mary wakefield, ph.d., r.n., faan assoc. dean for rural health & director health workforce...

Mary Wakefield, Ph.D., R.N., FAAN Assoc. Dean for Rural Health & Director

Health WorkforceAcademyHealth Annual Research Meeting

June 2, 2007

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IOM Vision for a

Reformed System – including the health

care workforce

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Professions EducationQuality Chasm Recommendation #12 A multidisciplinary summit of leaders within the health professions should be held to discuss and develop strategies to:

• restructure clinical education at all levels

• assess the implications of change for credentialing programs

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RCH 5 Forces Affecting

Health Professions Education

1) Shift from acute care to chronic care.

2) Need to manage a continually expanding knowledge base and technological innovation:

• information technology

• biomedical advances

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Forces Affecting Health Professions Education

(continued)3) More clinical practice in teams and

complex delivery arrangements.4) Changing patient-provider

relationship - more empowered consumers.

5) Health personnel shortages and discontent; squeeze on costs.

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RCHFive Core Competencies

Across Professions

•Goal is to achieve broad consensus across all the health professions.

•Core but not exhaustive set.

•Application will differ across disciplines.

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RCH Reform education so

that:All health professionals are educated to deliver

patient-centered care as members of an interdisciplinary team, emphasizing evidence-based

practice, quality improvement approaches, and informatics.

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1.) Patient Centered Care• Share power and responsibility

with patients and family members.

• Communicate with patients in a shared, open manner.

• Allow for patient individuality and values.

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Teams• Learn about team members’

expertise.

• Define roles and processes.

• Demonstrate group skills, including conflict resolution.

• Coordinate and integrate care across clinicians and settings.

• Customize care.

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Public Views about Effective Actions to Improve Care Quality

22 27 26 34

92 90 88 81

0

20

40

60

80

100

120

140

Computerizedmedical records

Doctors andnurses working asa team/expandedrole for nurses

Receivingreminders for

preventive care

Doctors practicingin groups rather

than on their ownsomewhat effective

very effective

(Commonwealth Fund, 2006)

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Practice•Formulate clear clinical questions.

•Know where/how to find best evidence.

•Determine where/how to integrate evidence into practice.

•Consider patient values.

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RCH4.) Quality Improvement

• Assess and measure the quality of care Individual, team and organization

levels.

• Design and test interventions to improve care processes: Compare to best practices Identify errors and hazards

• Continually measure.

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5.) Informatics

•Manage knowledge and information

•Make decisions

•Communicate

•Reduce errors

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RCH Current IOM

Concerns/EffortsProblem Indicators:

• Supply/Demand mismatch.

• Wide geographic variation in use of healthcare workers.

• Wide disparities in access to appropriate services.

• Inefficient use of current health workers.

• Workforce members without knowledge, skills to address individuals health care needs.

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Interprofessional Health Care Education (IPHC):

An example from the University of An example from the University of North DakotaNorth Dakota

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• “the process by which a group of students from the health related occupations with different educational backgrounds learn

together during certain periods of education, with interaction as an important

goal, to collaborate in providing pro-motive, preventive, curative, rehabilitative,

and other health related services.”

World Health Organization, 1988

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Why Interprofessional Health Care?

• Complexity of illness.

• Poor communication.

• Breakdown barriers between professions.

• Disparity between work environment and education.

• Quality health care.

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Task Force Observations

• Many topics are important to all health care professions.

• Learning with other health care team members to prepare individuals who ultimately must practice in teams.

• Patients should benefit from improved effectiveness of care rendered by individuals better prepared to function as team members.

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Task Force Goal

Explore new opportunities to strengthen interdisciplinary education in order

to better prepare health care professionals for

interdisciplinary practice.

Such educational opportunities should improve the ability of

graduates to meet patient needs through team practice.

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IPHC Course ObjectivesAfter completing this course the student will:1. Demonstrate group process skills for effective

interaction and gain an understanding of the contribution of one’s own discipline to the team.

2. Demonstrate team decision making using clinical cases.

3. Demonstrate team member characteristics essential to team effectiveness.

4. Articulate one’s professional contributions as a team member.

5. Describe the role of other health professionals and their contributions to the team.

6. Demonstrate a shared patient-centered approach to health care delivery.

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Student Levels• Physical Therapy 2nd year• Nutrition and Dietetics 2nd year• Occupational Therapy (2nd year)• Nursing Senior 1st semester• Medicine 2nd year

• Social Work Senior and 1st or 2nd year graduate students

• Communication Science SeniorDisorders

• Physician Assistants Senior• Clinical Lab Sciences Graduate students

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Sample Stereotypes• Nurses don’t know anything – are lazy - don’t

do anything.• Doctors are in it for the money.• Doctors are arrogant.• Sexy “porn nurse.”• Nurses just follow orders - don’t have

judgment.• He’s a doctor-he’s going to have a huge

house, he’s special – not a real person.• PT students do massages – chiropractors

have more education that PT’s.

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Case Process

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• Who are the primary healthcare professionals directly involved in Ms. Olson’s care during her ACUTE/ER phase of care? What do we know about the roles/training of each?

• Which healthcare professional would be the “leader” of the team at this point? WHY?

• What is the organizational structure of the ER?

• What can facilitate or impair communication in the ER? How might this impact Ms. Olson’s care?

• What types of error might occur?

• What contributes to poor patient outcomes and error?

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Faculty Learning ObjectivesMs. Olson

1. Describe the educational training role and contribution of each healthcare team member involved in this case. Be inclusive of disciplines not at the table.

2. Identify the best team work practices for ER, in-patient and out-patient. Give supportive evidence.

3. Describe the major sources of error in healthcare delivery. Identify risks for error, preventive measures and barriers.

4. Apply communication systems from other non-healthcare disciplines to the interdisciplinary healthcare team. What can be learned? Explain rationale (example aviation crew resource management.)

Faculty Learning Objectives (Cont.)

5. What is HIPAA? Describe the key elements of HIPAA and how it impacts the teams’ ability to provide quality care for Ms. Olson.

6. Identify issues of ethnic, cultural and linguistic diversity that impact delivery of services by health care team. Describe how these variables impacted the management of this specific case.

7. Define what is meant by a patient-centered approach to care. Provide supportive evidence. How is patient-centered care achieved by a healthcare team?

8. What are the barriers to an ideal healthcare team? How could you be involved in system change for the future?

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For more information contact:

Center for Rural HealthUniversity of North Dakota

School of Medicine and Health SciencesGrand Forks, ND 58202-9037

Tel: (701) 777-3848

Fax: (701) 777-6779

http://medicine.nodak.edu/crh