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PROMOTING PARTNERSHIP FOR HEALTH This book forms part of a series entitled Promoting Partnership for Health publishedin association with the UK Centre for the Advancement of Interprofessional Education (CAIPE).The series explores partnership for health from policy, practice and educational perspectives.

Background: Older adults living with stroke and other comorbidities often experience care transitions across multiple health sectors. Managing stroke in addition to other comorbidities requires the expertise of an interprofessional stroke-specific team. A learning simulation tool can develop competencies for interprofessional integrated stroke care to support care quality and patient safety. Findings from this work are relevant to faculty/educators in health professions education programs and for clinicians in stroke care settings. The simulation tool is freely accessible and can be adapted to the educational context for use with interprofessional stroke teams or to use as an interprofessional education activity. Approach: Guided by the INACSL Standards of Best Practice for simulation development, researchers and expert stroke clinicians co-designed the simulation scenario. We engaged a team of researchers and interprofessional front-line stroke clinicians from an academic teaching hospital in designing the simulation case scenarios to ensure the relevancy to current practice. This included developing the script for the video scenes which included an actor patient role. The case incorporated both stroke patient and family caregiver perspectives.Learning objectives were informed by experiential and reflective learning theories, and the Canadian Patient Safety Institute (CPSI) Safety Competencies. Multiple types of fidelity (e.g., physical environment, conceptual, psychological) were incorporated to create a realistic case scenario representing current best practices for stroke and care transitions. The simulation is intentionally focused on managing an older stroke survivor complex trajectory through two formal integrated care transitions from hospital to home in the community.The simulation incorporates concepts related to current system-level changes and existing integrated models of stroke care in Ontario, Canada. Integrated care models are people-centered approaches to address fragmented care systems to improve quality of care, through the coordination of people care needs across services, providers, andsettings. The simulation promotes active learning, problem-solving, and critical thinking skills. The content incorporates Canadian Best Practices for Stroke Care, CPSI Safety Competencies for Health Professionals, the International Foundation of Integrated Care Pillars, and the Model for Improvement quality framework. Results: This innovative open-access simulation features two video-recorded scenes featuring an interprofessional integrated approach to stroke care across two care transitions from ) acute care to a rehabilitation hospital, and 2) a rehabilitation hospital back to the patient home in the community. The simulation profiles the specific knowledge and skills of the interprofessional team members roles for stroke care. Further, the simulation intentionally highlights how the patient is actively engaged as a member of the interprofessional integrated stroke team. The video simulation has been used in the context of undergraduate/graduate courses with further uptake that can be considered in practice contexts such as stroke rehabilitation programs to enhance safe, quality integrated care transitions. Results from the in-class evaluation of the video simulation focusing on the student experiences of the debrief discussions will be presented. Implications: This simulation can be used in a variety of contexts to support learning about interprofessional integrated stroke care in both academic and practice settings. The series of debriefing questions can be adapted for use within specific contexts. To date, there has been some uptake in hospital stroke teams. Next Steps: We are currently building on this simulation to co-design and experiential learning initiative to inform further content on community-based integrated stroke care. In this work we are engaging stroke community members including health and social care providers, stroke patients, family caregivers, undergraduate and graduate students in co-developing the content and pedagogical approaches.

Backgrround: Interprofessional education (IPE) and collaborative practice competencies are foundational for students and professionals working in integrated care teams. Key informants descriptions of IPE training in Ontario hospital-to-home integrated care programs are presented. Study findings offer implications for health professions education in academic programs and continuing professional development in practice settings. Approach: A qualitative descriptive approach was used to interview 3 leaders in integrated care programs across Ontario. Participants were asked about how and what forms of interprofessional education are currently used to train health professionals to work within the current hospital-to-home integrated care programs. Participants described facilitators and barriers to implementing IPE within their programs and offered recommendations to support such initiatives in current practice environments. Thematic analysis was used to elucidate key findings which were interpreted through the lens of an interprofessional learning continuum model and competencies for integrated care. Results: Both formal and informal interprofessional education (IPE) within hospital-to-home integrated care programs can support competency development (e.g. role clarity, communication, teamwork) for interprofessional practice across health sectors. Key Informants acknowledged the importance of cross sector IPE to understand patient care trajectories, and healthcare provider roles more fully. IPE in academic and practice settings should include content about fundamentals of integrated care, teamwork competencies, and principles of collaborative practice. Implications: It cannot be assumed that all health and social care professionals understand the fundamentals of integrated care nor how to work effectively in teams. Developing these competencies should begin in formal academic programs and must continue to the practice setting where teams can continue to develop and grow together with the populations to whom they provide care and service. Next StepsFindings from the present study have informed new undergraduate and graduate curricula - more indepth content about integrated care as been embedded within two professional practice courses. The findings have also informed a new project. We are currently embarking on the development of a co-designed teaching learning initiative to inform an experiential teaching and learning curriculum for community-based integrated stroke care. We are engaging stroke community members including stroke patients, family caregivers, undergraduate and graduate students in co-developing both the content, pedagogical and evaluation approaches.

