Uncrossing the lines of communication
Posted: May 14, 2012
IPE helps straighten the kinks
Teamwork, communication, and respect – oh my! Interprofessional education is everywhere at ATSU. Although it is not a new concept in health professions education, it seems IPE’s wildfire growth is catching momentum in programs across the University.
As Still Magazine sought to find out what ATSU is doing, in its usual pioneering style, to lead the way in IPE, we asked: What does it look like and how does it work? Who is involved? How is it transforming the way our students learn? How does it affect the way in which our social mission is lived out every day? How does it affect outcomes for patients?
Trouble on the horizon
To say that the healthcare system in the United States is troubled is putting it lightly. The quality of care isn’t up to par, costs are through the roof, and access is severely limited. Chances are you might even know someone who has suffered as a result of a medical error, misdiagnosis, or an improper prescription. Research indicates that between 50-80 percent of errors in patient care can be traced back to poor communication among healthcare providers. That spells trouble for our students, who are entering a variety of health professions each year, and for patients, who rely on our graduates’ ability to deliver quality care.
The case for IPE
Takeaways:
1. The healthcare system is broken. Health professions education wants to help fix it.
2. IPE is a viable solution to critical healthcare miscommunications.
3. ATSU puts IPE front and center, preparing a collaborative health professions workforce for future success.
According to the Institute of Medicine, interprofessional education occurs when two or more professions learn with, from, and about each other to improve collaboration and the quality of care.
The principle is simple: Healthcare practitioners in the field must work together as patient needs grow in complexity, so why not learn how to work together from the get-go? Through IPE immersion, students ideally will develop the ability to share knowledge and skills collaboratively.
The results: Understanding, cooperation, and teamwork increase across healthcare disciplines. Communication increases and relationships are strengthened. Students learn more because they are engaged. A world of collaborative research possibilities opens. And, the benefits don’t just end with student learning. Healthcare delivery becomes increasingly patientcentered, which is the ultimate goal.
ATSU is working toward this goal in many ways. Our founding osteopathic philosophy and long-standing social mission parallel the IPE movement. It’s clear that interprofessional teams will be increasingly common in healthcare delivery and that ATSU graduates will be expected to work as part of interprofessional teams that provide coordinated, whole person healthcare.
The University’s recently refined mission statement addresses its stance on IPE and positions ATSU as truly learning-centered. As a core institutional focus, these learning opportunities are fostered at each of our schools and college.
IPE is interwoven in our new strategic plan, holding the University accountable for making it a reality across all its programs. According to the plan, all full-time faculty and students are targeted for participation in IPE and team-based, patientcentered experiences beginning in the 2014 academic year. However, many of these experiences exist today.
Here, five large- and small-scale projects are examined – each built upon the foundation of IPE. Project results amply demonstrate that IPE is vital to student learning, intrinsic to ATSU’s mission, and yields positive results in terms of patients’ healthcare outcomes.
Posture Police
When dental students at ASDOH see red Posture Police T-shirts enter the simulation lab, backs suddenly straighten and arm positions shift. It’s just a friendly reminder of the ergonomic lessons learned from physical therapy students at ASHS.
When the dental program approached PT about collaborating three years ago, the statistics were bleak.
“Within the profession of dentistry, there is an amazing incidence of people who have disability claims throughout their career and a lot of times it ends their career,” says Cheri Hodges, PT, DPT, assistant professor, physical therapy.
The Posture Police program is a proactive approach in mitigating the potential hazards for dentists caused by poor ergonomics. And, it’s an engaging way to bring professions together. PT students and faculty first present an active lecture on the incidence of debilitating injuries common in the dental profession. They then demonstrate the proper ergonomic approach for the back and upper extremities and walk dental students through posture and strengthening exercises.
As a follow-up, PT students make surprise visits once a week for three months to the dental lab to help ergonomically adjust chairs, demonstrate how to lean over the sim mannequins, and adjust equipment and lighting based on personal needs. The dental students have been so receptive to the program that they often ask questions about pain, general fitness, and injury prevention of their PT counterparts.
“I think the manner in which we have helped the dental students will not only have an impact on their life but will help me as a physical therapist to better educate future patients who are dentists,” says one PT student in a follow-up evaluation.
It’s clear that the interdisciplinary nature of this project has postured the relationship between ATSU’s dental and PT crowds.
Human Anatomy: knee injury case problems
It seemed obvious to Human Anatomy Director Sue Hillman, MS, MA, ATC, that her students needed more opportunities to work together outside of their regular professional sub-sets. Having taught first-year physical therapy, occupational therapy, and athletic training students for years at ASHS, she found that some professions struggled with the curriculum and some felt disrespected by the other professions. In January, these students were introduced to their first IP project. Interdisciplinary teams were created and assigned a knee injury case problem with varying layers of complication, allowing each profession the opportunity to take a lead role in diagnosis and treatment.
According to Hillman, the project was a success. Approximately 80 percent of students reported that they enjoyed working and learning from students in other programs. Students said the session was fun and that they felt respected. And, comprehension was off the charts. While working in teams, students were asked to identify anatomical structures on a cross section, which, according to Hillman, has been difficult for students in the past. Nine of the 11 groups scored 100 percent.
