Barriers to Implementation
Barriers to initiating IPE can be encountered at various levels of the organization including among the administration, faculty members, and students. A study of Canadian schools identified that the main barriers of IPE were scheduling, rigid curriculum, "turf battles," and lack of perceived value to IPE. Attitudinal differences in health professionals, faculty members, and students also influence implementation of IPE. A lack of resources and commitment can negatively affect the implementation of IPE.
Barriers at the administrative level are multifactorial, including the perception of whether it is worthwhile to direct resources to a new change given the demands of the other missions of an institution. It is important that administrators understand and facilitate the need for changing the education and training of professionals as health care changes. In addition, logistical concerns such as scheduling and space may need to be overcome at the administrative level to advance a longterm commitment to IPE. Faculty members will also need to appreciate the advantages of IPE so that they can be fully engaged in implementing the change. Faculty members may be resistant to changes due to increased workload and lack of time. Leaders in the professional field have a responsibility to motivate faculty members to make these changes and have a system to reward faculty members for their efforts in developing and implementing IPE. Operations management of the education system in many professions will need to be altered to align the curricula to one another. This includes the physical space as well as course design and scheduling. Ideally, the physical space of schools and colleges should be adaptable to IPE. This may require modification of current structures of schools, and IPE should be considered when new schools are being designed and built. Another barrier in implementation is the logistical challenge of synchronizing classes among different health professions so that students can physically be together to learn. It may be difficult to find common times for IPE courses and available classrooms large enough to accommodate the increased numbers of students. Also, even if a university has multiple health professions schools, they may not be in close proximity to one another. This may require allocating resources to develop multi-professional laboratories and classrooms for IPE.
The IOM report states that education should not occur in a vacuum, and a "hidden curriculum" exists. "This ‘hidden curriculum’ of observed faculty or clinician behavior, informal interactions and conversations with fellow students and with faculty and practicing professionals, and the overall norms and cultures of the training or practice environment is extremely powerful in shaping the values and attitudes of future health professionals." The fact that many health care settings have not yet fully implemented interprofessional team care can be a barrier for IPE. Students may struggle with the application, or may not see the necessity of the team skills they learn during IPE. It is necessary to instill in students the importance of IPE to promote future change in the profession of pharmacy and in the overall health care system.
University environments differ considerably with respect to presence of different combinations of health professional schools within the universities or their surroundings. This will create another level of challenge. The design of a standardized curriculum for IPE that will include different professional schools is dependent on a variety of issues. IPE should be implemented in the basic, foundational courses. Developing these bridges between professions in basic courses may lay a foundation that will establish the tenets of interprofessional team care throughout the training period.
Assessing the outcome of IPE is particularly important give the resources committed to IPE. A systems approach for the centralized assessment of the health professional's outcome may become necessary. This will require all stakeholders to devise consistent evaluation tools and methods. Multidisciplinary development of the outcomes assessment process necessitates time and resource commitment from all of the health professions involved.
The process of implementing a new culture and cultural changes may indeed surprise the stakeholders with unknown barriers that were not anticipated during the original planning efforts. Professional organizations such as AACP, Accreditation Council for Pharmacy Education (ACPE), American College of Clinical Pharmacy (ACCP), American Pharmacists Association (APhA), American Society of Health-Systems Pharmacists (ASHP), should work on a similar platform to overcome these barriers. A mutual collaboration of different health delivery professions will be needed to promote and implement IPE. All stakeholders, even in an individual profession and involved in education (as mentioned above) should come together for a better outcome of IPE.