the nuts and bolts of activity planning...#jaleadership2019 the nuts and bolts of activity planning...

#JALeadership2019

The Nuts and Bolts of Activity

Planning

DEBORAH WITT SHERMAN, PhD, ARNP, ACHPN, FAAN

KATHY CHAPPELL, PhD, RN, FNAP, FAAN

Interprofessional Collaboration in

Health CareDeborah Witt Sherman, PhD, ARNP, ANP-BC, ACHPN, FAAN

Soros Foundation, Project on Death in America Faculty Scholar

Professor of Nursing

Florida International University and

Tenshi College, Sapporo, Japan

D. Sherman’s Experience with Interprofessional Collaboration

➢ Aaron Diamond Post-doctoral AIDS Research Fellowship with colleagues from Health Psychology at CUNY, NY➢ Soros Foundation Project on Death in America Faculty Scholar to begin Palliative Care in the US➢ Co-Director of one of the first Palliative Care Interprofessional Fellowship Programs at the Bronx, VA, NY➢ Developed a blueprint for a Palliative Care Interprofessional Institute- education, research and clinical

practice at University of Maryland➢ Leading role in developing an interprofessional palliative care course at University of Maryland➢ Member of an interprofessional palliative care team: Mt Sinai Medical Center, NY, University of Maryland➢ Developed research proposal to study interprofessional collaboration using simulation at Florida

International University➢ Developed an Interprofessional Strategic Plan for the Nicole Wertheim College of Nursing and Health

Sciences➢ Chair of the Interprofessional Committee of the Faculty Senate at Florida International University➢ Interprofessional Research ➢ Interprofessional teaching at Tenshi College, Japan➢ Numerous publications regarding interprofessional collaboration➢ Lead a systematic review of the structure, process and outcomes of interprofessional collaboration in health

care education and clinical practice

Differences in Concepts❖Multidisciplinary- team role specialized and professionals

concentrate on their own task

❖Interdisciplinary- limits the concept of knowledge ascribed to a discipline

❖Interprofessional—roles are specialized but everyone is expected to interact

❖Interprofessional collaboration—interaction among professionals who may bring their own discipline specific knowledge, but additionally offer their own unique experiences, values, educational background and roles to the interprofessional process

❖Teamwork—a dynamic process involving at least two health professionals with a common goal, including assessment, planning, implementing and evaluating health care

❖Transdisciplinary-- roles are specialized but everyone is prepared to replace each other when needed

Institute of Medicine Challenges for Interprofessional Collaboration

• Redesign health care education

• Retrain health professionals already in the workforce

• Redesign the health care system

We will do so with new skills and ways of relating to each other as health care professionals, as well as with

our patients, families, and communities.

Need for Interprofessional Collaboration

• Preventable morbidity and mortality

• Inadequacies in costly and fragmented systems of care

• Lack of patient-centered care

• Need for professionals to practice to the full extent of their education and training

• Need to retrain the current workforce with interprofessional skills

• Group accountability for quality health care

• Enhanced integration and communication of health care services

• Appreciation for a sense of interdependence rather than independence among health care providers

Triple Aim of Interprofessional Collaboration

• Improve the experience of healthcare

• Improve the health of populations

• Reduce the cost of health care

Interprofessional CollaborationFlips Negatives to Positives

• Inconsistent messaging

• Episodic care

• One size approach

• Payment based on quantity

• Illness focused

• Consistent messaging

• Consistent care

• Individualizes care

• Payment based on quality

• Prevention focused

Stakeholders

• Individuals

• Individual professions

• Communities and populations

• Academic centers

• Health care centers

• Accrediting bodies/agencies

• Policy makers

• Informaticists

• Economists

• Researchers

Definition of Interprofessional Education

• “Collaborative work supported by teaching and learning strategies that improves the quality of care offered by two or more health professionals” (Park, 2014).

The Team Leader• Leadership of the team is by the best qualified to address the

issue

• Keeps the team focused on purpose, goals and approach

• Builds commitment and confidence

• Insures the appropriate skill mix of team members

• Removes obstacles

• Manages external relations

• Creates opportunities

• Does real work

• THE MOST EFFECTIVE TEAM HAVE

5 TO 10 MEMBERS

Team Processes

➢Forming

➢Storming

➢Norming

➢Performing

Core Competencies for Interprofessional Collaboration

• Shared values and ethics

• Communication

• Team based practices

• Climate of mutual respect

• Knowledge of one’s own roles and responsibilities

• Knowledge of the roles and responsibilities of other team members

Principles of Interprofessional Health Care

• 1) Patient-centered and community/population focused rather than profession centered

• 2) Relationship focused

• 3) Process oriented

• 4) Linked to education strategies and activities that are developmentally appropriate and integrated across the learning continuum

• 5) Applicable across the professionals by acquiring essential knowledge, attitudes, values, and skills which allows for team-based brainstorming and problem solving

• 6) Sensitive to the system’s context with applicability across practice settings

• 7) Outcomes driven (IPE, 2011)

Keys to Successful IPE Initiatives

• Commitment from senior administrators with regard to budget, space use, financial and human resources, resolve calendar conflicts and create a central office or committee to authorize, implement and evaluate IPE initiatives.

