uthealth advances in teaching and learning day

The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration Cooperative Agreement Award No. UE5HP25067. The National Center is also funded in part by the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, The John A. Hartford Foundation and the University of Minnesota. © 2015 Regents of the University of Minnesota, All Rights Reserved.

Barbara F. Brandt, PhD Director, National Center for Interprofessional Practice and EducationAssociate Vice President for Education, Academic Health Center University of Minnesota Academic Health Center

Susan M. Meyer, PhDChair, National Center Nexus Learning System Advisory CommitteeCo-director, University of Pittsburgh Center for Interprofessional Practice and EducationAssociate Dean for Education and Professor, University of Pittsburgh School of Pharmacy

June 9, 2017 University of Texas - Houston

UTHealth Advances in Teaching and Learning Day

Welcome and Introductions

Barbara F. Brandt, PhD Director, National Center for Interprofessional Practice and EducationAssociate Vice President for Education, Academic Health Center University of Minnesota Academic Health Center


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Barbara F. Brandt, PhD Director, National Center for Interprofessional Practice and Education


The State of Interprofessional Practice and Education in Turbulent Times!

Topics

• Minding the gap of the current turbulent IPE environment

• How the National Center is working for you

• New Models of Care Require New Models of Learning: Tools you can use

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Learning Partner Acknowledgement

Many thanks to all of our advisors, program participants, Nexus Innovations Network, funders, and many stakeholders from whom we learn every day.

Special thanks: National Advisory CouncilNexus Learning System Advisory Committee American Interprofessional Health CollaborativeAngela Willson, National Center Education & Training Manager“Conversation Café” Champions

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Interprofessional Education and Collaborative PracticeThe “New IPE” – Interprofessional Practice and Education

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Interprofessional education “occurs when two or moreprofessions learn with, about, and from each other toenable effective collaboration and improve healthoutcomes.”

Interprofessional, collaborative practice “occurs whenmultiple health workers and students and residents fromdifferent professional backgrounds provide comprehensivehealth services by working with patients, their families,carers (caregivers), and communities to deliver the highestquality of care across settings.”Adapted from:The Centre for the Advancement of Interprofessional Education, UK, 1987World Health Organization, Framework for Action on Interprofessional Education and Collaborative Practice, 2010.

What We Value:National Center Vision

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We believe high-functioning teams can improve theexperience, outcomes and costs of health care.

National Center for Interprofessional Practice andEducation is studying and advancing the waystakeholders in health work and learn together.

National Center FundersHealth Resources and Services Administration CooperativeAgreement

Award No. UE5HP25067Robert Wood Johnson Foundation

Gordon and Betty Moore FoundationJosiah Macy Jr. Foundation

John A. Hartford Foundation

What We Value:National Center Vision

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We believe high-functioning teams can improve theexperience, outcomes and costs of health care.

National Center for Interprofessional Practice andEducation is studying and advancing the waystakeholders in health work and learn together.

National Center FundersHealth Resources and Services Administration CooperativeAgreement

Award No. UE5HP25067Robert Wood Johnson Foundation

Gordon and Betty Moore FoundationJosiah Macy Jr. Foundation

John A. Hartford Foundation

The Nexus: Our Vision for Healthnexusipe.org

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Triple Aim of AlignmentImproving quality of experience for patients, families, communities and learners

Sharing responsibility for achieving health outcomes and improved learning

Reducing cost and adding value in health care delivery and education

HRSA PrinciplesJune 1, 2012 Funding Opportunity Announcement

A coordinating center for interprofessionaleducation and collaborative practice will provide

leadership, scholarship, evidence, coordination, and national visibility to advance interprofessional education and

practice as a viable and efficient health care delivery model. (p.4)

“Unbiased, neutral convener”

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The Nexus Focus

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How do we improve the patient experience of

care, improve the health of populations,

and reduce the per capita cost of health care simultaneously?

Patients, Families & Communities

Health Workforce for New Models of Care

Learner Pipeline

How do we create a health workforce in the right locations, specialties and practice settings

that has the skills and competencies needed to meet the demands of a transformed

health care system while preventing burnout?

Today I owe:

How do we prepare the next generation of health

professionals for a transformed health care system while improving

experience and decreasing costs?

How do we prepare the next generation of health

professionals for a transformed health care system while improving

experience and decreasing costs?

$100K

Unbiased, Neutral Convener:“Calling the circle”

– Convenes groups and tees up “thorny IPE issues” topics for discussion and recommendations

– Works inter- and intra-professionally to promote dialogue and understanding

– Cannot favor one profession over the other– Cannot advocate for one model over the other– Collects data and information to make sense while

striving to be objective

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Unbiased, Neutral Convener:“Calling the circle”

– Advances thinking about the field based upon evidence, experience and expertise

– Based upon evolving models of IPE, identifies partners to educate and train in specialized areas

– Advocates for our values, based upon what we are learning makes a difference

– Says what needs to be said. . .

