GiiC Investigators - RGP



The Geriatrics, Interprofessional Practice and Interorganizational Collaboration (GiiC) Initiative: Enhancing Shared Care of Frail Seniors

The GiiC initiative is a collaboration of the Regional Geriatric Programs of Ontario located in Hamilton, Kingston, London, Ottawa and Toronto, the Centre for Education and Research on Aging and Health (CERAH) at Lakehead University in Thunder Bay and the North East Specialized Geriatric Services (NESGS) Group in Sudbury. CERAH and the NESGS Interest Group are affiliated with the Northern Ontario School of Medicine.

Acknowledgements

The GiiC Project is funded by the Ministry of Health and Long-Term Care through a HealthForceOntario, Interprofessional Care Education Fund and supports the Provincial Interprofessional Care Blueprint for Action. The willingness of Family Health Teams and Community Health Centres across the province to join our initiative is gratefully acknowledged as is the support of the Quality Improvement & Innovation Partnership, the Association for Ontario Health Centers and the Arthritis Community Research and Evaluation Unit

GiiC Investigators

Dr. David Ryan, PhD, CPsych, Project Director

Director of Education & Knowledge Processes

Regional Geriatric Program of Toronto

Assistant Professor, Faculty of Medicine University of Toronto

Dr. Cheryl Cott, BPT, MSc, PhD

Associate Professor, Faculty of Medicine, University of Toronto

Director, Arthritis Community Research & Evaluation Unit

Dr. William Dalziel, MD, FRCPC

Chief, Regional Geriatric Program of Eastern Ontario

Dr. Iris Gutmanis

Director of Evaluation & Research Regional Geriatric Program of Southwestern Ontario

Assistant Professor, Department of Epidemiology and Biostatistics, Schulich School of

Medicine & Dentistry, The University of Western Ontario

Mr. David Jewell, MSW, MHSc

Administrative Director, Regional Geriatric Program of Central Ontario

Assistant Clinical Professor, Dept of Psychiatry & Behavioural

Neurosciences, McMaster University, Hamilton

Dr. Mary Lou Kelley MSW, PhD

Director, Centre for Education & Research & Aging & Health (CERAH),

Professor, School of Social Work & Northern Ontario School of Medicine,

Lakehead University, Thunder Bay

Dr. Barbara Liu, MD, FRCPC

Executive Director, Regional Geriatric Program of Toronto

Assistant Professor, Faculty of Medicine, University of Toronto

Dr. John Puxty, MD, FRCPC

Medical Director, Regional Geriatric Program of South Eastern Ontario

Associate Professor & Chair, Division of Geriatric Medicine

Queens University, Kingston

GiiC Initiative Steering Committee

Dr. Nick Kates,

Director of Programs, Hamilton Family Health Teams

Professor, Faculty of Medicine, McMaster University

Ms Brenda McNeil

Executive Director, Anne Johnston Health Station, Toronto

Ms. Marlene Awad, BSC MHA

Director, Administration & Information Management

Regional Geriatric Program of Toronto

Mr. Kelly Milne, BScOT

Program Manager, Regional Geriatric Program of Eastern Ontario

Ms. Catherine Matheson, BSW, MBA, CEC

General Manager, Community Development

City of Greater Sudbury

Ms. Linda Pisco, BA, MA

Education Planner, Center for Research and Education in Ageing and Health

Lakehead University

Kelly Simpson, M.A., Cert Ed

Regional Development & Education Coordinator, Specialized Geriatric Services

Regional Geriatric Program of Southwestern Ontario

Ms. Maureen Vickers BScN

Director, Specialized Geriatric Services

Regional Geriatric Program of Southwestern Ontario

And

Dr. David Ryan, Project Director

Dr. William Dalziel Dr. Cheryl Cott Mr. David Jewell

Dr. Iris Gutmanis Dr. John Puxty Dr. Mary Lou Kelley

Dr. Barbara Liu

The Project Evaluation Team

The Arthritis Community Research & Evaluation Unit

Dr. Cheryl Cott, Director

Ms. Nicole Donaldson, Research Assistant

GiiC Consultants

Deanna Abbott-McNeil, BScPT

RGP Kingston

Darlene Harrison, RN, HBScN, GNC(C)

