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April 2019
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TD Magazine

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Close the Divide

Interprofessional education and a collaborative culture will help healthcare organizations achieve the Quadruple Aim.

If your healthcare organization is like many others, you'll probably answer yes to one or more of the following: Are you having issues with silos in your organization? Are power dynamics between professions and disciplines preventing safe delivery of care? Is bias toward skill set and knowledge preventing teamwork? Are you having difficulty consistently achieving your intended outcomes?

Too often in healthcare, the professional training and development for practitioners is the root of the dysfunctional teamwork. For example, doctors and nurses begin their academic careers separately, learning alongside their professional peers, thereby risking a myopic perspective of patient care. Throughout postgraduation and residency, they remain separated and, thus, are not equipped to work in high-functioning teams with a diverse peer group of varying professions and perspectives. This jarring reality slows down patient care delivery. The mistrust and misunderstandings that can arise risk patient safety and quality outcomes. And when these same physicians and nurses seek further professional development, it is too frequently delivered in a segregated-by-profession manner, perpetuating the divide.

Enter interprofessional practice and education (IPE) to bridge this gap. IPE creates a collective space between interprofessional education, interprofessional practice, and collaborative practice.

The what, why, and how of IPE

IPE began in 1969 as a patient-centric education methodology to purposefully foster mutual understanding between disciplines and professions. Whether on a small or large scale, IPE is a lever for healthcare organizations to use to break through the traditional disciplines and professional silos. As a pedagogical approach, IPE is perfect for preparing learners at all levels and disciplines to deliver patient care in a team environment. For example, healthcare organizations can address the power dynamics between nurses and physicians by fostering a collaborative learning experience, which creates trust in skill set and purpose. In such an environment, learners develop a rich understanding of the all-important shared goal: patient safety. That shared goal becomes the foundation of a team environment.

The best business case for IPE training is what happens outside the classroom; when accomplished correctly, it is an organizational change to the delivery of care. As John Maxwell writes, "teamwork makes the dreamwork"—and that is true especially with respect to patient safety, quality, and service. IPE cultivates camaraderie by acknowledging professional interdependency in a high-risk environment, one that demands consistency of outcomes; improves provider engagement, which in turn improves the patient experience; and results in a positive economic impact. Research conducted by the Institute of Medicine (now known as the National Academy of Medicine) demonstrates that IPE increases patient safety and experience outcomes, improves healthcare quality, and reduces cost. Further, IPE helps teams understand the other's role and communicate effectively with each other.

Recently, the Triple Aim framework—focusing on patient experience, improving population health, and ultimately reducing costs—expanded to the Quadruple Aim framework. The premise of the fourth aim is caring for the caregiver—basically, addressing the rapidly increasing occurrence of provider burnout. When you teach IPE, you teach providers what high-functioning and cohesive teams look and feel like. Creating such teams reduces burnout by improving work life, as Thomas Bodenheimer and Christine Sinsky explain in "From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider." When two or more professions partner with one another not just to learn about and from one another but also with each other, cohesive healthcare teams can be formed.

Because healthcare curriculums have only minimally begun to integrate IPE, healthcare organizations must begin to close that gap.

What does IPE look like?

The successful design of IPE begins with understanding the dynamics of a high-functioning team. To start, trainers or coaches bring together learners from two or more healthcare professions who work together in a collaborative learning environment. The talent development practitioner can lead teams through experiential learning and reflective interaction. These exercises should allow for the development of a shared common goal (such as a treatment option) that the team decides. Trainers or coaches help teams work through the process of making joint decisions about a patient's health issue while ensuring that all team members are supported as they take on a leadership role appropriate to their specific position.

With the correct audience, IPE training in healthcare can occur almost anywhere. Opportunities to partner academically include during clinical practice, formal and informal simulations, training workshops, and virtual experiences. To set expectations, IPE training should begin with orientation when a new employee joins the organization and then be reiterated during the beginning of a training program. It is most beneficial if it continues throughout an employee's healthcare career.

An advantage to IPE training is that it does not require an elaborate budget to be successful—but it does require time and commitment. One example of a low-budget training scenario is an informal simulation exercise. The simulation could be related to a specific task or communication skill, where two professionals must work together to achieve a common goal (for example, sedation for a bedside procedure or discharge planning).

