto (UofT) who partnered with the University of British Columbia (UBC), the Northern Ontario School of Medicine (NOSM), Queen’s University (Queen’s) and Université Laval (ULaval). The project was supported by the five universities as well as the Ontario Ministry of Health and Long-Term Care (MOHLTC). Each of the regional partners was connected with affiliated networks across multiple sites in Canada, the United States, and globally.

The CIHLC was chosen by the U.S. Institute of Medicine’s (IOM) Board on Global Health, who then formed the Global Forum on Innovation in Health Professional Education (Global Forum), as one of four international innovation collaboratives from an international competition of academic institutions around the world. The three other collaboratives were from South Africa, Uganda and India.

The collaboratives were intended to incubate and pilot ideas for reforming health professional education called for in the 2010 Lancet Commission report, “Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World”. The CIHLC was chosen for its vision of interprofessional leadership development to strengthen health systems.



12 Canadian Interprofessional Health Leadership Collaborative Project

Context

The Lancet Commission called for “leadership mobilization” as one of four essential enabling actions to create an environment to support specific reforms. According to the Commission, “A competent and enlightened professional workforce in health contributes to the larger national and global agendas for economic development and human security. Leadership in professional education should certainly come from within the academic and professional communities, but it should also be backed by political leadership in other parts of government and society when decisions affecting resource allocation to health are made. This broad engagement of leaders at all levels - local, national, and global—will be crucial to energize instructional and institutional reforms.”

There was wide support for many of the Commission’s recommendations, and the CIHLC provided strong evidence of Canadian institutions taking the Commission’s recommendations forward.

The call for change has been widespread with both the need to transform education to strengthen health systems internationally, as well as the importance of health professionals in leading change.

As health care landscapes change and reforms to health and health education are introduced, the need for collaborative leadership to facilitate system, organization and health delivery improvements has become critical. Health professionals and educators, administrators and health executives need to understand how to lead change and build strong relationships, and are well positioned to lead changes to health and related education in the 21st century.

2. THE CANADIAN INTERPROFESSIONAL HEALTH LEADERSHIP COLLABORATIVE

A. Rationale for Formation of Collaborative

The CIHLC with its vision of collaborative leadership for health system change, identified collaborative leadership as both a pillar for interprofessional collaboration at the professional team level, and an enabler for connecting and making changes within and amongst health delivery organizations and education institutions at the broader system level. With the recognized complexity inherent in health care systems, the CIHLC challenged the traditional models and put forward the hypothesis that collaborative leadership enables access to the full potential of the knowledge and expertise of others.

In addition, the CIHLC was well-positioned to deliver on its proposed initiative in that the Canadian national and provincial governments, as well as academic institutions in the past 10 years, have already demonstrated significant leadership in establishing interprofessional education and collaborative care at the organizational, practice and policy levels through the development, implementation and evaluation of program initiatives.

The CIHLC’s role in the IOM’s new Global Forum was expected to provide the Canadian universities with opportunity for international engagement and the potential for Canadian contribution to public policy. Alignment with the Lancet Report and the Global Forum’s objectives was a major goal and could only be achieved through a multi-University partnership, as no single institution could provide all the expertise. This alignment is shown in the table on the next page.


IOM Global Health Objectives Canadian Collaborative

Instructional Reforms

1. Adopt a competency-based curriculum √Competency-based leadership curriculum

2. Promote interprofessional and transprofessional education

√ Adoption of core principles

3. Exploit the power of IT for learning √eCommunity of Practice for communication; social networking analysis for measuring change

4. Harness global resources and adapt locally √ Co-creation of leadership series with international colleagues

5. Strengthen educational resources √Comprehensiveleadershipseriespackagedforflexibleandglobal use

6. Promote new professionalism √ New wave of professionalism across health professions

7. Establish joint planning mechanisms √ Webinars, video conferences

Institutional Reforms

2. Expand from academic centres to academic systems √ Expand to integrated academic systems

9. Link through networks, alliances and consortia √Use of national networks such as Canadian Health Leaders and Canadian Health Association

10. Nurture a culture of critical inquiry √

B. Project Vision, Goal and Objectives

CIHLC’s vision was collaborative leadership for health system change to globally transform education and health.

The goal of the project was to use a pan-Canadian approach, with global engagement, to co-create, develop, implement and evaluate a global model for collaborative leadership targeted to health care practitioners and health organization administrators with a learner and patient-centered perspective.

CIHLC Key Objectives

1. Develop a collaborative leadership model for health system change;

2. Build and leverage existing partnerships within Canada and abroad - enhance the facilitation and implementation of collaborative leadership programs;

3. Utilize existing information technology mechanisms and social media to maximize cost-effective methods to effectively support communities in leadership training;

4. Developnewacademicproductivityandscholarshipsthatwillinfluenceglobalpolicyreform;and

5. Develop an evaluation framework that measures planned and emergent change at the educational, practice and system levels.


C. Project Membership, Governance and Implementation

CIHLC Membership

In 2011, the then University of Toronto’s President, Dr. David Naylor, sent the call for proposals from the IOM to all of the leading Canadian university Presidents across the country. Further, the then Dean of Medicine at UofT, Dr. Catharine Whiteside, extended an invitation to all Canadian Faculties of Medicine, as well as selected Faculties of Nursing and Schools of Public Health to participate on the collaborative proposal submission. The institutional executive heads who accepted this invitation each identified two representatives to join the project.

All representatives were faculty members, researchers and administrators, who were health professionals and who worked in or with interprofessional settings. The CIHLC membership covered a multitude of health care professions and interprofessional teams serving and meeting the needs of diverse and culturally sensitive groups such as Aboriginal, Francophone and inner-city populations. There was a strong collective capacity for distance education and learning, community engagement and social accountability, as well as flexibility in curriculum development, innovation and evaluation.

The Secretariat was established at the UofT’s Centre for Interprofessional Education (CIPE) at the University Health Network (UHN), to provide overall coordination and support to the CIHLC. Its team, consisting of a director, a coordinator and research associates reported to the co-leads at the University of Toronto.

Each site hired a research associate to support its activities and several consultants with expertise in curriculum development, evaluation and research were contracted. Over 20 staff and consultants during the three year period were engaged in activities to support this project. For a list of CIHLC members and staff see Appendix A online for Canadian Interprofessional Health Leadership Collaborative Membership.

Committee Structure

The CIHLC partners created a National Steering Committee (NSC) to oversee and drive the implementation of the CIHLC activities. The NSC had representation from each of the five universities. For a description of the roles and responsibilities, please see Appendix B online for NSC Terms of Reference.

RAs

NOSMCo-Leads

RAs

Queen’s UCo-Leads

RAs

UofTCo-Leads

RAs

UBCCo-Leads

RAs

ULavalCo-Leads

MOHLTC- TPA -UofT

ProjectCo-LeadsSecretariat

IOM

National Steering Committee

Deans of Medicine and Health Sciences

CIHLC Structure


Co-Leadership Model

A co-leadership model with shared responsibility was adopted to allow the CIHLC to demonstrate co-ownership, mentorship, succession planning and transparent collaboration across the multiple health professions. The project co-leads were Dr. Sarita Verma and Professor Maria Tassone, UofT. The site partner co-leads were: Dr. Lesley Bainbridge and Dr. Maura MacPhee, UBC; Dr. David Marsh and Ms. Sue Berry, who was later replaced by Dr. Marion Briggs, NOSM; Dr. Margo Paterson and Dr. Rosemary Brander, Queen’s; and Dr. Emmanuelle Careau and Dr. Serge Dumont, ULaval. For biographies of all NSC members please see Appendix C online for National Steering Committee Biographies.

Roles and Responsibilities

Participating schools brought diverse areas of expertise and experience in health professional education through learning and innovation within the undergraduate, postgraduate, graduate, continuing education and professional development sectors. Each partner brought exceptional strengths to the collaborative, such as global networks, regionally-integrated health education and health care systems, interprofessional education, change leadership and training, social accountability, and cultural and clinical competencies. The CIHLC was structured to leverage these collective strengths.

Although all members had a role in the foundational research, creation, implementation, evaluation and knowledge transfer of this initiative, each university took on leadership for a key element of the project. Leadership was allocated based on site expertise, as follows: UBC for evaluation; Queen’s for curriculum development; NOSM for community engagement and social accountability; ULaval for Francophone and curriculum development; and, UofT for oversight of the project, the Secretariat, and an environmental scan of collaborative leadership.

D. Project Foundational Documents

At the onset of the project, the CIHLC produced several documents to set the stage for universities to work together. A “Statement of Collaboration” was created, outlining the CIHLC scope of the partnership, governance and leadership, roles and responsibilities, and other broad guiding principles for collaboration. See Appendix D online for full Statement of Collaboration. The Deans of all five participating universities signed the document in May 2012, confirming their support for the activities of the CIHLC.