CERAH

Mary-Lou van der Horst, RN, BScN, MScN, MBA

RGP Hamilton

Lyne Marcil, BScOT, BA, Geriatric Assessor

RGP Ottawa

Catherine McCumber, RN, BScN, MN, GNC(C)

RGP Ottawa

Susanne Murphy, BScOT, MSc

RGP Kingston

Donna Scott, RN, BScN, CHRP

RGP London

Tanya Shute, MSW, RSW

CERAH

Deana Stephen, RSSW

NE SGS Interest Group

Ken Wong, BScPT, MSc

RGP Toronto

GIIC Project Overview

Introduction

Population aging presents significant challenges to the health care system in Ontario. Not the least of these is the fact that 82% of seniors have one or more chronic health conditions and 43% have three or more conditions. This later group of seniors is at risk of becoming frail. Frailty, characterized by complex bio-psycho-social and functional problems, is associated with increased health system usage and puts seniors at risk of loss of the capacity for independent living and lowered quality of life (Wolff et al, 2002). Within the aging demographic, frailty may be the fastest growing segment across the province and particularly in northern regions and outside high-density urban areas (Manuel & Schultz, 2001)

Ageing demographics will have a significant impact on human resource planning and development in all professions working in many health care contexts across the circle of care (McKnight et al. 2003). Providing care to the expanding population of frail seniors requires an both an increase in the numbers of care providers and development of our skill sets. Our skill sets require expertise in three broad competencies - geriatrics, inter-professional practice and inter-organizational collaboration. Competence in geriatrics is required because the clinical presentations of frail seniors are unique and include the ‘geriatric giants’ of dementia, delirium, falls, continence and poly-pharmacy often co-occurring in complex ways. Competence in inter-professional practice is required because the complexities of these clinical presentations are such that optimal care requires an interdisciplinary team. Inter-professional teamwork, as outlined in the recently published Health Force Ontario, Inter-professional Care: Blueprint for Action (Oandasan & Closson, 2007), is the care delivery method of choice in caring for frail seniors (Geriatrics Interdisciplinary Advisory Group, 2006). Finally, competence in inter-organizational collaboration is required because the management of frail seniors requires the sharing of care across many organizational boundaries from primary and community based care to emergency and hospital-based services. Table 1 provides an overview of these competencies.

On the need for training in the core competencies

Repeated surveys demonstrate that curriculum time devoted to geriatrics in the academic preparation of health professionals is insufficient. In our own surveys, for example, frailty-focused service ‘specialists’ in all disciplines tell us that they when they graduated they lacked the confidence and skill sets to care for frail seniors. They tell us that they required extensive continuing education that was acquired through informal ‘on the job’ processes, specific time-limited educational events and pilot projects though groups such as the RGPs of Ontario. These findings from the inter-professional geriatric ‘specialists’ appear independent of year of graduation (Ryan & Kirst, 2005). Limitations on geriatrics training are a challenge to the health systems capacity to meet the needs of an aging population.

The need for renewed focus on preparing health professionals for inter-professional practice has recently been documented in the Health Force Ontario, Inter-professional Care: Blueprint for Action (Oandasan & Closson, 2007). The blueprint argues that because inter-professional practice is an essential characteristic of health care delivery in the real world, preparation for inter-professional practice must be formally incorporated into the academic and continuing

education of health professionals. Simply putting people together to work does not necessarily create effective teamwork. In formative academic training health professionals must build

attitudes and expectations supportive of inter-professional practice that with appropriate support can be refined in the workplace to improve the quality of services to patients (Barr, 2000).

The Inter-professional Care: Blueprint for Action and the emergence of Local Health Integration Networks in Ontario also guide us towards the importance of inter-organizational collaboration in the delivery of effective health care. But, just as simply putting people together to work does not necessarily create effective teamwork, so simply requiring organizations to work together does not necessarily lead to effective shared care. Inter-professional practice and inter-organizational collaboration require ongoing coaching, support and facilitation. Resources to meet this ongoing need are seldom available in the workplace.

Between Specialized Geriatric Service providers affiliated with the Regional Geriatric Programs of Ontario, Community Health Centres and Family Health Teams who are and will increasingly be the primary source of care for the growing population of frail seniors, there exits a combination of skill sets and needs that can respond to the issues of human resource scarcity for geriatric care and the need to provide practice based training in inter-professional practice and inter-organizational collaboration as outlined in the Blueprint for Action.

