health communities-of-practice-yuri-quintana
TRANSCRIPT
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
DEVELOPING PROFESSIONAL COMMUNITIES OF PRACTICE
Yuri Quintana, Ph.D.
Director, Global Health Informa9cs
November 2014
An Academic Division of the Dept of Medicineat Harvard Medical Faculty Physicians at BIDMC, Inc.
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11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
AGENDA
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! Global Health Challenges
! Defining Communities of Practice
! Developing Professional Communities
! Case Study
! Road Ahead
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Global Health Challenges
• Rising chronic diseases • Aging popula9on • Late or no diagnosis • Lack of trained healthcare workers • Lack of essen9al medicines
• Lack of appropriate equipment
• Poor or no integra9on of health IT systems • Lack of reliable data at local, regional & na9onal level • Poor coordina9on of healthcare delivery • Rising costs of healthcare • Adap9ng healthcare delivery to regional needs
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11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Chronic Diseases Epidemic
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Source: SCIENCE VOL 333 29 JULY 2011 www.sciencemag.org
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Diabetes Epidemic
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Source: IDF 2013 World Atlas http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Global Shortage of Healthcare Workforce
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• There will be a shortage of 230,000 physicians across Europe in the near future.
• The number of caregivers in 36 countries in Africa is inadequate to deliver even the most basic immuniza9on and maternal health services.
Source: Deloitte 2014 Global health care outlook https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/dttl-lshc-2014-global-health-care-sector-report.pdf
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Global Shortage of Healthcare Workforce
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Source: WHO Report - A UNIVERSAL TRUTH: NO HEALTH WITHOUT A WORKFORCE http://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/
• WHO 2014 Report - 57 countries identified in 2006 with low human resources • 17 countries have no data point in the past five years.
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Definition
• A community of prac.ce (CoP) is a group of people from a common profession or interest area that share knowledge and experiences with each other so that they can grow personally and professionally.
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11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Types of Communities
• Local Group
• Regional Socie9es
• Na9onal Professional Socie9es
• Interna9onal Professional Socie9es
• Limited Frequency of mee9ngs, limited depth of collabora9ons
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11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Evolution of Community of Practice
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People with Common Needs
Join a List
Create a
Discussion
Forum
Share
Best
Prac9ces
Create New Knowledge
Collec9ve
Intelligence
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Evolution of Communities
Connect
People Connec9ng with Common Needs
Access to Con9nuing
Educa9on
Access Best Prac9ce Guidelines
Collaborate
Peer to Peer Support
Develop New Best Prac9ces and Guidelines
Disseminate new knowledge
Trust
Mentoring Networks
(Senior – Junior member)
2nd Opinion Networks
(advice giving in real 9me)
Data Sharing for Quality Improvement
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Professional Societies Special Interest Groups
Communities of Practice
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Facilitators
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Cri9cal Mass of People
Common Needs
Clear Goals
Transparent and Inclusive Leadership
Focus on Sharing not Credit
Suppor9ve Community
Open to Innova9on
Common Tools and Language
Suppor9ve and Responsive Community
Renewal of Leadership
Evolving and Relevant Goals
Crea9on of New Communi9es
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Barriers
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Misaligned Goals and Needs
Inflexible and Non-‐Transparent Leadership
Domina9ng Personali9es Focused on Credit
Hidden Agendas
Lack of Access to Knowledge
Ins9tu9onal Rigidity Infrequent Mee9ngs
Non-‐Responsive Community
Non-‐Returning Membership
Non-‐Renewing Leadership
Irrelevant Mission and Goals
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Components of an Online Community of Practice
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Online Learning Pla7orm - Online Seminars - Self-‐Paced Courses - Instructor Led-‐Courses - Care Guidelines - Competency-‐based curriculums
linked to online educa9onal resources
- Clinical Case Library
Online Collabora.on Pla7orm - Online web mee9ng services - Group shared documents - Online teaching classes - Online clinical case discussions for
second opinion on care treatments - Online mee9ng minutes notes - Recorded mee9ngs archive - Shared collabora9ve projects tools
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Case Study: Central America Pediatric Oncology
• 1980s: Few pediatric oncologists, -‐ civil wars, earthquakes, floods and hurricanes -‐ childhood cancer survival rates below 20% [1]
• 1990s: Specialized centers form -‐ training via site visits and annual regional mee9ng -‐ survival rates climb slowly to over 20% [2]
• 2002-‐2014: Cure4Kids.org launched to provide online educa9on and collabora9on tools -‐ weekly online mee9ngs to discuss best prac9ces -‐ survival rates climb to 48% [3]
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Sources: [1] Ann Oncol. 1993 Jan;4(1):37-40; [2] Lancet. 1998 Dec 12;352(9144):1923-6; [3] Pediatr Blood Cancer. 2014 May;61(5):827-32.