• Making IPE a central priority in the strategic plan

• Engage fully faculty and students rewarding interprofessional curriculum development and efforts

• Recognize students as powerful allies

• Start small and expand initiatives

• Include professions outside of healthcare i.e. engineering or architecture

Outcomes Measured In Relation to Interprofessional Collaboration based on the

Literature• Attitudes towards other disciplines/professions

• Knowledge, skill, and abilities around IPE and collaborative practice

• Behaviors related to transferring IPE learning into practice

• Organizational culture and readiness related to IPE

• Patient-family satisfaction with care

• Provider satisfaction involving teamwork processes, and work environment

• Team function

• Collaborative leadership

• Interprofessional conflict resolution

Assumptions Regarding Interprofessionl Collaboration

(Sherman et al., 2017)

• Interprofessional plan should be instituted early

• Interprofessional plan offers a whole-person approach

• Interprofessional plan should be developed across the illness trajectory

• Team leader is dependent on the stage of the illness, clinical issues, and points of rehabilitation, recovery, or peaceful death

• Interprofessional plans create seamless transitions for patients and family

• Interprofessional team has shared accountability and responsibility for the processes and outcomes of health care

• Highly functional team requires mutual respect of team members and valuing of shared or unique competencies and contributions

• The professional lens of a discipline determines the clinical assessment, prioritization of clinical problems, and interventions

Continuation of Assumptions about Interprofessional Collaboration(Sherman et al., 2017)

• Team members must recognize their own abilities and limitations based on the professions scope of practice, as well as their state of novice to expert

• Working as a member of an interprofessional team is like learning a dance in which you learn “not to step on each other’s toes,” but rather demonstrate fluid movements.

• Expertise of the team may be dependent on variability in team culture including the professions represented, ethnicity/race, age, and gender of team members.

• Expertise of the team may be dependent on the length of time the team has worked together, including group dynamics and changes as members move in or out of the team.

• Interprofessional collaboration changes as patient/family populations change and teams are subject to external forces from within or external to the health care system, as well as changes in the educational system or society at large.

Analyzing Interprofessional Teamwork

• Use of Collaborative Framework of Gaboury et al. (2009) and Burzotta et al. (2011) to analyze interprofessional teamwork:

• 1) group composition (characteristics of group members)

• 2) group structure (pattern of positions and roles)

• 3) group development (changes in perspectives)

• 4) group process (patterns of interactions);

• 5) task performance (quantity, quality and speed of performance)

• 6) what fosters collaboration;

• 7) what challenges collaboration

• 8) what are the benefits of collaboration

• 9) what are the drawbacks of collaboration; and

• 10) in future experiences what would you do differently?

Group Composition and Structure:Characteristics of Group Members

• Health professionals represented by the team (i.e. MD, RN, CNS, SW, Pharmacist)

• Level of expertise/experience of each group member (i.e. RN with one year experience or 30 years)

• Level of education of each team member (i.e. basic RN or Advance Practice Nurse)

• Age of group of health professionals (i.e. 20s-70s)

• Gender of health professionals

• Length of time that the group has worked as a team

• Expected leader of the team (i.e. MD or other health professional depending on the clinical population or issue)

Group Process: Positions and Roles

Who is the formal leader of the team?

• Self-appointed

• Chosen by group

Communication styles of leadership

• Democratic

• Autocratic

• Shared leadership

• Rotating leadership

Group Process: Positive Patterns of Interaction

• Self-motived

• United

• Decisive

• Cohesive

• Active listening

• Interactive

• Accountable

• Compromising

• Negotiating

• Thoughtful

• Decision makers

Interprofessional Group Development: Changes in Perspective

• Improved outlook regarding teamwork

• Recognition of alternative approaches

• New frame of reference regarding approach to care

• Revaluation of personal values and expectations

• Understanding of shared knowledge and skills with other health professionals

• Understanding of the unique focus of other professionals and their expertise

• Change in beliefs about the value of interprofessional care

• Appreciation of each team member and what they contribute

Quantity, Quality, and Performance of Interprofessional Teamwork

• “Committed to participation”

• “Attendance at meetings a priority”

• “Conflicts of time” but use of “email summaries”

• “Break due to excessive end of semester commitments”

• “Break for the winter holiday”

• “Disruption of the group due to an unforeseen administrative event experienced by the leader,” created “uncertainty” and “stress” for group members

• “Reconvening of group in person and by emails”

• “Didn’t know how to respond to the administrative related issues”

• “Felt it was important to continue this work which the University expects”

What fosters collaboration?

• “Self-awareness and mindfulness with a non-anxious presence”• “Emphasis on collaboration at the University level” • “Collaboration is promoted “when you have someone who is willing to serve as the

champion and assume leadership of the group, yet with the ability and skill to engage all team members”

• “Collaboration is enhanced when the “leader” is willing to “facilitate the process,” with members demonstrating “equal responsibility and accountability”

• “There is also increased collaboration when there is “lateral recognition and respect for the knowledge of other group members,” and the “creation of collective energy when you are brainstorming”

• “Collaboration is fostered when there is “an opportunity to have a shared purpose with a common goal”

• “Accountability increases the stakes”• “Willing to come to the meetings because they “enjoyed the conversation” feeling “too

often, we sit in our silos with little to no opportunity to engage on a topic of mutual interest, but now we had a project that involved all of our interests”

• “When a meeting is respectful, people can agree to disagree,” “when people convey an openness,” and are “engaged and attentive to the ideas of each other,” “listening without interrupting,” and “showing a level of cooperation,” then “it is really pleasant to work together”

What are thechallenges of collaboration?