Goals and objectives

Through this initiative we propose the development of a network of excellence in practice based interprofessional education and interorganizational collaboration in primary care that will support the academic initiatives outlined in the Health Force Ontario, Inter-professional Care: Blueprint for Action and help the province in managing the consequences of its ageing population.

The primary outcomes arising from this initiative are as follows:

1) The consolidation of a team of GIIC resource consultants situated within the RGPs of Ontario,

the Centre for Education and Research on Aging and Health at Lakehead University and the North East Specialized Geriatric Services Group in Sudbury to train coach and mentor a provincial network of GiiC facilitators.

2) The development of a province-wide network of 200 GiiC facilitators situated in Family Health

Teams (FHT) and Community Health Centers (CHC) to assist their teams and organizations in

the delivery of collaborative shared care to frail seniors.

3) A set of GIIC teaching resources and facilitation tools with an online repository

4) An intersectoral and province-wide health services workforce with enhanced awareness and

knowledge of each other and higher levels of skill in the three competencies

6) A sustainability plan for each network hub consistent with each group’s specific needs and

leveraging existing resources and skill sets

7) Improved shared health care for seniors and especially frail seniors

Table 1. A framework of competencies for health human resource development

The Geriatric clinical core competencies for frailty focused services

1. The nature of frailty

2. Dementia, delirium, depression, falls, continence, polypharmacy – the Geriatric Giants

3. Context specific geriatric assessment tools

4. Specialized geriatric services and their processes

5. Senior friendly environments and seniors safety.

6. Geriatrics and models of geriatric care giving

The Inter-professional core competencies

Assessment competencies include the ability to:

1.  Assess the culture of a working team

2.  Assess the characteristics of a team’s development

3.  Understand the formal and informal influence processes on teams

4.  Understand individual styles of behavior and problem solving

5   Assess team meeting behavior 

6. Identifying the correct locus of decision-making

 

  Intervention competencies include:

1.   Create consensus on a best practice

2.   Engage formal and informal opinion leaders

3.   Small group facilitation

4.   Communication, confrontation and conflict resolution

5.   Manage task and process needs

6    Edumetrics – measurement procedures that teach

7 The ability to engage patients/clients and their families as team members

8. Inter-professional mentoring and coaching

9. Inter-professional ethics

Developing inter-organizational core competencies

Inter-organizational assessment competencies include:

1. Recognizing teams within teams

2. Network analysis and system pragmatics

3. Assessment of boundary functions

4. Organizational culture and power analysis

5. Understanding expectancy dynamics

6. Privacy, confidentiality and inter-organizational collaboration

7. The colleges, the skill sets and cognitive maps of the health professions

Inter-organizational intervention competencies include:

1. Network building and support

2. Managing change in a networked environment

3. Inter-organizational human resource facilitation

4. Diversity management

5. Inter-organizational negotiation and issues management

Selected References

Allen, M, Ryan, D. & Sibbald, G. (2002). Information Technology & CME: Learning in Communities of Practice, Presented at the Annual Meetings of the Canadian Association of Continuing Health Education, Halifax.

MacKnight, C, Beattie, BL, Bergman, H, Dalziel, WB, Feightner, J, Goldlist, B, Hogan, DB, Molnar, F & Rockwood, K. (2003) Response to the Romanow Report: The Canadian Geriatrics Society  Geriatrics Today: Journal of the Canadian Geriatrics Society 6 (1), pp. 11-15

Wolff JL, Starfield B, Anderson G. (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. JAMA, 162: 2269–2276.

Geriatrics Interdisciplinary Advisory Group (2006) Interdisciplinary Care for Older Adults with Complex Needs: American Geriatrics Society Position Statement. Journal of the American Geriatrics Society, 54(5), 849-852.

Ryan, D. & Kirst, J. (2005) Core Competencies for Specialized Frailty Focused Services. Presented at the Annual Meetings of the Ontario Gerontology Association, Toronto 2005.

Ryan, D., Cott, C. & Robertson, D. (1997) A conceptual tool-kit for thinking about inter-teamwork in clinical gerontology. Journal of Educational Gerontology, 23, 651-668.

Ryan, D. (1996) A history of teamwork in mental health and its implications for teamwork training and education in gerontology. Journal of Educational Gerontology, 22(5), 411-431.

