A Collaborative Approach to Teaching Interprofessional Care and Improvement

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A Collaborative Approach to Teaching
Interprofessional Care and Improvement
Greg Ogrinc, MD, MS Dartmouth Medical
School February 12, 2009
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Objectives

• Understand the development and evaluation of the
  Institute for Healthcare Improvement (IHI) Health
  Professions Education Collaborative (HPEC)
• Identify how national collaboratives can impact
  local efforts

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IHI Collaborative Breakthrough Series Model
Select Topic
Participants
Prework
Develop Framework and Changes
P A D S
P A D S
Congress, Guides, Publications, Etc
Planning Group
LS1
LS2
LS3
Supports Email Visits Phone Assessments Senior
Leader Reports
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IHI Health Professions Education Collaborative
Select Topic
Participants
Prework
Develop Framework and Changes
P A D S
P A D S
Congress, Guides, Publications, Etc
Planning Group
LS1
LS2
LS3
Supports Email Visits Phone Assessments Senior
Leader Reports
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A different type of collaborativeWengers
Community of Practice

• Design for evolution
• Open dialogue between inside and outside
  perspectives
• Invite different levels of participation
• Develop both public and private community spaces
• Focus on value
• Combine familiarity with excitement
• Create a rhythm for the community

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IHI HPECMission

• The HPEC is a collaborative of health profession
  education programs committed to the creation of
  exemplary learning and care models that promote
  the improvement of health care through both
  discipline-specific and interprofessional
  learning experiences.

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IHI HPECVision

• International leader for the development of
  knowledge about teaching improvement
• Forging strong interprofessional and
  inter-institution relationships among faculty

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HPEC Journey
ACGME offices - Chicago
Mayo Medical School
University of Minnesota
Indiana University
University of Connecticut
Vanderbilt
2004
2005
2006
2007
2008
2003
2009
University of Tennessee-Memphis
IHI - Boston
Dartmouth
University of Cincinnati
University of Manitoba
University of Missouri-Columbia
ACGME - Chicago
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IHI HPECValues

• The health of our patients and education of our
  students are our main priorities.
• Respect for one another and for truth is integral
  to our community.
• Our actions demonstrate a commitment to act
  ethically, welcome differences, and encourage
  open exchange.
• Our interactions will model the professionalism
  expected of health professionals, researchers,
  and educators.
• We strive for excellence that comes from
  collective and individual effort.

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HPEC Operations Plan (07-08)

• Foster learning for health professional students
  about the improvement of health and health care
  for patients.
• Ensure the development of faculty for teaching
  about the improvement of health care.
• Speed change and reduce the cost of change in the
  development of health professionals who
  incorporate the principles of improvement into
  their daily work.
• Model improvement principles and values in our
  own work as education leaders.

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quality improvement

• The combined and unceasing efforts of everyone
  health care professionals, patients and their
  families, researchers, administrators, payers,
  planners, educators to make changes that will
  lead to better patient outcome, better system
  performance, and better professional development.

Batalden and Davidoff, QSHC, 2007
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Better patient (population) outcome
Better professional development
Better system performance
Batalden and Davidoff, QSHC, 2007
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Better patient / population outcome
Better professional development
Everyone
Better system performance
What might be the foci of inquiry?
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Goals and ObjectivesGoal 1

• Foster learning for health professional students
  about the improvement of health and health care
  for patients.
• Within 24 months, 100 receive didactic and
  experiential learning about improvement
• Within 24 months, 100 of students receive
  interprofessional training
• All sites develop, use, and assess tools to
  evaluate student knowledge and skills
• At conclusion of training, 100 students describe
  occasion when they participated in an improvement
  project

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Goals and ObjectivesGoal 2

• Ensure the development of faculty for teaching
  about the improvement of health care.
• Within 24 months, 100 participating schools will
  have cohort of faculty for teaching improvement
• Within 24 months, 50 participating schools will
  have faculty generating academic products about
  education and/or practice of improvement

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Goals and ObjectivesGoal 3

• Speed change/reduce the cost of change in the
  development of health professionals who
  incorporate the principles of improvement into
  their daily work.
• By June 2008, 10 programs or courses that have
  spread within HPEC
• By June 2008, 5 programs or courses that have
  spread outside HPEC
• By November 2007, create collaborative
  partnership with accreditation leaders in all
  professions