• “Territorial behavior”• “Competing time demands”• “Breaking down silos”• “Incentivizing and rewarding”• “Motivating and determining readiness”• “Limited budgets• “High faculty workloads”• “Differing obligations of health professionals” • “Challenges in coordination of schedules and meeting times”• “Challenge is moving from a more autonomous focus to an interprofessional focus and finding their

“niche” among other members of the health care team• “Collaborative efforts are clearly disrupted by external issues which were out of our hands. We weren’t

sure whether there would be “retribution by administration if we continued our work given the existing politics”

• “Challenges when there are personality conflicts or turf wars, not to mention individuals who speak disrespectfully in group meetings. Yet, this group modeled professional interactions”

• “Concern that curriculum is driven by accreditation so it makes it difficult to have interprofessional courses when the criteria for accreditation is different in many disciplines”

• “Many Colleges have different academic calendars, so there are challenges in when to offer an interprofessional course, where does an interprofessional course fit best in already full program curriculums, as well as who gets the credit hours not only in terms of faculty workload, but student tuition”

• “Interprofessional education should start early and go beyond the classroom to learning together during clinical placements, but that is quite a logistical challenge”

What are the benefits of collaboration?• “The simulated case developed during this initiative could be used as an exemplary

case study for IPE opportunities in the College

• “This initiative was “one step in breaking down our disciplinary boundaries”

• “This initiative was an example of leading by example”

• “Benefits of collaboration are “shared experiential learning,” “improved socialization among members of the disciplines,” “sharing of knowledge” and “increased awareness regarding the education and competence of other team members”

• Value of a “collective identity” and “shared responsibility”

• “In clinical practice, there is improved coordination and utilization of health care resources”

• Challenges existing ideas to find innovative solutions

• “Stimulates the work environment”

• Improves working relationships

• “The potential for improved work satisfaction because you have a sense of support”

• Opportunities for research and grant funding

• Develop innovative curriculums

• “Coordinated care of higher quality for patients and families because you have shared problem solving and shared trust”

• May brand an organization

• Reframe professional identify with more expanded definition

• Standardization of accreditation processes

What are the drawbacks of collaboration?

• “Sometimes it is easier to just make the time yourself to work on a project”

• “There is usually someone who wants to take charge and make sure their agenda is met, maybe that is more a challenge than a drawback”

• “In this economy, we are also being asked to do more with less, shared teaching and shared responsibility for academic outcomes of other professions may make us all wear even more hats”

• “It is hard enough coordinating class schedules of students from our own disciplines and their clinical placements, we can only imagine the nightmare of doing this for all of our students”

What could be done differently in the future?

• “Leadership is important to keep the group moving forward despite challenges, you keep the ball moving”

• “We need to keep this going; we need to do more things together. It has to be a part of the culture”

• “This was a good first step. Now we have to sit together and develop a course that addresses shared competencies that we identify across the different disciplines”

• “We need faculty from other disciplines to co-teach a class so students can gain an interprofessional perspective”

• SUMMARY: All team responses indicated that they valued IPE and collaboration, maintaining the momentum together requires persistence, vision, and commitment

Learning Strategies for IPE in Education

• Curriculum that thread the concepts of IPE in course readings and assignments

• Inviting faculty and students from other disciplines into the classroom to discuss a topic

• Joint teaching of a course which has a common topic as well disciplinary unique information

• Interprofessional yearly event with case study, diverse panel participants, and students from diverse disciplines who discuss the case

• Community work with students from other disciplines

• Role play of a different discipline than your own

• Feedback from patients and families regarding the care offered by team members

• Reflections of personal experiences when a team approach was used to achieve a goal

Providing Collaborative Environments and Learning Spaces

• Shared lounges and auditoriums

• Shared classrooms

• Shared simulation labs

• Large class activities

• Small team activities in classrooms or community/practice settings

Implications of Collaboration: Clinical Practice

Transformative change in education and clinical practice involves

interprofessional networking of colleagues within, across, and beyond the

university into the health care agencies and systems.

Approaching a Clinical Case from an Interprofessional Perspective

• Identify the group of health professionals to care for the specific patient/family

• Which health professionals should be part of the interprofessionalteam?

• Determine the leadership of the group

• Chairperson or co-chair or rotating leadership

• Determine group processes

• Best time and place to meet for formal meetings

• Communication by email

• Provide an agenda for meetings

• Shared leadership or participation based on issue presented and professionals expertise on the topic

An InterprofessionalComprehensive Health History

• Develop a comprehensive health history from an interprofessionalperspective

• Identify all components of a comprehensive history

• Recognize the shared areas of assessment

• Unique areas of assessment

• Brainstorm the information about the patient case

• Have a “group think” about what is happening in the case

• Share additional clinical data needed to focus the physical examination and identification of diagnoses

Identifying and Prioritizing Clinical Diagnoses as an Interprofessional Team

• Identifying and prioritizing clinical diagnoses as an interprofessional team

• Overarching diagnoses

• Pain

• Constipation

• Depression

• Impaired cognitive function

• Impaired activities of daily living

• Psycho-social-spiritual distress

InterprofessionalInterventions

• Developing and evaluating diagnosis specific interventions

• Discipline specific interventions to address a clinical problem based on the expertise of the health professional

• Complementary/synergistic Interventions: Care by one discipline complements or enhances the care by another team member

• Collaborative Interventions: Humanistic and Holistic (Mind-Body-Spirit) offered by all health professionals—Valuing , Respect, Compassion, with the Intention to Heal and Promote Health

Interprofessional Interventions

• Timing of interventions: immediate, short-term, long-term

• Types of Interventions by Health Professionals

• Pharmacologic interventions

• Non-pharmacologic interventions

• Complementary/alternative interventions

• Spiritual interventions

• Further diagnostic testing

• Referral to other health specialists (i.e. opthamologist, chaplain, social worker, psychologist)

• Support of health administrators in finding appropriate level and type of care and supportive services needed for patient and family

Conducting “Schwartz” Rounds

• Foundation supported

• Challenging case for an interprofessonal team

• Analyzing the case from an interprofessional perspective

• Examining the structure, process and outcomes of the interprofessional collaboration

Conclusion• As we lead by example, we are meeting the clarion call

of the Institute of Medicine (2013) to educate the health care workforce with skills of relating to each other, thereby optimizing comprehensive, holistic, and quality health care. Interprofessional initiatives require commitment to the advancement of each health discipline as we encourage their ability to practice to their full extent of their scope of practice, with optimal team cooperation, and collaboration.

