1

Interdisciplinary collaboration (IdC) within primary care teamsNicosia, May 2009

Paolo Tedeschi, Mes – Management & Health LabScuola Superiore S.Anna of Pisa, Italy

p.tedeschi@sssup.it

2

• Short introduction about Scuola Superiore Sant’Anna & Mes Lab

• Interdisciplinary collaboration within primary care teams

• The European Forum for Primary Care Position Paper

Agenda

3

Scuola Superiore Sant’Anna is a peculiar public university, working in the field of applied sciences: Economic Sciences, Legal Sciences and Political Sciences for the Class of Social Sciences, and Agricultural Sciences, Medical Sciences, and Industrial and Information Engineering for the Class of Experimental Sciences.

It offers undergraduate, graduate and executive education.

Scuola Superiore Sant’Anna & Mes Lab

Mes Lab is responsible for producing and spreading innovation in healthcare management, in order to sustain the quality, effectiveness and efficiency of the Italian public health system, in particular concerning the Tuscan regional health care system.

Mes Lab main activities:

•Applied research (working within the system…)

•Managerial training (executive programs, Master in HC management, …)

•Performance evaluation & benchmarking (region, health authorities & providers, organisational units) Visit MeS-Lab at:

www.meslab.sssup.it

4

The performance evaluation system… will it reach also Idc?

From 2004 MeS-Lab has developed a multidimensional evaluation system for Tuscany Region to assess and monitor LHAs and THs performance, and to implement the regional benchmarking and spread out best practices.

The performance evaluation system is based on benchmarking and consists of 50 measures, made up of 130 indicators, classified in six reporting areas.

5

• Short introduction about Scuola Superiore Sant’Anna & Mes Lab

• Interdisciplinary collaboration within primary care teams

• The European Forum for Primary Care Position Paper

Agenda

6

Is IdC just about this?

3,8

3,0 3,12,8

2,3 2,11,6 1,7

4,23,8

3,4 3,43,0

2,4 2,32,02,1 2,1

0

1

2

3

4

51990 2004

Practising physicians per 1000 population

Sou

rce:

OEC

D H

ealth

Dat

a 20

06

11,1

7,9

5,86,8 7,2

5,65,0

10,79,9 9,7 9,2 9,0

8,2 7,9 7,5

5,4

0

2

4

6

8

10

12 1990 2004

Nurses per 1000 population

* France does not include auxiliary/practical nurses. ** Italy reports only nurses employed in hospitals.

7

Is it just a nice to have?

Do we need it just to compensate some skills shortages?

Is it because of the search for recognition by new professions?

Another healthcare management fad?

OrDo we need it because of structural and lasting changes (e.g. chronic diseases, change in life styles, non-medical services, etc.) which require cost-effective organisations able to manage complexity of care as well as to reconfigure services according to individual & local community needs?

Team-based care can make a difference... are they good value for money?

Research shows that team-based care can offer better access to services, shorter wait times, better coordination and comprehensiveness of care, and fewer visits to hospitals and doctors (which care refocus on medical issues).

Why then “IdC” within primary care teams should be a relevant topic?

8

Drivers to “IdC”… considering also the 2008 Green Paper on the European Workforce for Health

9

Integrated care

Positioning “IdC” vs. other relevant concepts for health service delivery, and for which “ultimate goal”?

Complementarity /

coordination of care

Multidisciplinarity

/ “IdC”

HC organisations

/ networks

HC processes

HC professional skills

& method of work

(e.g. task substitution)

Continuity of care

-OOHs

-DM programs

- Patient pathways

-Case management

-Home-care

- ...

There’s need to be tangible benefits for patients...

10

Key questions & conditions about IdC in primary care

• which evidence, drivers and barriers, should be accounted for the development of IdC in primary care?

• which educational, workforce planning and managerial policies are currently adopted?

• which organisational and operational conditions allow the improvement of trustworthy relationships among different primary care professions?

• which features of IdC enable integration of individual “patient-to-professional” relationships with embedded “patient-to-team” relationships?

• which patterns of task delegation are followed (e.g. from GPs to Assistants, Nurses, Pharmacists, other Therapists, etc.) and how can be improved?

• which approaches allow to optimize skill-mixes and avoid burnout?

• which coordinating mechanisms among professions (e.g. protocols, clinical pathways, role and task definition, minimum levels of collaboration) and support systems (e.g. electronic medical records, patient summaries, decision support systems, pay for performance, etc.) do favour IdC?

11

• Short introduction about Scuola Superiore Sant’Anna & Mes Lab

• Interdisciplinary collaboration within primary care teams

• The European Forum for Primary Care Position Paper

Agenda

12

Provisional structure & method for the EFPC Position Paper on IdC

• Introduction: setting the case for IdC within primary care• Main features and drivers for the development of IdC within primary care• IdC at work across Europe (case-studies, expert consensus)• Lessons learned and recommendations for IdC consolidation within primary care

Through the Position Paper we wish to assemble a common framework able to...

• highlight solutions which are likely to improve service delivery, quality of care, patient experience and satisfaction... starting from medical education and workforce management.

• reinforce primary care not just as a healthcare cost-cutting opportunity, but also as a personal and distinctive added-value service to patients.

• convince that IdC at the very heart of primary care capabilities to take care of most patients and local community needs... but teams need to be activated for real!!!

13

SEE YOU IN PISA! Ciao

In collaboration with Scuola Superiore Sant’Anna, Pisa

The 2010 conference of “The Future of Primary Healthcare in Europe” will be in Pisa, Italy (August 30 – September 1,

2010)