Correspondence to Alyssa Indar; alyssa.indar@gmail.com Introduction Patient safety has become a global priority to support reducing harm associated with healthcare delivery.1 In Canada, patient safety incidents (PSI) are the third leading cause of death behind heart disease and stroke and are associated with an additional cost to the healthcare system of $2.75 billion each year.2 PSIs occur across the healthcare continuum, but over half are associated with surgical care, which consists of preoperative, intraoperative and postoperative care.3 4 Globally, four main threats to surgical safety have been identified: (1) insufficient recognition of safety as a public health concern, (2) lack of available data related to surgical outcomes, (3) the inconsistent implementation of existing safety practices, and (4) the complexity of the surgical setting.5 The WHO Guidelines for Safe Surgery, published in 2009, have increased and highlighted the importance of surgical safety worldwide. A leading cause of these events is communication failure between care providers during surgical care, and between transition points during ‘hand-offs’ or ‘handovers’.6 Information shared at these transition points is required to facilitate continuity of information and patient care, and to prevent medical errors.7 This has resulted in national organisations, such as the Canadian Patient Safety Institute (CPSI), identifying surgical safety as a key priority. In a joint review by the Canadian Medical Protective Association (CMPA) and the Healthcare Insurance Reciprocal of Canada (HIROC), data from 2004 to 2013, which consisted of 2974 legal cases, were reviewed and nearly half of the incidents occurred due to system-level factors, rather than physician or healthcare provider (HCP)-level factors.8 A frequent system-level issue was lack of adherence to protocols, such as use of the surgical safety checklist (SSC), which is intended to improve team communication.8 9 In addition to incidents that cause patient harm, PSIs also include events that do not lead to patient harm as well as near-miss events.10 Hamilton and colleagues report that near misses and adverse events are under-reported, particularly within the operating room (OR) setting suggesting that exploration of how teams communicate in all phases of surgical care is necessary.11 The purpose of this narrative review is to identify and summarise leading practices, tools and resources for effective communication and teamwork during surgical care including the immediate preoperative, intraoperative and postoperative phases.12 This review addressed the following questions: Table 1 Summary of search terms Phases of surgical care Search terms Preoperative handover, handoff, preoperative, interdisciplinary communication, interprofessional relations, communication, checklist, practice guideline, organizational innovation, transition of care, patient discharge, continuity of patient care, interdisciplinary collaboration, checklist, operating room, preadmit department, and preoperative admission checklist Intraoperative handover, handoff, intraoperative, interdisciplinary communication, interprofessional relations, communication, checklist, practice guideline, organizational innovation, transition of care, patient discharge, continuity of patient care, interdisciplinary collaboration, checklist, operating room, and surgical safety checklist Postoperative handover, handoff, postoperative, interdisciplinary communication, interprofessional relations, communication, checklist, practice guideline, organizational innovation, transition of care, patient discharge, continuity of patient care, interdisciplinary collaboration, checklist, operating room, postanaesthetic care unit, and anaesthesia recovery room Included articles were peer-reviewed journal publications and contained a sample or direct link to a process or tool intended to improve communication or teamwork during surgical care.

