Interprofessional Education: Transforming Care through Team Work - Adriana Perez
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Adriana Perez, PhD, ANP-BC, Assistant Professor & Southwest Borderlands Scholar, Arizona State University College of Nursing Latino Health Forum 2014
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Interprofessional Education: Transforming Care through Team Work - Adriana Perez
- 1. PPLLEENNAARRYY SSEESSSSIIOONN IInntteerrpprrooffeessssiioonnaall EEdduuccaattiioonn:: TTrraannssffoorrmmiinngg CCaarree tthhrroouugghh TTeeaamm WWoorrkk AAddrriiaannaa PPeerreezz,, PPhhDD,, AANNPP--BBCC ASSISTANT PROFESSOR & SOUTHWEST BORDERLANDS SCHOLAR CO-DIRECTOR, HARTFORD CENTER OF GERONTOLOGICAL NURSING EXCELLENCE
- 2. HHiissttoorriiccaall CCoonntteexxtt • Crossing the Quality Chasm: A New Health System for the 21st Century (IOM Report, 2001) – More than 70 peer-reviewed publications documented serious health outcomes from 1990-2000 – Cooperation among clinician should be a priority
- 3. Health Professions Education: A Bridge to Quality (IOM Report, 2003) • Students and working professionals to develop and maintain proficiency – Delivering patient-centered care – Working as part of interdisciplinary teams – Practicing evidenced-based medicine – Focusing on quality improvement and – Using information technology
- 4. Health Care System Challenges
- 5. Institute of Medicine Report High-quality, patient-centered health care for all will require a transformation of the health care delivery system
- 7. Interprofessional Education • “Occasion when two or more professionals learn with, from and about one another to facilitate collaboration in practice” (CAIPE, 1997, p. 3) • Interprofessional education involves educators and learners from 2 or more health professions and their foundational disciplines who jointly create and foster a collaborative learning environment (CAIPE, GITT, IOM)
- 8. A New Era in Health & Health Care • With the passage of the Affordable Care Act (ACA) there is new incentive to advance interprofessional practice.
- 9. Exemplar • Comprehensive Geriatric Education Program (HRSA) – Overall efforts aimed at developing future leaders in gerontology and improving outcomes in geriatric care. • Nursing • Social work • Physical therapy
- 10. Desired Outcomes • Positively influence the attitudes and perceptions of students by reducing negative stereotypes to help overcome barriers to collaboration • Common curricula in education can result in the development of common concepts, values, perspectives and language, which, in turn will provide a frame of reference for collaborative practice
- 11. Evidence • Limited research has been conducted on interdisciplinary education • Systematic review (2007) found: – Positive changes in knowledge, skills, attitudes, and beliefs – Impact on quality health care
- 12. Exemplar • Interprofessional Approaches to Healthy Aging – Broad-based coalitions – Scenarios aligning interprofessional education and collaborative practice – Team based competencies
- 13. Stakeholders • Buy in from Dean of each college • Support from Associate Dean for Academic Affairs for each college • Program Directors/Block Directors • Support of faculty to be involved • Student acceptance of interdisciplinary experience • Health facilities
- 14. Barriers • Unprepared faculty • Differences across schools and students • Structural barriers • Limited research • Unsupportive training environments
- 15. Traditional Education Systems • Underscore a hierarchy • Discourage the challenge of authority • Discourage the acknowledgement of error
- 16. Key Messages • Identify Interprofessional Education as an institutional goal • Identify administrative & faculty champions • Establish relationships with other universities & health care programs • Consider faculty development and recognition program • Long-term sustainability, including funding resources • Consider who is missing as part of the health care team
- 17. Conclusion • Health professionals must be educated in a multidisciplinary environment that will enhance communication and collaboration. • Benefits include a greater potential for solving complex problems compared to any one profession acting alone. (IOM, 2001).
Notas del editor
- The first IOM report called To Err is Human was actually released in 2000 and focused on a specific type of quality problem, mostly medical errors – in 2001 the final report called Crossing the Quality Chasm: A New Health System for the 21st Century, is a call to action for improvement in the American health care delivery as a whole system due to multifaceted changes that include an increase in chronic disease, growing evidence-based and technological innovations, a rising number of clinical practice teams, complex delivery arrangements, and the different relationships established between patient and clinicians.