A companion document “Principles of Collaboration: Grants, Knowledge Transfer, Authorship and Ownership” was created to lay out principles and processes around grant applications and funding, knowledge transfer and intellectual property. See Appendix E online for Principles of Collaboration.

Early in the process of establishing the work of the CIHLC, a logic model was adopted by the NSC as a base to anchor and establish a framework to move the project forward in program development and evaluation activities. This model was adapted as the project and program evaluation needs evolved. See Appendix F online for Collaborative Leadership (CL) Program for Transformative Change Logic Model.

E. Funding

The IOM selected the CIHLC as the North American innovation collaborative but it was required to raise its own resources for the development and oversight of the project. To maximize the success of this international opportunity and to initially launch the project, the five Deans of Medicine and Health Sciences agreed to support their leads until external funds could be secured. The University of Toronto provided the early seed funding to establish and house a Secretariat to support CIHLC activities.


The CIHLC co-leads contacted and met with over 25 research granting organizations, governments, and other organizations to secure funds. In addition, UofT’s Office of Advancement team communicated with several international foundations and pursued partnerships to support the CIHLC activities.

Within its first year, the project received funding support from the Ontario Ministry of Health and Long-Term Care (MOHLTC) for the three Ontario universities’ contribution to the project. The Transfer Payment Agreement (TPA) was fully executed between MOHLTC and UofT for funding of $2.7 million over three years between April 1, 2012 and March 31, 2015. As one of the TPA requirements, Letters of Understanding were executed between NOSM, Queen’s and UofT. UofT was responsible for managing the Ontario government funding resources related to the CIHLC and its activities over the three year period.

ULaval and UBC supported most project related expenses outside of travel for meetings, learner support, and some evaluation and translation costs, which were covered by the MOHLTC project funds. All universities contributed in-kind for the participation of their CIHLC university leads and other staff.

F. Implementation Process

The CIHLC project was initially designed to be implemented in five phases over a period of five years, in alignment with the IOM request for proposal. The period of implementation was reduced to three years based on the IOM’s revised sponsorship period to the four international innovation collaboratives and the duration of funding from the MOHLTC.

The five phases included the project set up, the research by way of reviews and scans, the creation and development of a collaborative leadership program, the implementation and evaluation of the program, and the production of the final products. Knowledge transfer activities began early in the project and continued throughout the five phases.

3. RESEARCH AND KNOWLEDGE ACQUISITION

The first phase of the project began by way of planning and implementing phased literature reviews to identify what had been done in peer-reviewed and grey literature, and to identify gaps that had already begun to refine the program’s objectives. The CIHLC conducted literature reviews and qualitative research on collaborative leadership and its potential for impacting health system change. The foundational research to inform the project direction and education program included:

• A scoping review of the literature on collaborative leadership for health system change;

• International key informant interviews on collaborative leadership;

• A rigorous systematic review of the scholarly evidence related to the efficacy and impact of leadership programs in health care;

• An extensive assessment and compilation of an inventory of Canadian leadership programs in Schools of Medicine, Nursing, Public Health and Business, their impacts on learners, and the competencies that these programs address;

• A review of community engagement and social accountability in the context of a leadership curriculum;

• A review of evaluation frameworks for process and pilot program evaluation; and

• A review of the literature on blended learning education.


A. Scoping Review

The scoping review outlined the definition and impact of collaborative leadership for health system change. This first review was completed in fall 2013 and served as the foundation for the project. It was intended to establish the level and rigor of evidence related to collaborative leadership for health system change and ultimately to identify what type of collaborative leadership best enables the global transformation of the health care system. In total, 183 journal articles or reports and approximately two dozen theoretical books were reviewed.

The findings suggested that there is no one definition, model or framework for the concept of “collaborative leadership.” The scoping review led the project team to note that the term “collaborative leadership” has been applied to diverse ways of practicing collaboration, generally aimed at the broad movement away from an “individual expert” model of leadership, to drawing on multiple perspectives for richer responses to complex questions or needs. In addition, the review found that collaborative leadership was broadly described as a necessity in a world of increasing complexity and rapid change, where no one person or perspective could possibly comprehend or influence the kinds of responses, thinking and actions required for sustainable transformation in health. With the completion of the scoping review, further refinement and validation on the definition of “collaborative leadership” for health system change was conducted.

B. Key Informant Interviews

To further refine and validate the definition of “collaborative leadership” for health system change, as well as to inform the leadership curriculum work, qualitative research was conducted in early 2013 through key informant interviews. The interview sample included 34 senior leaders in IPE, Canadian educators, government, hospital and student leaders, and international thought-leaders, to learn from their experiences and perspectives.

The characteristics and practices of collaborative leaders described by the interviewees validated those described in the scoping review. Some common key elements included humility, excellence in communication, self-awareness/self-reflection, co-creating a shared vision with others, influencing and engaging people, and the ability to effectively use group processes. Although there were common ideas about the characteristics and practices that described the process of collaborative leadership, there was no single shared understanding of how collaborative leadership should be defined. The CIHLC researchers agreed on a definition of a collaborative leadership program as follows: “Develop people to lead systems that enable socially accountable change in their community”.

C. Literature Review

The goal of the systematic literature review of peer-reviewed journals was to provide an evidence base for existing curricula in interprofessional collaborative leadership education. The initial search of the peer-reviewed literature produced over 30,000 article titles. After applying the CIHLC’s selection criteria using double-blinded selection, the number was reduced to 250 English peer-reviewed papers on educational leadership programs published during 2000-2012. Only seven of these papers specifically referenced collaborative leadership. These were very general and did not present a structured and specific program for collaborative leadership capacity development. The two specific common elements addressed by every collaborative leadership program were collaborative problem-solving and shared decision-making.


A cluster analysis was performed on the results concerning the competencies identified in the literature review and those addressed in the leadership frameworks previously identified in the environmental scan. Five themes emerged from this analysis: innovation and system change to improve service delivery, tools to transform service delivery, collaboration/leadership, team-building and partnerships, and personal/interpersonal competencies.

D. Inventory of Canadian Leadership Programs

This review of the grey literature focused on available university level programs in medicine, nursing, and public health as well as business programs whose curricula addressed collaborative (distributed/complexity/shared) health leadership and leadership in general. In addition, leadership curricula offered by professional associations and organizations such as the Canadian Medical Association and the Canadian Nursing Association were reviewed.

The research was conducted to see what collaborative leadership programs already existed in Canada, and to identify gaps that could be addressed in the new program creation. There was also consideration to use the results of this review to produce a search tool of leadership programs for health care students and professionals seeking to develop their leadership skills.

Approximately 350 health leadership programs were identified, with about 30 graduate, continuing education and executive level programs presenting possible collaborative leadership content. Only seven of the 30 were identified to have a clear collaborative leadership component. Many of the 30 programs were based within the same department of an institution. In total, 16 surveys were sent to individuals representing the courses. There were 11 responses representing 11 programs. Of the 11 respondents, all programs identified themselves as multiprofessional or interprofessional. Common competencies included team building, team leading, shared decision-making and ensuring all were heard, evidence-based decision making, system change, personal development and emotional intelligence.

Fromasynthesisoftheresearchconductedtodefinecollaborativeleadership,reviewliteratureoneducationprograms,andinventoryofCanadianprograms,theCIHLCidentifieduniqueelementsofcollaborativeleadership.

Unique Elements of Collaborative Leadership

• Transformational leadership that drives system change;

• Co-creation of a shared vision;

• Consideration of diverse perspectives;

• Shared decision-making;

• Working within complex systems;

• Bridging across professions, organizations, sectors;

• Ongoing, adaptive practice;

• Appreciative inquiry, generativity; and

• Social accountability.

Source: CIHLC Environmental Scan Summary Report


E. Social Accountability and Community Engagement

The CIHLC researchers studied the evidence around Community Engaged Medical Education (CEME) and its key dimensions through the CEME: Systematic Thematic Reviews (CEMESTR) project. Medical education became the focus as most of the literature in social accountability in health education was found in medicine at this time. CEMESTR’s systematic literature and realist review was completed and approximately 800 relevant articles were identified. In addition, approximately 40 international experts participated in the review process. The study aimed to identify the ways in which different relationships between medical education programs and communities impact educational and health outcomes.

