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Associate Vice President for Education University of Minnesota

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1 Associate Vice President for Education University of Minnesota
Barbara F. Brandt, PhD Director Associate Vice President for Education University of Minnesota The 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.

2 It‘s “scope” of practice!
It’s health professions education system It’s the payment system! 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.

3 Practice transformation away from episode of care
Preventive Medicine Medication Refills Acute Care Nursing Test Results Master Builder DOCTOR Chronic Disease Monitoring Here 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. Case Manager Medical Assistants Behavioral Health Paul Grundy MD MPH IBM Director Healthcare Transformation Director Patient Centered Primary Care Collaborative Source: Southcentral Foundation, Anchorage AK

4 Triple Aim System Integrator Population Health Per Capita Cost Patient
The System Integrator Creates a partnership across the medical neighborhood Drives PCMH primary care redesign Offers a utility for population health and financial management Patient Experience The 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. Prouctivity Paul Grundy MD MPH IBM Director Healthcare Transformation Director Patient Centered Primary Care Collaborative 28 Copyright 2011 by IBM

5 Framework for Action on Interprofessional Education and Collaborative Practice, World Health Organization, 2010 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. 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

6 Inteprofessional Practice and Education before the Nexus
We are starting from a position of great chaos.

7 Interprofessional Collaborative Practice =
Teams / Teamwork Integrative Health Primary Care High functioning teams Interprofessional Collaborative Practice = About, from & with Access to Care Healthcare/ Medical Homes Acute Care There 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 alignment Improved quality of the user experience and learner experience, and Creating shared responsibility For the transformed system these outcomes are: improved health of the population Reduced percapita cost and improved quality Users engaged in achieving health Service-Learning Patient Safety / Quality

8 IPE: Opportunities for Community-Campus Partnerships linked to Health
Integrated Health care & Higher Ed System Transformation Driving Costs Out of Systems Improved Health and Learning Outcomes Community Health Outcomes Workforce Development Access to care Patient Safety/Quality The 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. Teamwork Getting to know each other Brandt, B.F. (2009). IPE: Past, Present & Future. Presentation to HRSA Advisory Committee on Community-based Interdisciplinary Linkages.

9 Other Needed Competencies
IPEC Competencies Values & Ethics for Interprofessional Practice Roles & responsibilities Interprofessional Communication Teams and teamwork Other Needed Competencies Population Health, including social determinants Patient-center decision-making Evidence-based decision-making Cost-effective practices Quality improvement and safe practice Stewardship Systems Thinking New 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.

10 This is the core vision of the National Center for Interprofessional Practice and Education.

11 National Center For Interprofessional
Practice and Education

12 The National Center for Interprofessional Practice and Education

13 Vision of the Transformed Approach to Health
Producing Positive Impact on Triple Aim Outcomes 1. Health of the Population Improved a. communities engaged in achieving health b. coordinated engagement regarding social determinants of health c. Implemented effective prevention, wellness and disease management programs d. mental health programs developed and implemented e. established metrics and measurement 2. Increasing value apparent a. improved per capita/system quality of care b. reduced per capita cost of care c, established metrics and measurements 3. Individuals, families, communities engaged in achieving health a. individuals behaving as consumers in the marketplace b. Individuals achieving well-being c. easy access to services needed d. ease of access to information e. engaged in the health of the community The Nexus: Education aligned and integrated with the process of care to: 1. Reduce cost and add value to the alignment 2. Improve the quality of the user and learner experience, and to 3. create shared responsibility Leading to Partnerships with A. New System Competencies 1.Team trained and experienced 2. Patient centered decision-making 3. Engaged in evidenced-based decision making, quality improvement and safe practice 4.Knowledgeable in population health, including social determinants 5.Practices in cost-effectiveness, adding value, stewardship and systems thinking B. Strategies for achieving and implementing competent teams C. Organizational models of shared resources, governance, management and accountability D. Value added business case and plan agreed to and implemented The 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.


15 Stakeholders 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 play in both the design and implementation of the change process.