Implementing IPE

The Interprofessional Education Collaborative has developed four competency domains for interprofessional collaborative practice:

  • values and ethics—relates to mutual respect and shared values, both within the interprofessional team and among patients and their families
  • roles and responsibilities—balance one another, thus allowing for the proficiency and skills of each to frame a successful team
  • interprofessional communication—supports the team approach to healthcare as it relates to communication with patients, their families, the communities in which they live, as well as with fellow healthcare professionals
  • teams and teamwork—aids in using the principles of team dynamics and the values within the team to effectively outline roles and deliver, according to the Interprofessional Education Collaborative, "safe, timely, efficient, effective and equitable" patient-centered care.

To implement IPE, key stakeholder support is essential. However, many stakeholders do not hold a strong belief of the benefit of providing such training. Key stakeholders' lack of perceived benefits can have a trickle-down effect, turning away potential learners. Additional barriers include the need for increased training of those delivering the IPE training, the lack of shared learning spaces, and scheduling conflicts. From an academic perspective, barriers may include challenges within course curriculums and campus geography—that is, the students' location.

The educators and learners ultimately drive the training program's success. With motivation and the determination for positive promotion of IPE's success, educators can support learners and provide them with the desired training. To do so, trainers can help learners see how training is applicable to daily practice—such as how better-functioning teams can provide a higher level of patient care or how collegial relationships improve work life. Coaches and trainers should provide learners with tools they can use immediately in their practice, such as role play to better handle challenging conversations during high-stress times.

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IPE at Christiana Care Health System

Once implemented, organizational structure, systems, and philosophy are critical to sustaining IPE. At Christiana Care Health System, a deeply rooted value system of love and excellence led to a new organizational structure to support learning and empower caregivers. The organization brought all education under one umbrella, the Institute for Learning, Leadership, and Development (iLEAD). The institute teaches all caregivers—inclusive of nurses, physicians, and advanced practice providers—safety, clinical, annual compliance, information technology, and leadership skills and knowledge.

For true IPE success—that is, to provide the best care for patients—the organizational restructure went beyond iLEAD. To elevate levels of collaboration between the learning and HR functions, Christiana Care created a chief people officer position. In this role, Dr. Neil Jasani provides oversight for iLEAD, HR, and medical affairs. Organizationally, this systems design supports the Quadruple Aim.

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Aim 1: Focus on patient experience. Christiana Care sought to make the patient experience better by first improving the caregiver experience. Thus, iLEAD launched two signature leadership development programs: Leading at Christiana Care and Diamond Experience. Both curriculums are based on providing an exceptional experience for all caregivers.

An interprofessional approach begins with faculty and continues to the invitees who are cross-functional, interprofessional, and nonhierarchical: chief officers, executives, vice presidents, directors, managers, and supervisors. Diamond Experience graduates rate this program with a Net Promoter Score of 78.4 percent, more than 30 percentage points higher than similar programs rated by Metrics That Matter.

Aim 2: Improve population health. iLEAD promotes population health by advocating for health literacy best practices across all disciplines and providing tools and support services to the entire continuum of care. For example, an interprofessional iLEAD team and Carelink CareNow are partnering with the Visiting Nurse Associations of America to provide educational resources for suppliers, expanding the interprofessional collaboration.

One such effort is a partnership with the state of Delaware, providing educational materials on the state's website to address the opioid crisis. Leveraging standardized patient education with a state-based health information network enables all caregivers to download and track documentation over the patient care continuum, which ensures that messaging is consistent and achieves the ultimate goal of patient safety. By crossing professional and disciplinary boundaries, the iLEAD team leverages education to support community health workers and those they serve.

Aim 3: Reduce costs. An integral part of iLEAD's interprofessional education portfolio is the Achieving Competency Today program, a national initiative of the Robert Wood Johnson Foundation. Nearly 30 interdisciplinary Christiana Care faculty members deliver this graduate-level course. Over its 12-week format, the curriculum achieves three objectives:

  • an intensive, action-based curriculum teaches learners about systems and practice improvement
  • interdisciplinary learning through collaboration on a performance improvement project design
  • connecting learners with the institution's executive leadership.

Working collaboratively with colleagues from other disciplines and professions is integral to the program's success. Interprofessional relationships are strengthened, resulting in a high-trust environment.

Aim 4: Care for the caregiver. iLEAD's Center for Provider Wellbeing offers an array of programs and information to help providers and their teams connect with the joy and meaning in their work. The goal is to mitigate sources of stress and burnout and help clinicians develop personal and professional resilience.