The definitions adopted for the study of “community based”, “community oriented” and “community engaged” programs mapped to the kinds of activities described, however, there was no consistency in how community terms and concepts were used. “Community based” activities gave little or no attention to how communities benefited, “community oriented” a little more, and “community engaged” programs the most. Therefore, the research identified a need for a fourth dimension of “community service” where the focus was on how the community benefits from the relationship. A number of different mechanisms were identified through which learners, teachers and programs interacted with communities. Learners benefited more where their work had a direct and appreciable impact on local concerns, either in the form of providing medical services or by addressing broader health issues through project work. Participation with, and accountability to, local communities significantly improved the impact on learners and communities.

This research informed the CIHLC project of the community engagement practices that underlie social responsibility and the principles that collaborative leaders would apply in their work or that of their organizations. The distinctions noted above between the definitions of community education and service informed how participants interacted with collaborating communities in the program Capstone initiatives. While the benefit to the community may have been under represented in the medical education context, this is less likely to be the case for projects undertaken in the context of improving (sub) population health or health services delivery, where the notion of mutual benefit is more easily recognized and sustained, since the goals of each partner are clear and aligned from the outset.

F. Evaluation

Framework

The CIHLC conducted a review of the research of evaluation frameworks relevant to this complex project. A toolkit, the “Evaluation Primer”, was developed to provide an overview of existing evaluation frameworks and tools that could be incorporated into the work of the CIHLC, and to ensure a common understanding of evaluation processes, terms and options. See Appendix G online for the CIHLC Evaluation Primer. From this foundational work, the CIHLC determined it would use developmental evaluation to assess the implementation and outcomes of the collaborative leadership program development. Developmental evaluation creates a close partnership between the evaluation team, the curriculum developers, learners, and community engagement teams.

Assessment Tools

As part of its foundational research, the CIHLC conducted a cross country scan of tools designed to assess and improve interprofessional practices and experiences. It selected several innovative, valid and reliable health professional education tools and assessments used to examine and define competencies related to interprofessional education. A monograph of four of these Canadian exemplars was created and shared at the IOM Global Forum workshop. See Appendix H online for IOM Workshop Handout: Tools in Assessing Health Professional Education: Canadian Exemplars.


Process Evaluation

The CIHLC evaluation team also conducted a process evaluation of the first half of the CIHLC project to gain greater insight of the CIHLC team functioning and to contribute to the knowledge base on collaborative leadership. Results showed that relationships and mutual support for innovation leads to a valued collaborative.

G. Blended Learning

To inform the design and operation of the collaborative leadership education program, a scan of the literature was conducted to understand best practices regarding blended learning education. Blended learning refers to the integration of online and offline learning methods, and combining face-to-face teaching and learning tools that support the learning. The main objectives of the review were:

• To provide an overview of the peer-reviewed and grey literature on e-learning and blended learning e.g., definitions, impact on learning outcomes and learning transfer, application to leadership development; and

• To summarize the best practices on how to effectively and efficiently integrate technology with learning and teaching methodology for optimal transfer of adult learning e.g., leadership development.

The review of over 100 articles and books on the subject of blended learning suggested that blended learning was becoming the preferred format for design and delivery of education programs. Key reported benefits included the enrichment of the learning process by the contribution of additional tools, and the ability to personalize learning, allow thoughtful reflection, and differentiate instruction from learner to learner across diverse groups.

4. CREATION AND DEVELOPMENT

The next phase of the project focused on knowledge application through the creation and development of collaborative leadership curricula. The results of the foundational work informed decisions on the level of the education program and the location of sites for piloting, based on the gaps and needs for collaborative leadership education. Although the level and availability of education programs varied between health professionals, the CIHLC made a key decision to offer the collaborative leadership education at a continuing education level for senior leaders from all health professions. This was considered to be the level needed for leaders who could impact on health system change most meaningfully.

A second key decision was to bring learners sponsored by each of the four university sites to Toronto in order to be more cost effective versus launching separate, smaller pilots across Canada. Participants would work on projects addressing regional priorities and under serviced needs, and integrate program learnings in the implementation and evaluation of their projects.

Based on the research on blended learning and expertise in this area, the CIHLC made the decision to offer its leadership program in a blended learning format.

A. Program Design and Development

The CIHLC created a collaborative leadership competency framework to inform program development, that synthesized the results of its literature reviews and other foundational work. This framework included the


most relevant competencies related to collaborative leadership development such as capacities for facilitating, empowering, being authentic and sustaining people working together in a collaborative way. It was used to inform the basis of the design of a collaborative leadership curriculum.

A monograph was prepared by the CIHLC to be a learning resource to support community engagement for health system change, starting from the principles of social accountability. This resource specifically supports change initiatives through the development, emergent enactment and continuous evaluation of, and adjustment to, these initiatives. Moreover, this resource is focused on strategies that support an organization’s mandate for social accountability. See Appendix I online for Community Engagement for Health System Change: Starting from Social Accountability monograph.

The CIHLC contracted curriculum experts to work with the NSC to create the overall design of a collaborative leadership curriculum that integrated key elements from the foundational research. An education team from the partnered CIHLC organizations worked with the curriculum experts on this initiative.

B. Partnership

As the CIHLC program development progressed, it became clear that there were similar leadership programs that could be utilized and modified as a means to reduce system redundancy, enhance existing opportunities, and improve cost effectiveness. After meeting with several leadership programs, the CIHLC identified the UHN’s Collaborative Change Leadership (CCL) Program as an exemplar in collaborative leadership for system change and one that most closely aligned with the CIHLC project vision and proposed design.

The UHN agreed to form a partnership with CIHLC and adapt its program to an advanced collaborative leadership program with the enhancements of social accountability and community engagement, an online presence and an enhanced evaluation.

Integration Planning

Through an iterative planning process, the CIHLC and CCL faculty worked together to create the Integrated CCL Program 2014-2015 (“Program”). The partners produced an adapted program design and curriculum, and guidelines for a Capstone initiative, to be used as the CIHLC’s proof-of-concept leadership program. The CIHLC committed support for the creation of toolkits, workbooks and other products for the integrated Program. The pan-Canadian perspective was to be captured through the sponsorship of learner teams from ULaval, UBC, NOSM and Queen’s. UofT learners were recruited through Toronto Academic Health Science Network (TAHSN) sponsors. Additional participants were recruited by way of a general call for applications open to Canadian and international health leaders, sent through a large IPE e-mail distribution, posted on CIHLC website and through personal contacts.

Partnership Documents

UHN and the CIHLC entered into a partnership on October 1st 2013. As an addendum to the partnership agreement, the partners co-created intellectual property policies around the materials created before, during, and after the partnership. The guiding principles for intellectual property of conjoint materials were based on the interprofessional contribution of each of the contributing organizations, and included: the Integrated CCL Program, the evaluation data, and the acknowledgments of the contributions of the CIHLC, UHN, and the MOHLTC in future use of all conjoint products. The document was signed by the Deans of Medicine and Health Sciences of the five universities and the Vice President Education for UHN.


The CIHLC also created a document which laid out principles and processes around authorship and knowledge transfer and dissemination amongst the CIHLC and UHN partners of the Integrated CCL Program.

5. THE INTEGRATED COLLABORATIVE CHANGE LEADERSHIP PROGRAM

The next phase of the project focused on the design and implementation of the co-created Integrated CCL Program 2014-2015, the CIHLC’s proof-of-concept leadership program.

A. Program Description

The Integrated CCL Program was intended to develop senior leaders who work in interprofessional settings in health care and health education, to lead health system transformation and to enable socially accountable change in their community. The Program covered a 10-month period with five, two-day face-to-face and intensive sessions, blended with coaching from faculty. Additional coaching and learning was offered via an online platform and the community of practice. Throughout and between these sessions, several instructional approaches were utilized including experiential learning, online learning, reflection, theory bursts, small and large group activities and peer learning/coaching. Due to the emergent nature of the Program, detailed designs and teaching plans for each session were adapted to the individuals and teams as the Program evolved. See Appendix J online for the Collaborative Change Leadership Program Brochure.

The Program sessions were held between April 2014 and January 2015. A description of each of the five intensives follows:

Module 1

The first in-person session included an overview of the core concepts included in the Program’s integrated model of collaborative change leadership; theory bursts on several core concepts including collaboration, generativity, Appreciative Inquiry (AI), reflection within the context of self-awareness; and an introduction to complex adaptive systems and organizational context. Teams began to apply their learning to their Capstone initiatives by first describing their purpose and “passion” related to their initiatives.

Module 2

In the second in-person session there was a continued focus on establishing a foundational understanding of collaboration, change, and leadership concepts and theories; theory bursts on social accountability and emergence; and an introduction to sensing, developmental evaluation, and personal practical theory. Application of learning to the Capstone initiatives continued within the context of the ‘Discovery’ and ‘Dream’ phases of AI.

