From Silos to Synergy: Designing CME for Real-World Healthcare Teams with Dr. Tina Patel Gunaldo

From Silos to Synergy: Designing CME for Real-World Healthcare Teams with Tina Gunaldo

[00:00:00] If you're a continuing education professional, developing content for healthcare teams, but unsure how to embed interprofessional collaboration meaningfully into your content. Today's episode is for you.

Maybe you're stuck using team-based care as a catch all phrase, or you've struggled to translate siloed roles into shared learning objectives. What you really want is to build education that reflects how healthcare actually works, collaborative, patient-centered, and evolving. But here's the challenge, language matters.

Systems resist and roles are often misunderstood. I'm your host, Alex Howson, and this is Write Medicine. Today we unpack how to bridge that gap with interprofessional collaboration expert Dr. Tina Patel Gunaldo, join us.

Tina Gunaldo: My name is Tina Gunaldo. I'm a physical therapist by [00:01:00] training, but for the past probably 13 years or so, I've worked in academia and have specifically focused on the area of interprofessional education.

Currently I'm working in a healthcare system but the focus of my title is health Equity and interprofessional collaboration. So I'm still getting to translate now. Interprofessional collaborative practice, right? Instead of interprofessional education. So translating interprofessional education to actually practice with healthcare professionals.

Understanding Interprofessional Education

Alex: So you're introducing a lot of terms there. Can you walk us through what those different things mean?

Tina Gunaldo: Yeah, so I think you were probably referring to interprofessional education and interprofessional collaborative practice. And so we'll start with interprofessional education. And so what's interesting is that I believe most of us have taken the time to read the World Health Organization report from 2010, and in that report.

It talks about [00:02:00] interprofessional education and defines it for us. And so most people will define interprofessional education as when two or more students learn about from and with one another. However, I’ll maybe take a little bit of a tangent and talk about how that definition has evolved over time.

And but most of us will quote that definition from the World Health Organization from 2010.

Interprofessional Collaborative Practice

Tina Gunaldo: Interprofessional collaborative practice is just taking that education that you received and now you're actually integrating it into the work that you do. So interprofessional collaborative practice can be called team-based care. I don't think that's the specific terminology we should always use. But most people understand team-based care. How do we work together across teams, across professions in order to achieve the highest level of health that a patient or a client wants to receive and achieve. So it's [00:03:00] very important when we talk about interprofessional education or interprofessional collaborative practice, that the patient or the client or the community is at the center of what we do.

Alex: That's really helpful and I want to dig into it just a little bit more because on the one hand I can hear some people who might think this is semantics. At the end of the day, are we all focused on the same thing and on the other side, people who share the view that language shapes practice. Can you speak to that dichotomy a little bit?

Tina Gunaldo: So I think this is a tough one, and I say this because coming from an academic mindset and perspective as well as a researcher, so I do have my PhD and I love to engage in research. And so from that perspective, I think it's very important for us to define exactly what we mean when we say team-based care.

Interprofessional collaborative practice interdisciplinary teams or multidisciplinary teams. So I would say words matter, right? However, [00:04:00] I'm also acknowledging that when you're talking to healthcare or health professionals or providers, team-based care resonates with them more. But it is so important when we're talking to our healthcare professionals that we are talking about the specifics of what those words mean because multidisciplinary practice.

Is very different than interdisciplinary practice, which is also different than interprofessional practice. And all of them have their place in healthcare delivery, Right? But we have to make sure that we understand when's the best time and context in which to employ multidisciplinary interdisciplinary, or interprofessional collaborative practice.

Alex: I think we'll circle back around to that toward the end of our conversation because I think those definitions are d are very relevant to, a CME/CPD audience that is creating education materials [00:05:00] and has to be very clear about which one of those terms sets the foundation for the materials that they're creating.

Challenges in Healthcare Collaboration

Alex: You've talked in your work about professional silos and you advocate for breaking those down. What do you see as key structural or cultural barriers that stop or that maintain those silos and stop interprofessional collaboration in healthcare?

Tina Gunaldo: So that's a great question.

I think you have to look at it from different perspectives. First of all, I think if. I'm talking to someone in the United States, it's very different than maybe when I'm talking to someone in Australia or the UK or Africa, because their system in which healthcare operates looks very differently.

