1/7/2015 Alliance QIE Webinar What Continuing Educators Need to Know About IPE January 7, 2015 __________________________________ With QIE Initiative support from Webinar Participation “how to” • Collapse and expand your Panel • Select your preferred audio mode • Submit text questions • Raise your hand BROUGHT TO YOU BY: 1 1/7/2015 Webinar Presenter Christine Arenson, MD Co-Director, Jefferson Center for InterProfessional Education Professor and Interim Chair Department of Family & Community Medicine Thomas Jefferson University Agenda • • • • • What is IPE and what is NOT IPE? Why is IPE important? How is Jefferson incorporating IPE? How should IPE be continued into CPD? Question & Answer What is the biggest difference between a sports team and a healthcare team? 2 1/7/2015 Practice!! Definition of Interprofessional Education When students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes World Health Organization, 2010 Definition of Interprofessional Practice Multiple health workers from different backgrounds work together with patients, families, carers and communities to deliver the highest quality of care World Health Organization, 2010 3 1/7/2015 What is NOT IPE? • An educator from one profession telling other health professionals how to do their work • Various professionals sitting in the same conference room listening to lectures delivered by educators from one or more professions • Self-study of materials prepared by one or more professions What IS IPE? • Learning about, from, and with each other • IPE requires interaction among various members of the healthcare team to share perspectives, challenges, and opportunities to improve team performance • Ideally, IPE will include the voice of the patient or healthcare consumer Education for the Health Team • “A major deterrent to fashion health care that is efficient, effective, comprehensive, and personalized is our lack of design for the synergistic interrelationship of all who contribute to the patient’s well-being.” • “We face a national challenge… the development of educational programs aimed at preparing future professionals for interprofessional collaboration.” Pellegrino, Institute of Medicine, 1972 4 1/7/2015 To Err Is Human: Building a Safer Health System Recommended interdisciplinary team training to increase patient safety and quality health care Institute of Medicine, 1999 Crossing the Quality Chasm All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, Institute of Medicine, 2001 and informatics. IOM Core Competencies • • • • • Provide patient-centered care Work in interprofessional teams Employ evidence-based practice Apply quality improvement Effective use of health information technology 5 1/7/2015 Health Professions Education: A Bridge to Quality Once in practice, health professionals are asked to work in interdisciplinary teams, often to support those with chronic conditions, yet they are not educated together or trained in team-based skills. Institute of Medicine, 2003 Wagner’s Chronic Care Model (1998) Wagner EH. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effect Clin Pract;1:2-4. IOM Report on Continuing Education for the Health Professions Warden, et. al. 12/4/2009 6 1/7/2015 IOM Conclusions about CE • Purpose of CE is to enable health professionals to keep their knowledge and skills up to date, with the ultimate goal of improving performance and patient outcomes • CE should be interprofessional and include a broad variety of professionals (e.g. dentists, dieticians, nurses, speech-language pathologists) IOM Recommendations • In CPD, learning opportunities – Stretch from the classroom to the point of care – Shift control of learning to individual practitioners – Adapt to individuals’ learning needs • CPD system offers promise to: – – – – Advance evidence-based, interprofessional, team-based learning Engender coordination and collaboration among the professions Provide higher quality for a given amount of resources Lead to improvements in patient health and safety Reasons for IPE in CPD • • • • • Access Patient safety Healthy workplaces Quality Better patient care - better outcomes 7 1/7/2015 “A team of experts does not make an expert team” Salas et al. Toward understanding of team performance and training. In Swezey, Salas, eds. Teams: Their training and performance. Norwood, NJ Ablex, 1992:3-29. Barriers to Interprofessional Practice • Organizational Structures/Culture • Power Imbalances – Formal & Informal “Turf Wars” • Role Socialization – How discipline transfer behaviors & attitudes Contributors to Power Imbalance • Unaware of the conceptual basis for practice of other disciplines • Poor communication among members of different disciplines • Chauvinistic attitudes; distrust; and lack of confidence in other disciplines • Few professionals are knowledgeable about the educational preparation, scope of practice, expertise, responsibilities, and competencies of other disciplines Orchard CA, Curran V, Kabene S. (2005). Creating a culture of interdisciplinary collaborative professional practice. Med Educ Online [serial online];10:11. 8 1/7/2015 IPE Competencies Around the Globe World Health Organization, March 2010 WHO Collaborative Practice Learning Domains • • • • • Teamwork Roles and responsibilities Communication Learning and critical reflection Relationships with and recognizing the needs of the patient • Ethical practice 9 1/7/2015 CIHC, 2010 U.S. Competencies: Overarching Goals 1. To guide the professional socialization of future health professionals in delivering interprofessional collaborative care that is timely and consistent in quality. 2. To encourage widespread implementation in health professions education and practice including identification of critical opportunities and challenges. 