applicant is well aware that he/she will be expected to grow an interdisciplinary team that will work seamlessly with the goal of each patient’s wellness in mind. Dr. Tiburcio graduated from Canadian Memorial Chiropractic College (CMCC) in 2007 knowing, from the get-go, that he wanted to work in an interdisciplin- ary, collaborative group but realizes that actually doing so taught him much more than he had expected. “As a chiropractor you have to deter- mine what your philosophy is with re- spect to patient care,” says Tiburcio. “To have an interdisciplinary collaborative practice, you must truly believe that this is what is best for your patient. Once you have decided this, then you are ready to build your clinic around this vision.” He continues: “A clinic with multiple health-care providers requires a sense of respect between all members. No one provider should be considered of less importance than the other. Clear goals and responsibilities should be outlined in order for each vertical to be successful and experience growth. Constant analy- sis of all healthcare providers and patient files will allow for constructive feedback and will ensure that the clinic grows and matures as a whole.” Dr. Tiburcio agrees that the time and education necessary to prepare for effec- tive and sustainable interdisciplinary col- laborative relationships are best harnessed before leaping into a collaborative setting. The next two sections will discuss different ways to approach this learning curve – one is in a practice setting, the other within an educational environment. CHIROPRACTORS AS COLLABORATION LEADERS A private clinic that includes practitio- ners from various disciplines – espe- cially where there are medical doctors and other medical personnel working alongside natural and/or manual practi- tioners – can be arranged in a number of fashions. The clinic could be owned and run by the physician/surgeon and staffed by the other practitioners, it could be a collection of practitioners who are independent, often under one roof and with minimal interaction, or it could be owned and run by someone other than a medical doctor, and staffed by a variety of practitioners. Collaboration, in these settings, can be informal, or very struc- www.canadianchiropractor.ca tured – the collaboration strategy might be a component of the initial vision for the clinic, or may develop according to the needs of the patients who form its cli- ent base and/or the development of the practitioners who serve those patients. There can be an alternate approach for achieving a collaborative environ- ment: whereas the intent for integrated collaboration would be present from the clinic’s inception, the actual execution of this goal is carried out as a process (see part 1 of this article) that is intended to foster effective, sustainable, truly patient- centred collaboration – i.e., the learning curve to respectful integration is consid- ered from the beginning. Dr. Hussein Rattansi graduated from the National University of Health Sci- ences in 2003 and practises in a clinic that fronts onto Toronto’s University Av- enue. The clinic, called “Emkiro Health Services” (website, www.emkiro.ca), is an interdisciplinary health-care facility that offers patients access to a variety of health-care options under one roof. It houses chiropractors, a registered di- etitian, registered massage therapists and family physicians, and hopes to in- clude a physiotherapist and psychologist amongst its numbers in the near future. Because the clinic is relatively new, communication and collaboration amongst its practitioners is currently relatively informal. The vision is to even- tually hold rounds where the clinic’s ser- vices will all be integrated into a struc- tured case management communication strategy. Collaboration in this setting, then, is being developed over time as each practitioner becomes acquainted with, and accustomed to, the work that is being carried out by other clinic mem- bers, noting their expertise and patient- centred goals. Respect and understand- ing is growing and developing amongst these health-care workers, leading to a communication structure which they hope, in Dr. Rattansi’s words, will “pro- vide the best care we can give.” Emkiro is an interesting set-up be- cause, here, the chiropractor and clinic owner, Dr. Rattansi, is the leader of a health-care team that includes physi- cians and other medical members whom he has hired along with practitioners of other disciplines. The practitioners are all quite young, as well, and have been recruited, by Dr. Rattansi, via university and training school employment place- ment services, professional publications/ newsletters/online portals, and even pro- vincial health-care provider employment agencies. (For information on health practitioner recruitment, Dr. Rattansi can be contacted at [email protected].) Dr. Rattansi established his clinic with the clear vision of hiring practitio- ners whose paradigm involves optimal patient-centred practice through respect- ful collaboration with members of the health-care team. Then, by not rush- ing into a structured collaborative pro- cess, he is allowing himself and his team members – who may not have received formal preparation for such a relation- ship – time to learn about each other’s work so that interdisciplinary efforts in future will be genuinely team-oriented and patient-centred. FROM THE HALLS OF LEARNING Part 1 of this article mentioned that preparation for successful interdisciplin- ary collaborative work must begin within health-care training institutions, includ- ing chiropractic schools. At CMCC in Toronto, interdisciplinary collaboration is being given increasing attention that has manifested, to date, as presentations, panel discussions and workshops at many of the school’s educational events as well as through various student inter- est groups. Two CMCC students, in particular, Luciano Di Loreto and Jessica Wong, were pioneers amongst their peers in these efforts. Now in their fourth year, both were instrumental in starting up the school’s Interprofessional Education Council and taking the group’s efforts to other health-care students including those at the University of Toronto Faculty of Medicine. As well, Di Loreto is cur- rently the 2010-2011 National Health Science Students’ Association (NaHSSA) president, and one of the representatives for chiropractic within that association. Through the time spent navigating the role and potential for collaborative ef- forts in tomorrow’s health-care environ- ment, Wong and Di Loreto have gleaned much valuable information. Both students believe that learning to work in a collaborative fashion with practitioners from other disciplines is a process, but one that should absolutely begin at the undergraduate training level. CANADIAN CHIROPRACTOR | MAY 2010 • 41
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