18 Paul Grundy MD MPH IBM Director Healthcare Transformation Director Patient Centered Primary Care Collaborative

19 Global Information Framework Public Health Prevention
PCMH in Action A Coordinated Health System Community Care Team Nurse Coordinator Social Workers Dieticians Community Health Workers Care Coordinators Public Health Prevention HEALTH WELLNESS Hospitals Health IT Framework PCMH Global Information Framework Specialists Evaluation Framework PCMH Operations Public Health Prevention Paul Grundy MD MPH IBM Director Healthcare Transformation Director Patient Centered Primary Care Collaborative 35 Copyright 2011 by IBM

20 Smarter Healthcare 36.3% Drop in hospital days 32.2% Drop in ER use
12.8% Increase Chronic Medication use -15.6% Total cost 10.5% Inpatient specialty care costs down 18.9% Ancillary costs down 15.0% Outpatient specialty down Paul Grundy MD MPH IBM Director Healthcare Transformation Director Patient Centered Primary Care Collaborative Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US - PCPCC Oct 2012

21 Perinatal Safety: Reducing Adverse Obstetric Events
Perinatal Safety Initiative 1. Evidence-based approach 2. Formalized interprofessional team training with emphasis on communication 3. Standardized, competency documented electronic fetal monitoring 4. High-risk obstetrical emergency simulation program 5. Integrated educational program disseminated among all providers Outcomes 1. Eleven adverse outcome measures were longitudinally followed 2. Individual components of the program were evaluated Results 1. Within the first year, the Adverse Outcome Index was significantly and meaningfully reduced and maintained throughout the two year study period 2. Significant and meaningful reductions in: a. Rates of return to operating room b. Birth trauma 3. Significant improvements in: a. Staff perceptions of safety b. Patient perceptions of the effectiveness how the team worked together c. Documentation and management of abnormal fetal heart rate tracings d. Documentation of obstetric hemorrhage Wagner B, et al Journal of Healthcare Quality 2011

22 IPECP 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) 57–63 2 Lynn A. Blewett PhD,1 Kelli Johnson MBA,2 Teresa McCarthy MD,3 Thomas

23 The Latest Cochrane Collaboration Analysis
Interprofessional education: effects on professional practice and healthcare outcomes (update) (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M

24 Limitations of Traditional Training
Kathleen Gallo Ph.D, MBA, RN, FAAN Senior Vice President Chief Learning Officer North Shore LIJ Limitations of Traditional Training Variable clinical experience amongst individuals during training Limited experience of managing rare events Ethical considerations of using patients for learning Current environment difficult to discuss and learn from mistakes Limited opportunities to acquire proficiency of skills in procedures

25 Simulation: Important
Kathleen Gallo Ph.D, MBA, RN, FAAN Senior Vice President Chief Learning Officer North Shore LIJ Simulation: Important part of the Solution Use simulation whenever possible for healthcare education Train in teams, those who are expected to work in teams Create new and realistic methods of learning without putting patients at risk

26 It’s Not About the Simulator
Kathleen Gallo Ph.D, MBA, RN, FAAN Senior Vice President Chief Learning Officer North Shore LIJ It’s Not About the Simulator The 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-Work Simulation Debriefing Reflection

27 Advantages of Simulation
Kathleen Gallo Ph.D, MBA, RN, FAAN Senior Vice President Chief Learning Officer North Shore LIJ Advantages of Simulation Deliberate practice of high risk, low incident events Fosters the development of leadership, interpersonal skills and team behaviors Minute by minute video and audio recording for reflective debriefing sessions and immediate feedback Higher level of learning - Teamwork - Communication - Critical Thinking - Technical Skills

28 Interprofessional Education (IPE)
Kathleen Gallo Ph.D, MBA, RN, FAAN Senior Vice President Chief Learning Officer North Shore LIJ Interprofessional 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 healthcare Essential Elements: Collaboration Respectful communication Reflection Application of knowledge and skills Experience in interprofessional teams


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