Module 3

The third in-person session included theory bursts on community engagement and the ‘Design’ phase of AI, a deepening of the integration of emergence and developmental evaluation, and an exploration of CCL in a traditional system. Application of learning to the Capstone initiative continued in teams and reflective experiences supported the continued evolution of the personal practical theories of CCL.

Module 4

The fourth in-person session included theory bursts on the ‘Destiny’ phase of AI, Theory U, strengths, and experiential learning of collective intelligence and sensing. Peer sharing and coaching in teams, and a focus on


sustaining collaborative change leadership in their system continued to expand and ground the application of learning to the Capstone initiative and to the development of self as a collaborative change leader.

Module 5

The fifth in-person session focused on what was achieved with respect to the Capstone initiatives, what was needed by the teams to take their work to the next level, the current state of their personal practical theory, and the continuation of the transformative journey of self as a collaborative change leader. A final theory burst focused on mindfulness. “One-minute Wonders” were presented, the momentum and sustainability of Capstone initiatives were explored, and collective portraits of CCL were created with team sponsored participation.

Online Learning/Learning Management System (LMS)

Online education was offered through the Blackboard Learning Management System (LMS) supplied and supported by the University of Toronto. The CIHLC designed and uploaded the Program information. The online tools provided a mechanism for individuals in different geographic locations to learn together, to post reflections and discuss the readings and videos that were posted online, and for the faculty to participate in discussions and to coach learners and teams between intensive sessions. The learning platform served other purposes such as document storage, deployment of evaluation surveys, and journal input.

Capstone Initiatives

All participants registered for the Integrated CCL Program with team Capstone initiatives where they could develop, design, implement, and evaluate a change initiative within their community or organization. The Capstone initiatives were to use the principles of social accountability and community engagement in identifying a priority population, such as the frail elderly, Aboriginal peoples, mental health, non-communicable diseases/chronic illness, youth and women, or lower socio-economic status. The focus of the initiatives was intended to be on, but not limited to, interprofessional care and education, quality and safety, and patient/family/community-centred care.

Many of these projects worked to engage communities to build interprofessional networks and processes to improve care, while others focused on building capacity through education. A description of each of the 11 Capstone initiatives can be found online in Appendix K - CCL Program - Capstone Initiative Descriptions.

All recruited learners were sponsored by their university or affiliated hospital or community to undertake their Capstone initiatives. The Capstone initiatives provided the learners with the opportunity to apply and practice the core Integrated CCL Program concepts.

Examples of Program Capstone initiatives

• Seniors health and wellness strategies in aboriginal communities;

• Mental health and addictions related to child and youth, rural and northern populations;

• Models of interprofessional, collaborative education and care; and

• Accessibility of ‘collaborative leadership’ education for French-speaking health leaders.


At the conclusion of the Program, participants submitted a collective team report on their Capstone initiatives which identified their passionate purpose for the Capstone initiative work; shared learning of leading the initiative as a collaborative; applicability of lessons learned beyond the Program; and, the impact of the Capstone within their system.

Mentorship

CIHLC NSC members from ULaval, NOSM, Queen’s and UBC provided leadership, advice and mentorship to their sponsored teams for Capstone initiative work. Faculty members of the Integrated CCL Program provided coaching to each team to support the integration of course learning with the Capstone initiatives.

B. Learner Teams

All learner teams were comprised of at least one senior leader in health and education, had an interprofessional composition, and had an identified Capstone initiative proposal that involved engaging the community. There were 31 participants in the Program, in 11 teams, representing Anglophone and Francophone Canada, and four provinces - Alberta, British Columbia, Ontario and Quebec.

Participant recruitment occurred through two primary streams:

1. The direct recruitment through each of the four CIHLC partner sites outside of Toronto, for a site sponsored proof-of-concept team; and

2. A general call for applications open to Canadian and international health leaders, sent through a large IPE e-mail distribution, posting on CIHLC website and through personal contacts.

Eleven learners were recruited directly through CIHLC sites and 21 learners through the general call for applicants.

Sponsors

All learner teams were supported by their institutions to attend the Program. CIHLC project funds were allocated to pay the registration, travel and accommodations of the four CIHLC university sponsored teams located outside of Toronto. These universities provided in-kind resources to mentor their team throughout the project.

C. Program Evaluation: Purpose, Methodology and Results

The CIHLC and UHN partners used a co-leadership and team participatory approach to develop the evaluation plan for the Integrated CCL Program. The evaluation served three main purposes:

1. To improve the delivery of the Program and future offerings of the Program;

2. To demonstrate the value, impact, or return on investment of the Program; and

3. To support uptake (future enrollment) and transferability or adaptability of the Program.


Methodology

A developmental evaluation approach was used to assess the implementation and outcomes of the Integrated CCL Program. Information was collected to address the five evaluation questions and demonstrate the value and impact of the Program. A variety of data collection methods were used (surveys, interviews, focus groups, and document review), collecting both qualitative and quantitative data from multiple respondent groups (learners, Capstone initiative teams, organizational sponsors, CCL faculty, and engaged community members).

Descriptive statistics were used to analyze the quantitative data. This involved the calculation of means and frequencies. Content analysis using MAXQDA (a qualitative software program) was used to analyze the qualitative data. Both planned and emergent coding was used by the four person analysis team.

Evaluation Results

Value of the Program

The Program was rated as very high quality by the learners. Learners appreciated the overall design and content of the course and remarked favourably about most of the pedagogical elements. Of particular note, learners found the following elements to be valuable: experiential activities conducted during the in-person sessions, the concept and practices of social accountability and community engagement, the readings, the learning community, coaching by CCL faculty, the personal practical theory of CCL, appreciative inquiry, alumni/faculty guests, time spent with team to work on Capstone initiatives, and attending the Program as a team.

Proposed Program Changes

While learners rated the Program as being of very high quality, they were able to offer suggestions for how the Program could be improved. The most common suggestions participants mentioned were increasing experiential learning activities, limiting the time dedicated to reflection in large groups, shortening the length of the in-person sessions, providing the slides electronically before sessions, reducing the number and length of readings, and maintaining contact with Program participants after the Program ended. In response to feedback from participants, the CCL faculty routinely adjusted the Program to better meet learners’ needs.

Program Learning Outcomes

The learners rated the Program as very successful in achieving learning outcomes. In addition, learners self-reported an average increase of 84% in understanding of core concepts. Prior to the Program, the majority of learners considered themselves to be within the “novice” to “intermediate” range of expertise. By the end of the Program, the majority of learners rated themselves within the “expert” range. Data from engaged community members and sponsors also attested to the acquisition of the skills associated with the core concepts.

The evaluation was designed to answer five questions:

1. What was valuable about the Program?

2. What changes need to occur in the Program to ensure its relevance/usefulness and to support sustainability?

3. To what extent did the Program achieve its Program and learning outcomes?

4. What else has changed/happened as a result of participating in the Program?

5. What value was created through the enhancements of social accountability and community engagement?


1. Learner Outcomes

Learners reported experiencing a variety of positive transformations in the way they approach their work and relate to colleagues. They described themselves as more confident, authentic and positive. They reported being more focused on drawing on the collective intelligence of their teams through generative questioning and appreciative inquiry. This transformation helped learners and teams leverage their strengths when leading change initiatives, as well as in their day-to-day activities. Some learners observed an increased interest in CCL from colleagues and managers in their organizations and communities. There appears to be some evidence that CCL concepts are spreading in these organizations as learners apply the concepts to other projects. Through their Capstone initiatives, some teams were successful in influencing changes to internal organizational processes and to client services.

2. Social Accountability and Community Engagement

It was clear that social accountability and community engagement were concepts that resonated with participants. There was ample evidence that all teams embraced the ideas of engaging with communities to co-create, implement and evaluate their initiatives. CCL faculty were also confident that learners successfully enacted the elements of community engagement. Sponsors who participated in the Program’s evaluation noted the extensive and unique engagements undertaken by learners.

Limitations of Evaluation

The main limitation of this evaluation was heavy reliance on learner self-reports. While efforts were made to engage community members and sponsors in the evaluation, the response rates from these groups were low. Nonetheless, the limited data that was available does begin to confirm that some learners were doing “something different” as they were taking on the concepts and practices of collaborative change leaders. However, the evaluation was not able to speak to the sustainability of these changes for the learners or the longer-term impact of the Program and the Capstone initiatives on health systems.

D. Conclusions of the Evaluation

The evaluation of the Program showed that learners perceived the CCL Program to be of very high quality with many valuable concepts and pedagogical strategies. The data also showed that learners reported the Program to be highly successful in meeting program and learning outcomes. Learners reported a variety of impacts including being transformed, learning new language, acquiring new knowledge and ways of being, increased confidence, and feeling energized.

