Andreas A. Theodorou M.D. Interim Co-Director, Interprofessional Education and Practice U of A Health Sciences Center Chief Medical Officer The University of Arizona Medical Center Professor and Associate Chair, Dept. of Pediatrics Chief, Pediatric Critical Care Medicine U of A College of Medicine
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Interprofessional Education & Practice (IPEP) · PDF fileJeff Skiles and Flight Attendants Donna Dent, Sheila Dail and Doreen Welsh ... Interprofessional education and practice are
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Andreas A. Theodorou M.D. Interim Co-Director, Interprofessional Education and Practice U of A Health Sciences Center Chief Medical Officer The University of Arizona Medical Center Professor and Associate Chair, Dept. of Pediatrics Chief, Pediatric Critical Care Medicine U of A College of Medicine
INTRODUCTION
Origin of Andy’s Error
Inadequate training
Poor medical team interaction
Inadequate supervision
Poor communication:
Attending to Resident
Poor patient outcome
Preventing Andy’s Error
Inadequate training
Good medical team interaction
(Pharmacist review of order)
Inadequate supervision
Poor communication:
Attending to Resident
Adverse Event Prevented!
March 27, 1977 Tenerife Island
Safety: System vs Technology
J. Brian Sexton found that
improvements in aviation
safety were due to improving
interpersonal skills
Over 70% of aviation accidents
occur due to flight crew
communication issues
Re-certification now involves
evaluation of interpersonal
skills!
“Crew Resource Management”
http://www.aviationteamwork.com/
The New Yorker: The Checklist December 10, 2007 Atul Gawande
Adverse event but minimized harm…
Purdue U Commencement Address Chesley Sullenberger, 2011
This constant pursuit of excellence isn't just about ego; it's not about individual achievements; it's about achieving the best result – and when you have a team that works well together, it provides the same satisfaction as when you're a member of a winning sports team. When everyone is doing their share in a collaborative way, it just feels right. I experienced this on January 15. My crew - First Officer Jeff Skiles and Flight Attendants Donna Dent, Sheila Dail and Doreen Welsh - and I never stopped working together to solve the challenges we faced.
We never gave up. We never lost faith in ourselves or each other. In a similar fashion, for each of you, no matter how dire a situation is, know that further action is almost always possible - and when you're part of a well-trained team, your chances of getting through a challenge or a crisis are immeasurably better than when you're not. When we are true to our ideas and work together, there is little we cannot accomplish.
History of IPEP
2001 2003 2000
To Err Is Human:
Building a Safer
Health System
To Err Is Human: Building a Safer
Health System (IOM, 2000)
The first of IOM “Quality” reports
“the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering.”
44,000-98,000 people die each year from mistakes
It was a call to action!
INSTITUTE OF MEDICINE To Err is Human: Building a Safer Health System (2000)
“…it is not acceptable for patients to be harmed by the health care system that is supposed to offer healing and comfort…”
“Failure of Communication” listed under causes of errors
History of IPEP
2001 2003 2000
To Err Is Human:
Building a Safer
Health System
Crossing the Quality
Chasm: A New
Health System for
the 21st Century
INSTITUTE OF MEDICINE Crossing the Quality Chasm: A New Health System for the 21st Century March 2001
“Bringing state-of-the-art care to all Americans in every community will require a fundamental redesign of the entire health system…”
A NEW HEALTH SYSTEM…
Safe
Timely
Effective
Efficient
Equitable
Patient-Centered
INSTITUTE OF MEDICINE Crossing the Quality Chasm: A New Health System for the 21st Century March 2001
Redesign Imperatives:
Reengineered care processes
Effective use of information
Knowledge and skills management
DEVELOPMENT of EFFECTIVE TEAMS
COORDINATION OF CARE across patient-conditions, services sites of care over time
History of IPEP
2001 2003 2000
To Err Is Human:
Building a Safer
Health System
Crossing the Quality
Chasm: A New
Health System for
the 21st Century
Health Professions
Education: A Bridge
to Quality
INSTITUTE OF MEDICINE Health Professions Education: A Bridge to Quality (7/2003)
“Although the academic environments of the various health professions generally are not interdisciplinary, practice environments are increasingly so, posing a serious disconnect…”
“…collaboration among clinicians in practice settings draws upon each profession’s strength and therefore optimizes care for patients.”
