1. Associate Vice President for Education University of Minnesota
Barbara F. Brandt, PhD
Director
Associate Vice President for Education
University of Minnesota
The National Center for Interprofessional Practice and Education is supported by a Health Resources and Services Administration Cooperative Agreement Award No. UE5HP In addition, the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation (RWJF), the Gordon and Betty Moore Foundation, and the John A Hartford Foundation have collectively committed up to $8.6 million in grants over five years to support and guide the Center, which will work to accelerate team work and collaboration among doctors, nurses and other health professionals— as well as patients—and break down the traditional silo-approach to health professions education.

2. It‘s “scope” of practice!
It’s health professions education system
It’s the payment
system!
It’s the health delivery system!
More primary care !!
There is no problem our system is great!
Team Training!!
The uncoordinated, costly, non-aligned health care delivery system must undergo transformative change into one that values population health, value-added health and consumer engagement.
A lot of efforts for change touch the elephant representing the new system in different places and focus on disparate and uncoordinated solutions. An approach to transformation must promote real change, component alignment, and capture the expertise present in the multiple professions that encompass the workplace of health.
A major effort with great potential for transformation is that which seeks to reconnect education with clinical practice in a way that promotes achieving improved population health, percapita cost reduction, quality improvement and consumer engagement.

3. Practice transformation away from episode of care
Preventive
Medicine
Medication
Refills
Acute Care
Nursing
Test Results
Master Builder
DOCTOR
Chronic Disease
Monitoring
Here we have the master builder model from the Flexner Report. At the time this was proposed, there was a great need. And, it served us well for many years. However, it has now outlived its usefulness and it is time to move on to a new approach to health, including health care.
Interestingly, this Flexnarian model was adopted by other health provider professions, also. Our greatest challenge is in moving beyond our professional mental models into a safe space to be creative in redesigning how we achieve health..
What is driving this change is all the marketplace forces that tell us the current “system” is not serving the health of the national well or cost-effectively. This realization has lead to a coordinated shift to an outcomes orientation, lead by the Triple Aim, as described by Berwick et al.
Case
Manager
Medical
Assistants
Behavioral
Health
Paul Grundy MD MPH
IBM Director Healthcare Transformation
Director Patient Centered Primary Care Collaborative
Source: Southcentral Foundation, Anchorage AK

4. Triple Aim System Integrator Population Health Per Capita Cost Patient
The System Integrator
Creates a partnership across the medical neighborhood
Drives PCMH primary care redesign
Offers a utility for population health and financial management
Patient
Experience
The Triple Aim of Berwick et al.
There is great enthusiasm that interprofessional teamwork, when applied to achieving population health and health care, will move the redesign along in a meaningful and timely way. Such an approach will necessitate a relinking of education, clinical practice and public health, fields and disciplines that have grown apart over the years.
Prouctivity
Paul Grundy MD MPH
IBM Director Healthcare Transformation
Director Patient Centered Primary Care Collaborative 28
Copyright 2011 by IBM

5. Framework for Action on Interprofessional Education and Collaborative Practice, World Health Organization, 2010
Interprofessional education occurs when “students” from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. Interprofessional education is a necessary step in preparing a “collaborative practice-ready” health workforce that is better prepared to respond to local health needs. A collaborative practice-ready health worker is someone who has learned how to work in an interprofessional team and is competent to do so. Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care. It allows health workers to engage any individual whose skills can help achieve local public health goals.
Definitions of an evolving field are challenging – even a forty year old field like interprofessional education and team care.
For example, re-read the 1972 U.S. Institute of Medicine Educating for the Health Team report and except for a few pronouns – it reads like a contemporary document from today.
The operational definition the National Center for Interprofessional Education and Practice is currently using is the 2010 World Health Organization definition and framework for IPE and collaborative practice and is a good starting point. While we all quibble with a word or two or an idea -- It is contemporary, grew out of a consensus process, builds upon many ideas, but also stimulates thinking in new ways.
Thus, The framework for action on interprofessional education and collaborative practice says:
From Slide