Given that the majority of teams were just entering the ‘Design’ or ‘Implementation’ phase of their Capstone initiatives, it was not surprising that fewer results were reported for communities, organizations and systems. The most impact noted beyond the learners centred on the spread of the concepts and increased interest within their organizations and communities.

This Program appeared to have set the learners on the right path for achieving transformative changes in health systems, as they reported the skills, abilities, and motivations to carry on with their work, and the spread of these practices within and across organizations. The presentations given by Program alumni during the in-person sessions showed that some teams were able to achieve significant improvements within their health care systems (e.g., significant decreases in waiting times). See Appendix L online for the full Evaluation of the Integrated Collaborative Change Leadership Program 2014-15 report.


Upon completion of the final in-person session, participants wrote a description of their total experience, and Program faculty prepared a synopsis of these reflections. A few comments are captured below. The synopsis can be found online in Appendix M CCL Reflective Themes.

In order to further demonstrate the value of this Program, it was recommended that longer term follow up evaluation be conducted.

6. KNOWLEDGE TRANSFER

The CIHLC was very active in knowledge transfer activities locally, nationally and internationally throughout the term of the collaborative, and these activities will continue beyond this project.

Since the partnership’s inception in 2012, the CIHLC used its established local, regional and provincial networks within Canada to present the project, engage stakeholders, and receive input on the potential opportunities provided by membership in the IOM Global Forum. The CIHLC project leads also engaged their networks to stimulate discussion about the Lancet Commission Report and provide recommendations that could be applied to Canadian health education reform. The CIHLC continues to maintain its project website as a means of sharing information on the project, the research, and the CCL Program.

A. Project Website and Other Communication

A CIHLC website was created to provide a user-friendly Internet platform to share project activities and learnings with the broader health education and care community. The website contains information on the project vision, team and sponsors, as well as the project objectives and background research that informed the Program development. The website was also used to recruit, register and direct learners to the Program, and to provide information on instructors and learning resources. The website provided a platform for learners and alumni to connect with instructors, Program administrators, their communities and each other, before, during, and after the Program.

The full website was translated into French in order to create a truly pan-Canadian forum for the CIHLC project and the education program, and to provide equal access to Anglophone and Francophone participants.

Within a 15-month period, over 2,000 new users from 92 countries accessed the website. The English website can be accessed at: http://cihlc.ca and the French website at: http://cihlc.ca/fr/ until September, 30th, 2015. Seminal documents will be housed at the UofT Centre for IPE’s website beyond that date.

The CCL experience:

• Was transformative and life-changing

• Unleashedtheirsenseofauthenticity,confidenceanddeeppurposeintheirwork

• Facilitated depth of integration of all strands of the CCL concepts

• Deepened understanding that there may not even be a “right” answer – that many paths create workable possibilities

• Mirrored and modeled this embracing of collective wisdom

• Learning cited a new foregrounding of social accountability

http://cihlc.ca

http://cihlc.ca/fr/


The project created a wide online and offline presence through various social media communication outlets and print. Information about the Program was available through press releases, and the official Integrated CCL Program brochure. Active links to these platforms were available on the CIHLC website.

B. Publications, Posters, Workshops and Presentations

The CIHLC partners have had a presence at many national and international conferences through invited workshops, posters and presentations. The CIHLC gave eight poster sessions, presentations and keynote speeches at various health related professional and interprofessional conferences throughout Canada including Thunder Bay, Victoria, Niagara, Vancouver and Toronto, as well as internationally, in Japan, the United States, Qatar, Hungary and South Africa. Collectively, these presentations outlined the importance of collaborative leadership for health system transformation and health system reform, as well as providing blueprints on how to create and assess collaborative leadership education. See Appendix N online for Conference Posters of the CIHLC.

In addition, the CIHLC gave nine workshops at conferences throughout Canada in Quebec City, Kingston and Toronto, as well as internationally in the United States, Thailand and South Africa. Through these interactive sessions, the CIHLC led discussions, reflection, and skills development in the areas of collaborative leadership for health system change, interprofessional education and community engagement.

The CIHLC will continue to showcase its work beyond the sunset of the project itself. The complete list of the CIHLC knowledge transfer activities is outlined below and also online as Appendix O - CIHLC Publications, Posters, Workshops and Presentations.

PUBLICATIONS

MacPhee, M., Paterson, M., Tassone, M., Marsh, D., Bainbridge, L., Steinberg, M., Careau, E., and Verma, S. (2013). “Transforming Health Systems through Collaborative Leadership: Making Change Happen!” 5th International Service Learning Symposium Paper Series.

Careau, E., Biba, G., Brander, R., Van Dijk, J., Verma, S., Paterson, M., and Tassone, M. (2014). “Health Leadership Education Programs, Best Practices and Impact on Learners’ Knowledge, Skills, Attitudes & Behaviors and System Change: A Literature Review”. Journal of Health Leadership.

MacPhee, M., Berry, S., Brander R., Van Dijk, J., Bainbridge, L. and Paterson, M. (2014). “A Hybrid Approach to Service Learning Via a New Leadership Development Program”. P. L. Lin, M. R. Wiegand, & A. R. Smith-Tolken, (Ed). Service-Learning in Higher Education: Building Community Across the Globe. Indianapolis, Indiana: University of Indianapolis Press.

Brander, R., MacPhee, M., Careau, E., Tassone, M., Verma, S., Paterson, M. and Berry, S. (2015). “Collaborative Leadership for the Transformation of Health Systems”. In D. Forman, M. Jones, & J. Thistlethwaite (Eds.) Leadership and Collaboration: Further Developments for Interprofessional Education. New York, NY: Palgrave, Macmillan.

Gertler, M., Verma, S., Tassone, M., Seltzer, J. and Careau, E. (in press). “Navigating the Leadership Landscape: Creating an inventory to identify leadership education programs for health professionals”. Health Care Quarterly.

http://cihlc.ca/news/

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http://cihlc.ca/wp-content/uploads/2014/02/5th-International-Symposium-on-Service-Learning-Paper-Series.pdf

http://www.dovepress.com/articles.php?article_id=16778




Brander, R., Bainbridge, L., Van Dijk, J., and Paterson, M. Transformative Interprofessional Continuing Education and Professional Development to Meet Patient Care Needs: A Synthesis of Best Practices. In C. Orchard, C. and L. Bainbridge (Eds.) Interprofessional client-centred collaborative practice: What Does it Look Like? How Can it be Achieved? Hauppauge, NY: Nova (due 2016).

POSTERS

Paterson, M., Bainbridge, L., Dumont, S., Berry, S., Marsh, D., Verma, S., and Tassone, M. (2012). The Canadian Interprofessional Health Leadership Collaborative. ATBH (All Together Better Health) VI – 6th Annual International for IPECP. Kobe, Japan. October 5-8 2012.

Verma, S., Tassone, M., Bainbridge, L., Paterson, M., Berry, S., Marsh, D., and Dumont, S. (2012) Building Community in Generating A Canadian Interprofessional Health Leadership Collaborative. Rendez-Vous 2012. Thunder Bay, Ontario. October 9-14 2012.

Paterson, M., Bainbridge, L., Careau, E., Van Dijk, J., Marsh, D., Berry, S., Remtulla, K., Tassone, M., and Verma, S. (2013). Fostering Interprofessional Learning and Practice Through the Development of Collaborative Leadership Curricula. Canadian Association of Occupational Therapists (CAOT). Victoria, British Columbia. May 29-June 1, 2013.

Verma, S., Tassone, M., Bainbridge, L., Berry, S., Careau, E., Marsh, D., Paterson, M., Wu, D., and Van Dijk, J. (2013). Collaborative Leadership for Relationship-Centred Health System Transformation. 2013 National Health Leadership Conference. Niagara, Ontario. June 10-11, 2013.

Tassone, M., Verma, S., Bainbridge, L., Berry, S., Careau, E., Lovato, C., Marsh, D., Paterson, M., and Van Dijk, J. (2013). Collaborative Leadership for Health System Change to Globally Transform Education and Health. Collaborating Across Borders (CAB) IV. Vancouver, British Columbia. June 12-14 2013.

Steinberg, M., Bainbridge, L., Verma, S., Tassone, M., Berry, S., Brander, R., Careau, E., MacPhee, M., Marsh, D., Paterson, M., Lovato, C., and Tam, B. (2013). Evaluating the CIHLC Collaborative Leadership Education Program. Assessing Health Professional Education: A Workshop. Institute of Medicine, Washington, DC. October 9-10, 2013.

Careau, E., Paterson, M., Verma, S., Van Dijk, J., Biba, G., Bainbridge, L., Berry, S., Marsh, D., and Tassone, M. (2013). We are all teachers and we are all learners”: Program Design for Teaching Collaborative Leadership. 5th International Symposium on Service Learning (ISSL). Stellenbosch, South Africa. November 20-22, 2013.

