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Pam Thompson, MD, CCFPMay 12, 2016

“Never doubt that a small group of thoughtful,

concerned citizens can change the world. Indeed it is the only thing that ever

has.”-- Margaret Mead

Acquire a framework to develop and implement an interprofessional community health initiative

Learn an approach to include service learning in project design and implementation

Learn techniques to build collaborative partnerships

Explore key elements to successful collaborative project design and development

Review the clinical structure of the SHOW integrated care clinic

© 21st Century Collaborative

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Stages in our Project Design

Success Defined: How do you know when you’ve made it? How do you measure success? What outcomes do you seek?

Stage

1

Stage

2

Stage

3

Stage

4

Stage

5A Way Forward: What is the action plan for change? How do you work collaboratively to implement change?

What to Do: What is working? Are there examples of models of success? What does the research and evidence have to say? Do policies and practice align? How will you design your project to address the problem? What do you need to succeed?

Those Affected: Who in the community is affected by the problem? Who can partner with you for change? What partners are key to change? Who will lead the way?

The Problem to Solve: What is the problem you want to solve? Define the goal for change. Is there a desire for change? What are the shared vision/values of the community for change? Why is solving the problem important? What does success look like?

Mission & Vision

Program Model

Partners

Education & Training

Technology

Funding

Evaluation

Elements of Project Design & Plan

Collaboration and Partnershipsare the future of health and make

change possible

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What is SHOW?

• Student Health Outreach for Wellness (SHOW) Community Health Initiative and Free Clinic

• Arizona’s first tri-university collaborative project • Run by students and guided by faculty• Diverse backgrounds: traditional health care disciplines,

business, journalism, law, global health, and computer science

• Unites students, faculty, community providers, community & government organizations, and underserved populations

• Mission: to provide holistic, client-centered health care services

• Interprofessional team-based care model

Where Did We Start?

Our small start-up began with a small group of students and faculty coming together with a big idea…improve the health and wellness of the those experiencing homelessness!

We took initiative and struck out to develop relationships with “THE BIG GUYS” – Arizona State University, Northern Arizona University, University of Arizona, Maricopa County Department of Public Health, Central Arizona Single Shelter (CASS), Human Services Campus (HSC)……

– in a relatively short time!

What did we do to sell the benefits of the program? Create a WIN – WIN opportunity for our partners!

Institutions…

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… are people

Student Leadership

Organizational Chart

CommitteesCommunications & Public RelationsFund Development & Sustainability

Programming & Special EventsResearch & Quality Assurance

Clinical OperationsTechnology

Volunteer Management & Human Resources

Program Director Elizabeth “Liz” Harrell DNP, PMHNP-BC

Medical DirectorSarada “Soumya” Panchanathan MD

MANAGEMENT TEAM

Nursing Director

Rita Wermers MSN, ANP-BC

Administrative DirectorMichelle DiBaise MPAS, PA-C

Program InnovatorPam Thompson MD, CCFP

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Project Partners

Collaboration

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How Did We Manage the Collaborative Process?

At Program Design & Start Up:

1. CASS and the HSC - CHAMPIONED the program and encouraged collaboration

2. We made a STRONG BUSINESS CASE for the program, looked for what we could do for partner organizations (win-win) and built accountability into the program design

How Did We Manage the Collaborative Process?

At Program Design & Start Up (cont.):

3. We NETWORKED to find partners that would also benefit from the implementation of this kind of program (shelters, community agencies, etc.)

4. We got BUY IN from decision makers within these organizations by addressing strengths, opportunities, and perceived threats at both administrative and front-line levels

How Did We Manage the Collaborative Process?

Ongoing Program Development:

5. Finding ways to TAILOR the program to meet the needs of the underserved individuals, community agencies, academic institutions, and government agencies

6. Building on current RELATIONSHIPS and developing new ones with a multitude of different types of organizations

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Joining Together for Success

How Did We Manage the Collaborative Process?

