You can do so much more for a patient when you work together

Interprofessional training and collaboration is seen as a solution to many issues in healthcare.

'But we have a gap between the competency levels of future professionals and what is actually needed in healthcare practice,' says Andrea Werkman, Hanze researcher and former INPRO project leader, succeeded by Sandra Jorna-Lakke. INPRO is an international project, co-funded by the EU, in which higher education and rehabilitation centres work together. The transition from higher education to practice is therefore an important theme of INPRO, which started in 2020.

Putting interprofessional collaboration into practice

Andrea: 'Over the past three years, we have been looking at what is needed to further develop interprofessional collaboration and to give the practice hands and feet so that people can get started with it.' A special project was already up and running within Revalidatie (Rehabilitation) Friesland. The partnership between this organisation and Hanze had existed for some time and Revalidatie Friesland also had a learning department in which healthcare professionals, students, teachers and patients worked together. The arrival of INPRO gave them the opportunity to make the working method more concrete. Joost Hurkmans, senior researcher and speech therapist (at RF) and work package leader for INPRO: 'Thanks to INPRO, we were able to do more research into interprofessional learning and collaboration in the learning department and thus ensure that our working method became transferable. For example, we wanted to know whether the interprofessional identity of students also develops over a period of twenty weeks, the duration of an internship.'

You discuss patients with people from all kinds of professions

Paula Schoo, fourth-year Hanze student of International Physiotherapy, already knew about INPRO and chose to do an internship at Revalidatie Friesland. 'For me, the main reason was to collaborate with other professional disciplines,' she says. 'You learn so much more this way. We discussed patients with speech therapists, occupational therapists, psychologists, and you try to find a language to understand each other. This way you get to know that discipline very well and you understand much better what the other person does in practice. We also shared an office and I was able to read all the reports of the others. For example, I read in a psychologist's report that a patient has a fear of falling. As a physiotherapist, I can do something with that.'

Sometimes you have to be a little bit rebellious

Joost: 'If you work together interprofessionally, you do a lot more together. This also means that you cannot stay isolated within your own specialism. Sometimes you may also do something that is not part of your job. Take my work as a speech therapist, for example. A patient may come in in a wheelchair, while it would be more convenient for them to be sitting at the table. Strictly speaking, you have to ask the help of a physiotherapist or an occupational therapist for this. When you help someone out of a wheelchair, you cross the boundaries of your own field of expertise. Andrea: 'Rules can be strict and if you want to work in a different way, sometimes you just have to take action. In other words, being rebellious in a conscious way, in order to break through these barriers.' Joost adds: 'Interprofessional collaboration requires you to be a generalist who can also take over tasks from others. Being flexible is very important, being able to move with what the capricious practice demands of us. And it doesn't matter whether you go left or backwards.'

Larger toolkit of solutions

Paula completely agrees with that: 'If you only have your own discipline, you miss out on a large section of the patient's treatment. For example, for one patient, I worked with an occupational therapist on grocery shopping. She did the cognitive aspect of the shopping list and I discussed with the patient whether we were going to walk and which route we would take. Working in this way has given me a much larger toolkit to come up with solutions. If, for example, I were to end up working in a small practice after my training, with only two employees, I know that for some things you have to talk to others. And that's really become easier for me because I know what they're doing, and how they're doing it. When you work together, you can do so much more for someone. You can create a much more meaningful treatment environment because you know what the other disciplines are doing. And you learn a lot from each other, all with the same goal: the patient can go home.'

I feel more like a physiotherapist now than when I started

An internship lasts about twenty weeks, during which time students try to develop an interprofessional identity. Paula thinks this gives them enough time. 'From week ten, we were given more responsibilities, and I was given the role of lead practitioner in the process. I noticed that others came to me with questions. There are supervisors, of course, but you still try to take the lead in the treatment. This allowed me to learn to function in a team in a safe environment. And at the end of the internship, you are largely in control of the patient's treatment.' Paula learnt a lot during her internship, although it was sometimes tough. 'I've gone through a great development, both personally and professionally,' she says. 'I feel much more like a physiotherapist now than when I started. You learn a lot about your profession, about working together and everything is new. In addition, you have to find a balance between your work, travel time and the personal part of your life. It's very important to keep enough time for that.'

Cultural differences in healthcare

Within INPRO, we work together with partners from professional practices in Belgium, Austria and Finland. Joost: 'Of course, this exchange also brings you into contact with cultural differences. For example, part of the programme is that teachers visit every week. In Austria, that turned out to be a four-hour drive, so that was not feasible in practice. And in Finland, the legislation is very different and a teacher is not allowed to work alongside you in a hospital department, for example. With us, this is allowed under supervision.'

Covid was an extra challenge, as the project started in January 2020. 'During the third pilot, everyone went home,' says Joost. 'Working together and meeting each other is important and how do you do that then?' The large practice room where everyone came together was replaced by three rooms where enough distance could be kept. The project members also learnt from this, because it was Covid that actually gave them tools to deal with extreme situations. This also applied to the partners in Finland and Austria, who started running a pilot in their own way.

Innovation takes time

Andrea: 'Interprofessional collaboration is not self-evident for everyone, but we are moving towards it more and more. It's the future, and schools and practices need to be prepared for it. At the same time, we have to take into account that making room for this way of working is sometimes difficult. Healthcare professionals also have their day-to-day work to do, and schedules to adhere to. And innovating in a learning organisation takes time.'

Products for the practice

Despite the challenges, INPRO has developed around 150 products over the past three years, such as lesson ideas, detailed lessons, online training courses, videos, guidelines, manuals, working methods and an INPRO competency framework. Everything can be found on the website inproproject.eu. The materials are in English. Some of them have also been translated into Dutch, German and Finnish. Andrea: 'These products give people in education and practice the opportunity to continue working on interprofessional collaboration. We've been very productive together lately and I'm super proud of that!'

Want to learn more about Interprofessional Collaboration? Read on.