- In 2002 (June 17-18) over 150 leaders and experts from health professions education, regulation, policy, advocacy, quality, and industry attended the Health Professions Education Summit to discuss and help the committee develop strategies for restructuring clinical education to be consistent with the principles of the 21st century health system.
- Our health and health care system face enormous challenges: an aging and sicker population, millions more insured, a primary care provider shortage, lack of preventive care and skyrocketing costs. The system itself suffers from fragmentation and an emphasis on quantity of tests versus quality of diagnosis and treatment and prevention. The good news is that this scenario means that policy-makers, health care systems, opinion leaders, payers, and consumers are open to change like never before.
- The roadmap for our campaign is the Institute of Medicine’s 2011 landmark report on the Future of Nursing: Leading Change, Advancing Health. As you may know, the IOM has produced many reports alerting the public about the various ways we need to change our health care system, but few reports have received as much attention as this one. It is one of the most viewed online reports in IOM history and ranked “most read” in 2011 and 2012. In basic terms, the report guides our areas of focus that I’ll discuss momentarily. The bottom line is that the experts behind this report believe that nursing must be prepared for health system transformation—and nurses must help to lead and shape this change.
- Studies have demonstrated how effective coordination and communication among health professionals can enhance the quality and safety of patient care. Health professionals working collaboratively as integrated teams draw on individual and collective skills and experience across disciplines. Integration of health service delivery better leverages the assets of health care and public health professionals. They seek input and respect the contributions of everyone involved. That allows each person to practice at a higher level. The inevitable result is better health outcomes, including higher levels of satisfaction of services received and improved wellness and preventive care.
- Interprofessional education involves educators and learners from 2 or more health professions and their foundational disciplines who jointly create and foster a collaborative learning environment. The goal of these efforts is to develop knowledge, skills and attitudes that result in interprofessional team behaviors and competence. Ideally, interprofessional education is incorporated throughout the entire curriculum in a vertically and horizontally integrated fashion
- Besides the controversial health insurance mandate, there are many programs that are a part of the ACA. One program in particular is the Coordinating Center for Interprofessional Education and Collaborative Practice More people will be insured under the ACA, so one of the first things we have to address is how can we expand access to care? The ACA is also changing how we pay for care, introducing new reimbursement models and financial incentives. These payment changes are in turn driving changes in how we organize care, demanding better coordination between different health care settings and providers. For example, at a system level, we’re creating accountable care organizations; at a clinical level we’re implementing patient-centered medical homes. Interprofessional team-based care is a key feature of these new delivery models. This is where IPE becomes important. We need to ensure our health professionals are trained to work effectively in these new delivery systems. That means training health professions students and trainees in a different way and in different models—teaching them what it means to work together and giving them practical experience in clinical settings where interprofessional practice is happening. In this way, IPE is very much aligned with our national strategy to create a better health system. Macy and three other foundations (John A. Hartford, Robert Wood Johnson and Gordon & Betty Moore) have jointly pledged $8.6 million in grants to support the center. We’re very excited about the relationship with the four foundations and how committed they are to the success of the center.
- To meet these enormous challenges, we need to expand our system’s focus and capacity. That means rethinking how we utilize resources. We are literally at the dawn of a new era in health with a transformation of our system well underway. We refer to it here as a transformation toward patient-centered care, or person-centered care. Whatever terminology you use, the goals are the same: 1. Improve quality; 2. Reduce costs and improve our return on investment; and, 3. Improve health outcomes. This is all good news for the people and populations we serve. It means making sure that coordinated health services are consistently provided in all settings, when and where patients need it, including at home and in the community. Besides the controversial health insurance mandate, there are many programs that are a part of the ACA. One program in particular is the Coordinating Center for Interprofessional Education and Collaborative Practice More people will be insured under the ACA, so one of the first things we have to address is how can we expand access to care? The ACA is also changing how we pay for care, introducing new reimbursement models and financial incentives. These payment changes are in turn driving changes in how we organize care, demanding better coordination between different health care settings and providers. For example, at a system level, we’re creating accountable care organizations; at a clinical level we’re implementing patient-centered medical homes. Interprofessional team-based care is a key feature of these new delivery models. This is where IPE becomes important. We need to ensure our health professionals are trained to work effectively in these new delivery systems. That means training health professions students and trainees in a different way and in different models—teaching them what it means to work together and giving them practical experience in clinical settings where interprofessional practice is happening. In this way, IPE is very much aligned with our national strategy to create a better health system. Macy and three other foundations (John A. Hartford, Robert Wood Johnson and Gordon & Betty Moore) have jointly pledged $8.6 million in grants to support the center. We’re very excited about the relationship with the four foundations and how committed they are to the success of the center.