Program Evaluation and Communication:

7. EVALUATION & REFLECTION: We are actively engaged in quality improvement practices; we respond to our partners’ concerns when they are voiced and reflect on ways to improve our program and relationships with our partners

8. We regularly UPDATE the community and our partners, in addition to our funders, to let them know what our challenges and successes have been

“What gets measured gets done;

If you don’t measure results, you can‘t tell success from failure; If you can’t see success you can‘t reward it; If you can’t reward success, you’re probably rewarding failure;If you can’t see success, you can’t learn from it;If you can’t recognize failure, you can’t correct it;If you can demonstrate results, you can win public support”.

Osborne & Gaebler in Utilization Focused Evaluation, 4th Edition. Michael Quinn Patton, 2008

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Summary of Collaborative Techniques

Get BUY IN from key

stakeholders

FIND A CHAMPION NETWORK

PROGRAM DEVELOPMENT

BUILD RELATIONSHIPS

EVALUATE & REFLECT

UPDATE & COMMUNICATE

Identify partners and

BUILD the CASE for a

Win-Win

TAILOR program to

meet client & community

partner needs

Work with multiple levels within a

partner organization and look for WAYS TO

MEET THEIR NEEDS

Consistently REVIEW your

PROGRAM (Quality Improvement) and

its RELATIONSHIPS in the community

REPORT OUT to the community, partners, and

clients regularly through a variety of ways (e.g. website,

reports, etc.)

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4 5 6

The animation automatically begins.

Collaborating for Success

Key Partnerships: How We Cooperate

Three State Universities: Established a Memorandum of Understanding to outline relationship and

shared responsibilities

Creates a ‘Learning laboratory’ for interprofessional education

Creates opportunities for shared research endeavors

Provides opportunities for students to do: internships, job skill development, community development, clinic management, research, conference presentations, project and program development

Provides a shared opportunity to have a positive impact in the community on social issues (homelessness, health disparity, poverty)

Provides an opportunity to engage and create relationships with a diverse group of community, business and government organizations

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Key Partnerships: How We Cooperate

Maricopa County Department of Public Health: Provides SHOW the opportunity to offer services on weekends to extend

homeless patients access to health services by providing use of their clinic site

Provides SHOW the ability to offer additional services to the shared patient population (Audiology, Behavioral Health, wellness programs etc.)

Partnership allows for shared access to client health records to ensure continuity of care

Provides SHOW the opportunity to offer potential access to research support and population health data

Provides a shared opportunity to collaborate in keeping the focus on issues related to homelessness

Key Partnerships: How We Cooperate

Human Services Campus (HSC) and Central Arizona Singles Shelter (CASS):

SHOW provides an opportunity for clients staying in the shelter to receive health services on the weekends which prevents unnecessary emergency department visits

SHOW provides access to additional health services and programs to the campus (e.g. yearly health fair on the HSC)

SHOW assists CASS and HSC to access resources and supports through the academic institutions (e.g. student interns, research)

HSC and CASS provide SHOW access to space and classrooms for health and wellness programs at no cost

Key Partnerships: How We Cooperate

Mercy Maricopa Integrated Care: Provides funding and support for workforce development and evaluation

Provided support for Health Fair (community booth and funding)

Provides assistance with building relationships with community health organizations

SHOW prepares an educated workforce of future health care professionals prepared to work in integrated care environments

Bruce and Diane Halle Foundation: Provides funding support for SHOW operations

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Key Partnerships: How We Cooperate

National Center for Interprofessional Education: Provides SHOW the opportunity to be part of a national data

repository on interprofessional education

SHOW provides the National Center data in support of their research

Macy Study: Offers students in SHOW an opportunity to take part in the Macy

study which is focused on advancing work in Interprofessional Education (IPE)

Provides funding to support SHOW as one of Macy’s integrated care sites (computer tablets)

How Do the Pieces Fit Together?

