new models of care require new models of learning · 2016-05-25 · new models of care require new...
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Accountable GME Linking GME to High-Value Health Care,
University of Michigan, Ann Arbor
Macy Regional Conferences on Innovations in GME
May 24, 2016
New Models of Care Require New Models of Learning
Barbara F. Brandt, PhD, Director
Associate Vice President for Education
Significant redesign thinking and realignment of the relationship between
United States health care practice and education around interprofessional
teamwork
Renewed interest in a fifty-year old field: Interprofessional education and
collaborative practice
Need for new models of learning: Implications for GME and post-graduate
education
Themes
We believe high-functioning teams can improve the experience,
outcomes and costs of health care.
National Center for Interprofessional Practice and Education is
studying and advancing the way stakeholders in health work and
learn together.National Center Funders
• Health Resources and Services Administration
• Robert Wood Johnson Foundation
• Josiah Macy Jr. Foundation
• Gordon and Betty Moore Foundation
• John A. Hartford Foundation
National Center Vision3
A coordinating center for interprofessional
education and collaborative practice will provide
leadership, scholarship, evidence,
coordination and national visibility to advance
interprofessional education and collaborative
practice as a viable and efficient health care
delivery model.
“unbiased, neutral convener”
June 2012 HRSA Funding Opportunity Announcement4
What is Interprofessional Education?
Why is IPE important today?
Stop and Think5
Interprofessional education “occurs when two or more professions
learn with, about, and from each other to enable effective
collaboration and improve health outcomes.”
Interprofessional, collaborative practice “occurs when multiple
health workers, students and residents from different professional
backgrounds provide comprehensive health services by working with
patients, their families, carers (caregivers), and communities to
deliver the highest quality of care across settings.”
Interprofessional education and collaborative practice:
The New “IPE” = Interprofessional Practice and Education
Adapted from: The Centre for the Advancement of Interprofessional Education, UK, 1987World Health Organization, Framework for Action on Interprofessional Education and Collaborative Practice, 2010.
• Different professions
• With, about and from
• Enable effective collaboration
• Improve health outcomes
Key Words
Triple Aim of Alignment• Improving 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
The Big Idea: The Nexus - Our Vision for Health8
Goal:
Provide patients with more comprehensive, accessible, coordinated and high quality care at lower costs
Greater emphasis on primary, preventive and “upstream” care
Care is integrated between:
– primary care, medical sub-specialties, home health agencies and nursing homes
– health care system and community-based social services
– Accountable health communities
Electronic health records used to monitor patient and population health—increased use of data for risk-stratification and hot spotting
Interventions focused at both patient- and population-level
Move toward “risk-based” and “value-based” payment models
What is going on in the United States?
Practice Game Changers – addressing inefficiencies, cost, errors
Interprofessional Education and Collaborative Practice:
Welcome to the Acceleration of the “New” Fifty Year Old Field
1972
1977
1987
1999
2001
2003 Competency Domains1. Values/Ethics 2. Roles/Responsibilities3. Interprofessional
Communication4. Teams and Teamwork
Today
2011
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The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration
Cooperative Agreement Award No. UE5HP25067. © 2013 Regents of the University of Minnesota, All Rights Reserved.
Principles:
Incentives to motivate higher value care
Alternative payment models
Greater teamwork and integration
More effective coordination of providers across settings
Greater attention to population health
Harness the power of information to improve care for patients
What will be the impact on workforce of HHS Secretary Burwell’s
announcement on value-based payment goals?
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Big Picture: Reframing, retooling and retraining
Low status of primary care
Specialization & sub-specialization
Nurse practitioners, Physicians Assistants, Clinical Pharmacists
Little interest in health care processes
Little evidence for teamwork
Redesign around primary care, prevention, population health
Impact of moving from fee-for-service to global payments?
The right worker partnering with patients, families and communities. How not the who
Quality & systems improvement leading to outcomes
Growing evidence for teamwork
1970 Barriers Today
Put patients first
Demonstrate leadership commitment
Create a level playing field
Cultivate team communication
Explore the use of organizational
structure
Train differrent disciplines together
Available at: Nexusipe.org
RWJF: Lesson Learned From the Field
Promising Interprofessional Collaborative Practices
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Re-enter
Interprofessional Practice and Education
New Models of Care Require New Models of Learning14
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The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration
Cooperative Agreement Award No. UE5HP25067. © 2013 Regents of the University of Minnesota, All Rights Reserved.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 and the University of Minnesota.