INSTITUTE OF MEDICINE Health Professions Education: A Bridge to Quality (7/2003)
Five Core Competencies
Provide patient-centered care
Employ evidence-based practice
Apply quality improvement
Utilize informatics
Work in Interdisciplinary Teams -cooperate, collaborate, communicate, and integrate care teams to ensure that care is continuous and reliable.
INSTITUTE OF MEDICINE Health Professions Education: A Bridge to Quality (7/2003)
A New Vision for Health Professions Education
All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.
“Instructional reforms should :adopt competency-driven approaches to instructional design”
“…promote interprofessional and transprofessional education that breaks down professional silos while enhancing collaborative and non-hierarchical relationships in effective teams”
History of IPEP
Since the IOM reports there have been numerous organizations and funding agencies that have joined the IPE campaign
Pandemic Flu: An Exercise Disaster Preparedness (Nov 2012)
Student Attendance
College Year/Semester Invited Absent Actual
TUC COM 2nd / 1 114 4 110
TUC COP 3rd 98 13 85
TUC CON BSN 2nd 13 2 11
TUC CON DNP varies 1 0 1
TUC CON MEPN 1st / 2 69 1 68
TUC COPH varies 92 9 83
TUC COL varies 42 3 39
TUC ASU SW varies 13 7 6
TUC Total 442 39 403
PHX COM* 2nd 46 0 46
PHX CON MEPN 1st / 1 17 0 17
PHX UA DNP 1 0 1
PHX COPH 5 0 5
PHX ASU SW 11 5 6
PHX COP 3 0 3
PHX NAU PA 1st 25 0 25
PHX TOTAL 108 5 103
TOTAL 550 44 506
Students$(N$=$281$for$Surveys)$$
Pandemic Flu Nov, 2012
My understanding of the ethical issues that arise during a pandemic flu outbreak (BEFORE and AFTER the activity)
3$
Pandemic Flu Nov, 2012
My expectations about the roles and responsibilities of government agencies during a pandemic flu outbreak (BEFORE and AFTER the activity)
3$
Pandemic Flu Nov, 2012
My appreciation of the type of difficult decisions that need to be made when medical and other resources are in short supply (BEFORE and AFTER the activity)
2$
Pandemic Flu Nov, 2012 My understanding of the degree of collaboration among professions that is necessary during a pandemic flu outbreak (BEFORE and AFTER the activity)
What Students Liked: Pandemic Flu 2008 and 2009
That we used an actual scenario for an interprofessional exercise, working together instead of talking about working together was much more effective. I enjoyed being able to work with non - nursing students (public health) and wished we had a law student.
It really opened my mind to how much difficult decision making and ethics are involved in something that seems simple and intuitive on the surface. When investigated even a little deeper, it clearly is not.
I enjoyed the ability to get information from my group to help make a decision. The team I worked with was very sharp and everyone contributed and was heard.
The respect shown to students for their current knowledge.
http://vimeo.com/55035876 2012 State-wide Pan Flu minicourse
The Disabilities Activity consisted of two parts: the live activity on
April 4, 2012 and the pre-activity tasks online in the D2L site. All
student materials (pre-activity and live activity including location
information) were housed in the course site in D2L. Facilitator
information was also available in the D2L Disabilities course site.
Disabilities Exercise: 6 Cases were reviewed by students
CASE #1: JACOB (Autism) Jacob is a six-year old boy with autism.
CASE #2: FRANK (Deafness) Frank is an 18-year-old teenager with a hearing disability.
CASE #3: EDWARD (Visual Impairment) Edward is a 36-year-old man who has been blind since childhood.
CASE #4: RACHEL (Mobility Impairment) Rachel is a 44-year-old woman with multiple sclerosis. Her disease has progressed so that she uses an electric wheelchair to get around.
CASE #5: ROSA (Intellectual Disability) Rosa is a 64-year-old woman with an intellectual disability.
CASE #6: JAMES (PTSD Disability) James is a veteran of the US Army who has been diagnosed with PTSD.
EDUCATION
PRACTICE
Resident Physician Orientation June 28, 2012
Learning Objectives
Identify who your team members are at UAHN.
Demonstrate that, as resident physicians, you
understand that your role on the health care team
involves working cooperatively with care providers
across the spectrum and with patient and their families.
Place the interest of patients and populations at the
center of interprofessional health care delivery.
Learning Objectives
Describe your understanding of the importance of
communication skills, including listening, in providing
quality care to individuals.
Use the full scope of knowledge, skills, and abilities of
available health professionals and healthcare workers to
provide care that is safe, timely, efficient, effective,
equitable, and patient centered (STEEEP).
