Inter Professional Education and

Collaborative Practice improve Health Outcomes

Anwar Santoso
The Indonesian Teaching Hospital Association
National Cardiovascular Centre – Harapan Kita Hospital
Departemen Kardiologi – Fak Kedokteran ~ Universitas Indonesia
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 Outline
• Shortage of health workforce?
• Key concept
• Health – Education System Interaction
• Inter-professional education model
• Summary

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• Global Health Workforce shortage & mal-distribution, due to:
– Demographic changes
– Epidemic shift
– Redistribution of the disability burden

• Change in health care system

• Change the role of health professionals
• Change the design of health professional education
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Crisp N & Chen L, N Eng J Med 2014; 370: 950 - 7
Global Health Workforce and Burden of Disease
based on WHO region

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Crisp N & Chen L, N Eng J Med 2014; 370: 950 - 7
Workforce of doctors and Nurse According to Country Region
in 2010

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Crisp N & Chen L, N Eng J Med 2014; 370: 950 - 7
Health Workforce in Five Countries based on Health Worker Types

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Crisp N & Chen L, N Eng J Med 2014; 370: 950 - 7
Nurse to doctor ratio = 3.64 (Indonesia)

Data Nakes BPPSDM - Kemenkes 2014

Data Nakes BPPSDM - Kemenkes 2014
Data-data registrasi dokter/dokter gigi Konsil Kedokteran Indonesia 2014
 Outline
• Shortage of health workforce?
• Key concept
• Health – Education System Interaction
• Inter-professional education model
• Summary

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• Inter-professional education occurs when two or
more professions learn about, from and with each
other to enable effective collaboration and improve
health outcomes

– Professional is an all-encompassing term that includes

individuals with the knowledge and/or skills to contribute
to the physical, mental and social well-being of a
community

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• Collaborative practice in health-care occurs when multiple
health workers from different professional backgrounds
provide comprehensive services by working with patients,
their families, carers and communities to deliver the
highest quality of care across settings

– Practice includes both clinical and non-clinical health-related work,

such as diagnosis, treatment, surveillance, health communications,
management and sanitation engineering

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 Health care team work
• Health care professionals
who perceive themselves
and other health care
professionals as part of a
team working
collaboratively for patient
centred care.

• “There is no “I” in team!

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Collaborative Practice
Health Care
Assessments
Integrated
Care Plan

Shared care plan

Individual Health Professionals

Patient

Schulich School of Medicine & Dentistry The University of Western Ontario

• Educational benefits:
– Students have real world experience and insight
– Staff from a range of professions provide input into
programme development
– Students learn about the work of other practitioners

• Health policy benefits:

– Improved workplace practices and productivity
– Improved patient outcome
– Raised staff morale
– Improved patient safety
– Better access to health-care
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 Outline
• Shortage of health workforce?
• Key concept
• Health – Education System Interaction
• Inter-professional education model
• Summary

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17
Systems Framework

Frenk J et.al. The Lancet 2010; 376: 1923 - 58 18

 Sistem Kesehatan Nasional
• Pengelolaan kesehatan yang diselenggarakan oleh semua
komponen bangsa Indonesia secara terpadu dan saling
mendukung guna menjamin tercapainya derajat kesehatan
masyarakat setinggi-tingginya:

• Komponen pengelolaan kesehatan, dikelompokkan dalam

subsistem:
• Upaya kesehatan
• Penelitian dan pengembangan kesehatan
• Pembiayaan kesehatan
• Sumber daya manusia kesehatan
• Sediaan farmasi, alat kesehatan dan makanan
• Managemen, informasi dan regulasi kesehatan
• Pemberdayaan masyarakat
Perpres no 72 tahun 2012 19
• Collaborative practice can improve:
– Access to and coordination of health
services
– Appropriate use of specialist clinical
resources
– Health outcomes for people with chronic
diseases
– Patient care and safety

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• Collaborative practice can decrease:
– Total patient complications
– Length of hospital stay
– Tension and conflict among care givers
– Staff turnover
– Hospital admissions
– Clinical error rates
– Mortality rates

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Mechanisms that shape inter-professional education
at the practice level

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Mechanisms that shape collaborative practice
at the practice level

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Influences that affect inter-professional education and
collaborative practice at the system level
 Outline
• Shortage of health workforce?
• Key concept
• Health – Education System Interaction
• Inter-professional education model
• Summary

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Key component of educational systems

Frenk J et.al. The Lancet 2010; 376: 1923 - 58

Levels of Learning

Frenk J et.al. The Lancet 2010; 376: 1923 - 58

Models of interprofessional and transprofessional education

Frenk J et.al. The Lancet 2010; 376: 1923 - 58

Identified mechanisms that shape inter-professional
education and collaborative practice
 Summary
• IPE and CP can mitigate the challenges faced
by health system
• Time to act to implementing the strategies 
to transform health-care delivery ultimately
improve health outcomes
•