© 2015 Regents of the University of Minnesota, All Rights Reserved
How do we improve the
patient experience of care,
improve the health of
populations, and reduce the
per capita cost of health
care simultaneously?
New Models of Care Require New Models of Learning:
Reframing, retooling and retrainingPatients, 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?$100K
How do we prepare the
next generation of health
professionals for a
transformed health care
system while improving
experience and decreasing
costs?
$100K
What is the evidence that Interprofessional Education
makes a difference?
An Interprofessional Learning Continuum Model
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FoundationalEducation
Graduate Education
Continuing Professional
Development
Reaction Attitudes/perceptions
Knowledge/skillsCollaborative behavior
Performance in practice
Interprofessional Education Tomorrow
Learning Outcomes
Learning Continuum(Formal and Informal)
Interprofessional Education Today
• The majority of IPE efforts today occur
early in the learning continuum
(Foundational Education) resulting in
lower level learning outcomes (reaction,
attitudes/perceptions and
knowledge/skills).
• The greatest opportunity for
collaborative practice is when
students/trainees are working together
in clinical practice, where relationships
are formed and interdependence is
readily evident.
• If the ultimate goal of IPE is to improve
health and system outcomes, education
& training for interprofessional
collaboration should increase across
the learning continuum.
• At best, there is only a weak connection
between formal classroom-based IPE
and improved health or systems
outcomes. 18
Learning occurs through and is a central part of everyday work in practice.
All members in the practice environment are learners.
Learning is intentional and is guided by the practice needs rather than a university curriculum.
Change in perception and meaning, based upon the practice environment.
Reintroducing the concept of “Workplace Learning”
Different professions and disciplines do not see the world the same way –
and that is good!
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5/24/2016
Who and how to teach IPE
Quality of facilitating IPE: critical to success
– Ensure IP learning environments – conducive and non-threatening
– Maximizing collaborative learning experiences
– Climate of safety and confidence
– Setting realistic goals, motivating learners, managing expectations,
assuring equal participation, minimizing friction
Intentionally develop facilitators
Pragmatic implications: Presage FactorsReeves et. Al. 2005, 2016
Strategies using adult learning theory, focused on how adults learn
Interactive and learning in interprofessional groups
Collaborative learning
Facilitated learning – roles for mentors
Reflective learning
Ideally, problem focused and related to collaborative practice
– Using simulations
– Experiential learning in practice
The IPE Process
Teaching/learning Principles of IPE
DS: Dental Student
Med Student: Medical students. Includes students from 7700, 7701, and 7511
Doctor of Nursing Practice (DNP): Includes those specializing in Psychiatry,
Pediatrics, Family Practice, and Midwifery
Academic Tourism:
Types and Duration of Educational Experiences
• integrate clinical / community 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 interprofessional team in meaningful ways,
• create a shared resource model to achieve goals, and
• encourage leadership in all aspect of the partnership.
Elements of the Nexus:
Aligning IPE with Transforming Health Care
• Growing research networks
(NIN, NEPQR)
• Links practice and education
• Comparative effectiveness
research
• National Center Data
Repository
• National Center
implementation support
• Actionable measurement
Nexus Innovations Network, HRSA NEPQR, and
the National Center Data Repository
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Rigorous Interventional Research Approach Example:
University of Kansas Medical Center
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Popular resources: nexusipe.org29
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LEARN MORE ABOUT THE SUMMIT AT:
nexusipe.org/nexussummit/2016
Attend the summit to participate in:
• Conversation Café: an opportunity to share work and describe key
results while exploring key issues surrounding IPE
• Nexus Fair: an interactive and energizing networking and learning
environment
• Skills-based on faculty development, design thinking and assessing team
performance
• Plenary Session: featuring visions of the future from change-making IPE
leaders
• And much more!
Points to Ponder
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nexusipe.org