IntroductionChildren with medical complexity (CMC) have chronic, intensive care needs managed by many healthcare practitioners. Medical advances have enabled CMC to survive well into adulthood. However, the availability of supports as CMC transition into the adult care system remain suboptimal, contributing to poor care coordination, and discontinuity. Promoting Intensive Transitions for Children and Youth with Medical Complexity from Paediatric to Adult Care (PITCare) aims to assess whether intensive patient and caregiver-oriented transition support beyond age 18 will improve continuity of care for CMC compared with usual care.Methods and analysisThis is a pragmatic superiority randomised controlled trial in a parallel group, two-arm design with an embedded qualitative component. CMC turning 17.5 years old will be recruited (n=154), along with their primary caregiver. Participants randomised to the intervention arm will be provided with access to a multidisciplinary transition team who will support patients and caregivers in care planning, integration with an adult primary care provider (PCP), adult subspecialty facilitation and facilitation of resource supports for 2 years. Outcomes will be measured at baseline, 12 and 24 months. The primary outcome measure is successful transfer completion, defined as continuous care in the 2 years after age 18 years old. Secondary outcomes include satisfaction with transitional care, self-management, care coordination, healthcare service use, caregiver fatigue, family distress, utility and cost-effectiveness. Qualitative interviews will be conducted to explore the experiences of patients, caregivers, the transition team, and healthcare providers with the PITCare intervention.Ethics and disseminationInstitutional approval was obtained from the Hospital for Sick Children Research Ethics Board. Our findings and resources will be shared with child health policymakers and transitions advocacy groups provincially, nationally, and internationally.Trial registration numberClinicalTrials.gov, US National Library of Medicine, National Institutes of Health, #NCT06093386.

Developing an operating room conflict management educational program for surgeons requires a formal needs assessment and information about behaviors that represent effective conflict management. Focus groups of circulating room nurses and surgeons were conducted at 5 participating centers. Participants responded to queries about conflict management training, conflict consequences, and effective conflict management behaviors. Transcripts of these sessions served as the data for this study. Educational preparation for conflict management was inadequate consisting of trial and error with observed behaviors. Conflict and conflict mismanagement had negative consequences for team members and team performance. Four behaviors emerge as representing effective ways for surgeons to manage conflict. There is a clear educational need for conflict management education. Target behaviors have now been identified that can provide the basis for a theoretically grounded and contextually adapted instruction and assessment of surgeon conflict management.

Background: By 2022, Canada will be short 60,000 RNs. Contributing to this shortage are difficulties experienced by new graduate RNs (NGRNs) transitioning to professional practice. Method: This grounded theory study explored NGRNs' transition experiences in the 12 months after completing Ontario's New Graduate Guarantee orientation program. Semistructured interviews were conducted with 10 NGRNs on the Nursing Resource Team in one urban Ontario academic hospital network. Results: Discovering Professional Self described NGRNs' transition as progressive, with transitory setbacks. In the early part of the transition, NGRNs experienced Surviving Without a Safety Net, which involved Experiencing Fear, Figuring It Out, and Learning on the Job. In the later part of transition, the NGRNs experienced Turning of the Tables, which involved Being Trusted, Gaining Confidence, and Feeling Comfortable in their professional role. Conclusion: Recommendations focus on educational strategies to enhance the NGRNs' transition experience. 2016;47(1):37–44. J Contin Educ Nurs. 2016;47(1):37–44.

Background: Stroke is a chronic disease affecting over 100,000 Canadians/year. As the Canadian population ages, more people are living longer with stroke and other chronic conditions (comorbidities). As a chronic disease, stroke care requires interprofessional, integrated approaches to care that extends across health and social sectors. There are marked inequities in stroke incidence, quality of care, access, complications and health outcomes based on factors such as race and social determinants of health. As new models of integrated stroke care are implemented, health professionals require different education and a broader understanding of the healthcare system to work collaboratively across health sectors. The skills needed to support stroke patients transitioning across health sectors require competency in interprofessional practice, stroke care, quality, safety, and integrated care. Current trends in educating future and current health professions include: 1) Increasing IPE to better prepare professionals for collaborative practice and cross-sector integrated care; 2) Education that is more patient-centred, community, and chronic disease oriented; 3) Competency- based education to be able to address health inequities and to be able to advocate for and partner with patients, families and communities; 4) Health professions education informed by the care delivery system in which its graduates will work; 5) Engaging community members e.g. health professionals, patients and families with lived experience demonstrates positive learning outcomes and student experiences and is critical in identifying learning priorities and designing, implementing and evaluating educational interventions. Approach: This project employed a community-engaged co-designed approach to develop, implement and evaluate an experiential learning activity for health professions students that increases their knowledge and skills in providing equitable interprofessional integrated stroke care for older adults from vulnerable populations. The project addresses the intersection of EDI with interprofessional practice enabling students to apply and practice relevant skills to promote access to equitable and culturally appropriate stroke care.  We co-designed the educational materials, case scenarios, vignettes, student and facilitator guides with patients and caregivers with lived experience with stroke, community stroke team members, a graduate nursing student, and faculty with interprofessional and integrated care, reflective practice and experiential learning expertise.  Results:  The learning materials were integrated in two undergraduate nursing courses in the winter 2025. One course was in-person and one online. Student experiences and reflections will be shared. It is anticipated that this project will enhance learners' knowledge, promote active learning, problem-solving, critical thinking and reasoning competencies. Learning activities will emphasize development of additional health professions competencies for interprofessional practice, EDI, person-centred care, advocacy, and critical and reflective thinking. Implications:  This project offers important learnings and insights in co-designing experiential health professions education materials that reflect the current realities of integrated stroke care across the care continuum. In addition, it can be used with both health professions students and existing healthcare professionals delivering integrated stroke care. Next steps:  We plan to share this work with other health and social care professionals across our university programs and with integrated stroke care programs. Revise materials based on this year’s implementation for continued integration in health professions education curricula.    