Selected References• Abu-Rish, E., Kim, S., Choe, L., Varpio, L., Malik, E., White, A., Craddick, K., et al. (2012). Current trends in

inpterprofessonal education in health science students: A literature review. Journal of Interprofessional Care, 26, 144-451.

• Brandt, B., Lutfiyya, M., King, J., Chioreso, C. (2014). A scoping review of interprofessional collaborative practice and education using the lens of Triple Aim. Journal of Professional Care, 28(5), 393-399.

• Engel, J., & Prentice, D. (2013). The ethics of interprofessional collaboration. Nursing Ethics,• 20(4), 426-435.• Gaboury, I., Bujold, M., Boon, H., & Moher, D. (2009). Interprofessional collaboration within • Canadian integrative healthcare clinics: Key components. Social Science & Medicine, 69, 707-715.• Gilbert, J., Yan, J., & Hoffman, S. (2010). A WHO Report: Framework for action on • interprofessional education and collaborative practice. Journal of Allied Health, 39, 196-197.• Hayward, K., Kochniuk, L., Powell, L., & Peterson T. (2005). Changes in student perceptions of • collaborative practice reaching the older adult through mobile service delivery, Journal of Allied Health, 34(4), 192-

198.• Interprofessional Education Collaborative (IPEC). (2011). Core competencies for • interprofessional collaborative practice: Report of an expert panel. Washington, D. C.: Interprofessional Education

Collaborative. • Karstadt, L. (2012). Does interprofessional education provide a global template? British • Milton, C. (2013). Ethical issues surrounding interprofessional collaboration. Nursing Science • Quarterly, 26(4), 316-318.• Norby, B. (2016). Healthcare students as innovative partners in the development of future • healthcare services: An action research approach. Nurse Education Today, 46, 4-9.• Norris, J., Lassche, M., Joan, C., Eaton, J., Guo, J., Pett, M., & Blumenthal, D. (2015). The • development and validation of the Interprofessional Attitudes Scale (IPAS): Assessing the interprofessional attitudes

of students in the health professions. Academic Medicine, 90, 1394-1400.• Olenick, M., Allen, L., & Smego, R. (2010). Interprofessional education: Concept analysis. • Advances in Medical Education and Practice, 1, 1-10.

Selected References• Parsell, G., & Bligh, J. (1999). The development of a questionnaire to assess the readiness of • health care students in interprofessional learning (RIPLS). Medical Education, 33(2), 95-100.• Pype, P., Symons, L., Wens, J., Van den Eynden, B., Tess, A., Cherry, G., & Deveugele, M. • (2010). Healthcare professionals’ perceptions toward interprofessional collaboration in palliative home care: A

view from Belgium. Journal of Interprofessional Care, 27, 313-319.• Rodger, S., & Hoffman, S. (2010). Where in the world is interprofessional collaboration? A • global environmental scan. Journal of Interprofessional Care, 24, 479-491.• Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zroarenstein, M. (2013). Interprofessional • education: Effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev, March 28: 3

10/1002/14651858CD002214. • Singh, N. ( 1998). Satisfaction with treatment team care planning rating scale. Midlothian, VA, • ONE Research Institute.• Sherman, D.W., & Wilkinson, A. (2019). Interprofessional collaboration. In M. Matzo, & D.W. • Sherman (5th Ed.) (pp. 37-47). Palliative care nursing: Quality Care through the end of life. New York: Springer

Publishers.• Sherman, D.W., Maitra, K., Hough, M., Restrepo, J., Barbera, S., Olenick, M., Randolph, M., • Simon, S., Gordon, Y., & Singh, A. (2017). Illustrating and analyzing the processes of interprofessional

collaboration: Lessons learned from palliative care in deconstructing the concept. Journal of Palliative Medicine, 20(3), 227-234.

• Speakman, E., Lyons, E., Giordano, C., Shaffer, K., & Sicks, S. (2015). Utilizing the Jefferson • Teamwork Guide during interprofessional clinical rounding, a collaborative practice experience. Retrieved from

http://whoeducationguidelines.org/content/utilizing-jefferson-teamwork-observation-guide-jtog-during-interprofessional-clinical.

• Verhaegh, K., Seller-Boersma, A., Simons, R., Steenbruggen, J., Geerlings, S., deRooil, J., & • Buurman, B. (2017). An exploratory study of healthcare professionals’ perceptions of interprofessional

communication and collaboration. Journal of Interprofessional Care,31(3), 397.400.• World Health Organization (WHO). (2010). Framework for action on interprofessional • education and collaborative practice. Geneva: World Health Organization. Retrieved April 11, 2011 from

https://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf.

http://whoeducationguidelines.org/content/utilizing-jefferson-teamwork-observation-guide-jtog-during-interprofessional-clinical

https://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf

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Best Practice Examples

of IPCE

DIMITRA TRAVLOS, PHARMD

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Best Practice Examples of IPCE

Boston Children’s Hospital

Victoria Cunningham, MBA, CHCP

Continuing Medical Education Specialist

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Postgraduate Institute of Medicine

Michael R. Lemon, MBA, FACEHP, CHCP

President

Postgraduate Institute for Medicine

• Founded in 1979 by Dr. William James

• Located in Denver, Colorado

• Achieved initial ACCME accreditation in 1994 and Jointly Accredited in

December 2017

• We fulfill our mission by forming successful alliances and working in

collaboration to jointly provide activities

• Experienced and passionate leadership team

• 7 Certified Healthcare Continuing Professional Development Professionals (CHCPs)

• 3 PIM staff members hold clinical degrees

Providing Trusted Independent CME/CE for Over 40 Years

Example: Adolescent Substance Use and Prescription

Medication Misuse

Initial Planning

• In-person meeting

• Multi-disciplinary team

• Data from NIDA on substance use disorder among teens were reviewed

Gaps Identified

GAP

“What they do”

Healthcare

Professionals

ARE NOT

- Screening

- Providing info

on impact

- Encouraging teens

to avoid substance

use

Performing a brief

screening and

intervention with

every adolescent

patient at every

encounter no

matter what

the setting

“What they should do”

Why?