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A National Birdseye View: Themes and ObservationsSelect Presentations, Consultations, Partnerships and Contracts for Services

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• 1199/SEIU Training Funds• 3M• Accreditation Council of Graduate Medical Education• American Assembly for Men in Nursing• American Interprofessional Health Collaborative• AMA – Accelerating Change in Medical Education• Association of Nurse Professional Development• American Association of Colleges of Nursing• American Association of College of Pharmacy• American Board of Medical Specialties• American Interprofessional Health Collaborative• American Medical Association• Association of Academic Health Centers• Association of Nursing Professional Development• Association of Schools and Programs of Public Health• American Physical Therapy Association • Association of Specialized and Professional Accreditors• Beyond Flexner Alliance• California Institute for Nursing and Health Care• Centers for Medicare and Medicaid Services • Council on Social Work Education• HRSA Nurse Education, Practice, Quality and Research

grantees• Indiana Center for Nursing• Joint Accreditors of Interprofessional Continuing Education• Josiah Macy Jr. Foundation• Institute for Healthcare Improvement (IHI)• Interprofessional Education Collaborative (IPEC)

• IOM Future of Nursing • IOM/NAM Global Forum on Innovations in Health Professions

Education• Macy T3 Faculty Development Program• National Advisory Council on Nurse Education and Practice • National Association of Community Health Centers• National Governors Association• National Health Policy Forum• National League of Nursing• National Nurse-lead Centers Consortium• National Quality Forum• Nursing Organizations Alliance• OptumHealth• Patient-Centered Primary Care Collaborative• Respiratory Nurses Society• University of North Carolina Cecil G. Shep Center• University of North Texas Health Sciences Center• University of Texas-Houston• VA Centers of Excellence in Primary Care• World Health Organization / Pan American Health

Organization• And more . . . . .

• Many team site visits -- scores of universities and practices• Many calls, emails. . . .

Satellite and Big Blue Marble

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View from the Satellite:Interconnection of Organizations

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Changing Views – 2013 and Today

2013 View from the Balcony 2017 View from the Satellite

But some things are becoming clearer!

ACA / “Obamacare,” CMMI, PCORI

National / Federal

Workforce redesign:Physician-led teams

Teams as health professionals

(Consumer-driven) Care

?? Repeal and replace

State-based decision-making

Workforce redesign:Team Optimization at lower cost (The how- not the who- at lower cost; “right team at the right time” -outcomes)

Accountable care communities: multi-sector involvement in health

Consumer-driven health

Minding the GapArticulating our Values in Today’s Environment

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Minding the GapArticulating our Values in Today’s Environment

Gaps: education and practice

Trusting professionals

Fee-for-service

Continuing education model

Silent Generation and Baby Boomers

Clinical professions

Gaps: intra-professional and inter-professional

Questioning the “Grand Bargain”

Value-based payments

Performance-based competency model

Gen X, Millennials and Gen Z

Population health (engagement of Public Health)

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“True North”: What Does it Mean?

• Commitment to interprofessional teams

• Value-based payment models

• “Consumer-driven” health care

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Trends in Value-Based Payments

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Making Sense of MACRA

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The National Center: What’s in it for you?

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Strategic Focus Areas

Thought LeadershipStrategic Imperative: Develop a network of trusted

affiliates and ambassadors on the “balcony”• 198 presentations to: ed. institutions, acad. and

prof. associations, certification boards, accreditors, govt/public health/policy/research, and health care delivery systems

• 10 formal advisory board roles• Hundreds of strategic consultations to support

the multisector advancement of IPEKnowledge Generation

Strategic Imperative: Facilitate evidence-based research approaches to inform practice and

learning in real time using standardized processes and scholarly dissemination

• Nexus Innovations Network• Robust cohort of Nexus sites demonstrating

innovation in IPE implementation• Special Issue of Journal of Interprofessional

Care• Growing Portfolio of Published, Peer-

Reviewed Research

Resource CenterStrategic Imperative: Leverage institutional and

community expertise in a robust framework to serve the end-user in the vanguard of IPE in practice

• Community-Sourced, Open-Access Resources and Learning Modules

• Practical Guides for Assessing Team Performance

• Relaunched Measurement Instrument Collection

• Amina and Carl in the Nexus

Education and TrainingStrategic Imperative: Utilize cutting-edge knowledge through data, experience, and expertise to create an innovative Nexus