Background: As integrated care models emerge in Ontario’s health care system, nurses are assuming new and expanded roles and responsibilities including care coordination and care transitions. Nursing education programs must therefore ensure graduates are prepared to work in evolving health care systems that emphasize population health and place nurses in roles that address the increasingly complex needs of patients with multiple chronic conditions. Supporting these complex patients across the health care continuum requires nurses to coordinate, communicate and collaborate with members of interdisciplinary and intersectoral teams. Canadian nursing schools currently face ongoing challenges of securing placement sites for undergraduate and graduate students. Typically, student placements occur within a single health care organization, often with an emphasis on acute care. However, nurses need to understand how to work in all health sectors, not just acute care. New and innovative clinical placement opportunities for both undergraduate and graduate nursing students are needed where they can be embedded within hospital to home integrated care or primary care teams and learn alongside other professionals in caring for patients across health and social care sectors. Exploring the feasibility of such placements is critical for training nurses to develop the required knowledge, skills, and competencies for integrated care. Approach: Our team comprised of faculty, a graduate student, practice partners from acute care, and home and community co-designed and used a qualitative descriptive approach. We aimed to explore the feasibility of implementing new clinical placement opportunities for senior undergraduate and graduate nursing students in the context of integrated care teams. We interviewed 15 key stakeholders including educators, clinical placement staff, nursing leaders within hospital and home integrated care programs, integrated care leads, undergraduate and graduate nursing students. Demographic data were collected including participant roles, place of employment and years of experience.  Interviews were conducted and audio-recorded and transcribed using the Zoom platform. Data analysis included descriptive statistics for quantitative data analysis and thematic analysis for the qualitative data. Ethics approval was received prior to commencing the study. Results: Preliminary findings indicate integrated care student placements would be valuable learning experiences for students to learn about integrated care delivery model, working in interprofessional teams, as few such placements currently exist. Broader knowledge of integrated care among health professionals working in practice and new academic-practice policy agreements should be explored to facilitate these placements.   Implications: Creating student placements in integrated care is critical for nurses to develop competencies for interprofessional teamwork and integrated care. As Ontario universities increase the number of nursing seats, faculty face ongoing challenges to find placements; new opportunities where nurses can support patients across the care sectors may offer important solutions. Findings from this work can inform what partnerships among academic and practice organizations, health professions and communities are  needed to develop, implement and sustain clinical placements within integrated care programs. Next steps: We plan to engage patients and caregivers co-designing new placement opportunities in collaboration with integrated care practice sites and identifying opportunities within curricula to implement integrated care placements.  

Prior research has shown that surgeons who effectively manage operating room conflict engage in a problem-solving stage devoted to modifying systems that contribute to team conflict. The purpose of this study was to clarify how systems contributed to operating room team conflict and clarify what surgeons do to modify them. Focus groups of circulating nurses and surgeons were conducted at 5 academic medical centers. Narratives describing the contributions of systems to operating room conflict and behaviors used by surgeons to address those systems were analyzed using the constant comparative approach associated with a constructivist grounded theory approach. Operating room team conflict was affected by 4 systems-related factors: team features, procedural-specific staff training, equipment management systems, and the administrative leadership itself. Effective systems problem solving included advocating for change based on patient safety concerns. The results of this study provide clarity about how systems contribute to operating room conflict and what surgeons can do to effectively modify these systems. This information is foundational material for a conflict management educational program for surgeons.