So when we think about professional silos, I think that's probably something that resonates across the globe. So I don't think that's unique. However, the way in which our insurance right works [00:06:00] here in the United States as well as our policy and procedures within healthcare settings. Those that are given to us or required to us through accrediting bodies such as the Joint Commission or through the Centers for Medicaid and Medicare or Medicare, Medicaid services.

So all of those organizations that make up the healthcare delivery system are really going to dictate the strength of professional silos. And so the strength in that they're very much keep us in silos are those that might be a little bit more lax to where we can feel like we can collaborate in between in different professions.

So I would say in regards to a challenge related to interprofessional collaborative practice is when t he healthcare system forces us through a physician, a nurse practitioner, a physician, assistant, or associate as the new name and or the emergency room, right? So [00:07:00] some type of provider centric path.

So when the healthcare system, based upon your insurance, based upon your knowledge, based upon state practice, act, or regulations, when that guides us specifically through two or three healthcare providers that is really limiting us in terms of professional silos. Or so I said, limited US in terms of interprofessional collaboration or any kind of collaboration because you're saying to the patient who really is the most important person on the team, you have to start your journey in one of these settings or with one of these providers, and that's just not the best way to meet the needs of the patient.

So how do you suggest overcoming those silos in order to meet the needs of the patient?

Overcoming Professional Silos

Tina Gunaldo: Yeah, so I think a lot of professions have done that already, and so audiology has done that In general, can't talk about every state in the United States. Physical therapy has to where you do not need a physician a physician associate, a nurse [00:08:00] practitioner referral in order to see the patient.

These autonomous health professionals can, if you have back pain, they can see you, they can call you up, ask if you have an appointment, you verify their insurance, and you don't even have to see a physician in order to seek services from a physical therapist or an audiologist. And I know in some states it's the same for occupational therapy, so I think it's profession by profession, but allowing the patient to choose their journey of where to start. Now, what's really important past the patient's right choice is that all healthcare team members realize that when a patient presents to you with more than just one singular. Issue and specifically maybe an issue or concern that's not within your scope of practice that you're going to collaborate or you're going to refer right with other healthcare professionals or providers to make sure you're meeting the needs of that patient.

And that's really more of the interprofessional collaborative practice as well.

Alex: [00:09:00] It's really interesting the way that you describe that. Because I talk to a lot of physicians about, challenges in patient management across all sorts of different disease states and of course collaboration is part of what they talk about. But it's also one of the major challenges that physicians repeat again and again. And so I'm wondering, as you're describing this interprofessional collaborative practice and the way that some professions have managed to really make that front and center, why it seems to be so difficult for physicians in particular, I would say to really get with the program.

Tina Gunaldo: So I will say it's difficult for everyone and the reason I say that is because probably from your training, when you think about being a healthcare provider, you have been trained into a culture that operates in silos. And so very rarely until interprofessional [00:10:00] education came about.

Were you ever being educated with other healthcare professions? So future healthcare professionals. And so it's really hard to start to talk about like how do I collaborate with them when I really don't know who they are? So interprofessional education is very purposeful to me. It's actually preventing a siloed approach to healthcare delivery, and it's actually promoting a better way, which is collaboration.

Now, when you're out in the healthcare world. There will be challenges in regards to collaboration. So some people would say that if you're not in the same physical location as different professions, it's much more difficult to collaborate, and that's true. However, I think it's really important for everyone to believe that interprofessional collaborative practice can happen asynchronously.

It's not what we always see. If we were to Google right, interprofessional collaboration, you would see these pictures of people [00:11:00] sitting around a table or standing next to maybe an x-ray or a chart in a hallway, right? Synchronous collaboration. Interprofessional collaborative practice can absolutely happen asynchronously.

It needs to happen asynchronously or we're not going to be efficient in the services that we're providing to our communities.

The Role of Technology and AI

Tina Gunaldo: interprofessional education or just say interprofessional work.

It has evolved over time. So what we imagined it to be or what it was, in the early two thousands is not maybe how we view it today. So with the advancement of technology, AI is a team member. How are we going to integrate, artificial intelligence of the various types that there are into our teams?

Because those platforms and models are very much supporting our patients and their health right now. Whether it's just to seek advice, just like they normally would Google it, right? Or search for it on some kind of internet provider. But it's, they're also in these [00:12:00] monitoring systems that's predicting.

