Co-creating a work-based interprofessional education programme for collaborative practice in maternity services in Botswana

Abstract

Background: Interprofessional collaboration is the foundation for improved patient and provider satisfaction, as well as increased organisational efficiency. Poor collaborative practices and communication failures have been identified as major contributors to preventable adverse events, organisational inefficiency, patient and provider dissatisfaction, and increased health care costs. The Joint Commission on Root Causes and Percentages for Sentinel Events reported poor communication and teamwork for 60% to 70% of adverse events and medical mishaps in health care systems between 2004 and 2015. Root cause analysis of maternal deaths yielded similar results in low- and middle-income countries. Poor communication and teamwork contribute to the lack of capacity and support to engage in interprofessional collaborative practice. Therefore, health care professionals should receive context-based work-based training in inter-professional collaborative care. Interprofessional collaborative care promotes patient-centred care and self- management, which improves healthcare outcomes. It also strengthens healthcare systems, resulting in better service delivery and health outcomes. Aim: The aim of the study was to co-create a work-based interprofessional education programme to enhance collaborative patient care in the context of hospital-based maternal health services in Botswana. The objectives were divided into three phases, which aligned to the Design-Based Research (DBR), used as a methodological framework: Phase 1: Analysis of practical problems Phase 2: Development of solutions Phase 3: Iterative cycles of testing and refinement

Methodology: The Design-Based Research (DBR) was used as a methodological framework.

Multimethod research designs were used to assist in the development of the training programme, which included a scoping review and a qualitative, the Criteria for Describing and Evaluating Training Interventions in Healthcare Professionals and a consensus design. In Phase 1, a scoping review was conducted to explore the considerations for promoting the implementation of work-based interprofessional education programmes. A stakeholder analysis followed and then a workshop with seven stakeholders provided their perspectives on the development of an interprofessional collaborative programme for maternity care healthcare professionals. In addition, women’s and healthcare professionals' perceptions and experiences with interprofessional collaboration in a maternity care setting were explored. In Phase 2, the data collected in Phase 1 informed experts in research, clinical care and programme development to develop a work-based interprofessional education programme. In Phase 3, an online expert survey with qualitative (open-ended) and quantitative (Likert scale) questions was conducted to validate the co-created work-based interprofessional education programme. Findings: In Phase 1, data from the scoping review revealed limited articles (n=28) explicitly addressing interprofessional collaboration in maternity settings. Although some educational institutions offered interprofessional collaboration training as part of undergraduate curricula, including maternity care, qualified professionals were rarely given this training. Four themes emerged as issues to consider when developing and implementing interprofessional collaboration intervention: resource mobilisation, conducive learning environment, healthcare professional valuation, and barriers to interprofessional collaboration/education implementation. The findings of the stakeholder analysis and engagement revealed that the following key stakeholders should participate at various stages of the study, beginning with the design phase and ending with the evaluation of the implemented training programme: (1) Health care providers and beneficiaries; (2) Curriculum development and training specialists; (3) Interprofessional Collaboration and Education networks and champions; (4) Quality/assurance (Validation and Evaluation) groups, and (5) Strategist/policy developer/advocacy groups. Evidence from the workshop with stakeholders confirmed the lack of interprofessional collaboration in maternity settings and provided insight into the needs, implementation concerns, and competency gaps associated with interprofessional collaboration in the maternity care setting, as well as how the training programme should be structured to address interprofessional competency gaps. The stakeholders suggested that we name the programme ‘MabogoDinku a Thebana’, which loosely translates as 'together we can'. The programme was consequently renamed Mabogo-Dinku work-based interprofessional education programme for collaborative care in maternity care setting. In-depth interviews with women (n=13) and healthcare professionals (n=27) revealed that they perceived poor communication, disrespectful behaviour, ineffective teamwork practices, a lack of understanding of each other's roles and responsibilities, ineffective resource coordination, hierarchical power struggles, and weak collaborative leadership as interrelated factors that influenced the delivery of interprofessional collaborative care. Based on the findings from Phase 1, a five to seven-week self-paced online work-based interprofessional education programme was co-created. In phase 3, six IPC experts/champions and e-learning specialists were recruited and provided content validation for the developed programme via a Google survey. The expert validation survey results revealed that the training programme had good content validity, with a mean of 0.88 for section B of the validation tool and 0.94 for section C. Conclusion: This study describes the co-creation of the Mabogo-Dinku work-based interprofessional education programme, which is intended to improve and support interprofessional collaboration in maternity care settings in low- and middle-income countries. The training programme could support healthcare systems in reducing clinical errors, overcoming hospital-based maternal mortalities and morbidities, reducing healthcare costs and consequently improve quality of care and may be used to guide educators in integrating IPE into their curriculum to close education-practice gaps.