interprofessional education and collaborative care: a ... · disruptive innovation •discuss a...
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Interprofessional Education and Collaborative Care: A Disruptive
Innovation?
Amy J. Barton, PhD, RN, FAANProfessor
Endowed Chair for Rural Health NursingAssociate Dean for Clinical & Community Affairs
Acknowledging the contributions of…
• Mark Earnest, MD, PhD
– Director, Interprofessional Education
• Gail Armstrong, RN, DNP
– QSEN Consultant, Institute for Healthcare Quality, Safety and Effectiveness
• Wendy Madigosky, MD, MSPH
– Macy Faculty Scholar
• Colleagues on the IPE Council
Objectives
• Compare the advent of interprofessionaleducation with the characteristics of a disruptive innovation
• Discuss a structured approach to developing IPE learning activities
• Describe the Colorado approach for integrating best practices into practice and education settings and for evaluating their outcomes.
Disclosures
• I have no disclosures to report.
IPECP and Disruptive Innovations
Structuring Learning Activities
The Colorado Experience
IPECP and Disruptive
Innovations
What is Interprofessional Education?
• Occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes
Disruptive Innovation
• The process of developing new products or services to replace existing technologies and gain a competitive advantage.
http://www.businessdictionary.com/definition/disruptive-innovation.html#ixzz3DK5tsqZS
What makes a technology disruptive?
Understanding based on observations
Intuitive, trial and error experimentation
Patterns emerge to enable rules-based work
A corollary to medicine
Intuitive medicine
Empirical medicine
Precision medicine
What will enable disruption?
Patient Outcomes
Solution Shops
Value-adding
processes
Key barriers
• Work done in each business model must be organized differently, and their cost accounting and pricing systems must be separated in structured in ways appropriate to each
• A key reason diseases remain in the realm of intuitive medicine is that they arise at the interdependent intersection of two or more systems of the body
What is needed in medical education
• Stronger focus on how to design value-adding processes
• How to work with other professionals ensconced within workflows
• How to function within professional networks
• How to utilize patient-centric networks
Structuring Learning Activities
CO-AUTHOR: THOMAS VAN HOOF, MD, EDDUNIVERSITY OF CONNECTICUT
The authors acknowledge the following support:
*Funding from the Josiah Macy, Jr. Foundation via the
AAMC/AACN Lifelong Learning Initiative
*Guidance from:
Dave Davis, MD, Association of American Medical Colleges
Nancy Davis, PhD, Association of American Medical Colleges
Kathy McGuinn, MSN, RN, CPHQ, Association of American Colleges of Nursing
Sub-Objectives
Describe a process in which assessment efforts are integrated with educational planning and instructional design while focusing on desired outcomes
Apply an expanded outcomes framework for planning and assessing interprofessional education
Identify key considerations in developing interprofessional curriculum with regard to content, process, and context
Evidence from Continuing EducationEducational activities should be based on assessed need
Passive approaches to learning are generally not effective in changing behavior
Multifaceted activities that combine several different interventions are effective
Step 1: select the outcomes of the activity
Community Health Status
Patient Health Status
Performance (Does)
Competence (Shows How)
Procedural Knowledge (Knows How)
Declarative Knowledge (Knows)
Satisfaction
Participation
Step 2: choose a target audience
Educational level
Disciplinary background
Workplace setting
Step 3: conduct a needs assessment
Educational requirements
Health system data
Patient care data
Step 4: Design summative evaluation strategy
Knowledge Skills Attitudes
Step 5: design formative evaluation strategy
• Presentation
• Example
• Practice
• Feedback
Format
Content
Step 6: choose intervention strategy to predispose audience
Teachable Moment
Current Performance
Data
Evidence-based
Guidelines
Factors contributing
to performance
Consensus on improvement
action
Step 7: Choose intervention strategy to enable audience
Presentation/Rule
Example/Demonstration
Practice
Feedback
Step 8: Choose intervention strategy to reinforce audience
Commitment to change
Course handouts
Reminders Case studies
Invitation/opportunity to participate in
performance improvement