Oandasan, I, Closson, T. (2007) Health Force Ontario, Inter-professional Care: Blueprint for Action. Online at

Oandasan, I, Reeves, S. (2005) Key elements of interprofessional education. Part 2. Factors, processes and outcomes  Journal of Interprofessional Care 19 (Suppl.1), 39-48

Manuel, DG, Schultz, SE (2001) "Adding years to life and life to years: life and health expectancy in Ontario. ICES Research Atlas, January

Barr, H. (2000) Working together to learn together: learning together to work together. Journal of Interprofessional Care, 14(2) 177-179.

Clark, PG, Puxty, J. & Ross LG (1997) Evaluating an interdisciplinary geriatric education and training institute: What can be learned by studying processes and outcomes?  Educational Gerontology 23(7), 725-744.

On the role of GIIC facilitators

Congratulations on being nominated to the role of GiiC facilitator within your organization.

Across the province the network of GIIC facilitators will comprise health professionals from many backgrounds. It will be an interprofessional team itself. So far, we have had physicians, advanced practice nurses, nurses, social workers, and occupational therapists nominated to represent their Family Health Team or Community Health Center.

The key selection criteria we suggested for recommending FHT/CHC facilitators were personal interest, breadth of clinical experience, acceptance by your colleagues and, perhaps ideally, the qualities of an informal opinion leader. Informal opinion leaders are individuals to whom others often turn for advice – they like answering questions, seem to stay up to date on a wide range of topics and communicate in a down to earth and humanitarian way. So congratulations once again, you must be a very special health professional.

We will provide you with 16 hours of training with our team of GiiC consultants and expert local faculty. Each of you will have a regional GiiC consultant who will support you when you return to your organization for a period of 3-4 months and, we hope, longer. We will invite you to a follow-up meeting to share your experiences with us and as well, we will invite you to the annual meetings of the staff of the Regional Geriatric Programs of Ontario, held in Toronto in the Spring, in order to build bridges to the provinces specialized geriatric services.

We will provide you with a GiiC toolkit in an electronic version. The toolkit will provide a range of tools on 18 dimensions of geriatrics and on interprofessional practice and interorganizational collaboration. For each dimension there are Quick Facts, Practice Aids, Practice Algorithms, Quizzes, Patient Handouts, Teaching Case Studies, Slide Materials and Reference materials, designed to help you in the facilitator role. The GiiC facilitator website is available for you at . It is a secure resource and once you have opened a membership, you can download the GiiC resources, discuss issues with each other and with your GiiC consultant.

But what specifically is required of you . . . ?

We know that there are no two FHTs or CHCs the same and that each organization responds to the needs of its frail seniors in diverse ways. Similarly, we anticipate that there will be a range of opportunities for you to implement GiiC processes in your organization. Some of you are working in organizations that want to introduce big changes in the care of frail seniors, while many of you will be working in organizations that are already going through significant developmental change. For you, GiiC might lead you to be able to find the right tool to better serve one of your teams seniors. Whether big or small, we will consider each instance a significant success. We know that big things often come from small beginnings and that it is hard to tell ahead of time which small beginning that might be.

We will be evaluating the project and part of the evaluation, having your team complete a perceptions of teamwork survey and network analyses of your team and its interorganizational collaborations, will itself be an intervention to help your team in these areas. We call this approach to measuring and teaching ‘edumetrics’.

With all of this in mind your GiiC facilitation might include some or all of the following activities:

Clinical geriatrics activities

Informal opinion leadership on geriatrics issues

Periodic reviews of geriatric practices

Coaching of clinical knowledge to practice activities

Liaison with formal geriatrics experts

Able to recommend context specific assessment tools

Inter-professional practice activities

Annual survey of team member perceptions of the team

Coordination and facilitation of quarterly team process meetings

Facilitate reflection on issues of team performance

Facilitate teamwork problem solving

Coordination of inter-professional mentoring for new staff

Inter-organizational collaboration activities

Annual inter-organizational network analysis and expectation surveys

Identification of inter-organizational boundary management functions

Facilitation of annual and ad hoc meetings of the inter-organizational network

Network feedback process analyses for quality improvement initiatives

Problem solving inter-organizational issues and concerns

But most of all keep in mind, that we are very grateful for your interest in our project. We will work hard to help you and for us success can come in both large and small initiatives.