Learning System to share the latest learning and tools

• Annual Nexus Summit• Nexus Learning System – New Models of

Care Require New Models of Learning• Strategic Program Partners• Individualized Faculty Development and

Technical Assistance• Joint IPCE Accreditation

Thought Leadership

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Expertise-formal and informal

advisory roles - leadership consults to

guide planning, investments

- customized resources to meet specific needs

Convener-facilitate “thorny IPE” dialogue

through unbiased lens- bring together diverse

perspectives to advance thinking- challenge traditional approaches

- invite innovation

Outreach-using findings in all

areas- facilitating learning and Nexus dialogue

-presenting at workshops, conferences

-utilizing affiliates to extend reach

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Education and TrainingStrategic Imperative: Utilize

cutting-edge knowledge through data, experience, and expertise to

create an innovative Nexus Learning System to share the latest

learning and tools

Resource CenterStrategic Imperative: Leverage

institutional and community expertise in a robust framework to serve the end-user in the vanguard of IPE in

practice

Strategic Imperative: Develop a network of trusted affiliates and ambassadors on the “balcony”

Thought Leadership

Knowledge GenerationStrategic Imperative: Facilitate

evidence-based research approaches to inform practice and

learning in real time using standardized processes, scholarly

dissemination

Thought Leadership

Results: Annual Nexus Summit

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2016 Summit

2017 Summit

Conversation Cafés: Identifying and Hearing Burning IPE IssuesCarry Forward for Results-Oriented Work

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Phase 1 Conversation

Cafés –2016 Summit

Issue Champion Carries the

Conversation Forward

Phase 2 Conversation

Cafés –2017 Summit

Results

Phase 1 (2016) and Phase 2 (2017)Conversations Cafés• Phase I to Phase II: Accreditation

– Focusing on new accreditation standards for IPE in pre-professional programs and interprofessional professional development, what criteria should be used to judge quality to promote new models of learning?

• Phase I to Phase II: The BIG Question– How do we help students, trainees, and practitioners gain the competencies to work in

new models of care when we are still practicing in traditional models?

• Phase I to Phase II: Organizational Models of IPE– What organizational models for aligning IPE and health care delivery will advance IPE

most effectively and efficiently?

• Phase I (2017): Team Optimization– What are the opportunities and unintended consequences of team optimization?

– What are the learning and education issues?

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Phase I Cafe recommendations: Accreditation

• IPE is a recommendation that tends not to be effectively enforced.

• Different professions have different standards.

• Assessing IPE is challenging: Lack of clarity about what constitutes evidence of achievement of a standard.

• IPE needs to be purposefully incorporated into the curriculum.

• The IPE experience needs to be formalized.

• Outcomes need to be clearer.

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Accreditation Conversation Café -Advancing the Dialogue in a 12 month cycle

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During April 2017 ASPA convening, 23 accreditors signed on to work on a white paper about agreement on criteria for IPE

August 2016

September 2016

April 2017

August 2017

Knowledge Generation:What are we learning

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Advancing the Field-critical success factors

-learning resources-IPE implementation

tools-standardized measures

Original Research -movement toward advanced

analytics-peer-reviewed research

Nexus Innovations Network

-Nexus implementation-comparative

effectiveness research-learning community

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learning and tools



practice


Thought Leadership




dissemination

Knowledge Generation

Lean Startup

Nexus Innovations Network:Participation Map

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Nexus Innovations Network

• Onboarding path

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199

2

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What We’ve Learned: Emerging Critical Success Factors

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Process of care redesign is about changing culture.

Compelling vision is required.

IP+E resourcing is critical.

Senior leadership is essential.

Impressions of team training effectiveness are mixed.

The Application of Informatics in Delineating the Proof of Concept for Creating Knowledge of the Value Added by Interprofessional Practice and Education. Healthcare 2015, 3, 1158-1173.

Resource CenterNexusipe.org

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Outreach-sharing IPE stories

-empowering ambassadors to spread

the word-connecting needs with

available resources-growing the community

and meeting people where they are

Resources and Expertise-leading edge resources designed

and curated in response to emerging trends and needs

-data-informed usability analyses for continuous quality improvement

Community Engagement

-vibrant discussion platform for burning

issues-unbiased, neutral

convener-professional directory empowers connections

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learning and tools



practice

The Resource Center Nexus:A unique space of shared value that brings together demonstrated expertise and new beginnings.