“This additional project brought some of the previously disengaged students back into the group,” says Hillman.
Hillman’s students are now knee-deep in IPE opportunities.
Heart Failure Project
Core competencies (developed by the interprofessional Education Collaborative):
1. Values/ethics for interprofessional practice
2. Roles/responsibilities for collaborative practice
3. Interprofessional communication
4. Interprofessional teamwork and team-based care
For many patients, a diagnosis of congestive heart failure means a hospital readmission is likely. Interdisciplinary student teams in the Heart Failure Project are hoping to change that.
Collaboration among the ATSU Aging Studies Project, Banner Heart Hospital, East Valley Adult Resources, and the Greater Valley Area Health Education Center has given rise to the grant-funded program, launched in fall 2011. Students actively work in interdisciplinary teams to educate patients with a primary diagnosis of congestive heart failure on proper dietary and nutritional guidelines. The goals are to help patients become better informed and better able to self-manage their condition. This can result in improved quality of life and reduce re-hospitalizations. And, students receive a healthy dose of IPE, learning about team-based care and the challenges that face older adults with chronic conditions.
“We could not recreate these experiences in the classroom,” says Elton Bordenave, MEd, CHC, director, Aging Studies Project, Arizona campus. Bordenave oversees this project and is responsible for developing interdisciplinary programming emphasizing geriatric healthcare.
“There are only a handful of projects like this around the country, and our students are getting to play an active role in perhaps the most aggressive of these experiments,” he says.
By visiting patient homes once a week for four weeks, students are exposed to economic, physical, and social situations that they wouldn’t have access to otherwise. Plus, they are working with peers from other disciplines, hopefully soaking up fresh perspectives and new skills.
ATSU students from four disciplines are participating – osteopathic medicine, dentistry, physician assistant, and occupational therapy. As part of an Arizona state-wide initiative to decrease the number of hospital readmissions for specific health issues, even more partners are being invited to participate. Grand Canyon University nursing students are already participating and, in the coming year, pharmacy students from Midwestern University will join the team.
It’s unclear whether patient outcomes are directly impacted by the interdisciplinary nature of the teams delivering the program; nonetheless, the project has won the hearts of students who are transcending disciplinary boundaries. Program data are limited, but results are promising. Data on the initial 25 congestive heart failure patients show that none of the participants were readmitted to the hospital within 30 days of discharge. The national 30-day average is a 25 percent readmit rate.
Still Standing Fall Prevention Outreach
According to the Centers for Disease Control and Prevention, a third of adults over age 65 fall each year, causing moderate to severe injuries. Since 2008, ATSU has made significant contributions to Arizona’s response to the fall issue through the Still Standing Fall Prevention Outreach.
Physical therapy, occupational therapy, audiology, athletic training, and physician assistant students are trained in A Matter of Balance fall prevention curriculum (licensed by MaineHealth’s Partnership for Healthy Aging, Portland, Maine) and are assigned to one of 23 senior and community centers around Maricopa County where they deliver the program over an eight-week period. Students are paired in interdisciplinary teams and deliver the curriculum to groups of 10-15 older adults.
Students have fallen for this IP opportunity. To date, 140 coaches have been trained and nearly 1,000 seniors have benefited. The program, which now runs nine months out of the year, meaningfully connects students from many disciplines with populations they wouldn’t be exposed to normally.
MaineHealth reports many positive outcomes for elderly participants. Evaluations indicate increased physical strength, improved confidence in their ability to manage a fall, and increased ability to perform everyday tasks.
“More than once I have received calls from [elders] who have told me that the fall prevention classes helped them overcome their fear of falling and allowed them to go out and do basic activities like grocery shopping,” says Bordenave, who also oversees this outreach.
House Calls
“Working as a tech in a hospital I saw firsthand how important every member of the team is to a patient’s overall care. I also saw very poor examples of teamwork. I watched physicians act disrespectfully toward members of the healthcare team. As I began medical school, I was thankful for these examples, both good and bad,” says second-year KCOM student Hillarey Stone. “I truly understand the importance of even the most minor players on the team, and I hope to always respect their opinions and value their important contributions to patient care.”
Students at KCOM (osteopathic medicine) and Truman State University (nursing, health sciences, and communication disorders) are connecting the IP dots, teaming up for House Calls, an in-home patient program that focuses on health promotion and disease prevention in senior and vulnerable populations.
Sponsored by the Department of Family Medicine, Preventive Medicine and Community Health, House Calls is part of the Complete DOctor course. Curriculum includes patient medical and social histories, basic physical exams, and patient education. Students, who have the option of joining an IP or DO-only team, make four hour-long visits to volunteer patients over a 12- to 14-month period and meet with faculty after each visit to discuss patient findings. IP student groups also discuss team dynamics.
“It goes beyond the nuts and bolts of a medical visit in order for students to see that their patient is more than their illness,” says KCOM Dean Margaret Wilson, DO, ’82, “There are so many other issues that impact that patient’s ability to stay healthy and get good healthcare.”