What may be happening to us physiologically in our body, that type of thing. So I think AI do we describe AI as a team member? Now? I think we have to consider AI as one of those professional team members. The second piece about interprofessional work, and I think I've said this already, so it's really just a reinforcement of this, is that even in the earlier work you did not see the terms of an active patient partner. .

So we're looking to have a very active partnership with our patients. And we're really going beyond shared decision making, but we're empowering the patient and we're educating the patient so that they can make the best decision. For them and what health, what type of health they want.

And those outcomes that they want related to their health. So interprofessional work is definitely evolving. I think [00:13:00] that's the biggest thing a s we're moving forward.

Alex: And you mentioned ai, you mentioned patients.

Patient-Centered Care and Communication

Alex: When the patient's voice is fully integrated to care, what is, how does that change interprofessional collaboration?

What does it look like?

Tina Gunaldo: So let's just say there's a lot of things to say about that. So what does it look like? I think if, let's maybe just take asynchronous, an example, because I think that might be helpful. So if it were all synchronously there and just say myself and another provider, the patient would be present and we would ask the patient, what do they want for their health?

What have they already tried to achieve the help that they want? And then what are they willing to try or what have they already learned about, right? What questions do they have? And so I think you start out asking the patient what are their health goals? Which most people will say I ask that all the time.

But what you're really asking the patient, based upon what they're coming in [00:14:00] to see you for, whether that's prevention or whether that's secondary or tertiary care, you need to reframe it within the context of why we're, why I'm seeing you today, or why we are seeing you today. What would you like, what was, what is your outcome in regards to this visit, but also your help.

And so you're allowing them to share their story first. Instead of you starting to ask questions of why are you here today? When did that happen? Have your symptoms gotten better or worse? So you allow them to tell their story from a more global perspective, and then you can get into the specifics.

So I think that's a key feature of what it might look like synchronously.

Alex: And do you see that you're hinting at a sort of fairly major shift in patient provider, patient clinician interaction. Do you see those changes in communication styles and interaction encounters changing

Interprofessional Education in Practice

Alex: Downstream at undergraduate education.

Tina Gunaldo: [00:15:00] I don’t, let's put it this way. I think there's always some organizations or institutions that are more forward thinking in what they're doing, and they're able to implement these types of changes. More quickly, and they're more flexible in terms of integrating those changes.

I think that's true for educational organizations. I think that's also true for the delivery side or even the prevention, the public health, population health side as well. So the more nimble you are. You're probably able to integrate the latest and greatest evidence-based information that we know into that practice or that education.

But I would have to say if we're thinking about majority, 51% but I think it's higher than that. I think a. Many are not pulling it all together in an integrative approach. And so students are learning about communication, over, I say over here, maybe in their first year of education, but then interprofessional education comes in a whole other section.

It's not related to a [00:16:00] particular course, and it's floating over here and their second year or their second semester. So I don't think we have a truly integrated model in how we teach it, but I'm not saying there's not some really great examples or for organizations out there doing it.

Alex: And so that leads me inevitably to continuing education and the potential role in continuing education for really emphasizing and teaching and reinforcing interprofessional collaborative practice.

Continuing Professional Development

Alex: Do you see examples of that happening and what needs to be in that education?

Tina Gunaldo: So I think about this a lot because usually where I see the biggest potential for interprofessional collaborative practice within the continuing professional development space is when we talk about unfortunately, disease topic.

So just maybe say diabetes. And that's where it is marketed to various different health [00:17:00] professionals. Many times what happens is that you have a panel which can be interprofessional in nature. You have different speakers talking and providing evidence-based information, and they all represent different professions.

But what we're not doing on the flip side is we're not asking for those small group discussions to occur. So that as a learner in the audience and as a professional, I'm not having the opportunity to take what I've just learned from the panel or the lectures and integrate that knowledge into discussions with various health professions who I might be sitting at the table with or I might have to, and I guess that's where it's not so structured.

I might have those unstructured conversations right in the hallway or during lunch or during a break or in a small, as a tangent to something. But it, that discussion needs to be more structured. I've been to [00:18:00] interprofessional conferences and there are several in the United States, but one of them nationally that I attend annually.