Gertler, M., Verma, S., Tassone, M., Seltzer, J., Careau, E. (2014). Inventory of Canadian Leadership Education Programs. International Conference on Residency Education (ICRE), Toronto, Ontario. October 24, 2014.

WORKSHOPS AND PANEL DISCUSSIONS

Careau, E., Berry, S., Paterson, M., Van Dijk, J., Remtulla, K., Bainbridge, L., Marsh, D., Tassone, M. and Verma, S. (2013). Fostering Interprofessional Learning and Practice Through the Development of Collaborative Leadership Competencies. Canadian Conference on Medical Education (CCME). Quebec City, Quebec. April 20-23 2013.


Verma, S., Careau, E., Tassone, M., Negandhi, H., Zodpey, S., de Villiers, M., and Bezuidenhout, J. (2013). [Roundtable] – Innovations in Teaching Leadership Through Professionalism. Establishing Transdisciplinary Professionalism for Health: A Public Workshop of the Global Forum on Innovation in Health Professional Education. Institute of Medicine. Washington, DC. May 14-15, 2013.

Bainbridge, L., Verma, S. and Tassone, M. (2014). Transforming Health Systems Through Collaborative Leadership: Catalyzing Change! ATBH (All Together Better Health VII), Pittsburgh, PA. June 6-8, 2014.

Tassone, M., and Verma, S. (2014). “Progress Report for the Institute of Medicine”. In Assessing Health Professional Education: Workshop Summary. Ed. Patricia A. Cuff. Washington, DC: The National Academies Press.

Brander, R., MacPhee, M., Careau, E., Paterson, M. and Van Dijk, J. (2014). Collaborative Leadership for Health Systems Transformation for the Scholarship of Teaching & Learning. International Society for The Scholarship of Teaching & Learning. Quebec City, Quebec. Oct 22-25, 2014.

Tassone, M. and Rosenfeld, J. (2014). Crafting the Future of IPE Linked Practice: Next Steps. Reaching the Summit: Leading the Way from Interprofessional Education to Practice. Toronto, Ontario. Dec 2, 2014.

Bainbridge, L and Austin, Z. (2014). Evaluating the Success of IPE Linked to IPP. Reaching the Summit: Leading the Way from Interprofessional Education to Practice. Toronto, Ontario. Dec 2, 2014.

Careau, E. and Paterson, M. (2014). Enabling the Leadership to Transform Interprofessional Practice. Reaching the Summit: Leading the Way from Interprofessional Education to Practice. Toronto, Ontario. Dec 2, 2014.

Briggs, M. and Creede, C. (2014). Enabling the Leadership to Transform Interprofessional Practice. Reaching the Summit: Leading the Way from Interprofessional Education to Practice. Toronto, Ontario. Dec 2, 2014.

PRESENTATIONS AND KEYNOTE SPEECHES

Verma, S. (2011). The CHSES Inaugural Retreat. The Council of Health Sciences Education Subcommittee (CHSES) – Inaugural Retreat, Toronto, December 7, 2011.

Verma, S. (2012). Innovation and Boundless Directions: Health Professions Education Reform. The Council of Health Sciences Education Subcommittee (CHSES) – 2012 Retreat. Toronto, December 20, 2012.

Tassone, M. (2012). Emerging Directions in Interprofessional Education. Council of Health Sciences Education Subcommittee 2012 Retreat. Toronto, December 20, 2012.

Verma, S., and Tassone, M. (2012) Linking Health Professions Education to Practice Canadian Successes & Lessons Learned. Educating for Practice: Improving Health by Linking Education to Practice Using Interprofessional Education – A Public Workshop of the Global Forum on Innovation in Health Professional Education. Global Forum on Innovation in Health Professional Education. Institute of Medicine. Keck Center of the National Academies, Washington, DC. August 29-30, 2012.

http://www.iom.edu/Reports/2014/Assessing-Health-Professional-Education.aspx

http://www.iom.edu/Reports/2014/Assessing-Health-Professional-Education.aspx

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Verma, S., and Tassone, M. (2012) Educating for Practice – Using Collaborative Leadership to Improve Health Education and Practice. Workshop II: Educating for Practice Learning How to Improve Health From Interprofessional Models Across the Continuum of Education to Practice. Global Forum on Innovation in Health Professional Education. Institute of Medicine. Keck Center of the National Academies, Washington, DC. November 29-30, 2012.

Verma, S. (2013). The Role of Health Professions Education in Transforming Healthcare in Academic Health Systems. Association of Academic Health Centers International – 1st Middle East & North Africa Regional Meeting. Doha, Qatar, March 18, 2013.

Verma, S. (2013) Leadership in Integrative Health for the 21st Century: Qualities, Intention, Outcomes. Academic Consortium for Complementary and Alternative Health Care (ACCAHC). Portland, Oregon. June 26-28, 2013.

Verma, S. (2013). International Trends in Health Professions Education Reform and Renewal. AACHI Inaugural Central and Eastern European Regional Meeting: Collaborative Health Care - Changing Paradigms in Education, Health Care and Research. Budapest, Hungary. November 7 - 8, 2013.

Careau, E., Paterson, M., Brander, R., Van Dijk, J. and Verma, S. (2014). Transforming Health Systems Through Collaborative Leadership: Curriculum Development. World Federation of Occupational Therapists. Yokohama, Japan. June 20, 2014.

Brander, R., MacPhee, M., Careau, E., Paterson, M. and Van Dijk, J. (2014). Collaborative Leadership for Health Systems Transformation. International Society for The Scholarship of Teaching & Learning (issotl 14). Oct 22-25, Quebec City, Quebec, Oct 22-25. 2014.

Careau, E. (2014). “To Train or Not to Train Collaborative Leaders” Is that the Question? The Health Professional Educator Network Annual Meeting. Quebec City, Quebec. Nov 14, 2014.

https://www.iom.edu/~/media/Files/Activity%20Files/Global/InnovationHealthProfEducation/2012-NOV-29/Canada.pdf

https://www.iom.edu/~/media/Files/Activity%20Files/Global/InnovationHealthProfEducation/2012-NOV-29/Canada.pdf


7. CANADIAN LEADERSHIP ACTIVITIES

A. Institute of Medicine Global Forum on Innovation in Health Professional Education

The IOM Global Forum, located in Washington D.C., brings together people who are policy leaders, academic experts and health professionals from nine countries and multiple professions to discuss and illuminate issues within health professional education, with a focus on issues related to interprofessional education. Members of the Global Forum gather to plan for and attend bi-annual Forum sponsored workshops which explore issues related to interprofessional education and care. As CIHLC co-leads, Dr. Verma was appointed as a member and Professor Tassone as the alternate, with responsibility for communications with the IOM and for participating in planning the Global Forum workshops.

Representatives from all of the five universities participated at the bi-annual workshops, and were invited speakers and facilitators at several of these workshops in Washington D.C. The workshops and planning forums provided excellent opportunities for discussion and feedback from international policy leaders.

At the initial August 2012 IOM Global Forum “Workshop 1: Educating for Practice: Improving Health by Linking Education to Practice using IPE” Dr. Verma and Professor Tassone gave Canadian examplars of IPE to the international community in their presentation “Linking Health Professions Education to Practice Canadian Successes & Lessons Learned”. At the second IOM Global Forum workshop “Workshop 2: Educating for Practice: Learning how to improve health from interprofessional models across the continuum of education to practice”, Dr. Verma and Professor Tassone presented “Using Collaborative Leadership to Improve Health Education and Practice” to provide an update on the CIHLC’s progress.

In October 2013, in conjunction with the IOM Global Forum’s workshop “Assessing Health Professional Education”, the CIHLC designed and led a “World Café” symposium and workshop to explore evaluation and assessment exemplars in the field of collaborative leadership education. CIHLC representatives were engaged in designing the format and questions, leading the Café as moderators, and facilitating several of the small group discussions, including international webcast table discussions that were recorded. Representatives from the Indian, South African and Ugandan collaboratives, as well as a representative from an associated university in Belgium were small group facilitators during the “Café”. Symposium participants spanned five continents, and the discussion revolved around innovative practices in transformative learning and collaborative leadership for health systems change, along with an exploration of the challenges and opportunities in the field.

In May 2014, at the IOM Global Forum’s workshop “Building Health Workforce Capacity Through Community-based Health Professional Education”, Dr. Verma, as a Forum member led a debate on admissions versus training to enhance community-based career choices, as part of a broader exploration of foundational issues. Professor Tassone participated in a breakout group on IPE linked to practice through scaling up the role of community colleges. In addition, Dr. Verma introduced the round table discussion “Innovations in Teaching Leadership through Professionalism” in which Professor Tassone and Dr. Careau participated in a panel as representatives of the CIHLC.

