Stepwise Approaches to Building Sustainable Models of Interprofessional Education (IPE) and Collaborative Care in

Ambulatory Community SettingsGina Rowe, PhD, DNP, MPH, APRN,BC, PHCNS-BC, CNE

Assistant Professor and Family Nurse PractitionerDNP/FNP Program at Shady Grove

University of Maryland School of Nursinggrowe@umaryland.edu

Rebecca Wiseman, PhD, RNChair, UM SON at Shady Grove

University of Maryland School of Nursingwiseman@umaryland.edu

The National Center for Interprofessional Practice and Education is supported by the Josiah Macy Jr. Foundation, the Robert Wood Johnson

Foundation, the Gordon and Betty Moore Foundation, The John A. Hartford Foundation and the University of Minnesota. The National Center was

founded with support from a Health Resources and Services Administration Cooperative Agreement Award No.UE5HP25067. © 2018 Regents of

the University of Minnesota.

This activity has been planned and implemented by the National Center for

Interprofessional Practice and Education. In support of improving patient care, the

National Center for Interprofessional Practice and Education is jointly accredited by the

Accreditation Council for Continuing Medical Education (ACCME), the Accreditation

Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center

(ANCC), to provide continuing education for the healthcare team.

Physicians: The National Center for Interprofessional Practice and Education designates this live

activity for a maximum of 1.5 AMA PRA Category 1 Credits™.

Physician Assistants: The American Academy of Physician Assistants (AAPA) accepts credit from

organizations accredited by the ACCME.

Nurses: Participants will be awarded up to 1.5 contact hours of credit for attendance at this workshop.

Nurse Practitioners: The American Academy of Nurse Practitioners Certification Program (AANPCP)

accepts credit from organizations accredited by the ACCME and ANCC.

Pharmacists: This activity is approved for 1.5 contact hours (.15 CEU) UAN: JA4008105-0000-18-061-

L04-P

The National Center for Interprofessional Practice and Education is supported by the Josiah Macy Jr. Foundation, the Robert Wood Johnson

Foundation, the Gordon and Betty Moore Foundation, The John A. Hartford Foundation and the University of Minnesota. The National Center was

founded with support from a Health Resources and Services Administration Cooperative Agreement Award No.UE5HP25067. © 2018 Regents of

the University of Minnesota.

Disclosures:

The National Center for Interprofessional Practice and Education has a

conflict of interest policy that requires disclosure of financial relationships

with commercial interests.

Rebecca Wiseman and Gina Rowe

do not have a vested interest in or affiliation with any corporate

organization offering financial support for this interprofessional continuing

education activity, or any affiliation with a commercial interest whose

philosophy could potentially bias their presentation.

The National Center for Interprofessional Practice and Education is supported by the Josiah Macy Jr. Foundation, the Robert Wood Johnson

Foundation, the Gordon and Betty Moore Foundation, The John A. Hartford Foundation and the University of Minnesota. The National Center was

founded with support from a Health Resources and Services Administration Cooperative Agreement Award No.UE5HP25067. © 2018 Regents of

the University of Minnesota.

All workshop participants:

• Scan your badge barcode or sign in to each workshop

• Complete workshop evaluations (paper) and end-of-Summit evaluation

(electronic)

Those who purchase CE credit:

• MUST sign in to receive credit

• Will be sent a certificate after the Summit

****If you would like CE credit but have not purchased it, see Registration

IPE Team at USG • Claire Engers, MSW, LCSW-C

• Barbara Nathanson, MSW, LCSW-C

• Katherine J. Morris, MSW, LCSW-C

• Joan Pittman, PhD, MSW, LCSW-C

• Jana Goodwin, PhD, RN, ANCP

• Heather B. Congdon, PharmD, BCPS, CDE, FNAP

“Buckets” of IPE: Where Does IPE in Practice Fit?

EXPOSURE IMMERSION COMPETENCE

Community PartnersMercy Health Clinic Holy Cross Outpatient Centers

-Gaithersburg & Germantown

*Clinic expansion funded by HRSA Cooperative Agreement Award No. UE5HP25067; the National Center for Interprofessional Practice and Education at the University of Minnesota (Josiah Macy Jr. Foundation, Robert Wood Johnson Foundation, Gordon and Betty Moore Foundation, John A. Hartford Foundation).