What don’t they know?

What don’t they know how to do?

Practice Gaps and Underlying NeedsAdolescent Substance Use and Prescription Medication Misuse

The healthcare team was waiting until negative consequences occurred for a teen before considering referral to specialized treatment

Healthcare Professionals don’t know:

• prevalence and types of substance use in teens

• data related to the positive impact of brief interventions by

healthcare professionals on deterring substance use in teens

Healthcare Professionals don’t know how to:

• approach this subject with parents and teens and lack tools

• facilitate the process of screening and brief intervention during any

patient encounter with a teen

Lessons Learned

• Seek feedback from members of the healthcare team in advance and/or limit the number of individuals that attend live planning sessions

• It can be difficult to agree on the need underlying a gap when you are working with subject matter experts from multiple specialties

• It’s critically important to consider the differences among the various members of the healthcare team

• The importance of your team members keeping the discussion focused on the problem the activity is designed to address

Challenges

• It’s often hard to articulate needs and gaps that you intuitively know, as in this example

• We couldn’t just write “it’s a huge problem”; we had to articulate the underlying needs to determine how to take on the gap

• It’s important to consider the context of a busy clinical practice• While it would be nice to have half an hour to engage in an in-depth

discussion of substance use with each teen, the reality is that the clinician may only have a few minutes

• We also had to consider what can be accomplished in this time frame when designing the educational intervention

Thank You!

720-895-5329 [email protected] www.pimed.com

Professional Excellence in Healthcare Education

304 INVERNESS WAY S STE 100

ENGLEWOOD CO 80112

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Washington University School of Medicine

Allyson Zazulia, MD

Associate Dean for CME

Accredited by ACCME since 1973Joint Accreditation in 2016IPCE professions: MD, nursing, pharmacy, PT, SW, athletic trainer

CME StaffVicki Tegethoff, RN, MHA Director of CMEChris Berry Administrative CoordinatorDeborah Hutson Educational Development CoordinatorMichelle Padgett Program CoordinatorMichelle Randall SecretaryAndrea Sondermann Administrative CoordinatorCathy Sweeney Grants CoordinatorRonda Thiemann Senior Financial AnalystTim Young Senior Multimedia SpecialistAllyson Zazulia, MD Associate Dean for CME

Located in St. Louis, MOIncludes schools of medicine, OT, PT, audiology & deaf educationSchool of nursing and college of pharmacy adjacent to campus2 teaching hospitals

• Jointly provided by Washington University School of Medicine, Pediatric Infectious Diseases Society, & Society of Infectious Diseases Pharmacists

• Credit offered: AMA, ANCC, ACPE, IPCE

10th Annual International Pediatric Antimicrobial Stewardship Conference

• Course objective• Improve antimicrobial prescribing for children by increasing the knowledge

and competence of individuals beginning an antimicrobial stewardship program (ASP) and improving performance of existing ASPs

• Professional practice gaps• Lack of knowledge about clinical and economic benefits of having an ASP

• Inability to implement and evaluate performance of an ASP

• Ineffective communication between ASP members and clinicians

Planning Committee

• 6 physicians

• 2 pharmacists

• 1 nurse

• 2 certified research professionals

• Executive Director of Pediatric Infectious Diseases Society

Course Faculty

• 16 physicians

• 5 pharmacists

• 1 nurse

• 1 epidemiologist

Attendees

• 97 physicians

• 72 pharmacists

• 10 RNs/NPs

• 2 PAs

• 7 PhD researchers

• 7 students

• 22 others

Agenda

• Talks

• Breakout sessions

• Pro-Con debate

• Oral and poster research presentations

• Communication workshop

Exemplary session: Credible Communication to Improve Prescribing

• Addressed how ASP success requires attention to clinician perceptions of antimicrobial stewardship and how to change clinician behavior by changing the dynamics of the interaction between stewards and clinicians

• E.g., “Antibiotic Police” perception

To be the one at the bedside assessing the patient and to have to make a phone call to somebody who wasn’t even in the hospital was frustrating. And I’m embarrassed to admit but we would totally game the system. We’d wait until the evening when they stopped the approval system overnight to order the antibiotic we wanted. I think stewardship is good and important. But the approach is everything.

- Academic Hospital Surgeon

Survey: What do you intend to change after this course? (select comments)

• My approach when teams greet ASP with 'what did we do wrong now?‘

• Use a more coercive, nonconfrontional approach where the focus is on the patient

• In-person ASP rounds instead of relying on telephone communication

• More handshake rounds*

• Develop interprofessional guidelines

• Include nursing in stewardship

• Work with nurse educators on each initiative

* ASP strategy characterized by (1) lack of restriction / preauthorization, (2) review of all prescribed antimicrobials,(3) a rounding-based, in-person approach to feedback by a pharmacist-physician team

Challenges

• Getting all planners from different professions in the same room at the same time

• Increasing use of small group break-out sessions directed at the whole team rather than large group sessions for the team, but break out to single profession sessions

Lessons learned/next steps

• Encourage as much involvement as possible in the planning of the activity from all represented professions

• Determine / acknowledge in the planning process what communication issues exist among professions and address these

• Encourage interprofessional small group activities with a facilitator who can engage participants