Step 9: Maintaining and building on completed activities
Share evaluation
results
Engage target audience in
planning
Improve continuity in
planning
Conclusion
With formative evaluation, planning educational activities in a step-wise fashion with content and context in mind increases the likelihood that summative evaluation will show improvements in patient care
The Colorado
Experience
Fitzsimons Army Medical Hospital
• 557 Acre campus
• Caught in a round of base closures 1996
• Given to the University of Colorado Health Sciences Center to develop a new campus
Vision for a Campus
• Planning Process: Interprofessional faculty … with an interprofessional vision
• Three Zones: Education, Research, Clinical Care
Clinical Care
Research
Education
The Anschutz Medical Campus
• Designed for Interprofessional Education
– Physical Plant shared by schools, not owned
– Common classrooms, centrally scheduled
– Faculty and admin offices share buildings
– Common community space for students, not segregated lounges
• The result of an Intentional Planning process
Diffuse Ideas
Bricks and Mortar
Integrated Plan
Effective Curriculum
Migrating to a Sustainable Future
IPE Director
•Education Coordinator
•Evaluation/Data Management
Program Assistant Directors
•Nursing
•Medicine
•Physician Assistant
•Pharmacy
•Physical Therapy
•Public Health
•Dentistry
Center for
Bioethics
•Education Coordinator
•IT Support
IPE organizational structure
• Deans constructed a cross-program leadership model to which IPE reports
• Funding requires both financial and personnel support from the Deans and IPE moves forward irrespective of external funding
• IPE now run by IPE director, 7 Associate Directors, two educational coordinators, and IT/assessment coordinator
Course considerations
• Make issues and themes relevant to all
• Stress positive aspects of teamwork in health care
• Make it interprofessional– Ask questions too broad for any one to answer
– Case studies with a profession representative vs featured role
– Lead by example
AMC 2013-14 – First Year Class
696 Future Health Professionals• Dental – 80
• Medicine – 184
• Nursing – 199
• Pharmacy - 184
• Physical Therapy – 66
• Physician Assistant – 44
• Anaesthesia Assistant - 12
Interprofessional Orientation
• One day
• Whole campus
• IP teams
• Sets the tone
Framework for Action on Interprofessional Education and Professional Practice
World Health Organization, 2010
Our Vision for Interprofessional Education
• Students that graduate from the Anschutz Medical Campus will be competent to participate as members of a collaborative interprofessional workforce.
Competency Domains to Advance the Triple Aim
Provide patient-centered care
Work in interprofessional
teams
Improve quality and patient safety
Improve population health
Practice evidence-based, cost-
effective care
Summary Report: Aligning Education and Practice to Advance the Triple Aim, Feb. 2013
Competency Integration
Collaborative-Practice Ready Workforce
IPEC
QSENIOM
CU’s IPE Program Goal
To improve population health, quality of care, and reduce health care costs through the creation of a patient-centered, collaborative practice ready workforce with competencies in:
– Quality and Safety
– Values and Ethics
– Teamwork and Collaboration
in the context of systems and systems-based practice.
The longitudinal IPE experience
Interprofessional Education &
Development Course
Clinical Transformation
(simulation)
Clinical Integration
(at practicum training sites)
Two to four years
IPED: small IPE team sessions32 hours of foundational team based learning over 2 semesters(8 sessions Spring 2015 and 8 session Fall 2015)
Teamwork & CollaborationTeam structureRoles & responsibilitiesSituational monitoringConflict managementAdvocacy & assertion
Ethics & Values:8 step method for analysisProfessional & patient
autonomyInformed consentConflicts of interestAccess to healthcare
Quality & SafetySystems level practiceRoot cause analysisEngaging with patientsImproving careContributing to a culture of
safety
Clinical transformations in CAPE• 4 hours of video-monitored simulations in which
participants experience role shifts required to enable effective team leadership and followership
• Scenarios: Focus on teamwork & collaboration
• Team reflection: Address ethical and patient safety issues experienced in scenario
Clinical Integrations
– Students learning and caring for patients in interprofessional teams
– Hospitals, clinics, dental clinics, home visits, transitions in care, palliative care, special needs, etc.