6. Inteprofessional Practice and Education before the Nexus
We are starting from a position of great chaos.

7. Interprofessional Collaborative Practice =
Teams / Teamwork
Integrative Health
Primary Care
High functioning
teams
Interprofessional Collaborative Practice =
About, from & with
Access to Care
Healthcare/
Medical Homes
Acute Care
There are many components and levels of interprofessional education and collaborative practice, depending on the health outcome being focused on, the skill sets needed for transformative change, the resources available and the nature of the interface between the educational institutions and the various provider and care delivery systems.
Education becomes integrated into practice so that all participants become learners and contributors to the outcomes of the triple aims for both the nexus and the transformed system of health:
For the nexus these outcomes are:
reduced cost via appropriate alignment
Improved quality of the user experience and learner
experience, and
Creating shared responsibility
For the transformed system these outcomes are:
improved health of the population
Reduced percapita cost and improved quality
Users engaged in achieving health
Service-Learning
Patient Safety / Quality

8. IPE: Opportunities for Community-Campus Partnerships linked to Health
Integrated
Health care & Higher Ed
System Transformation
Driving Costs Out of Systems
Improved Health and Learning Outcomes
Community Health Outcomes
Workforce Development
Access to care
Patient Safety/Quality
The partnerships formed when interprofessional education and collaborative practice become integrated into a single process can, and will improve both health and learning outcomes.
This transformative change process begins with each participant getting to know each other and what knowledge, skills and experience each has to contribute with appropriate engagement. Over time a series of developmental steps occur via teamwork to improve quality, access workforce development, community health and in driving costs out of the system, improving both health and learning outcomes.
Teamwork
Getting to know each other
Brandt, B.F. (2009). IPE: Past, Present & Future. Presentation to HRSA Advisory Committee on Community-based Interdisciplinary Linkages.

9. Other Needed Competencies
IPEC Competencies
Values & Ethics for Interprofessional Practice Roles & responsibilities Interprofessional Communication Teams and teamwork
Other Needed Competencies
Population Health, including social determinants
Patient-center decision-making
Evidence-based decision-making
Cost-effective practices
Quality improvement and safe practice
Stewardship
Systems Thinking
New professional competencies are needed. Those shown here were developed by the Interprofessional Education Collaborative. IPEC is comprised of a representatives from all the major health professions, including public health.
As the movement into interprofessionalism as occurred, more new competencies are being added. Some examples include: population health, user engagement, cost effectiveness and evidence-based decision making.

10. This is the core vision of the National Center for Interprofessional Practice and Education.

11. National Center For Interprofessional
Practice and Education

12. The National Center for Interprofessional Practice and Education

13. Vision of the Transformed Approach to Health
Producing Positive Impact on
Triple Aim Outcomes
1. Health of the Population Improved
a. communities engaged in achieving health
b. coordinated engagement regarding social
determinants of health
c. Implemented effective prevention, wellness
and disease management programs
d. mental health programs developed and
implemented
e. established metrics and measurement
2. Increasing value apparent
a. improved per capita/system quality of
care
b. reduced per capita cost of care
c, established metrics and measurements
3. Individuals, families, communities
engaged in achieving health
a. individuals behaving as consumers in the
marketplace
b. Individuals achieving well-being
c. easy access to services needed
d. ease of access to information
e. engaged in the health of the community
The Nexus:
Education aligned and integrated with the process of care to:
1. Reduce cost and add value to the alignment
2. Improve the quality of the user and learner experience, and to
3. create shared responsibility
Leading to Partnerships with
A. New System Competencies
1.Team trained and experienced
2. Patient centered decision-making
3. Engaged in evidenced-based decision
making, quality improvement and safe
practice
4.Knowledgeable in population health,
including social determinants
5.Practices in cost-effectiveness, adding
value, stewardship and systems
thinking
B. Strategies for achieving and implementing
competent teams
C. Organizational models of shared
resources, governance, management and
accountability
D. Value added business case and plan
agreed to and implemented
The National Center for Interprofessional Practice and Education, was created at the federal level by HRSA to help move the transformative processes ahead. This slide summarizes where the national center is today.
Overall, creating a nexus of integrated practice and education leads to new partnerships that produce positive impacts on the Triple Aim Outcomes. In doing so, each nexus achieves its own triple aims.
The new partnerships implement new system competencies, strategies for implementation, organizational models and a business model that can work. Note that the system competencies include population health, cost-effective and evidence-based practice, value added approaches to health, and systems thinking.
Each nexus effort needs to be directly linked to achieving one or more of the outcomes of improved health of the population, value added, or the engagement of users in achieving health.