Objectives

• To help you to plan next steps to build/expand sustainable IPE/C models in the community

• Learning Objectives:– Articulate the value of IPE in ambulatory settings

– List 3 challenges to IPE/C initiatives in ambulatory settings

– List 3 strategies to implement IPE/C in ambulatory settings

Stepwise Progression in Montgomery County, MD

• Developed “IPE” Faculty Group

• IPE clinic at Mercy Health Clinic – 2014

• Expansion to Holy Cross Clinics – 2016

• National Center Training

• Future Progression

Funding

Grants• Internal

• External– Small

– Large

– Single vs. Multi-year

Sustainability• Part of Routine Teaching

• Academic Teaching Center

• Reimbursement for Time

• Train Clinicians & Staff

Stairstep Model

IPE/IPC Challenges

• Culture of practice

• Time & Funding

• Administrative

– Patient/student recruitment

– Rigid curricula

– Schedule coordination

– Quantifying outcomes

– Staff turn-overSustainability?

IPE/IPC STRATEGIES

RWJF Lessons from the Field:Promising IPC Practices

• Put patients first

• Demonstrate leadership commitment

• Create a level playing field

• Cultivate effective team communication

• Explore the use of organizational structure

• Train different disciplines together

• Time, relationships, “IPE pockets”, “name it”, start small, multiple reinforcements

- Tomasik, J., & Fleming, C. (2015). RWJF.

Kotter’s 8 Steps to Lead Change

1) Create a Sense of Urgency

2) Build a Guiding Coalition

3) Form a Strategic Vision/Initiatives

4) Enlist a Volunteer Army

5) Enable Action by Removing Barriers

6) Generate Short-Term Wins

7) Sustain Acceleration

8) Institute Change

Troika Consulting(25 minutes)

• Write down an IPE/IPC goal or challenge (2 minutes).

• Quick Round Robin Consultations

– Interdisciplinary groups of three

–7 minutes/person:

• 2 minutes: share your goal/challenge

• 5 minutes: peer consultations

Lipmanowicz, H. & McCandless, K. (n.d.).Liberating Structures: Including and Unleashing Everyone. Available from: http://www.liberatingstructures.com/8-troika-consulting/.

15% Solutions(25 minutes)

• Write down an actionable 15% solutions IPE/IPC expansion strategy (2 minutes).

• Quick Round Robin Consultations

– Interdisciplinary groups of three

–7 minutes/person:

• 2-3 minutes: share actionable strategy

• 4-5 minutes: peer feedback

Lipmanowicz, H. & McCandless, K. (n.d.).Liberating Structures: Including and Unleashing Everyone. Available from: http://www.liberatingstructures.com/8-troika-consulting/.

Summary

• Take Away Messages– Developing IPE Models is challenging

– Questions remain

• Patterns

Stepwise Approach to Sustainable Model of IPE and IPC (Competence)

• Start small - pilot

• Go slow

• Build upon successes

• Learn from pitfalls

• Assess!

• PDSA

Liberating Structures References• Lipmanowicz, H. & McCandless, K. (2014). The

surprising power of liberating structures: Simple rules to unleash a culture of innovation. Seattle, WA: Liberating Structures Press.

• Lipmanowicz, H. & McCandless, K. (n.d.). Liberating Structures: Including and Unleashing Everyone. Available from: http://www.liberatingstructures.com/8-troika-consulting/.

Select ReferencesWhy IPE/IPC?

• Bradley, E.H. and Taylor, L.A. (2013). The American health care paradox: Why spending more Is getting us less. New York, NY: Public Affairs.

• Commonwealth Fund. (2015). U.S. healthcare from a global perspective. (2015). From: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

• Institute for Healthcare Improvement. (2017). The IHI Triple Aim Initiative. From: http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx

• Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 Update. From: http://www.aacn.nche.edu/education-resources/IPEC-2016-Updated-Core-Competencies-Report.pdf

• QSEN Institute. (2007, 2012). QSEN competencies. From: http://qsen.org/• Reeves, S., et al. (2016). A BEME systematic review of the effects of interprofessional education: BEME guide no. 39.

Medical Teacher, 38(7), 656-668.