10 1/7/2015 IPE AT JEFFERSON Thomas Jefferson University IPE Core Competencies Values/Ethics: Respect the unique cultures, values, roles/responsibilities and expertise of other health professionals. Roles/Responsibilities: Explain the roles and responsibilities of other health/healthcare providers and how the team works together to provide care. Interprofessional Communication: Work to ensure common understanding of information, treatment, and health/healthcare decisions by listening actively, communicating effectively, encouraging ideas and opinions of other team members and expressing one’s knowledge and opinions with confidence, clarity and respect. Team and Teamwork: Reflect on the attributes of highly functioning teams and demonstrate the responsibilities and practices of effective team member(s). Adapted from IPEC Core Competencies for Collaborative Practice , 2011 11 1/7/2015 Communication Tool: SBAR • Easy, fun, and effective classroom/ small group learning activity • Students or professionals from different backgrounds role play a series of cases, using SBAR • They learn the tool, and learn a lot about the perspectives, biases, perceptions that different groups have about each other • They also learn that we don’t all use the same language to mean the same things Example • Situation: The receptionist just called to tell me Mrs. Jones is at her desk and is very short of breath. • Background: Mrs. Jones is a 67yo patient of Dr. Smith who has a history of severe COPD. She was discharged from the hospital 2 days ago. She says she wasn’t able to fill her prescriptions since she got home. • Assessment: We need to see her right away. • Recommendation: Can you bring her to an exam room while I set up a nebulizer? Simulated Emergency • Patient suffers a code while being scanned in MRI • Patient has status epilepticus while in the physical therapy gym • Provides an opportunity for a variety of health professionals to practice team skills and learn with, from, and about each other at the same time 12 1/7/2015 CLINICAL PRACTICE TEAMS 13 1/7/2015 ABCDE Bundle in the ICU • Implementing a new evidence-based care protocol involving early mobility of intubated patients in the ICU • Staff “buy-in” to the evidence but have many concerns about the practical logistics of implementation • Early roll-out resulted in many patients not receiving the full bundle of services TeamSTEPPS Training • Core concepts: impact of improved communication on safety and patient outcomes • CUS (I am Concerned; I am Uncomfortable; this is a Safety issue) • 2 Challenge Rule – it is everyone’s responsibility to speak up assertively if they perceive a safety issues; others on the team must acknowledge the concern TeamSTEPPS, http:/teamstepps.ahrq.gov How did it work? • Brief didactic session • Participants generated a list of barriers to implementation of the ABCDE bundle • Volunteers role-played a typical scenario • Group debriefed what went well and what could go better; brainstormed how to use the new tools taught • Group brainstormed solutions to the perceived barriers, and brought these forward to management 14 1/7/2015 INTERPROFESSIONAL CLINICAL ROUNDING Opportunities • Inpatient – Clinical Rounding, i.e. Colorectal Service – Rehab Team Conference – Rehab Dispo Dilemmas – OB Board Rounds – OB/Peds Discharge Planning Meetings – Pharmacy/Nursing assessment and education • Outpatient – Ambulatory Teaching Practice Goal of Interprofessional Clinical Team Rounds Provide a real-time, collaborative practice learning experience for health professionals, residents, and students 15 1/7/2015 Example: Colorectal Service Clinical Rounding • Professionals: medicine, nursing, pharmacy • Surgery residents and colorectal surgery fellows • Students: 3rd/4th year medicine, junior/senior level BSN-nursing and 4th year pharmacy • Formal IPE rounds occur once/ week • Enhanced team communication, early “catches” of post-op concerns, improved use of consultation (i.e. wound care, pharmacy) Real-time Simulated Emergencies • Obstetrical team identified opportunity to train for emergencies • Use of “in situ” simulation on the clinical floor • Occur regularly (every 6-8 weeks) but without notice • Allow teams to practice and have identified opportunities to improve patient safety Tools for Successful IPE • Interactive learning techniques • Educate practicing teams together • Meaningful evaluation strategies 16 1/7/2015 Interactive Learning Techniques • Role-playing – i.e. SBAR scenarios • Clinical simulation – With or without standardized patients and/or standardized colleagues – High fidelity simulation, i.e. for surgical teams – “in situ” simulation in live practice settings Finding Opportunities for Practicing Teams to Learn Together • Challenging to pull teams out of clinical work for “team CE” • Benefits are clear – healthcare is likely the only industry that does NOT routinely have teams practice together • Major change from the tradition of the “CME Conference” Finding Opportunities • We use our students as catalysts – i.e. clinical rounding started for students, but the entire team is engaged • Quality improvement projects are natural opportunities • In situ simulation, TeamSTEPPS training 17 1/7/2015 Justifying Teams Training Together • Identify outcomes that matter and document impact – i.e. improved Patient Satisfaction or Quality metrics – Improved performance on clinical bundles, readmissions, etc. • Monitor impact on “Culture of Safety” and staff/ physician satisfaction and retention – not traditional CE outcomes, but critical Meaningful Evaluation • Use existing metrics when possible! – Press Ganey surveys – GPRO, other quality metrics • Give participants concrete behavioral anchors to measure team-work effectiveness • Adopt available validated tools Jefferson Team Observation Guide Yes No Not Observed Are questions asked to more than one person? Do people appear to pay attention to one another? Are ideas supported by other members? Do people add other, supporting, pieces of information regarding the patient? Does anyone hang back from the group? Are all those who are in involved in the case involved in the discussion? 18 1/7/2015 Existing Tools • AHRQ TeamSTEPPS evaluation tools • Team Clinical Simulation tools – University of Washington – Western University • Maintenance of Certification tools for physicians Resources • National Coordinating Center for Interprofessional Practice and Education, https://nexusipe.org/ • MedEdPortal IPE Collection, https://www.mededportal.org/ipe/ • Jefferson Center for InterProfessional Education (JCIPE), http://www.jefferson.edu/university/interprofessiona l_education.html Questions & Answers 19 1/7/2015 More On Interprofessional Education (IPE) Attend These Sessions—2015 Annual Conference Wednesday, January 14, 2015 • 4:15 PM - 5:15 PM – Interprofessional Education (IPE) Special Interest Group (SIG)Room: Texas Ballroom C Thursday, January 15, 2015 • 4:00 PM - 5:00 PM – Beyond Shared Content: What Does Interprofessional Education Imply and Require? Friday, January 16, 2015 • 1:45 PM - 2:45 PM – A Collaborative and Interprofessional Approach to QI Education on Rheumatoid Arthritis • 1:45 PM - 2:45 PM – You Say 'Tomato,' I Say 'Tomato': When 2 Accreditors Collaborate on Interprofessional EducationRoom: Grapevine Ballroom A www.ACEhpAnnual.org 20