Both students and patients are benefiting. Students develop meaningful relationships with real patients in real settings. They interact with interprofessional peers while learning to administer a range of functional patient assessments.
This unique avenue for receiving healthcare allows patients to share wisdom and healthcare observations. And, they gain friends and important social contacts while taking advantage of community resources.
Student interest in being a part of IP teams continues to increase. When it launched in 2002- 03, seven teams participated in House Calls. In 2010-11, 50 teams participated.
“I think that the interprofessional opportunity to explore how to work with each other is a great experience and evolves as they continue to work within that team,” says Janet Head, EdD, director, Aging Studies Project, Missouri campus, and AHEC program co-director. AHEC contracts with Family Medicine to coordinate patient volunteers for the program.
Dr. Head knows a thing or two about IPE. Having been a nurse, she too has personally experienced the benefits of IP communication. Not to mention, her passion for the subject led her to do her 2007 dissertation on IPE, with House Calls as her research base.
Her data on attitude measurement showed that DO students who participated in IP teams had a better sense of the efficiency of teams; had a greater appreciation of the value of teamwork; felt that shared leadership was hard for them, but still showed an appreciation for it; and rated their teamwork skills as improved and stronger.
“Students seem to struggle with who will lead the teams and how the work will get done,” Dr. Head says. “But, one of the important aspects of teamwork is conflict resolution – they learn how to settle disputes with the best possible outcome for the patient.”
Patients seem especially pleased with the program, the interactions with local students, and the distinctive approach each profession brings to the conversations at their kitchen tables.
“I’ve met a lot of nice kids through the program. We get to know the students like family,” says Tepa Ross, a local resident who has been a part of House Calls for a year.
“The interdisciplinary teams get a chance to see how different disciplines do things differently. It’s good for our students, as developing physicians, to see how it takes a team to be successful in the delivery of healthcare,” adds Dr. Wilson. “The bottom line is that the patient is the center of healthcare, and everyone else works together to best satisfy the needs of the patient. Recognition of everyone’s roles and contributions is a starting point.”
Tying it all together
Douglas L. Wood, DO, PhD, senior vice president – academic affairs, is currently at the helm of implementing ATSU’s IPE and learning-centered initiatives (along with co-chairs David Wayne, PhD, special assistant to SVP-AA, and John George, PhD, associate dean, educational development & services). According to Dr. Wood, the initiative is visionary.
“It truly is the medical practice of the future in this country,” he says. “Healthcare will be enhanced and there is likely to be a lowering of costs to patients.”
Programs such as Posture Police, the Human Anatomy project, Congestive Heart Failure Project, Still Standing, and House Calls demonstrate that interprofessional education can positively impact those involved. Patients and students benefit, and the creative ways for putting it to use and applying it in a clinical setting are seemingly endless. These programs set the stage for successful interdisciplinary teamwork in the future.
Similarly, the outcomes of other grassroots IPE efforts at ATSU have yielded positive results. When a handful of professors from audiology, physical therapy, and physician assistant studies decided to lead sessions where students could talk about their roles in treating a patient, they found that all the students reported obtaining new knowledge. Between 93-97 percent of students, depending on the discipline, reported that this new knowledge would be useful in clinical practice.
One student reported, “There is more collaboration between our professions than I previously thought. There are many things we can learn from each other that will make our patient interactions more effective.”
And then there are the happy endings no one could predict. Consider third-year dental student Bao Huynh’s quick thinking and interdisciplinary training that led to a healthy outcome for one patient. While receiving dental treatment at the ASDOH On-site Mesa Clinic, the patient received what turned out to be life-saving information. Huynh noticed a small mole on the patient’s face and advised her to have it checked. At Huynh’s suggestion, the patient followed up with her doctor, discovering that the mole was melanoma skin cancer. Thankfully it was in its early stages.
“Thank you for teaching your students to watch for health issues other than teeth. I am very thankful that I went to ATSU and was assigned to Bao Huynh,” the patient later wrote. “It was certainly a life-saving experience. I will forever be grateful.”
The hardest part is getting started
While ATSU is making strides in creating a truly learning-centered environment for students by weaving an interdisciplinary component into many of its programs, it comes as no surprise that the upshot cannot happen overnight.
“This is not an easy venture,” says Dr. Wood, who described the many barriers ahead.
First in impeding the way is a non-existent universitized school calendar and corresponding student schedules. Each school and program operating on a different calendar makes it nearly impossible to get faculty and students in the same place at the same time. (According to Dr. Wood, ATSU will bring that piece substantially into play in the fall of 2013.) Then there are the more deep-seated issues such as disciplinary silos, resistant attitudes, and lack of training for faculty on how to integrate IP opportunities into curriculum.
Despite the challenges in making IPE a reality, ATSU is forging ahead. Our students, who are already demanding more opportunities for interprofessional education, will continue to uncross the lines of communication as they grow and develop into compassionate educators and practitioners. We expect our efforts will make a profound impact for patients and the way in which healthcare professionals respect and communicate with one another.