Why IPE/IPC? – Nursing

• American Association of Colleges of Nursing. (2011). The essentials of baccalaureate education for professional nursing practice. From: http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf

• American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. From: http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf

• American Association of Colleges of Nursing. (2011). The essentials of masters education in nursing. From: http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

• Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. From: http://nationalacademies.org/hmd/reports/2010/the-future-of-nursing-leading-change-advancing-health.aspx

• National Organization of Nurse Practitioner Faculties. (2012). Nurse practitioner core competencies. From: http://www.nonpf.org/?page=14

• Speakman, E., Sicks, S., Collins, L., Dallas, S. Forstater, A., & Herge, E. (2016). National League for Nursing Guide to Effective Interprofessional Education Experiences in Nursing Education. Available from: www.nln.org/docs/default-

source/default-document-library/interprofessional-education-and-collaborative-practice-toolkit1.pdf

Select ReferencesIPE/IPC – General Practice

• Agency for Healthcare Research and Quality. (n.d.) Team STEPPS: Team Strategies and Tools to EnhancePerformance & Patient Safety. Retrieved from: https://www.ahrq.gov/teamstepps/index.html.

• Brashers, B., Owen, J. & Haizlip, J. (2015) Interprofessional Education and Practice Guide No. 2: Developing and implementing a center for interprofessional education, Journal of Interprofessional Care, 29:2, 95-99.

• Djukic, M., Fulmer, T., Adams, J.G., Lee, S., and Triola, M.M. (2012). NYU3T: Teaching, technology, teamwork. A model for interprofessional education scalability and sustainability. Second Generation QSEN, Nursing Clinics of North America, 47(3), pp. 333-346.

• Hall, L.W. and Zierler, B.K. (2014). Interprofessional Education and Practice Guide No. 1: Developing faculty to effectively facilitate interprofessional education, Journal of Interprofessional Care, 29:1, 3-7.

• Institute of Medicine. (2015). Measuring the impact of interprofessional education (IPE) on collaborative practice and patient outcomes. Washington, DC: The National Academies Press. Available from: http://www.nationalacademies.org/hmd/Reports/2015/Impact-of-IPE.aspx

• Institute of Medicine. (2013). Interprofessional education for collaboration: Learning how to improve health from interprofessional models across the continuum of education to practice: Workshop summary. Washington, DC: National Academies Press. Available from: http://www.nationalacademies.org/hmd/Reports/2013/Interprofessional-Education-for-Collaboration.aspx.

• Jennings, J., Nielsen, P., Buck, M.L., Corry, M., Cutler, C., Faucher, A….Ogden, K. (2016). Collaboration in practice: Implementing team-based care. Obstetrics & Gynecology, 127 (3), pp. 612-17.

• Lawlis, T.R., Anson, J. and Greenfield, D. (2014). Barriers and enablers that influence sustainableinterprofessional education: A literature review. Journal of Interprofessional Care, Early Online: 1-6.

• Reeves, S., Boet, S., Zierler, B. & Kitto, S. (2015) Interprofessional Education and Practice Guide No. 3: Evaluating interprofessional education, Journal of Interprofessional Care, 29:4, 305-312.

• Tomasik, J., & Fleming, C. (2015). Lessons from the Field: Promising Interprofessional Collaboration Practices, White Paper, The Robert Wood Johnson Foundation. Retrieved from: rwjf.org.

• Willgerodt, M.A., Blakeney, E.A., Brock, D.M., Liner, D., Murphy, N. and Zierler, B. (2015). Interprofessional Education and Practice Guide no. 4: Developing and sustaining interprofessional education at an academic health center. Journal of Interprofessional Care, Early Online: 1-5.

Select ReferencesIPE/IPC – Ambulatory/Community Practice

• Arnold, M.E., Buys, L., and Fullas, F. (2015). Impact of pharmacist intervention in conjunction withoutpatient physician follow-up visits after hospital discharge on readmission rate. American Journal of Health-System Pharmacists, 72, Suppl. 1, pp. S36-42.

• Coleman, M.T., McLean, A., Williams, L., and Hasan, L. (2017). Improvement in interprofessional studentlearning and patient outcomes. Journal of Interprofessional Education & Practice, 8, pp. 28-33.

• Coleman, M.T., Roberts, K., Wulff, D., Van Zyl, R., and Newton, K. (2008). Interprofessional ambulatoryprimary care practice-based educational program. Journal of Interprofessional Care, 22(1), pp. 69-84.

