Presentation on theme: "Associate Vice President for Education University of Minnesota"— Presentation transcript:
1Associate Vice President for Education University of Minnesota Barbara F. Brandt, PhDDirectorAssociate Vice President for EducationUniversity of MinnesotaThe National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration Cooperative Agreement Award No. UE5HP In addition, the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation (RWJF), the Gordon and Betty Moore Foundation, and the John A Hartford Foundation have collectively committed up to $8.6 million in grants over five years to support and guide the Center, which will work to accelerate team work and collaboration among doctors, nurses and other health professionals— as well as patients—and break down the traditional silo-approach to health professions education.
2It‘s “scope” of practice! It’s health professions education systemIt’s the paymentsystem!It’s the health delivery system!More primary care !!There is no problem our system is great!Team Training!!The uncoordinated, costly, non-aligned health care delivery system must undergo transformative change into one that values population health, value-added health and consumer engagement.A lot of efforts for change touch the elephant representing the new system in different places and focus on disparate and uncoordinated solutions. An approach to transformation must promote real change, component alignment, and capture the expertise present in the multiple professions that encompass the workplace of health.A major effort with great potential for transformation is that which seeks to reconnect education with clinical practice in a way that promotes achieving improved population health, percapita cost reduction, quality improvement and consumer engagement.
3Practice transformation away from episode of care PreventiveMedicineMedicationRefillsAcute CareNursingTest ResultsMaster BuilderDOCTORChronic DiseaseMonitoringHere we have the master builder model from the Flexner Report. At the time this was proposed, there was a great need. And, it served us well for many years. However, it has now outlived its usefulness and it is time to move on to a new approach to health, including health care.Interestingly, this Flexnarian model was adopted by other health provider professions, also. Our greatest challenge is in moving beyond our professional mental models into a safe space to be creative in redesigning how we achieve health..What is driving this change is all the marketplace forces that tell us the current “system” is not serving the health of the national well or cost-effectively. This realization has lead to a coordinated shift to an outcomes orientation, lead by the Triple Aim, as described by Berwick et al.CaseManagerMedicalAssistantsBehavioralHealthPaul Grundy MD MPHIBM Director Healthcare TransformationDirector Patient Centered Primary Care CollaborativeSource: Southcentral Foundation, Anchorage AK
4Triple Aim System Integrator Population Health Per Capita Cost Patient The System IntegratorCreates a partnership across the medical neighborhoodDrives PCMH primary care redesignOffers a utility for population health and financial managementPatientExperienceThe Triple Aim of Berwick et al.There is great enthusiasm that interprofessional teamwork, when applied to achieving population health and health care, will move the redesign along in a meaningful and timely way. Such an approach will necessitate a relinking of education, clinical practice and public health, fields and disciplines that have grown apart over the years.ProuctivityPaul Grundy MD MPHIBM Director Healthcare TransformationDirector Patient Centered Primary Care Collaborative28Copyright 2011 by IBM
5Framework for Action on Interprofessional Education and Collaborative Practice, World Health Organization, 2010Interprofessional education occurs when “students” from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. Interprofessional education is a necessary step in preparing a “collaborative practice-ready” health workforce that is better prepared to respond to local health needs. A collaborative practice-ready health worker is someone who has learned how to work in an interprofessional team and is competent to do so. Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care. It allows health workers to engage any individual whose skills can help achieve local public health goals.Definitions of an evolving field are challenging – even a forty year old field like interprofessional education and team care.For example, re-read the 1972 U.S. Institute of Medicine Educating for the Health Team report and except for a few pronouns – it reads like a contemporary document from today.The operational definition the National Center for Interprofessional Education and Practice is currently using is the 2010 World Health Organization definition and framework for IPE and collaborative practice and is a good starting point. While we all quibble with a word or two or an idea -- It is contemporary, grew out of a consensus process, builds upon many ideas, but also stimulates thinking in new ways.Thus, The framework for action on interprofessional education and collaborative practice says:From Slide
6Inteprofessional Practice and Education before the Nexus We are starting from a position of great chaos.