Thought Leadership




dissemination

Resource Center

Nexusipe.org

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Sessions by Country – April 2016-2017

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80,644

2,965

1,499

1,310

2,432712

Resource Center: Freely Available Institutional and Community Expertise

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Resource Center: Amina and Carl in the Nexus

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Number One Request: “Assessment”

• Evolution of the measurement collection• Importance of research on linkages between education,

practice, and Triple Aim (cost, quality, patient experience)

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Community generatedopen source exchange

26 toolsin curated collection

Building community

capacity

2014 2017

Today: Building Capacity in Foundation Areas*Nexusipe.org

*Measurement, assessment, evaluation

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Measurement CollectionResource Center Support

Resources

Open-source, community exchange

Qualitative tools to measure processes, explore emerging areas, build theory

Support local teaching, curriculum, programming

Selected tools, vetted by Center’s advisory board

Quantitative tools to measure IPECP processes and impacts on Triple Aim

Support generalizable evaluation / research

Measurement Primer

To RIPLS or not to RIPLS

Consumer Report on Team Assessment Tools

Practical Guides on Assessment and Evaluation

Assessment and Evaluation Home Page


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Education and Training

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Curated Expertise-responsive

consultations on leadership,

organizational models-faculty development approaches to ensure

IPE sustainability

Nexus Learning System-training series tailored to

organizational developmental strategies and adapted based on

current learning-tools and resources to address

spectrum of IPE needs

Strategic Collaborations

- Program collaborations to

address specific needs (custom and standard)- Modular content for

flexibility in use- Expanding the bench, utilizing broad base of

expertise

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learning and tools Resource CenterStrategic Imperative: Leverage


practice


Thought Leadership




dissemination

Education and Training

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Nexus Learning System: You will experience a “taste” today.

National Center 2017 Learning Opportunities

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Morning Break

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Barbara F. Brandt, PhD Director, National Center for Interprofessional Practice and Education

Susan M. Meyer, PhDChair, Nexus Learning System Advisory Council


Aligning Interprofessional Education with Clinical Practice Redesign: What It Means for Amina and Carl

Amina in the Nexus

57Click here to watch Amina

https://www.youtube.com/watch?v=DzChp4bvaas&feature=youtu.be&stamp=1496326591&sig=3d13b69a

Interviews to learn about the Nexus at the micro level: academic-clinical practice• Seven PCMHs selected by Patient-Centered Primary

Care Collaborative

• National Center participated in interviews to learn:• Presence of interprofessional education • “Nexus” – alignment of IPE with clinical practice redesign

• What are characteristics of sites that display both, as reported in the interviews?

• Articulate themes to inform new development

Characteristics of the Patient Centered Medical Home (PCMH)

A team-based health care delivery model

Continuous care to populations of patients with the goal of obtaining maximized health outcomes

An approach to providing comprehensive primary care for children, youth and adults

Shift care from acute to ambulatory / community settings

Care coordination – essential, requiring additional resources – health information technology – appropriately trained staff to provide coordinated care– workforce redesign

Reduce costs

Interprofessional Education and Collaborative PracticeThe “New IPE” – Interprofessional Practice and Education

60

Interprofessional education “occurs when two or moreprofessions learn with, about, and from each other toenable effective collaboration and improve healthoutcomes.”

Interprofessional, collaborative practice “occurs whenmultiple health workers and students and residents fromdifferent professional backgrounds provide comprehensivehealth services by working with patients, their families,carers (caregivers), and communities to deliver the highestquality of care across settings.”Adapted from:The Centre for the Advancement of Interprofessional Education, UK, 1987World Health Organization, Framework for Action on Interprofessional Education and Collaborative Practice, 2010.

The Nexus: Our Vision for Healthnexusipe.org

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Triple Aim of AlignmentImproving quality of experience for patients, families, communities and learners

Sharing responsibility for achieving health outcomes and improved learning

Reducing cost and adding value in health care delivery and education

Elements of the “Nexus”

• integrate clinical practice and education in new ways,

• partner with patients, families, and communities,

• strive to achieve the Triple Aim in both health care and education (cost, quality, and populations),

• incorporate students and residents into the interprofessionalteam in meaningful ways,

• create a shared resource model to achieve goals, and

• encourage leadership in all aspect of the partnership.