Progress reports to the IOM as well as summaries of the CIHLC presentations were published as part of the IOM workshop summary reports. See Appendix P online for a list of IOM Global Forum on Innovation in Health Professional Workshop Summary Reports.



http://www.iom.edu/~/media/Files/Activity Files/Global/InnovationHealthProfEducation/2012-AUG-29/0106-Verma-and-Tassone.pdf

http://www.iom.edu/~/media/Files/Activity Files/Global/InnovationHealthProfEducation/2012-AUG-29/0106-Verma-and-Tassone.pdf

https://www.iom.edu/Activities/Global/InnovationHealthProfEducation/2012-NOV-29.aspx

https://www.iom.edu/Activities/Global/InnovationHealthProfEducation/2012-NOV-29.aspx

http://www.iom.edu/Activities/Global/InnovationHealthProfEducation/2013-OCT-09.aspx

http://www.iom.edu/Activities/Global/InnovationHealthProfEducation/2013-OCT-09.aspx

http://www.iom.edu/Activities/Global/InnovationHealthProfEducation/2013-MAY-14.aspx

http://www.iom.edu/Activities/Global/InnovationHealthProfEducation/2013-MAY-14.aspx

http://www.iom.edu/~/media/Files/Activity Files/Global/InnovationHealthProfEducation/2013-MAY-14/Verma.pdf

http://www.iom.edu/~/media/Files/Activity Files/Global/InnovationHealthProfEducation/2013-MAY-14/Verma.pdf


Innovation Collaboratives

At the outset, the IOM invited the CIHLC to take on a leadership role among the four international innovation collaboratives given the pre-existing strengths of its component institutions and the tradition of the Canadian health system for innovating to increase affordable care.

Capitalizing on the presence of the other three innovation collaboratives (from South Africa, India and Uganda) at the IOM semi-annual workshops, the CIHLC led the coordination and facilitation of meetings with the innovation collaboratives to seek synergies and areas of collective work and to explore the possibilities for future collaborations.

IOM Forum Membership and Sponsorship

The IOM’s commitment to support the four innovation collaboratives ended in December 2013. At that time, the CIHLC co-leads were invited and accepted a three-year term membership as a sponsor to the IOM Global Forum. Dr. Verma and Professor Tassone accepted this privilege to remain members as lead and alternate, and to become sponsors with registration paid by UofT. This three-year term ending in December 2016 extends the opportunity to provide a Canadian voice to the direction of the Global Forum activities and to provide expertise and guidance to workshops, studies and discussions.

As Global Forum members, Dr. Verma and Professor Tassone had several opportunities for leadership. Both co-leads participated at the IOM Global Planning Forum in May 2014, at which time Dr. Verma was invited to present the UofT Faculty of Medicine’s Global Health Strategy as an exemplar of global health outreach.

Through its IOM Global Forum membership, Professor Tassone was invited to speak by providing a Canadian perspective at its open session in Washington in October 2014, regarding the first IPE consensus study of the Global Forum – Measuring the Impact of IPE on Collaborative Practice and Patient Outcomes.

B. Reaching the Summit: Leading the Way from Interprofessional Education to Practice

The CIHLC co-sponsored a large high level Summit entitled Reaching the Summit: Leading the Way from Interprofessional Education to Practice, in partnership with the Centre for Interprofessional Education (CIPE); the Council of Health Sciences Education Subcommittee (CHSES); the Office of Integrated Medical Education (OIME); and, the Toronto Academic Health Science Network Education Committee (TAHSNe), which was led by the UofT, Faculty of Medicine in December 2014. The Summit brought together 150 leaders, researchers, teachers and practitioners across the health science professions to exchange knowledge and contribute to strategic plans to advance interprofessional education linked to care. The Summit was hosted by Dr. Verma, in her then position as Deputy Dean of the Faculty of Medicine and as co-lead of the CIHLC. The CIHLC university site leads and some faculty of the Integrated CCL Program attended the Summit and led components of the conference. Dr. George Thibeault, the President and CEO of the Josiah Macy Jr. Foundation, and an IOM Global Forum member, provided the keynote address.

The Summit provided a forum to encourage dialogue on the Lancet Commission, “Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World.” The participation of all five universities in these discussions provided an opportunity to consider and converse about system change. The concept of this kind of academic summit was aligned with a key recommendation of the Lancet Report, “Academic summits could be considered to engage the support of the wider university leadership as a crucial factor for success of reform efforts in schools and departments that are directly responsible for health professional education.”

https://s3.amazonaws.com/files.cepdtoronto.ca/support_files/29992/UofT.SummitReport.FINAL.pdf

https://s3.amazonaws.com/files.cepdtoronto.ca/support_files/29992/UofT.SummitReport.FINAL.pdf


Common themes from the breakout discussion groups revealed strong support for a collaborative approach. Group discussions identified an urgent need for collaborative practice based leadership and professional development in this area as a means to transform interprofessional practice. A key proposed strategy was to invest in programs and projects that enable patient perspectives and address process challenges, and to identify and support champions of IPE and IPP at all levels. Leadership programs were identified as a mechanism to facilitate recommended actions. The Summary of Proceedings report can be accessed at www.cpd.utoronto.ca/summit/report/.

8. OUTCOMES AND FUTURE OF CIHLC

A. Beyond the Project

The CIHLC closed its secretariat at the end of June 2015 when its final reports were completed.

CIHLC members continue to demonstrate the impact of the CIHLC work through extensive knowledge dissemination activity with multiple book chapters, peer-reviewed articles in press, posters, workshops and abstracts, as well as presentations around the world. The CIHLC website will remain active until September 2015. Products such as the monograph on community engagement created by the CIHLC are available to anyone interested in, or becoming involved with, a socially accountable, community engaged transformative change initiative. The Evaluation Primer can be used by educators, learners, faculty and practitioners to provide understanding of evaluation processes, term and options for program evaluations.

All narrative reports on the project, including the bi-annual reports and final reports, the five university detailed site reports, and a comprehensive evaluation of the Integrated CCL Program will be kept at the CIPE, and will be available for others to learn from the CIHLC and partnership experience.

Dr. Verma and Professor Tassone will continue to represent the project, as appointed members and sponsors of the IOM Global Forum. The meetings of the IOM Global Forum will continue to provide a Canadian voice beyond the CIHLC and the opportunity to learn about health professional education from experts from around the world.

B. Impact of the CIHLC-UHN Partnership on Future Programs

The next CCL Program will be offered from October 2015 to June 2016 in Toronto. The unique contributions of the CIHLC will continue in the upcoming Program, based on the positive outcomes of the Integrated CCL Program. These include social accountability and community engagement as core concepts and the blended model of learning. Building on its new pan-Canadian and international partnerships, the CIHLC has extended the awareness of the CCL Program to an international audience.

The creation of a workbook for the Integrated CCL Program will contribute to a more efficient and effective way for participants to integrate the Program information and maintain a record for future use.

The Program was culturally validated and translated in part, through ULaval’s sponsored team and the Program faculty, to set the foundation for a French language version.

http://www.cpd.utoronto.ca/summit/report

http://www.cpd.utoronto.ca/summit/report


C. Planning for Future Programs

The CIHLC, in collaboration with the UHN, developed a marketing and communications plan for future iterations of the CCL Program. This comprehensive plan includes the introduction of more social media avenues and a wider distribution of information to capitalize on a broader national and international audience.

The CIHLC website template was repurposed for the next launch of the CCL Program, providing a visually similar and effective website that transitioned from the meaningful partnership. The new website – http://collaborativechangeleadership.ca/ offers a history of the CIHLC partnership on its home page, and vignettes of testimonials from the Integrated CCL Program alumni.

The CCL Program may consider offering consultation services to other leadership/ interprofessional education programs and organizations around collaborative leadership in health care, building on the national and international connections and an increased awareness and support for collaborative leadership for health system reform.

http://collaborativechangeleadership.ca/

http://collaborativechangeleadership.ca/


“Partofdefiningcollaborativeleadershipisdeterminingwhatitisnot.Collaborativeleadershipisnotjustthetraitsofoneleader in the room. It represents a cultural shift to a less hierarchical shared form of leadership.”

“Social accountability and community engagement are important components and anchors for collaborative leadership.”

“Collaborative leadership has been entering further into the academic vocabulary as a result of the CIHLC’s work, and, in some organizations it has led to a culture shift.”

“The CIHLC has brought Canadian viewpoints to an international audience and helped to push forward collaborative leadership and interprofessional education, through its work with the IOM and presentation of its research at conferences around the world.”