- 2 other studies found…
- In addition to formal curriculum, the culture or “hidden curriculum” is important (these include academic and practice educational settings) Current educational systems underscore a hierarchy, discourage the challenge of authority as well as the acknowledgement of error, all of which prevent effective teamwork that can promote quality of care and patient safety (IOM, 2001). Despite these norms, the American Council on Pharmaceutical Education (1997), the Accreditation Council for Graduate Medical Education (2002), and the National League for Nursing Accreditation Commission (2002) all have established competencies that focus on interdisciplinary team practice, and interpersonal and communication skills.
- Recognizing for any major change to occur, attention needs to be focused on the stakeholders for implementation. Institutional leaders often provide creative leadership to address scheduling and other countless structural issues that are a barrier to interdisciplinary education Students might already feel overloaded and might not see the value of the experience on their certification We also wanted to include health facilities as it is these entities that employ the graduates from ASU programs. The training would begin in the academic arena but needs to be carried forth in the work environment.
- Because some faculty might view this as time intensive and might not be adequately prepared to teach in an interdisciplinary setting, and to teach skills necessary to foster joint decision-making Schools have philosophical and cognitive style differences and there are demographic/sociological differences across student bodies and faculty – fears that professional identity and power may be diluted through an interdisciplinary focus and of course no clear consensus on when to incorporate interdisciplinary education into the curricula Structural barriers – separate housed professional schools and clinical arenas where students get hands on experience, separate faculty, school calendars, and different points of entry into the profession Limited research conducted which leads to maintenance of the status quo Even when there is interdisciplinary curricula or teaching, students generally are trained in didactic settings that do not employ interdisciplinary teams
- In addition to formal curriculum, the culture or “hidden curriculum” is important (these include academic and practice educational settings) Current educational systems underscore a hierarchy, discourage the challenge of authority as well as the acknowledgement of error, all of which prevent effective teamwork that can promote quality of care and patient safety (IOM, 2001). Despite these norms, the American Council on Pharmaceutical Education (1997), the Accreditation Council for Graduate Medical Education (2002), and the National League for Nursing Accreditation Commission (2002) all have established competencies that focus on interdisciplinary team practice, and interpersonal and communication skills.
- We recognize that it may be time intensive to initiate this interdisciplinary experience and faculty may be less included to participate because of this. We would encourage the identification of appropriate incentives for teaching, training faculty, and providing role models in both the academic and clinical settings Grant funding could be sought to provide funding for the development, implementations and evaluation of this interdisciplinary experience. Grant funding would also allow for the conduct and dissemination of research focused on the effects of interdisciplinary education on the quality of patient care and costs to health care.
- First, it’s important to note that the literature search focused on interdisciplinary education is not only minimal (In 2001 Cooper et al reported that most studies 47% have been published in the UK) , it is also complicated by the inconsistent and multiple terminologies used to describe health professionals working in team settings – multidisciplinary (working in parallel from disciplinary specific bases to address common problems, interdisciplinary/interprofessional (working jointly but still from disciplinary specific) and transdisciplinary (working jointly but sharing a conceptual framework that draws together concepts, theories, and approaches from parent disciplines. Shared learning, collaborative learning One goal of Interdisciplinary education is to tear down the walls that separate health professionals. Simple rules for the 21st Century Health Care System 10 Rules Current approach: preference is given to professional roles over the system New rule: cooperation among clinicians is a priority