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Case Study: Central America Pediatric Oncology
Connect
AHOPCA pediatric oncology society annual mee9ng
Access to con9nuing
Educa9on on Cure4Kids.org
Access experts via Web mee9ngs on Cure4Kids.org
Collaborate
Develop common protocols on Cure4Kids.org
Disseminate new knowledge via weekly mee9ngs on Cure4Kids
Trust
Data sharing for quality improvement on POND4Kids.org
Second opinion consulta9on
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Knowledge Synthesis
Continuous Quality Improvement
Education and Knowledge Sharing
Sources: Quintana Y, O’Brien R, Patel A, Becksfort J, Shuler A, Nambayan A, Ogdon D, Chantada G, Howard SC, Ribeiro RC. Cure4Kids: Research challenges in the design of a website for global education and collaboration. Information Design Journal 2008; 16:3, 243-249. May D, Quintana Y, Chantada G, Ribeiro R. Developing Oncopedia: Creating and Editing an Online Collaborative Educational Resource for a Global Audience, Science Editor, Council of Science Editor, May – June 2009, Vol 32, No 3, pp. 75-77. Quintana Y, Patel AN, Naidu PE, Howard SC, Antillon FA, Ribeiro RC. POND4Kids: a web-based pediatric cancer database for hospital-based cancer registration and clinical collaboration. Stud Health Technol Inform. 2011;164:227-31. PubMed PMID: 21335715
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Case Study: Central America Pediatric Oncology
• Online mee9ngs for
– Con9nuing educa9on – Second opinion on case management – Program administra9on development
• Key Success Factors – Regular mee9ng 9me – Mul9-‐disciplinary team par9cipa9on
– Involvement and mentoring of new staff
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Sources: Guimera D, Hernandez H, Huertas M, De Colsa A, Robles VP, Johnson K, Quintana Y, Caniza MA. Combined web-based distance learning followed by brief on-site practice: a cost-effective way of training infection preventionists in countries with limited resources. Am J Infect Control 39:E152-E153, 2011.
Santiago TC, Jenkins JJ, Pedrosa F, Billups C, Quintana Y, Ribeiro RC, Qaddoumi I. Improving the histopathologic diagnosis of pediatric malignancies in a low-resource setting by combining focused training and telepathology strategies. Pediatric Blood Cancer. 2012 Feb 7.
AlFaar A, Kamal S, Abouelnaga S, Greene W, Quintana Y, Ribeiro R, Qaddoumi I. International Telepharmacy Education: Another Venue to Improve Cancer Care in the Developing World. Telemedicine and e-Health. 2012 Jul-Aug;18(6):470-4.
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Case Study: Central America Pediatric Oncology
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Common needs
Clear goals
Focus on sharing not Credit
Weekly mee.ngs to discuss clinical cases
Suppor9ve community –
Developed common protocols adapted to local resources
Access to con.nuing educa.on on Cure4kids.org
Shared data and outcomes on POND4Kids.org
Peer-‐to-‐Peer Collabora9ons
Expanded from 1 to over 30 communi9es in en.re region -‐ Clinical Protocols
-‐ Nursing
-‐ Pallia9ve Care
-‐ Laboratory Medicine
-‐ Pathology
-‐ Data Management
-‐ Clinical Improvement
Source: Richardson, S., Banks, M.S., Kettinger, W., and Quintana, Y. (In Press) IT and Agility in the Social Enterprise: A Case Study of St. Jude Children’s Research Hospital’s ‘Cure4Kids’ IT-Platform for International Outreach. Journal of the Association of Information Systems. 2014: 15(1).
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Case Study: Central America Pediatric Oncology
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Sources: Quintana Y, Patel AN, Arreola M, Antillon FG, Ribeiro RC, Howard SC. POND4Kids: A Global Web-based Database for Pediatric Hematology and Oncology Outcome Evaluation and Collaboration. Stud Health Technol Inform. 2013;183:251-6. Ayoub L, Fu L, Pena A, Sierra JM, Dominguez PC, Pui CH, Quintana Y, Rodriguez A, Barr RD, Ribeiro RC, Metzger ML, Wilimas JA, Howard SC. Implementation of a data management program in a pediatric cancer unit in a low income country. Pediatric Blood Cancer. 2006 Jul 21. Barr RD etl al. Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA): a model for sustainable development in pediatric oncology. Pediatr Blood Cancer. 2014 Feb;61(2):345-54.
• Increased survival rates from 20% to over 50% for common types of cancer in some low income clinics
• Expanded Communi9es of Prac9ce to all disciplines
• Expanded Mul9-‐Disciplinary Teamwork • Mul9plier effect – impact beyond ped-‐onc clinic • Quality Improvement Ini9a9ves
-‐ Late Referrals (community outreach)
-‐ Toxic deaths (adap9ng protocols) • Crea9on of new communi9es of prac9ces
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Expanded Architecture of CoP Platforms
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• Early Diagnosis • Pa9ent Referrals
• Community Health Indicators
Community
Outreach
• Op9mizing Clinical Care
• Crea9ng Peer Networks
Clinical Care
• Pa9ent Reported Data
• Family Care Networks
Pa9ents and Families
Creating communities along the continuum of healthcare
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Systematic Approach
• Need reliable data to analyze and plan • Plan has to have objec9ves, target outcomes, 9melines
• Design solu9on to regional needs • Long term commitment
• Training is key • Culture change approach • Incen9ves and rewards • Pilot programs with plans to scale
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11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Road Ahead
• Select area to focus • Iden9fy people with keen interest in CoPs • Engage with community to define needs
• Establish communica9on plakorm
• Pilot a clinical community of prac9ce
• Extend to other disciplines • Create regional networks
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11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
Thank you!
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Yuri Quintana, PhD
Director, Global Health Informatics
An Academic Division of the Dept of Medicineat Harvard Medical Faculty Physicians at BIDMC, Inc.
TM