“The CIHLC expanded the scholarship on collaborative leadership, which previously had little written on it.”

9. REFLECTIONS AND CONCLUSION

A. ReflectionsoftheNationalSteeringCommittee

At the final in-person meeting in March 2015, the NSC reflected on the collaborative project experience and considered how some of their learnings could be applied to future activities. An expert in health leadership, external to the CIHLC, facilitated conversations for members to share perspectives about collaborative leadership, identify CIHLC project outcomes, and share their learnings from the project.

Some of the NSC leads’ perceptions on collaborative leadership and learnings from the project are shared below:

Overall, it was agreed that the CIHLC achieved its objectives. The NSC highlighted the need for a longitudinal study that would extend well beyond the project to evaluate success.

Some of thoughts of the NSC leads on their experience with the project are noted below:.

“This project provided an opportunity to work with expert colleagues across Canada and share knowledge and expertise.”

“This three-year journey within CIHLC strengthens our belief that collaborative leadership is essential for enabling changes and strengthening health systems, improving service delivery through interprofessional care, and ensuring better patient health outcomes.”

“Contributing to activities to develop a pan-Canadian educational program on collaborative leadership was for us an honor and an intellectual and co-creative adventure.”

“CIHLCpartnershipamongfiveprominentCanadianuniversitiesinitselfconstitutesapositiveexampleofexcellenceininterprofessional education for health system transformation.”

“My hope is that we will be able to continue our professional relationships and academic/research collaborations beyond the life of this project.”


B. Conclusion

The Lancet Commission Report (2010) highlighted a call from 20 professional and academic leaders for major reform in the training of doctors and other health care professionals for the 21st century. Major changes were required as a result of the fragmented, outdated, and static education programs that produced graduates who failed to meet the needs of society and there was a mismatch between the health programs and the health system. The Commission argued for major reform across the entire medical education system, in order to produce competency-led curricula for the future. A major enabling action was to produce new leadership that could collaborate across health professions in community, hospital and primary care settings and lead health system transformation. The Canadian Interprofessional Health Leadership Collaborative responded to the Institute of Medicine’s call for proposals and was chosen as one of four collaboratives to participate in the Global Forum on Innovation in Health Professional Education, which began to implement the Lancet Report’s reforms around the world and influence thought on new ways to train health professionals.

Through its partnership with five universities to explore a less defined and traditional type of leadership as an effective and transformative approach for complex system change, the CIHLC engaged in a three-year project that was unique and catalytic in Canada. Through its research, the delivery and evaluation of its advanced education program in partnership with the University Health Network, and its prolific knowledge transfer activities, the CIHLC has raised the profile and importance of collaborative leadership, together with community engagement and social accountability, as a key lever to health system and education reform.

The five university partners and their CIHLC members remain grateful to the Ontario Ministry of Health and Long-Term Care, Dr. David Naylor, the former President of the University of Toronto and Dr. Catharine Whiteside, the former Dean of Medicine of the University of Toronto, for their support and relentless engagement in the project. In addition, each University owes much to the support of their sponsors – the Deans of their Faculties who provided guidance and insight as the project evolved. Finally, the CIHLC acknowledges its deep gratitude to the Institute of Medicine and the Global Forum on Innovations in Health Professional Education for furthering the dialogue and catalyzing change through interprofessional health education reform and demonstrating new models for leadership. The opportunity for a Canadian collaborative to be part of a highly visible and influential international discourse and interchange of innovation, has created a level of leadership and capacity across all of the five partners that is sustainable for the long term.

Through its partnership with

fiveuniversitiestoexplorea

lessdefinedandtraditional

type of leadership as an

effective and transformative

approach for complex

system change, the CIHLC

engaged in a three-year

project that was unique and

catalytic in Canada.


LIST OF APPENDICES

Following is a list of this Report’s appendices. Please visit our website, www.ipe.utoronto.ca/community-engagement/

cihlc-project/cihlc-final-report, to review these references.

Appendix A Canadian Interprofessional Health Leadership Collaborative Membership

Appendix B National Steering Committee Terms of Reference

Appendix C National Steering Committee Biographies

Appendix D Statement of Collaboration

Appendix E Principles of Collaboration: Grants, Knowledge Transfer, Authorship and Ownership

Appendix F Collaborative Leadership Program for Transformative Change Logic Model

Appendix G CIHLC Evaluation Primer

Appendix H Institute of Medicine Workshop Handout: Tools in Assessing Health Professional Education: Canadian Exemplars

Appendix I Community Engagement for Health System Change: Starting from Social Accountability

Appendix J Collaborative Change Leadership Program Brochure

Appendix K Collaborative Change Leadership Program - Capstone Initiative Descriptions

Appendix L Evaluation of the Integrated Collaborative Change Leadership Program 2014-15

Appendix M CollaborativeChangeLeadershipProgram-ReflectiveThemesfromParticipantFeedback-Faculty Synthesis

Appendix N Conference Posters of the Canadian Interprofessional Health Leadership Collaborative

Appendix O Canadian Interprofessional Health Leadership Collaborative Publications, Posters, Workshops and Presentations

Appendix P Institute of Medicine Global Forum on Innovation in Health Professional Education Workshop Summary Reports

www.ipe.utoronto.ca/community-engagement/cihlc-project/cihlc-final-report

www.ipe.utoronto.ca/community-engagement/cihlc-project/cihlc-final-report

http://www.ipe.utoronto.ca/sites/default/files/Canadian Interprofessional Health Leadership Collaborative Membership_3.pdf

http://www.ipe.utoronto.ca/sites/default/files/National Steering Committee Terms of Reference.pdf

http://www.ipe.utoronto.ca/sites/default/files/CIHLC National Steering Committee Biographies_0.pdf

http://www.ipe.utoronto.ca/sites/default/files/Appendix D STATEMENT OF COLLABORATION.pdf

http://www.ipe.utoronto.ca/sites/default/files/Principles of Collaboration for the CIHLC_0.pdf

http://www.ipe.utoronto.ca/sites/default/files/Collaborative Leadership %28CL%29 Program for Transformative Change Logic Model.pdf

http://www.ipe.utoronto.ca/sites/default/files/CIHLC Evaluation Primer.pdf

http://www.ipe.utoronto.ca/sites/default/files/IOM Workshop Handout Tools in Assessing Health Professional Education.pdf

http://www.ipe.utoronto.ca/sites/default/files/IOM Workshop Handout Tools in Assessing Health Professional Education.pdf

http://www.ipe.utoronto.ca/sites/default/files/Community Engagement for Health System Change.pdf

http://www.ipe.utoronto.ca/sites/default/files/Collaborative Change Leadership Program Brochure.pdf

http://www.ipe.utoronto.ca/sites/default/files/CCL 2014-2015 Capstone Initiative Descriptions.pdf

http://www.ipe.utoronto.ca/sites/default/files/Integrated CCL Program Evaluation Report.pdf

http://www.ipe.utoronto.ca/sites/default/files/Reflective Themes from Participant Feedback - Faculty Synthesis_0.pdf

http://www.ipe.utoronto.ca/sites/default/files/Reflective Themes from Participant Feedback - Faculty Synthesis_0.pdf

http://www.ipe.utoronto.ca/sites/default/files/Conference Posters of the CIHLC.pdf

http://www.ipe.utoronto.ca/sites/default/files/CIHLC Publications Posters Workshops and Presentations_0.pdf

http://www.ipe.utoronto.ca/sites/default/files/CIHLC Publications Posters Workshops and Presentations_0.pdf

http://www.ipe.utoronto.ca/sites/default/files/IOM Summary Reports.pdf

http://www.ipe.utoronto.ca/sites/default/files/IOM Summary Reports.pdf

Lead Authors: Dr. Sarita Verma (UofT), Prof. Maria Tassone (CIPE)

Contributors: Dr. Lesley Bainbridge (UBC), Dr. Rosemary Brander (Queen’s),

Dr. Marion Briggs (NOSM), Dr. Emmanuelle Careau (ULaval), Dr. Serge Dumont (ULaval),

Dr. Maura MacPhee (UBC), Dr. David Marsh (NOSM), Dr. Margo Paterson (Queen’s)

CIHLC Secretariat Project Team: Jane Seltzer, Matthew Gertler

Editors: Leslie Smith, Marcella Fiordimondo (UofT)

Graphic Design: Layne Verbeek (iCommunicate)

Printed by: The Printing House

Copyright ©2015

Centre for Interprofessional Education, University of Toronto @ Toronto Western Hospital

399 Bathurst Street, Nassau Annex,Toronto, Ontario, M5T 2S8

www.ipe.utoronto.ca

Not to be reproduced without the permission of the authors.

http://www.ipe.utoronto.ca