7Interprofessional Collaborative Practice = Teams / TeamworkIntegrative HealthPrimary CareHigh functioningteamsInterprofessional Collaborative Practice =About, from & withAccess to CareHealthcare/Medical HomesAcute CareThere are many components and levels of interprofessional education and collaborative practice, depending on the health outcome being focused on, the skill sets needed for transformative change, the resources available and the nature of the interface between the educational institutions and the various provider and care delivery systems.Education becomes integrated into practice so that all participants become learners and contributors to the outcomes of the triple aims for both the nexus and the transformed system of health:For the nexus these outcomes are:reduced cost via appropriate alignmentImproved quality of the user experience and learnerexperience, andCreating shared responsibilityFor the transformed system these outcomes are:improved health of the populationReduced percapita cost and improved qualityUsers engaged in achieving healthService-LearningPatient Safety / Quality
8IPE: Opportunities for Community-Campus Partnerships linked to Health IntegratedHealth care & Higher EdSystem TransformationDriving Costs Out of SystemsImproved Health and Learning OutcomesCommunity Health OutcomesWorkforce DevelopmentAccess to carePatient Safety/QualityThe partnerships formed when interprofessional education and collaborative practice become integrated into a single process can, and will improve both health and learning outcomes.This transformative change process begins with each participant getting to know each other and what knowledge, skills and experience each has to contribute with appropriate engagement. Over time a series of developmental steps occur via teamwork to improve quality, access workforce development, community health and in driving costs out of the system, improving both health and learning outcomes.TeamworkGetting to know each otherBrandt, B.F. (2009). IPE: Past, Present & Future. Presentation to HRSA Advisory Committee on Community-based Interdisciplinary Linkages.
9Other Needed Competencies IPEC CompetenciesValues & Ethics for Interprofessional Practice Roles & responsibilities Interprofessional Communication Teams and teamworkOther Needed CompetenciesPopulation Health, including social determinantsPatient-center decision-makingEvidence-based decision-makingCost-effective practicesQuality improvement and safe practiceStewardshipSystems ThinkingNew professional competencies are needed. Those shown here were developed by the Interprofessional Education Collaborative. IPEC is comprised of a representatives from all the major health professions, including public health.As the movement into interprofessionalism as occurred, more new competencies are being added. Some examples include: population health, user engagement, cost effectiveness and evidence-based decision making.
10This is the core vision of the National Center for Interprofessional Practice and Education.
11National Center For Interprofessional Practice and Education
12The National Center for Interprofessional Practice and Education
13Vision of the Transformed Approach to Health Producing Positive Impact onTriple Aim Outcomes1. Health of the Population Improveda. communities engaged in achieving healthb. coordinated engagement regarding socialdeterminants of healthc. Implemented effective prevention, wellnessand disease management programsd. mental health programs developed andimplementede. established metrics and measurement2. Increasing value apparenta. improved per capita/system quality ofcareb. reduced per capita cost of carec, established metrics and measurements3. Individuals, families, communitiesengaged in achieving healtha. individuals behaving as consumers in themarketplaceb. Individuals achieving well-beingc. easy access to services neededd. ease of access to informatione. engaged in the health of the communityThe Nexus:Education aligned and integrated with the process of care to:1. Reduce cost and add value to the alignment2. Improve the quality of the user and learner experience, and to3. create shared responsibilityLeading to Partnerships withA. New System Competencies1.Team trained and experienced2. Patient centered decision-making3. Engaged in evidenced-based decisionmaking, quality improvement and safepractice4.Knowledgeable in population health,including social determinants5.Practices in cost-effectiveness, addingvalue, stewardship and systemsthinkingB. Strategies for achieving and implementingcompetent teamsC. Organizational models of sharedresources, governance, management andaccountabilityD. Value added business case and planagreed to and implementedThe National Center for Interprofessional Practice and Education, was created at the federal level by HRSA to help move the transformative processes ahead. This slide summarizes where the national center is today.Overall, creating a nexus of integrated practice and education leads to new partnerships that produce positive impacts on the Triple Aim Outcomes. In doing so, each nexus achieves its own triple aims.The new partnerships implement new system competencies, strategies for implementation, organizational models and a business model that can work. Note that the system competencies include population health, cost-effective and evidence-based practice, value added approaches to health, and systems thinking.Each nexus effort needs to be directly linked to achieving one or more of the outcomes of improved health of the population, value added, or the engagement of users in achieving health.
15Stakeholders Have Important Functions in the Transformation There are multiple stakeholders with roles to play in both the design and implementation of the transformation of the current approach to health. In the depiction in the slide, stakeholder groups include nexus enablers, practitioners and delivery systems, and policy and regulation. A new system needs to happen with public health goals integrated into health care in a way that focuses on both the health and the well-being of the nation’s citizens.The core of all this occurs when the health professionals, current and those to be defined, integrate with health care in a way that focuses on, and incents, aligned systems outcomes. In this process, public health and health care must be inculcated into both the process and the outcomes to be achieved.Professional, policy and consumer groups will all have a role to playin both the design and implementation of the change process.