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Goals and ObjectivesGoal 4

• Model improvement principles and values in our
  own work as education leaders.
• a. Within 12 months, 100 HPEC members will
  describe how they are using improvement
  principles in their work as educators

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Team Reports

• Required as an active member of HPEC
• Once per year on Survey Monkey
• Report structure
• Quantitative questions related to Goals and
  Objectives
• Qualitative description of programs and
  initiatives at your site

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Realist Evaluation

• Developed by Ray Pawson and Nick Tilley in the UK
• Professors of Sociology
• Particularly interested in the evaluation of
  programs implemented to reduce crime
• Basic yes/no question of evaluation is
  insufficient

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An Explanatory Quest

• WHAT works for WHOM in what CIRCUMSTANCES?
• (sometimes addand in what respects, and how?)

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Steps in Realist Evaluation

• Elicit working theories. Select a promising
  theory.
• Formalize hypothetical context, mechanisms, and
  outcome processes (CMO).
• Test the theory.
• Collect data (qualitative, quantitative).
• Present a refined (and improved) theory to inform
  future interventions.

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Definitions

• Theories Interventions are theory incarnate.
  Theories are multiple.
• Mechanism Describes what it is about the
  interventions that bring about effects. The
  mechanism is the process through which subjects
  interpret and act upon the interventions. It is
  the pivot around which realist research revolves.
  
• Context Pre-existing features of a
  locality/situation/microsystem into which
  interventions are introduced and which are
  relevant to the operation of the mechanism.
  Context is not just locale.
• Outcome patterns Intended and unintended
  consequences resulting from the activation of
  different mechanisms in different contexts.
  Decipher the reasons behind why the outcomes that
  occur.

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Test situation
C Context of interventions
M Mechanisms
O Patterns of (un)intended outcomes
consequences from activation of mechanisms
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Realist Hypothesis Grid
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What works in HPEC, for whom, in what
circumstances?

• Foster learning for health professional students
  about the improvement of health and health care
  for patients.

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What works in HPEC, for whom, in what
circumstances?

• Ensure the development of faculty for teaching
  about the improvement of health care.

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What works in HPEC, for whom, in what
circumstances?

• Speed change and reduce the cost of change in the
  development of health professionals who
  incorporate the principles of improvement into
  their daily work.

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What works in HPEC, for whom, in what
circumstances?

• Model improvement principles and values in our
  own work as education leaders.
• 22 of 27 reporting HPEC schools describe quality
  as a focal point in the organizations strategic
  plan.
• Institutions supply funds for students to attend
  HPEC and IHI National Forum
• One site actively (and visibly) uses improvement
  methods to assess and change curriculum

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What is occurring at the sites?

• University of Minnesota
• Since 2003, Physician and Society, year 2, Intro
  to Clinical Med
• Improvement projects as part of course
• Lehigh Valley Medical Center
• Exemplary care and learning site in pediatrics
  and internal medicine
• University of Missouri-Columbia
• Year 2 and 3 interdisciplinary patient safety
  curriculum
• Year 4 in-depth improvement projects
• University of Manitoba
• Provincial (system-wide) effort at teaching
  interprofessional care and linking to improvement
  of care

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Dartmouth Medical Student Perspective

• Initial visit to preceptor for year 1 student
• Im so impressed!
• After eight months at preceptor
• This the clinical care processes can be done
  better.

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Learning about QI at DMS
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Interprofessional Education at Dartmouth

• CLARION root cause analysis team
• National competition
• Local competition
• Identifying opportunities
• Colby-Sawyer College nursing program
• University of Connecticut School of Pharmacy
• Massachusetts College of Pharmacy

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Summary

• National collaboratives help focus local work
• Set priorities by local leaders
• Create faculty contacts across institutions
• Investment was modest, but vital (combination of
  seed funding and local contributions)
• Local educational efforts are enhanced by the
  national collaborations
• Provides framework and a connection for faculty
  and students
• Encourages faculty development
• Enhances opportunities to work across institutions