Integrative care includes interprofessional collaboration and interdependent considerations such as genetics, social determinants of health, and community support and resources.
In a recently published report, Northwestern Health Sciences University (NWHSU) has identified seven domains of knowledge, skills, and behaviors that clinicians need to provide the best integrative care.
Integrative care has many elements. At NWHSU, the concept of integrative care extends beyond multi-disciplinary care, including team-based and holistic care, interprofessional collaboration, and partnerships between patients and communities. Integrative care also includes interdependent considerations such as genetics, social determinants of health, community support and resources, and beliefs and habits that influence health.
Domain 1, values, ethics, culture, and diversity: In integrative care, clinicians work with colleagues in other professions in a climate of mutual respect and shared values, with the recognition that there is diversity in and between disciplines as well as diversity in patient populations.
Values, ethics, culture, and diversity are the connective tissue of integrative care and a transdisciplinary approach to healthcare, says Michele Renee, DC, director of integrative care at NWHSU. "It is the shared mindset that unifies diverse paradigms of healing, creating a dynamic approach in which each point of view is honored and yet not sufficient in and of itself. We are also acknowledging the importance of social factors, from socio-economic status to religion to cultural norms, and professional diversity, from indigenous healing to mainstream medicine to complementary and integrative healthcare approaches. All these differences are important considerations in providing robust, multifaceted, and individualized approaches to care."
Domain 2, patient-centered care: Clinicians should seek out, integrate, and value contributions and engagement of the patient, family, and community in designing and providing care.
Patient-centered care acknowledges the pivotal role of patients in their care, Renee says. "Patient-centered care calls out the importance of acknowledging the bio-psycho-social-spiritual nature of whole person care. It is vital that healthcare providers are not doing to the patient, but rather with the patient. Our patients are active participants in care and the most important person in a healthcare team."
Domain 3, roles and responsibilities: Clinicians should use knowledge of their role and the role of other professions to identify and address the healthcare needs of patients, families, and communities.
"For team-based care to work, we must each understand the part we play, the unique skills others bring, and how we all fit into the larger picture. This is a dynamic process, created uniquely for each person we serve. These skills are essential to ensure care is complete and wraps around our patients and communities," Renee says.
Domain 4, interprofessional communication: Clinicians should be responsive and responsible in their communication with patients, families, communities, and other healthcare professionals, which helps establishing a team approach to health and the treatment of disease.
Communication is often where healthcare fails, so shared communication competencies are essential, Renee says. "This includes understanding ourselves, acknowledging biases, identifying and resolving conflict when it arises, and documenting care in a way that is universally understood. Multilayered communication is key to building trusting relationships."
Domain 5, team and teamwork: Clinicians should practice relationship-building values and embrace team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient-centered care that is safe, timely, efficient, effective, and equitable.
Patients and communities rely upon their healthcare teams knowing how to evaluate, plan, and deliver care, Renee says. "This involves designing and implementing evidence-informed systems that support effective teamwork, and creating accountability for each care team member to focus on all aspects of patient and population focused problem solving. Team-based care goes beyond what happens in the treatment room or hospital to include social determinants of health and health equity."
Domain 6, collaborative leadership: Clinicians should foster shared leadership and collaborative practice of care.
Healthcare professionals need to cultivate the skill of passing the baton as needed, Renee says. "One provider may be providing the primary intervention at one moment in time and complementary care at another. The needs of the patient change over time and the care team needs to be prepared to collaborate and share leadership accordingly, leaning on one another's unique insights and expertise as needed."
Domain 7, well-being and resilience: Clinicians need to recognize that the health of an individual has positive and negative effects on their ability to make change around them and adopt sustainable strategies to address challenges, while remaining committed to their sense of purpose.
Building a resilient healthcare system starts with the well-being of healthcare professionals, Renee says. "Health creation begins with prioritizing self-care, which in turn reduces burnout and improves job performance and satisfaction. Learning the skills to identify one's circle of influence, develop a growth mindset, and cultivate grit prepare providers to better support patients in their own health creation by putting the focus on well-being and resilience instead of disease management."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Clinicians engaged in integrative care are committed to patient-centered care.
Integrative care clinicians should use knowledge of their role and the role of other professions to identify and address the healthcare needs of patients, families, and communities.
Integrative care clinicians should practice relationship-building values and embrace team dynamics to perform effectively in different team roles.