Dr. David Ryan, PhD CPsych

GiiC Project Director

Tel. 416.480.6100 x3369

Email david.ryan@sunnybrook.ca

Table of Contents

GiiC People

GiiC Overview

On the role of GiiC facilitators

The GiiC Toolkit

Frailty

A Framework for the Assessment of Frail Elderly with Co-Morbidities in Primary Care

Advance Care Planning

Quick Facts on Preparing Advance Care Plans

Clinical Assessment Tools and Algorithms

• Process Guide to Advance Care Planning

• Advance Care Planning Mnemonic Guide

Patient/Client/Family Handouts

• An Advance Care Planning Brochure for Families

• Advance Care Planning Terms in Use

Teaching Slides on Advance Care Planning

Teaching Slides on Engaging Families in Advance Care Planning

Advance Care Planning Knowledge Quiz

Capacity Assessment

Capacity Assessment Toolkit Overview

Capacity Assessment Quick Facts

Clinical Assessment Tools and Algorithms

• An Aid to Capacity Evaluation (ACE)

• A Teaching Case Study on the Use of ACE

• Pocket Guide to Determining Decision Making Ability

• A Patient Capacity Risk Assessment Framework

• A Risk Assessment Worksheet

Capacity Assessment Teaching Case Study 1 & 2

Teaching Slides on Capacity Assessment

NICE Tool on Capacity Assessment

Caregiver Support

Caregiver Support Knowledge and Practice Tips

Caregiver Support Provincial Contacts

Clinical Tools and Algorithms

• The Zarit Burden Structured Interview

Patient/Client Handouts

• Caregiver Support Handout

• Checklist for Caregivers

• Caring for a Loved One with Dementia

Teaching Slides on Caregiver Support

Caregiver Support Reference List

Table of contents (cont)

Delirium

Causes of Delirium in Primary Care

Delirium Quick Facts for Primary Care

Clinical Tools and Algorithms

• The Confusion Assessment Method (CAM) for Primary Care

• The Delirium Decision Tree for Primary Care

• Delirium + 2Ds Comparison Table for Primary Care

• Delirium and Medications Overview for Primary Care

Delirium in Primary Care Teaching Slides

Delirium in Primary Care Teaching Case Study

The Best Practice Blogger on Delirium

Dementia Screening and Assessment

Overview

Flowchart with Provincial Resources

Patient/Client/Family Pre-Assessment Forms

• Informant Questionnaire on Cognitive Decline (Short Form)

• Lawton-Brody Modified Physical Self-Maintenance Scale

Clinician Tools and Algorithms

• Target Symptom Checklist

• AD8 Informant Interview, Scoring and Interpretation Guide

• Montreal Cognitive Assessment Test

• Montreal Cognitive Assessment Test Normative Data

• Folstein Mini-Mental Status Questionnaire (Bilingual version)

• Folstein ‘Copy Drawing’ stimulus

• Folstein Interpretation Guide

Dementia Screening and Assessment Teaching Slides and Dementia Quiz

Late Life Depression

Late Life Depression Fact Sheet

Depression Pocket Guide

Late Life Depression Poster

Late Life Depression Patient/Client/Family Pamphlet

Late Life Depression Teaching Slides and a Quiz

Driving Capacity

Driving Capacity and Dementia Facts

Clinical Tools and Algorithms

• The Dementia and Driving Checklist – Screening Tool

• The Dementia and Driving Screening Summary Sheet

• Trail Making Tests

• Driving and Dementia Decision Algorithms

• Driving Cessation – Talking with Seniors about Driving

• How to report to The Ministry of Transportation

Patient Handouts

• License Renewal After 80

• Dementia and Driving

Dementia and Driving Capacity Teaching Slides

Table of contents (cont)