And in that one you do break out into small discussions, usually small groups, and you have discussions about the topic at hand and you share perspectives and more than likely you're in a group with different professions being represented. So I think it's really important in continuing professional development is to structure the engagement so that the health professions truly have that opportunity.

Going back to the definition of learning about from and with one another. The patient may not be present, but we're not gonna be perfect all the time in all of our team approaches.

Alex: And so that's that's very much in the live in person situation where hopefully there would be some kind of facilitation.

There will be perhaps facilitators at each group h elping to shape that discussion. A lot of education is online, [00:19:00] text-based. Focused on data and all sorts of things. Are there best practices that you would recommend for the folks who are creating that content?

Especially when it's intended for in the context of interprofessional education. For instance, I'm thinking of writers, but, writers, designers assessment experts who are synthesizing information across disciplines, how can they play a stronger role in making sure that information has an interprofessional purchase?

Best Practices for Interprofessional Education

Tina Gunaldo: So the first thing I think about when you ask that question was how do we synthesize information across different professions? And when I hear that, I think about how. In a, from an interprofessional learning perspective it's great to come to a consensus, but we don't necessarily always want to synthesize and combine the information from different professions because different professions are trained in different ways [00:20:00] and they're cultural norms.

Their training all shows up in their, you write that individual work and it's that individual work and how you perceive or your knowledge, what you're going to do. That's truly where interprofessional learning occurs. So I would say in terms of synthesis of information, you wanna be careful not to combine too much of the information because what's really important is if I were to say do you believe this patient is ready for discharge?

So maybe it's a case example. Here's all of the notes within the medical record, and you're asking someone to review the medical record and the various tabs or flow sheets, et cetera. And if I were to ask you, is this patient ready for discharge, which is a very general question, as a physical therapist, which that's what I am by training, I would answer that question probably very differently.

I'm maybe looking at functional mobility or safety. Whereas a physician might be [00:21:00] looking to physiological state, right? Medical, state, medical acuity. If you were to ask a speech language pathologist, it might have more to do with being able to swallow by on their own or do they need some other form of nutritional supports or some type of different form of communication so that they can communicate safely once they get discharged.

And so I think it's really important for us not to combine too much. And I guess that's the the gist of what I'm trying to say, but allow each profession to show their uniqueness. Don't shy away from acknowledging that we also have overlap in our practices, because that's truly where we start to understand as a physical therapist, if there's an occupational therapist on the team as well.

And we are both covering, just say balance. So to help the reduced falls. If the occupational therapist is seeing this patient and has a really great relationship, could I [00:22:00] as a physical therapist join in? Sure. If occupational therapist is already meeting those expectations for the patient in regards to decreasing falls, I step back as a physical therapist, and that's a part of interprofessional practice too.

We're not going to be a part of the team just because we're a different profession. We have to be very purposeful in our role and allow others to step up or if not even step up, take the role of what. I would normally do because I know that's in the best interest of the patient. Adding multiple people to a person's team only makes it more complex.

Alex: And one of the things I'm hearing there is that it's really important for a ll members of the team to be very clear about what their roles and responsibilities are, as well as the roles and responsibilities of their colleagues. And for people who are involved in creating education, they really need to know the nuances of those differences between roles and responsibilities, because that's where the goals often lies i n education. [00:23:00] Just as a kind of a roundup question here.

Conclusion and Final Thoughts

Alex: What does it look like when a healthcare team truly lives the life or lives the principles of interprofessional collaborative practice?

Tina Gunaldo: I'll say this, even though I love the area of interprofessional work and I might have a lot of experience in it, it is truly a reflective practice for me.

So I'm always striving to do better. So initially I was going to answer your question from a very healthcare provider centric perspective. But that's not who we're serving. And so I might flip it, what does it look like for the patient? Not what does it look like for, I think that's two different questions.

So I'm hesitating right now because I'm trying to decide myself what's the best way to do it. I always try to say to myself, what, as a patient, what would I appreciate in my healthcare team? And I would expect, or I would [00:24:00] appreciate collaboration when collaboration is needed so that provider or that healthcare professional is motivated to collaborate.