• Dubouloz, C., Savard, J., Burnett, D. and Guitard, P. (2010). An interprofessional rehabilitation universityclinic in primary health care: A collaborative learning model for physical therapist students in a clinical placement. Journal of Physical Therapy Education, 24(1), 19-24.

• Farlow, J.L., Goodwin, C., and Sevilla, J. (2015). Interprofessional education through service-learning: Lessons form a student-led free clinic. Journal of Interprofessional Care, 29(3), pp. 263-4.

• Gaglioti, A.H., Barlow, P., Thoma, K.D., and Bergus, G.R. (2017). Integrated care coordination by aninterprofessional team reduces emergency department visits and hospitalizations at an academic health centre. Journal of Interprofessional Care, 31(5), pp. 557-65.

• Haggarty, D. and Dalcin, D. (2014). Student-run clinics in Canada: an innovative method of deliveringinterprofessional education. Journal of Interprofessional Care, 28(6), pp. 570-72.

• Haines, S.L., DeHart, R.M., Flynn, A.A., Hess, K.M., Marciniak, M.W., Mount, J….Zatzkin, W. (2011).Academic pharmacy and patient-centered health care: A model to prepare the next generation of pharmacists. Journal of the American Pharmacists Association, 51, pp. 194-202.

• Helling, D.K. and Johnson, S.G. (2014). Defining and advancing ambulatory care pharmacy practice: It istime to lengthen our stride. American Journal of Health-System Pharmacists, 71, pp. 1348-56.

• Institute of Medicine. (2014). Building health workforce capacity throuigh community-based healthprofessional education: Workshop summary. Washington, DC: National Academies Press. Available from: http://www.nationalacademies.org/hmd/Reports/2014/BuildingHealthWorkforceCapacity.aspx.

Select ReferencesIPE/IPC – Ambulatory/Community Practice, con’t.

• Anderson, E.S., Ford, J. & Kinnair , D.J.(2016) Interprofessional Education and Practice Guide No. 6: Developing practice-based interprofessional learning using a short placement model, Journal of Interprofessional Care, 30:4, 433-440.

• Brewer, M.L. & Barr, H. (2016) Interprofessional Education and Practice Guide No. 8: Team-based interprofessional practice placements, Journal of Interprofessional Care, 30:6, 747-753.

• Lie, D.A., Forest, C. P., Kysh, L. & Sinclair, L. (2016) Interprofessional education and practice guide No. 5: Interprofessional teaching for prequalification students in clinical settings, Journal of InterprofessionalCare, 30:3, 324-330.

• Moskowitz, D., Glasco, J., Johnson, B. and Wang, G. (2006). Students in the community: An interprofessionalstudent-run free clinic. Journal of Interprofessional Care, 20(3), pp. 254-9.

• Paschke, S.M., Witwer, S., Richards, W.C., Jessie, A., Harden, L., Martinez, K….Vinson, M.H. (2017). American Academy of Ambulatory Care Nursing position paper: The role of the registered nurse in ambulatory care. Nursing Economic$, 35(1), pp.39-47.

• Schuttner, L., Zhang, Z., and Kuo, A. (2017). Reducing ER use through a trainee-designed, interprofessionalcare group for high-utilizing chronically ill patients: A pilot program. Journal of Interprofessional Education & Practice, 9, pp. 86-90.

• Shrader, S., Hodgkins, R., Laverentz, D. Zaudke, J., Waxman, M., Johnston, K. & Jernigan, S. (2016). Interprofessional Education and Practice Guide No. 7: Development, implementation, and evaluation of a large-scale required interprofessional education foundational programme, Journal of InterprofessionalCare, 30:5, 615-619.

• Shunk, R., Dulay, M., Chou, C.L., Janson, S., and O’Brien, B. (2014). Huddle-coaching: A dynamic intervention for trainees and staff to support team-based care. Academic Medicine, 89(2), pp. 244-50.

• Thommes, T. (2004). Stimulating and funding interprofessional education. University of Minnesota Academic Health Center. Available from: https://conservancy.umn.edu/bitstream/handle/11299/102518/Stimulating_Funding_Interprofessional_E

ducation_AHC_UofM.pdf?sequence=1• Wang, T. and Bhakta, H. (2013). A new model for interprofessional collaboration at a student-run free clinic.

Journal of Interprofessional Care, 27, pp. 339-40.