To see interprofessional teamwork expand beyond the walls of Christiana Care's John Ammon Medical Education Center, iLEAD chartered the Interprofessional Clinical Education Committee. Before the committee's establishment, the same care team would approach different educators to design educational solutions for clinical problems. Now, the committee minimizes duplicated efforts and accelerates solutions by bringing an interprofessional representation team for clinicians to discuss issues and seek solutions from multiple perspectives, thereby reaping holistic answers that the organization easily adopts systemwide.

To sustain IPE, Christiana Care also employed the Interprofessional Clinical Education Committee to serve the entire organization by providing one singular intake and consultative experience to close the interprofessional gaps in communication and education. The committee's value proposition was to develop a standardized process to streamline the creation and sharing of information across disciplines. Christiana Care attributes the committee's quick adoption and sustained success to ensuring all applicable stakeholders are represented in the decision-making process. The committee recommends solutions based on data collected around how widespread the current problem was, the number of providers affected, resources needed, and the harm that resulted.

Minimize power dynamics

IPE helps to dissolve professional and disciplinary silos in organizations. Through empathy-driven learning, healthcare organizations can mitigate power dynamics, therefore supporting safe delivery of care. The professional bias that is often evident relative to skill sets and knowledge dissipates, making way for professional appreciation of different perspectives and approaches. The resulting high-functioning teams deliver patient-centric safety, quality, and service in an environment of meaningful work that is supported by compassionate interactions between interprofessional team members.


Interprofessional Education Resources

European Interprofessional Practice and Education Network: Established in 2005, EIPEN was one of the first interprofessional networks. Its goals are to promote effective interprofessional education training in European higher education and improve collaborative practice in health and social care in Europe. www.eipen.eu

Interprofessional Education Collaborative: Established in 2009, IPEC promotes interprofessional collaborative practice to improve population health outcomes. www.ipecollaborative.org

National Center for Interprofessional Practice and Education: Its goal is to bridge the gap between health professions education and the U.S. healthcare delivery system. https://nexusipe.org

About the Author

Christina “Tina” Coidakis-Barss, PhD, MS, MEd, SSBB, CAPP, joined Christiana Care as vice president of strategic learning and development in iLEAD (the Institute for Learning, Leadership, and Development) in 2018. She oversees Christiana Care's strategic L&D needs and assists with designing and implementing solutions to improve organizational performance. She also leads the creation and delivery of effective educational and development programming that prepares employees to meet the company’s strategic goals.

Prior to Christiana Care, Coidakis-Barss was the corporate director of leadership and learning at Houston Methodist Hospital System. She was responsible for creating and directing leadership development and engagement strategies for more than 23,000 employees across eight hospitals. At Cleveland Clinic, she served in several roles over an eight-year period, most recently as associate director of its Samson Global Leadership Academy, overseeing interprofessional executive development programs for both internal and external learners.

Academically, she received master’s degrees in instructional design technology (American Intercontinental University) and strategic leadership (New England College), as well as her PhD in management and sustainable systems design (Case Western Reserve University, Weatherhead School of Management). Her background as a Lean Six Sigma Black Belt coupled with recent certification in applied positive psychology shape her holistic approach in coaching and mentoring.

About the Author

Angela Patchell, MSN, APRN, AGCNS-BC, RN-BC, CPAN, is the nursing professional development manager of systemwide nursing and unlicensed assistive personnel (UAP) orientation for Christiana Care Health System. Angela joined Christiana Care Health Systems in 2005 and served in various roles in the health system prior to her current role.

Angela received her associate of science in nursing from Cecil College, bachelor of science degree in exercise science from Towson University, and her master of science in nursing from Wesley College. She is an advanced practice nurse holding board certification as an adult-gerontology clinical nurse specialist and is certified in both nursing professional development and peri anesthesia nursing. In addition, Angela has earned bronze-level certification in Kirkpatrick Methodology and is currently pursuing her certification through Juran for Lean Six Sigma Green Belt.

In her current role, she is accountable for ensuring a successful onboarding program for new nurses and UAPs as well as promoting evidence-based practices, including incorporating Lean Six Sigma methodologies. Angela has experience in leading and developing interprofessional education for novice healthcare providers.

Angela’s nursing career has been dedicated to creating high-quality, reliable systems of care and producing professional development programs for the next generation of nurses and healthcare professionals to lead in these ever-changing times.

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Great article, Lets close the gap with IPE!
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