As well as has the time to collaborate and knows how to collaborate. And those are three different distinct, areas. And so then as a provider, I would say and I say provider, I, now that I'm in healthcare delivery, I know that provider's usually three other professions and I'm really a healthcare professional, but, or I'm not called a provider, but as a healthcare professional, what I would like to see is that when I would. If I think about something in regards to the patient's plan of care and all of a sudden I'm like, oh, let me bounce that off of my colleague, but you know what? I know this colleague over here, whatever profession it might be. I know I remember something about their training like that might be important to them that I feel very free to speak up, reach out to them.

Have the conversation in a very open and respectful way. Not that [00:25:00] I'm saying, Hey, let's do something different, but should we consider another alternative? And then as soon as we can, we get in front of the patient so that we're having these conversations with the patient at the same time, we're not having them by ourselves as providers, and then we're making some decisions, right?

And then presenting it to the patient. No, that's not how it really should go. Thinking about how it should occur. I should have the opportunity as a healthcare professional to freely reach out to my colleague. Have that conversation in terms of psychological safety and opportunities to share perspectives and then being able to really be flexible and provide the same context and information to the patient, but in, in very layman's terms to lose our jargon when we're talking with that patient.

So I hope that's helpful 'cause. It's really two lenses that we should be asked that question.

Alex: Absolutely. And are there two or three things that you would want a continuing professional development, continuing [00:26:00] education for healthcare professional audience to take away from this conversation? So folks are involved in developing education, particularly for an interprofessional audience.

What are some things that they really need to pay attention to when they're developing that education?

Tina Gunaldo: Okay, so one, I'm gonna go back to learning objectives and I would say look to, in the United States Canada has their own, the UK has their own, Australia has their own. But here in the United States, I would say look to the interprofessional education collaborative.

So IPEC (Interprofessional Education Collaborative). Look at their latest competencies, which are four main competencies, which you mentioned. One, roles and responsibilities, communication teams, and teamwork and values and ethics. And then look at those 33 sub competencies. And so not saying that make those your learning objectives, but allow them to guide the development of your case and your information.

So that's one suggestion I would say, because then, we're at least saying this is the principle of what's guiding this particular [00:27:00] learning that we're hoping to occur. I would say the second thing is maybe you're one person, one writer. So create that network of different healthcare professionals around you, asking them to bounce off ideas to say, Hey, is this, is this correct?

Is this how you would do it? I would say expand your network. It might take some time, but try to find some health professions not only within the different profession, but also within different settings, because those settings matter, right? Acute care hospital versus home health.

So setting is important. And the third thing I would say is always remind people that interprofessional work is patient centered. And so if for community based centered, so if you can somehow introduce the perspective from the patient or have the patient's voice or quotes, and you're leading with that first.

Instead of the patient is a 51-year-old, and keep describing them [00:28:00] demographically. And then with comorbidities, I would say start out by telling the patient's story. I think those are three things that I think can change the momentum of interprofessional work. We get to see that we're not seeing the patient as this clinical design, but we're seeing them as a person, right, when we present them in a way. And and you're allowing that story to unfold in alignment with the guidance of those IPEC self competencies.

Alex: That's gold. Tina Patel Gunaldo physical therapist, researcher, and champion of interprofessional collaborative practice. Thank you so much for sharing your wisdom and insights with listeners of Write Medicine.

Thank you so much for having me.

Thanks for listening to this conversation with Dr. Tina Gunaldo. As you think about your next CME activity, here are three takeaways you can bring into your practice. First design for collaboration, not just information delivery. Build in structured opportunities for [00:29:00] learners from different professions to learn with, from and about each other, whether that's through case-based discussions, simulations, or reflective questions that surface multiples perspectives.

Second, put the patient's voice first. Start with the patient's story, not the demographic data. When the patient becomes a true partner in care, learners are more likely to engage in meaningful interprofessional thinking. And third, be precise with your language. Terms like interprofessional, interdisciplinary, and multidisciplinary aren't interchangeable and each shapes how your learners understand collaboration. So get clear on the distinctions and use them with intention. And if you're unsure when to use interprofessional versus interdisciplinary, we've got you covered. We created a one page quick reference guide to help you use team-based language precisely and avoid common tracks traps in CME content development.

It's [00:30:00] perfect for writers, educators and reviewers who want to level up their clarity. So grab the download in the show notes and keep it handy as you create your next piece of content keep these insights in mind as you create continuing education content for

Interprofessional collaborative practice.. Until next time, keep on creating the Write Medicine for your learners and clients.

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