Old Wine in New Skins: Interprofessional Education for the Next Century

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Old Wine in New Skins Interprofessional
Education for the Next Century

• Pamela H. Mitchell and the Health Sciences
  Partnerships in Interdisciplinary Clinical
  Education (HSPICE)
• University of Washington, Seattle

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Interprofessional Education for the New Century

• Why interprofessional education?
• Why now - is there a new imperative?
• How have we approached it for the new century?
• How has it gone - will it last to the next?

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Impetus for Interdisciplinary Teams

• 1970s 80s - Coordinated care for specific
  populations
• 1990s
• Increased access for underserved
• Economic incentives to reduce cost
• Complexity of interventions

• 1990s - Managed care
• 2000s
• Quality
• Safety
• Partners
• New rules

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Crossing the Quality Chasm A New Health System

• New Rules
• Care based on continuous health relations
• make two column with rules
• single with press release statement

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Isolated Learning Among the Professions

• One important byproducthas been the education
  of thousands of health care workers
  approachesfor applying the scientific method to
  daily work. Blumenthal Kilo, 1998, p. 633

• Change in health professions education is a core
  part of any improvement effort Gelmon et al
  2000, p. 132-133
• Absence of rigorous research testing the
  effectiveness of interprofessional education,
  Barr et al, 1999

.
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Interprofessional Education for the 21st Century

• GOMPE - Group on Multiprofessional Education
  (AAHC)
• Interdisciplinary Professional Education
  Collaborative (IHI)
• Community-Based Quality Improvement in Education
  of Health Professionals (HRSA, BHPr)
• UK - Centre for Advancement of Interprofessional
  Education

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What do we still need to know?

• Impact of interprofessional education
• Student competencies in collaborative practice
• Subsequent interprofessional practice

• Impact of interprofessional education on patients
  
• Quality of care
• Cost and ease of access
• Overall satisfaction

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System Dimensions Underlying Quality Improvement
Strategic
Technical
Cultural
Structural
Shortell et al, 1996 Shortell, Bennett Byck,
1998
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Difficulty in balancing an integrated approach

• Strategic important issues for the
  system/provider
• Structural - system organizational structure
  supports quality initiatives in clinical
  environments

• Cultural - underlying beliefs, norms behavior
  -supports or inhibits clinician behavioral change
• Technical - participants have necessary training
  and skill

Shortell et al 1996
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Core Competencies

• Competent in practice discipline
• Understand respect others approach
• Context complexity of population health
• Basic group skills

• Linkages for integrated service
• Experience working on common problems

Mitchell Crittenden, 2000
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Core lessons applicable to clinical improvement

• Systems knowledge is more efficiently learned in
  the context of real work
• Outcomes of care useful information to learn
  about the beneficiaries of care
• Experience of collaboration with others is a
  learning tool in itself.

Cleghorn Baker, 2000, Journal of
Interprofessional Care 14(2)
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Building healthcare quality

• If the future were easy, it would be here by now

Harold I. Goldberg, Frontiers in Health Services
Management, 15(1), 1998
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Partnerships Health Sciences Interdisciplinary
Clinical Education

• Funded by the University Initiatives Fund of the
  University of Washington
• 1997-2001

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Health Science Partnerships in Interdisciplinary
Clinical Education (hSPICE)
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Aim of the Project

• Develop, implement, and sustain
• Interdisciplinary model for clinical education
• Six Health Science schools
• Two Library and Information Science units

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Goals of this Presentation

• Describe a clinical education partnership
• Define the evaluation parameters
• Identify components relevant to your own health
  care educational system

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Lasting Impact requires balance of the elements

• Without strategic plan nothing important happens
• Without structural support, quality changes stays
  in one place

• Without cultural support and change, there are
  only small, local, temporary effects
• Without adequate knowledge skill, nothing gets
  off the ground

Shortell,Bennett Byck 1998
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Core Values and Strategies

• Menu of opportunities
• Technological innovations and linkages
• Evaluative strategies
• Building on existing unit and university
  strengths rather than duplicating
• Evolutionary rather than revolutionary

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Current Initiatives

• Respect roles approaches to clinical, social
  problems
• Understand context for population-based care
• Improve group process skills

• Core competencies

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Current Initiatives (cont...)

• Seminars
• Pre-professional (freshman)
• Health Science Students (classroom-based)
• Health Science students (clinically based)

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Current Initiatives (cont....)

• Communication Strategies
• World Wide Web site
• Convocation for incoming health sciences students
• Training manuals

http//healthlinks.washington.edu/courses/hspice
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Center for Health Sciences Interprofessional
Education

• The Center brings together essential partners
• Health care providers
• Faculty
• Students
• Patients in their communities
• Together they can improve the quality of life and
  health for individuals and populations

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Center Goals

• Foster curriculum innovations across the health
  sciences and information science schools
• Provide infrastructure for accountability in
  interdisciplinary health professions
  certificates, new training initiatives, and
  faculty development
• Foster evaluative research... impact of health
  professions interdisciplinary educational
  innovations on students, providers, faculty and
  health of the public.

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Current Initiatives (cont..)

• Partnerships
• Institutions
• Community service agencies
• Academic Units

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Evaluation Parameters Impact

• Student and faculty evaluations
• 350 students faculty involved
• Faculty report renewed energy
• Students rate offerings highly
• Organizational impact
• Increased value for interdisciplinary work
• Positioned for major influence on curricular
  revisions
• Population-health - Community partnerships
  interested in duplicating model regionally

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Impact

• 350 students faculty involved
• Faculty report renewed energy
• Students rate offerings highly
• Increased value for interdisciplinary work
• Positioned for major influence on curricular
  revisions
• Community partnerships interested in duplicating
  model regionally

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Future Directions

• Incorporate all health science students into
  selected medical student courses
• Further integration into each of the health
  science schools curriculum
• Develop Center for Interdisciplinary Education
  and Research

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Relevance to Others

• No care is provided in unidisciplinary manner
  anywhere
• Barriers to interdisciplinary communication
  coming down
• Strong disciplinary leaders can make it happen

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HSPICE Steering Team

• Dentistry Tom Morton
• HS Library/ Library Science Sherrilynne Fuller,
  Debra Ketchell, Ellen Howard
• Medicine Ruth Ballweg, Bob Crittenden, Gino
  Gianola, Dan Hunt, Dick Root, Doug Schaad, Lynn
  Robins, Deb Kartin (PT)
• Pharmacy Gail Anderson, Peggy Odegard

• Nursing Basia Belza, Rebecca Kang, Deb Ward
• Public Health Ann Marie Kimball, Tanis Mihulyak
  (nutriton)
• Social Work Gunnar Almgren, UWMC
• Program Coordinator Bertine Easterling