I n gre d i e n t s fo r S u c c e s s

Buy in from community

Case for Change

Being Adaptive

Risk-taking

Champions of Change

Masterful/High Level Facilitation

Shared Vision/Agenda

Network of Partners

Knowledge/Data

Communication

Training

Evaluation/Reflection

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O v e r c o m i n g O b s t a cl e s

NIMBY

Communication

Differing Agendas/Goals

Bureaucracy

Managing Change

Implementing New Practices

Personalities

Financial

Expectations/Outcomes

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Managing information and communicating effectively often

becomes an obstacle

Community Partnerships

Change Relationships

Mobilize resources

Influence Systems

Catalysts for Change

Coordinate Efforts

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Passion for health. Compassion for people.

SHOW Clinical ModelStudent Health Outreach for Wellness

Clinic Management 

Student Management

Shift Manager

Dispensing Manager

Lab Manager

Navigator Lead

Faculty Management

Program Director

Medical Director

Administrative Director

Nursing Director

ResearchLead

Management teams operate side by side  (flattened hierarchy)

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Patient

Management Team

Navigator Team

Teaching Team

Provider Team

Clinic Structure: Patient‐Centered Care

Navigator Team

• Comprised of undergraduate and social work students

• Advocate for patients 

• Direct patient flow

• Connect patient to ongoing program activities

• Collect data for clinic improvement

Teaching Team‐ Integrated, Interprofessional 

General Medicine

NursingPhysician Assistant

Behavioral Health

Physical Therapy

AudiologySpeech 

PathologyOccupational 

Therapy

Health professional students 

• Responsible for patient assessment, diagnoses, treatment, planning, 

and evaluation

Preceptors: Licensed Faculty & Community Providers

• Responsible for facilitating and mentoring the Teaching Team in 

developing diagnoses and treatment plan for patients

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Clinic Structure‐ Integrated, Interprofessional 

Waiting Room

• Patient fills out forms

• Entered into EMR

• Social Work forms filled out

Initial Exam

• Health Professional Students conduct triage/initial exam

Final Exam

• Provider conducts final visit with assistance of health professional students

Patient Surveys

• Navigator follow‐up

• Patient satisfaction surveys

Patient Leaves Clinic 

Teaching Team Huddle #1

Teaching Team Huddle #2

Clinic Structure‐ Integrated, Interprofessional 

Interprofessionalism is encouraged by: 

1) interdisciplinary assessment 2) team huddles and 3) post‐shift huddles

The “Team Huddle” is crucial to interprofessional (IP) care in SHOW • Team leader (preceptor) facilitates 

discussion regarding patient case

• Occurs intentionally three times throughout visit

1. After vitals, patient history, and chief complaint are collected

2. After initial examination 

3. After patient’s visit has ended (to review the case)

SHOW Rapid Cycle Quality ImprovementIncorporates PDSA

Plan (Post‐Shift Huddles)

What are we doing now and how can we improve it?

Create process for improvement

Do

Implement solution

Study 

Did plan lead to improvement? 

Any unexpected  effects?

Adjust

Make changes to further improve plan

Internal “Customers”‐ Students, preceptorsExternal “Customers”‐ Community Partners, patients

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IP Teamwork Example: Triage/Initial Exam

Plan 

Triage is conducted by nursing, leaving these students in a silo lacking interprofessionalism

How can SHOW make triage more interprofessional?

Do

Merge triage into initial exam, so nursing students can work collaboratively with other 

health professional students; more interprofessional practice

Study 

Are nursing students benefitting from working with health professional students?

Has the quality of triage increased or decreased?

Adjust Adjust roles of health professional students in triage/initial exam

Passion for Health. Compassion for People.

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Future Directions

Formal Integrated, IP Education for Preceptors

IP Dose Tracking

Student Leadership Measures

Increase Formalized Quality Measures

AcknowledgementsFaculty and staff at Arizona State University, 

North Arizona University, University of 

Arizona

SHOW students and volunteers

Community Preceptors

Partner Organizations:  Maricopa County 

Department of Public Health, CASS, Human 

Services Campus, Crossroads, Mercy 

Maricopa Integrated Care, Macy grant, and 

Bruce and Diane Halle Foundation