Three Programs

• University of Oklahoma’s Family Medicine Center,

• San Francisco Veterans Administration Medical Center

• New Mexico State University Counseling Psychology Program

Refined Definition of the Nexus

“Clinical practices in transforming systems that partner with health professions education programs

think and act differently

learning organizations that support continuous professional development

while educating the next generation of health professionals”

Characteristics

• Sharing a vision

• The patient-centered curriculum

• Innovation for culture change

• Spontaneous team leaders

• Benefits of the Nexus to the practice

• Benefits of the Nexus to students and residents

Sharing a vision

• An extraordinary commitment to workforce development between PCMH and partner health professions education program

• Able to articulate common purpose and strategies to address significant barriers– Understand and meet each partner’s needs and

perspectives– Bridge culture to create new one – Significant face-to-face time, often unpaid – Builds relationships, trust and working appreciation

for one another

The patient-centered curriculum

Start with the patient in mind: not clinical practice or health professional education program

Being PCMH helps with relevant educational program

Successful strategies:• Needs of patient, then incorporate learner• Shared decision-making partnership with patients

explicitly role models the needs and wants of patients for all learners

Innovation for culture change

• Explicitly articulated:

– Essential role of site champions – A commitment to a fundamental cultural shift

away from a traditional, hierarchical to more innovative team-based approach

– Critical to transformation of clinical practice– Teaching / learning strategies to learn in practice

how to function in teams – Small changes add up

Spontaneous team leaders

• Shift to patient-centered curriculum

• Role of collaboration and conflict resolution skills

• Promotes leadership no matter which profession or whether clinician, student or resident

• Naturally learning new skills in practice

Benefits of the Nexus to the Practice

• Benefits to the whole site, including clinicians and staff

• Students and residents bring new ideas about interprofessional education and collaborative practice

• Students asking “tough questions” about efficient and effective patient care

Benefits of the Nexus to students and residents

• Intentionally trained in skills needed in practice

• More “collaboration-ready” and confident

• Marketable skills

• Prepared for practice in underserved areas

• Learn to address barriers to practice

Practical Take Homes

• Start with the patient in mind

• Design for practice and education model around principles of PCMH

• Significant commitment to develop a shared vision that benefits all


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Click here to watch Carl in the Nexus

https://vimeo.com/211353184


Working Session 1:

Think BIG and Start SMALL: Using the National Academies of Medicine Interprofessional Learning Continuum Framework


Friday, June 9, 2017

75Figure 3-2, Reprinted with permission from Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes, 2015 by the National Academy of Sciences, Courtesy of National Academies Press, Washington, D.C.

IPE: Educating Today’s and Tomorrow’s Workforce

Learning Continuum(Formal and Informal)

FoundationalEducation

GraduateEducation

Continuing Professional Development

Interprofessional Education Today

Interprofessional Education Tomorrow

Learning Continuum(Formal and Informal)

Interprofessional Education

Foundational Education

Graduate Education

ContinuingProfessional Development

Where on the LEARNING CONTINUUM are your efforts focused?

What are defining features of your INTERPROFESSIONAL EDUCATION activities?

Who is/are the LEARNER(S)?

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IOM (Institute of Medicine. 2015. Measure the impact of interprofessional education on collaborative practice and patient outcomes. Washington, DC: The National Academies Press.

FIGURE 3-2 The interprofessional learning continuum (IPLC) model.NOTE: For this model, “graduate education” encompasses any advanced formal or supervised health professions training taking place between completion of founda-tional education and entry into unsupervised practice.

Health and System OutcomesIndividual health

Population/public health

Organizational changeSystem efficienciesCost effectiveness

Have you explicitly targeted HEALTH OUTCOMES at the individual level?If so, what are they?

Have you explicitly targeted HEALTH OUTCOMES at the population/community level?If so, what are they?

Do you anticipate SYSTEM OUTCOMES?Organizational change?System efficiencies?Cost effectiveness?

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Enabling or InterferingFactors

Professional cultureInstitutional cultureWorkforce policyFinancing policy

What are ENABLING features of your PROFESSIONAL CULTURE?Are the cultures of your partners synergistic? complementary? contradictory?

What are INTERFERING features of your PROFESSIONAL CULTURE?

What are ENABLING features of your INSTITUTIONAL CULTURE?Are the cultures of your partners synergistic? complementary? contradictory?

What are INTERFERING features of your INSTITUTIONAL CULTURE?

What is the local FINANCING POLICY? Is it ENABLING or INTERFERING? How? What is the local WORKFORCE POLICY?

Is it ENABLING or INTERFERING? How?

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Kirkpatrick’s Expanded Outcomes Typology

Lunch

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Working Session 2:

Designing Your Future - The “Stairstep” View of Nexus Developmental Stages- SOARR: Strengths and Assets, Opportunities, Aspirations and Results, ResourcesBarbara F. Brandt, PhD Director, National Center for Interprofessional Practice and Education

Susan M. Meyer, PhDChair, National Center Nexus Learning System Advisory Committee

June 9, 2017

What is Our Team’s Nexus Developmental Stage?

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National Center SOAR: Strengths, Opportunities, Aspirations, Results

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Thank you!Questions:

[email protected]

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