• Allow time for informal interaction

• Next year: encourage role play of interaction between ASP & clinician

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Baystate Health

Kim Barcher

Accreditation & Compliance Specialist

Infusing Arts and Humanities into Continuing Interprofessional Education

Best Practice

Kim Barcher

Accreditation & Compliance Specialist

Office of Continuing Interprofessional Education

Baystate Health

About Baystate Health

• Integrated health care delivery system serving over 800,000 people throughout western New England

• Five regional hospitals serving patients in urban and rural settings, and the region’s only level 1 trauma center & level 3 NICU

• Over 1.6 million outpatient visits, including home visits

• Over 4,200 babies born

• More than 37,200 surgeries performed

BERST Museum RoundsMuseum of Fine Arts, Springfield, MA

Provided by: Baystate Education Research and Scholarship of Teaching (BERST) Academy and

Baystate Continuing Interprofessional Education

• Baystate Education Research and Scholarship of Teaching (BERST) Academy is a interprofessional teaching academy at Baystate Health open to all employees• 140 members • Across 60 different professions

• The Gaps• The need for problem-solving strategies among a diverse

interprofessional team, specifically with clinical problem solving

• Communication among diverse teams

Addressing the Professional Practice Gap

Our planning team included a physician who specializes in teaching clinical reasoning, a pharmacy educator, nurse

educator, museum educators and a non-clinical curriculum design specialist who has a background in the humanities

• One of the largest challenges has been in breaking down the silos, in some cases between professions and education, to promote team based learning and thoughtful discussion

• Time - Clinicians need up to 6 months advance notice for a ½ day event

Challenges

Lessons Learned & Impact on Future Education

• Our BERST Academy celebrates the Power of Education

• BERST Museum Rounds created a successful, interprofessional space to learn problem-solving and communication

• We use education to create change and improve practice by offering a community of educators and leaders in health professions education

• Our BERST programming using the humanities to support participants in the design of educational activities and innovative teaching strategies has created quite a lot of interest and excitement at Baystate

• We hope to continue the momentum with our upcoming 2020 BERST Graphic Medicine Rounds and the continued growth of BERST Academy

Reach out to connect with us on:• Creating and sustaining a teaching academy at your institution• Infusing the Arts and Humanities into Continuing Interprofessional

Education• Working with non-clinical education specialists

Angela T. Sweeney, MEd, MA, Curriculum Design Specialist, BERST [email protected]

Thank you!

#JALeadership2019


National Comprehensive Cancer Network

Karen Kanefield

Manager, CE Accreditation & Program Operations


Best Practice Case Study

NCCN 2019 Annual Conference Keynote Address: Patient Experience

with Innovative Therapies

NCCN Mission and Vision


Who We AreAn alliance of leading cancer centers devoted to patient

care, research, and education

Our MissionTo improve and facilitate quality, effective, efficient, and

accessible cancer care so patients can live better lives

Our VisionTo define and advance high-quality, high-value, patient-

centered cancer care globally

NCCN’s IPCE Team


Robert Carlson, MD, Chief Executive Officer

Wui-Jin Koh, MD, Senior Vice President/Chief Medical Officer

Kris Gregory, RN, MSN, OCN, Vice President, Clinical

Information Programs

Ann Karosas, RPh, BCOP, Oncology Pharmacist, Drugs &

Biologics Programs

• Challenges of treating with new and innovative therapies

➢ Recognition and management of immune-related adverse events and toxicities associated with innovative therapies (CAR T)

• Barriers to receiving treatment (cost, access)

➢ Diminished clinical trials experience due to lack of patient/caregiver education

• Responsibility of health care system to optimize patient experience

➢ System-level exclusion of interprofessional oncology care team

Professional Practice Gap


Keynote Faculty/Planners


Frederick Locke, MD

Moffitt Cancer Center

Alix Beaupierre, BSN, RN, OCN

Moffitt Cancer Center

Jeffrey Backer, MD, FACEP

Emergency Physician, Cancer Survivor

• Evolution of content throughout the planning process (be flexible)

• Incorporating the patient voice (understand your audience)

• Staying up-to-date in the rapidly changing clinical environment of oncology (guideline recommendations vs. clinical trials)

• Understanding the role of the interprofessional oncology care team in clinical trial management and patient outcomes (be open-minded)

Challenges


Cell manufacturing may take 17-21 days or more.Please let your nurse know if you are claustrophobic—you will need an MRI of your brain during work-up.Remember to stay well hydrated => 2Liters fluid daily before apheresis (cell collection) and outpatient chemotherapy.

Sun Mon Tue Wed Thu Fri Sat

Stop most oral blood thinners 5-7 days before cell collection—ask your nurse about your specific medication—some HOLD times areshorter.

1 2 3 4 5

Work-up Work-up Work-up

Sign collection consent

6 7 8 9 10 11 12

Team visit for labsand

medical clearancefor t-cellcollection.

Cell collection

Dietician Consult PharmacyConsult

Team visit & sign

remainder of consents

13 14 15 16 17 18 19

Teamvisit

CAR-T Class at 1pm

STOP ALL ORALBLOOD

THINNERS5-7 days before

line placement

20 21 22 23 24 25 26

LOCAL LODGING RECOMMENDED UNTIL ADMISSION TOHOSPITAL

Restagingand

diagnostics may

include BM Bx,

Pet/CT, or lymph

node biopsy.

-1ST FLOOR MAIN HOSPITAL-PET SCAN- (YOU MAY EAT A LOW CARB MEAL 6HRS. PRIOR TO SCAN-THEN WATER ONLY UNTIL SCAN ISCOMPLETED)

Consults and possible

diagnostic such as

Neurology,

Psychology and

Cardiology.

STOP Injectableblood thinners aftermorning dose.