Share accountability with other professions, patients, and
communities for outcomes relevant to prevention and
providing high quality, safe and cost-efficient health care.
Participating Specialties
Dermatology (1)
Emergency Medicine (16)
Endocrinology (1 Fellow)
Family Medicine (14, 1 Fellow)
Gastroenterology (2 Fellow)
General Surgery (16)
Hematology Oncology (1)
Infectious Disease (1 Fellow)
Internal Medicine (38)
Neurology (4, 1 Fellow)
Anesthesiology (7)
Cardiology (1 Fellow)
Participating Specialties
OB/GYN (4)
Ophthalmology (4)
Orthopedics (2)
Pathology (6)
Pediatrics (15, 1 Fellow)
Psychiatry (13)
Pulmon/CC (3 Fellows)
Radiation Oncology (2)
Radiology (5)
Sports Med (1 Fellow)
Surgery, General (19)
Urology (1)
Vascular & Interventional Radiology (1)
My understanding about the important role good communication plays in high quality
and safe clinical outcomes (listening & integrating)
1 3
20
42
35
1 1 6
37
56
0
10
20
30
40
50
60
None at all A little A moderateamount
A lot A great deal
Pe
rce
nt
(N
=1
90
)
BEFORE AFTER
My understanding about the potentially adverse impact of disruptive behaviors on
patient care and safety
1 4
27
37 31
0 1
10
40
50
0
10
20
30
40
50
60
None at all A little A moderateamount
A lot A great deal
Pe
rce
nt
(N
=1
90
)
BEFORE AFTER
My knowledge of how to integrate the clinical skills and expertise of other team
members
0 5
42
33
20
0 1
14
53
33
0
10
20
30
40
50
60
Not at allknowledgeable
Slightlyknowledgeable
Moderatelyknowledgeable
Veryknowledgeable
Extremelyknowledgeable
Pe
rce
nt
(N
=1
90
)
BEFORE AFTER
The degree of RELEVANCE that IP education/activities like this have to:
1 2
9
42 46
1 3
7
42 47
0
5
10
15
20
25
30
35
40
45
50
Not at allrelevant
Slightlyrelevant
ModeratelyRelevant
Very relevant Extremelyrelevant
Pe
rce
nt
(N
=1
91
)
Improving health care outcomes
Increasing patient trust in health care teams
The degree of RELEVANCE that IP education/activities like this have to:
1 2
11
41 46
1 5
16
37
42
0
5
10
15
20
25
30
35
40
45
50
Not at allrelevant
Slightlyrelevant
ModeratelyRelevant
Very relevant Extremelyrelevant
Pe
rce
nt
(N
=1
91
)
Maximizing the contributions of each team member
Decreasing disruptive behaviors
The degree of RELEVANCE that IP education/activities like this have to:
1 2
9
36
53
1 5
17
38 39
0
10
20
30
40
50
60
Not at allrelevant
Slightlyrelevant
ModeratelyRelevant
Very relevant Extremelyrelevant
Pe
rce
nt
(N
=1
91
)
Improving patient safety
Increasing job satisfaction among health care providers
The degree of RELEVANCE that IP education/activities like this have to:
• Plans for IP Education Building on Tucson campus
Develop the Program’s Long-Term Evaluation
Faculty Recognition/Promotion for IPEP Activity
Keys to Sustainability
Lessons Learned To Date
Students want to meet peers from other professions to understand their perspective about a health care or public health issue
Students want to discuss and solve things together, face-to-face
Most students are engaged in the small group discussion
Very important to have trained and skilled facilitators! • Now have detailed training sessions and facilitator guides
Faculty must also be aware and supportive of IPE to be effective facilitators
Students enjoy seeing faculty from their colleges participating as speakers/facilitators
Lessons Learned (continued)
Logistics, time of day, length of exercise, and snack breaks are important considerations
Setting and logistics are critical for small group interaction (moved away from large ballroom)
Must have clear objectives
Technology is a must…but don’t depend on it
Planning effective learning activities is time consuming
All activities must be evaluated and debriefed
Lessons Learned (continued)
…and an IPEP curriculum takes
substantial resources!
IPEP Blog and Website
IPEP Social Media and Connections
Transformative Change from the Classroom to Practice Collaborating Across Borders (CAB) IV, June 12-14, 2013in beautiful Vancouver, British Columbia, Canada www.cabiv.org