18Paul Grundy MD MPHIBM Director Healthcare TransformationDirector Patient Centered Primary Care Collaborative
19Global Information Framework Public Health Prevention PCMH in ActionA CoordinatedHealth SystemCommunity Care TeamNurse CoordinatorSocial WorkersDieticiansCommunity Health WorkersCare CoordinatorsPublic Health PreventionHEALTH WELLNESSHospitalsHealth ITFrameworkPCMHGlobal Information FrameworkSpecialistsEvaluationFrameworkPCMHOperationsPublic Health PreventionPaul Grundy MD MPHIBM Director Healthcare TransformationDirector Patient Centered Primary Care Collaborative35Copyright 2011 by IBM
20Smarter Healthcare 36.3% Drop in hospital days 32.2% Drop in ER use 12.8% Increase Chronic Medication use-15.6% Total cost10.5% Inpatient specialty care costs down18.9% Ancillary costs down15.0% Outpatient specialty downPaul Grundy MD MPHIBM Director Healthcare TransformationDirector Patient Centered Primary Care CollaborativeOutcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US - PCPCC Oct 2012
21Perinatal Safety: Reducing Adverse Obstetric Events Perinatal Safety Initiative1. Evidence-based approach2. Formalized interprofessional team training with emphasis on communication3. Standardized, competency documented electronic fetal monitoring4. High-risk obstetrical emergency simulation program5. Integrated educational program disseminated among all providersOutcomes1. Eleven adverse outcome measures were longitudinally followed2. Individual components of the program were evaluatedResults1. Within the first year, the Adverse Outcome Index was significantly and meaningfullyreduced and maintained throughout the two year study period2. Significant and meaningful reductions in:a. Rates of return to operating roomb. Birth trauma3. Significant improvements in:a. Staff perceptions of safetyb. Patient perceptions of the effectiveness how the team worked togetherc. Documentation and management of abnormal fetal heart rate tracingsd. Documentation of obstetric hemorrhageWagner B, et al Journal of Healthcare Quality 2011
22IPECP in a Transitional Care Unit Lynn A. Blewett PhD,1 Kelli Johnson MBA,2 Teresa McCarthy MD,3 Thomas Lackner PharmD,4 and Barbara Brandt PhD,5 Improving geriatric transitional care through inter-professional care teams, Journal of Evaluation in Clinical Practice 16 (2010) 57–632 Lynn A. Blewett PhD,1 Kelli Johnson MBA,2 Teresa McCarthy MD,3 Thomas
24Limitations of Traditional Training Kathleen Gallo Ph.D, MBA, RN, FAANSenior Vice PresidentChief Learning OfficerNorth Shore LIJLimitations of Traditional TrainingVariable clinical experience amongst individuals during trainingLimited experience of managing rare eventsEthical considerations of using patients for learningCurrent environment difficult to discuss and learn from mistakesLimited opportunities to acquire proficiency of skills in procedures
25Simulation: Important Kathleen Gallo Ph.D, MBA, RN, FAANSenior Vice PresidentChief Learning OfficerNorth Shore LIJSimulation: Importantpart of the SolutionUse simulation whenever possible for healthcare educationTrain in teams, those who are expected to work in teamsCreate new and realistic methods of learning without putting patients at risk
26It’s Not About the Simulator Kathleen Gallo Ph.D, MBA, RN, FAANSenior Vice PresidentChief Learning OfficerNorth Shore LIJIt’s Not About the SimulatorThe power of individual or team training in a simulation environment lies in the integration of validated educational methods into the real simulation experience (Dunn, 2008)Pre-WorkSimulationDebriefingReflection
27Advantages of Simulation Kathleen Gallo Ph.D, MBA, RN, FAANSenior Vice PresidentChief Learning OfficerNorth Shore LIJAdvantages of SimulationDeliberate practice of high risk, low incident eventsFosters the development of leadership, interpersonal skills and team behaviorsMinute by minute video and audio recording for reflective debriefing sessions and immediate feedbackHigher level of learning- Teamwork- Communication- Critical Thinking- Technical Skills
28Interprofessional Education (IPE) Kathleen Gallo Ph.D, MBA, RN, FAANSenior Vice PresidentChief Learning OfficerNorth Shore LIJInterprofessional Education (IPE)Interprofessional education occurs when learners from the health professions and related disciplines learn together about the concepts of health care and the provision of healthcare services toward improving the effectiveness and quality of healthcareEssential Elements:CollaborationRespectful communicationReflectionApplication of knowledge and skillsExperience in interprofessional teams