CAREGIVER REQUIRED NOTHING TO EAT OR DRINK FTER 12 MIDNIGHT IN PREPARATION FORLINE PLACEMENT NEXTDAY

DAY-6

Early AM -4TH FLOOR

BMT CLINIC-

LABWORK and MD

CLEARANCE

BMT TreatmentCenter

RADIOLOGY-LINE PLACEMENT-2ND FLOOR PRE OPAREA-BONEMARROW BIOPSYTREATENT CENTER-LINE CARETEACHING

CAREGIVERREQUIRED

DAY-5

Early AM -4TH FLOOR BMT CLINIC-LABWORKBMT TreatmentCenter

FLU/CY

Chemo Plan

avg 6-8hrday

CAREGIVERREQUIRED

DAY-4

Early AM -4TH FLOOR BMT CLINIC-LABWORK

BMT Treatment

Center FLU/CY

Chemo

Plan avg 6hr day

CAREGIVER

REQUIRED

DAY-3

Early AM -4TH

FLOOR BMTCLINC-LABWORK

BMT Treatment

Center FLU/CY

Chemo

Plan avg 6hr day

CAREGIVER

REQUIRED

27 28 29 30 31

DAY-2

Early AM -4TH

FLOOR BMTCLINC-LABWORKBMT TreatmentCenter

DAYOF REST CAREGIVERREQUIRED

DAY-1

ADMIT -TOMOFFITT-INPATIENT ADMISSIONDAYAT12:30PMPARK IN RED VALET, PROCEED TO THE ADMISSIONSOFFICE. IF YOUR

DAY-0

INPATIENT CELL INFUSION

Recovery in the

hospital until any adverse effects resolve and it is safe to discharge you to outpatient care. A minimum of 8 but an average of 10-14 inpatient days has been noted.CAREGIVER

Discharge planning. You will need a caregiver daily

and be seen in the Outpatient BMT Treatment Center or Clinic frequently until Day+30. After DAY+ 30 you will be discharged to your primary Oncologist. You will return at approx. 3 month intervals forrestaging.

CAREGIVER REQUIRED FOR DISCHARGE

zClinical trial consent and meet

with ICE-T Attending and Clinical Trial Coordinator

Nurse, Social worker.

Clinical trial medical testing and lab work.

Apheresis and collection of cells.

Shipping of cells, Processing of cells, return

of cells.

Start of outpatient

chemotherapy in BMT

Treatmentcenter.

Discharge to outpatient follow up in BMT

Treatmentcenter.

Discharge to primary

oncologyprovider.

• Meet your ICE-T team, learn about the clinical trial, decide if it is right for you, ask questions, and receive nursing education about the entireprocess.

• Please start to think about relatives and friends who can support you during the treatment. There will be times that are required to have a caregiver. While you are hospitalized, you are not required to have a caregiver although someone who knows you well can be a valuable asset to the team and they may stay with you in your room.

• Please discuss any concerns about caregiving and local lodging with your social worker.

• You will now follow up in either the clinic you started out in or with your local oncologist.

• Please remember to call them directly during this phase to discuss any new or unresolved symptoms.

• After you are well enough to be discharged from the hospital, (10-14 days on average), you will be discharged and followed up in the BMT Treatment Centerdaily.

• You will be seen daily for labs and assessment. We are a phone call away; please do not hesitate to call with symptoms or questions.

• You may have follow up scans or bone marrow biopsy as outlined by the clinical trial.

• You will be referred back to your primary oncology team approximately 30 days after receiving your cells.

YOU WILL NEED A CAREGIVER WITH YOU DAILY FOR THIS PHASE OF THERAPY.

• After you have received your chemotherapy outpatient, you will be admitted to the hospital for the next phase of the trial.

• You will meet with many different team members who assist in helping you and your loved ones during the hospitalization. These include Nurses, Physicians, advance practice professionals, physical therapy, nutritionist, social workers, case managers, chaplains, and others.

• Please let the staff know about any issues, big or small you may be having. Refer to inpatient guide, CAR-T teaching sheet for side effects,etc

• You will receive the chemotherapy associated with this clinical trial in the BMT Treatment center. There you will be cared for by specially trained nurses, and medical providers. The first day you will be cleared toproceed.

• You will have a central line placed that will remain in for the duration of the therapy and until you recover. You will have some testing done as well according to your disease. This will serve as a baseline for the trial. You will come in daily until you are admitted.

• Please call the BMT Clinic Triage phone number 24 hours a day to report symptoms or if you have any questions.

YOU WILL NEED A CAREGIVER WITH YOU DAILY FOR THIS PHASE OF THERAPY.

• Your cells will need to be shipped to the processing center. This must be done the day that we collect them. The process of altering the cell and growing more cells takes about 2 ½-4 weeks.

• You may need chemotherapy while you wait, that will be handled by your primary oncology team.

• Once we hear from the cell processing company, we will schedule the rest of the CAR-T therapy. You will receive a final schedule of appointments when that date is determined.

• Your cells are collected by a process called apheresis where by either peripheral or central IV, blood is removed from the body and the T-Cells are pulled out. This process takes about 8 hours.

• You may feel tired or run down during and after the procedure. This is a normal reaction. Any IV access used will be removed before you leave. If it was a central line, you will need to lay flat for about an hour after removal.

• Please ask the Apheresis team for sandwiches or beverages. Warm blankets are also available. Do not hesitate to let us know how to make your time in the apheresis unit more comfortable. Apheresis located in the Clinic Building on the 4th floor.

Admission to the

hospital, cell infusion,

recovery.

Eligibility testing: Medical testing used

to satisfy the clinical trial acceptance

criteria. Final decision for admission to

clinical trial is made.