End of Life Care

Physical and Mental Comfort at the End of Life Overview

On Bereavement and Grieving

Pain Management Quick Tips – The WHO Analgesic Ladder

Patient/Client/Family Handouts

• When a Family Member is Dying

• When a Family Member Has Died

• Food For Thought

• Other Handouts/Poster

The Compassionate Care Benefit

Teaching Case Study on End of Life Care

Teaching Slides on End of Life Care

Teaching Slides on Working With Families

Falls

An Introduction to Falls in Primary Care

Quick Reference Sheets

Clinical Tools and Algorithms

• A Framework for Falls Management in Primary Care

• A Falls Algorithm

• The Timed Up and Go Test

• Falls Evaluation for the Initial Visit

• American Geriatric Society Falls Evaluation Checklist

Patient/Client Pre-Assessment Forms

• Falls Description

• Home Safety Questionnaire

• Falls Focused Medical History

Patient Handouts from Key Associations and Agencies

Teaching Slides on Falls

References

Incontinence

An Introduction to Urinary Incontinence in Primary Care

Quick Reference Sheets

Clinical Tools and Algorithms

• Initial Management of UI in Women, Men and Frail Elderly

• Secondary Management of UIO in Frail Elderly

• Urinary Incontinence Evaluation Form

Patient Pre-Assessment Forms

• Incontinence Patient Information Form

• International Consultation on Incontinence Questionnaire

• Patient Incontinence Impact Questionnaire

• Bladder Diary

Patient Handouts on UI from Key Associations and Agencies

References

Teaching Slides on Incontinence

Table of Contents (cont)

Oral Health

Oral Health Quick Facts

Oral Health for Older Adults in Primary Care Resource Kit

Tips Facts and Myths on Oral Care in the Community

Oral Pathology Basics

Clinical Tools and Algorithms

• Oral Health Assessment Tool for Primary Care

• Oral Health Impact Profiles

• Oral Health Audit Tool for Primary Care

Medications that Impact Oral Health in Primary Care

Special Topics on Oral Health

• Cancer Care-Mucositis, Dementia Care, Denture Care

• Managing Oral Care for the Elderly Diabetic Patient

• Dry Mouth and Managing Xerostomia, Dysphagia, Gum Disease

• Palliative End Stage Oral Care, Renal Disease and Oral Health

• Root Caries, Swallowing, Stomatitis, Keeping Teeth for a Lifetime

• Caregiver Handout on Oral Health and Dementia

The Best Practice Blogger on Oral Health

Teaching Slides on Oral Health

References

Osteoporosis

Osteoporosis and Bone Fracture Risk Assessment

Risk Assessment Instrument – Pocket Reference

Teaching Case Study on Osteoporosis and Bone Fracture

Teaching Slides

Best Practice Blogger on Bones

Pain

An Overview of Pain in Primary Care

Clinical Tools and Algorithms

• Pain Assessment Algorithm

• Pain Assessment Algorithm for Non-Verbal Patients

• History and Physical Findings – Pain

• Pain Follow-up Flow Chart

Patient Pre-Assessment Forms

• Pain History

• Persistent Pain – Follow-up Questionnaire

• Daily Pain Diary and Instructions for Use

• Geriatric Depression Scale (Short Form)

Patient Handouts on Pain

Teaching Slides on Pain in Primary Care

References

Table of contents (cont)

Periodic Health Exam

Introduction to Geriatric Periodic Health Exam in Primary Care

Quick Reference Sheets

Clinical Tools and Algorithms

• Clinical Process Overview

• Periodic Health Exam Flowchart

• Geriatric Periodic Health Exam Tracking Form

• Geriatric Periodic Health Exam Interprofessional Screen

Patient Pre-Assessment Forms

• Geriatric Periodic Health Exam Patient Form

Patient Handouts

Teaching Slides on the Geriatric Periodic Health Exam

References

Polypharmacy

Facts and Figures on Polypharmacy and the Elderly

Practice Tips on Safe Prescribing for the Elderly

The Beers Criteria for Possible Unsafe Medication Use

Canadian Guidelines on Inappropriate Prescribing Practices for the Elderly

Clinical Tools and Algorithms

• Improved Prescribing for the Elderly Tool

• Medication Review Worksheet

Patient Handouts

• Medication Tips: Keeping Your Medications in Check

• Warfarin

References

Interprofessional Practice

The Dimensions of Teamwork Survey

Informal Roles Analysis

The Stages of Team Development

The So Short Styles Exercise Overview

The So Short Workshop Materials

Build-a-Case for GiiC

Trauma Care Provides a Snapshot of the History of Health Care Teamwork

Teaching Slides on Interprofessional Teamwork in Health Care

Annotated Bibliography of Recent Interprofessional Practice References

Interorganizational Collaboration

Thinking Through Interorganizational Collaboration in Health Care – An Overview

Stages of Team Development and Collaboration Checklist

Interorganizational Boundary Function Review

Outcome expectation Worksheet

Teaching Slides on Practice in a Networked Health System

Teaching Slides for a Workshop on Interorganizational Collaboration

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