• Representation of IPCE team in planning AND faculty

• Regular inclusion of patient voice, where applicable and possible

• “Big picture” topics balanced with clinical presentations

Impact on Future Education



NCCN Member Institutions

#JALeadership2019


MedStar Health

Mikki Asgin

Director, Continuing Professional Education

Cynthia Pineda, MD

Medical Director

DISCOVER IPCE Tools at Work!Cindi Pineda, MD FAAPM&R CHCP

Associate Medical Director, CPE, MedStar Health

Associate Professor, Clinical Rehabilitation Medicine

Georgetown University School of Medicine

Mikki Ashin

Director, Continuing Professional Education,

MedStar Health

Our IPCE Mission and Organization

MedStar Franklin Square Medical Center

MedStar Georgetown University Hospital

MedStar Good Samaritan Hospital

MedStar Harbor Hospital

MedStar Health Research Institute

MedStar Heart & Vascular Institute

MedStar Institute for Innovation

MedStar Institute for Quality and Safety

MedStar Medical Group

MedStar Montgomery Medical Center

MedStar National Rehabilitation Network

MedStar St. Mary's Hospital

MedStar SiTEL

MedStar Southern Maryland Hospital Center

MedStar Union Memorial Hospital

MedStar Washington Hospital Center

Georgetown University

Problem #1• There is a lack of a systematic process of integrating QI in continuing

education activities at our local hospitals (e.g. Grand Rounds, Morbidity

and Mortality conferences).

• Healthcare is rapidly changing with a growing emphasis on improving the

patient experience, health of populations and reducing cost.

• There has been a shift from a predominant focus of learners' acquisition of

medical knowledge and procedural skills to care coordination, system

science, patient safety and interprofessional team-based continuing

education.

• Developing and strengthening links between quality improvement (QI) and

IPCE is critical to address these gaps.

Tool #1: The QI-IPCE Mind MapA mind map

• is a diagram used to visually organize information to show relationships among pieces of

the whole

• created around a central concept to which associated ideas are connected and

subsequently branch out in a non-linear layout

• transforms a long list of monotonous information into a colorful visual diagram

MedStar Health has started to utilize mind mapping during IPCE hospital committee

meetings as a tool for needs assessment planning and to strategically identify

relevant topics based on strategic areas of quality improvement.

The healthcare team and institutional needs change over time. The QI-IPCE mind map

is dynamic and can be updated as needed to accommodate real time gaps and

needs.

Mind Map ExerciseIdentify the healthcare team (QI Leader, interprofessional planners that reflect the target

audience)

Pre-work (topics and sources of information)

Bring materials: a mind map app or white board/markers

Start with a central concept (QI and IPCE), then identify branches using the stoplight approach

• Identified Area of Improvement

• Source of Information

• IPCE session

Mind Map Example

Quality Improvement and IPCE

Patient Safety Events

Patient Safety

Sepsis

Population Health

Performance Data (OPPE)

Wellness

Updates

Acute Care Priorities

Antibiotic Stewardship

High Value Care

Regulatory Requirements

Risk Management

Licensing Specialty Board

Opioids

LGBTQIA

HIV/AIDS

Guidelines

Technologies

Programs

Therapies Policies & Procedures

Accreditation

Community and Population Health

Cognitive Behavior Therapy for Depression and Anxiety

MedStar Health Community Health Needs Assessment Survey (Cancer, Behavioral Health, Diabetes, Heart Disease)

Mortality Data

Chest Pain for the Front Line Practioner

Diagnostic Methods

Stroke

Diabetes Symposium

Colon Cancer and Screening Update

Morbidity and Mortality Conference

Committee Recommendations

Nuclear Medicine Procedures in Inpatients

Update on Hepatitis C Treatment

New Lipid Guidelines

What You Always Wanted to Know About Transfusions TB Diagnosis and Management

The New Total Cost of Care in Maryland

Managing Stress and Building Resilience

MedStar Health Survey

September 19, 2019

100

Impact of QI-IPCE Mind Map

• Dynamic tool for strategic planning and successful implementation of

relevant IPCE with the goal of improving team-based care and patient

outcomes.

• Penetration of system and/or local priorities and integration in CE

• Increased use of quality metrics to build educational programs

• Addition of other educational formats supporting adult learning aside from

traditional didactic lectures

• Reinforces education planned by and for the team where members from

two or more professions learn with, from and about each other. This results

in effective collaboration, improvement in skills, strategies, performance in

practice and/or patient outcomes.

Problem #2

As we continue to expand our IPCE portfolio, we have found that

planners, faculty and staff continue to need ongoing education in

creating, delivering and measuring IPCE activities.

Tool #2: e-CE Guide(pronounced “easy”)

MedStar Health e-CE Guide to Planning a Continuing Education Activity

• Designed by the team for the team!

Using an iterative design model, content was developed and reviewed by an

interprofessional group of users (nurses, PAs, pharmacists and physicians) and

an instructional designer. Learner feedback was incorporated in the module design

and the revised product disseminated to activity planners, faculty and staff.

• On-demand RISE® module linked to the activity planning document with the ability to modify content when needed, which is important as we continue to

add professions to the scope of our CE portfolio.

Engaging and enables the user (e.g. activity planner) to practice skills and receive

feedback.

• Learners are provided with concise examples and tools (e.g. list of action verbs).

Planners have the opportunity to practice writing their own learning objectives.

Practice and Feedback

Lessons Learned

DISCOVER IPCE tools that work!(Dynamic. Interprofessional. Strategic. Concise. On-demand. Versatile. Engaging. Relevant)

IPCE is a strategic asset for improving patient outcomes when relevant healthcare team and

institutional quality and patient safety gaps are identified during the planning of educational

activities.

Questions?

Contact Us!

[email protected]

Cynthia.G.Pineda@ email.sitel.org

mailto:[email protected]



the nuts and bolts of activity planning...#jaleadership2019 the nuts and bolts of activity planning...

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