15. Stakeholders Have Important Functions in the Transformation
There are multiple stakeholders with roles to play in both the design and implementation of the transformation of the current approach to health. In the depiction in the slide, stakeholder groups include nexus enablers, practitioners and delivery systems, and policy and regulation. A new system needs to happen with public health goals integrated into health care in a way that focuses on both the health and the well-being of the nation’s citizens.
The core of all this occurs when the health professionals, current and those to be defined, integrate with health care in a way that focuses on, and incents, aligned systems outcomes. In this process, public health and health care must be inculcated into both the process and the outcomes to be achieved.
Professional, policy and consumer groups will all have a role to play
in both the design and implementation of the change process.

18. Paul Grundy MD MPH
IBM Director Healthcare Transformation
Director Patient Centered Primary Care Collaborative

19. Global Information Framework Public Health Prevention
PCMH in Action
A Coordinated
Health System
Community Care Team
Nurse Coordinator
Social Workers
Dieticians
Community Health Workers
Care Coordinators
Public Health Prevention
HEALTH WELLNESS
Hospitals
Health IT
Framework
PCMH
Global Information Framework
Specialists
Evaluation
Framework
PCMH
Operations
Public Health Prevention
Paul Grundy MD MPH
IBM Director Healthcare Transformation
Director Patient Centered Primary Care Collaborative 35
Copyright 2011 by IBM

20. Smarter Healthcare 36.3% Drop in hospital days 32.2% Drop in ER use
12.8% Increase Chronic Medication use
-15.6% Total cost
10.5% Inpatient specialty care costs down
18.9% Ancillary costs down
15.0% Outpatient specialty down
Paul Grundy MD MPH
IBM Director Healthcare Transformation
Director Patient Centered Primary Care Collaborative
Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US - PCPCC Oct 2012

21. Perinatal Safety: Reducing Adverse Obstetric Events
Perinatal Safety Initiative
1. Evidence-based approach
2. Formalized interprofessional team training with emphasis on communication
3. Standardized, competency documented electronic fetal monitoring
4. High-risk obstetrical emergency simulation program
5. Integrated educational program disseminated among all providers
Outcomes
1. Eleven adverse outcome measures were longitudinally followed
2. Individual components of the program were evaluated
Results
1. Within the first year, the Adverse Outcome Index was significantly and meaningfully
reduced and maintained throughout the two year study period
2. Significant and meaningful reductions in:
a. Rates of return to operating room
b. Birth trauma
3. Significant improvements in:
a. Staff perceptions of safety
b. Patient perceptions of the effectiveness how the team worked together
c. Documentation and management of abnormal fetal heart rate tracings
d. Documentation of obstetric hemorrhage
Wagner B, et al Journal of Healthcare Quality 2011

22. IPECP in a Transitional Care Unit
Lynn A. Blewett PhD,1 Kelli Johnson MBA,2 Teresa McCarthy MD,3 Thomas Lackner PharmD,4 and Barbara Brandt PhD,5 Improving geriatric transitional care through inter-professional care teams, Journal of Evaluation in Clinical Practice 16 (2010) 57–63
2 Lynn A. Blewett PhD,1 Kelli Johnson MBA,2 Teresa McCarthy MD,3 Thomas

23. The Latest Cochrane Collaboration Analysis
Interprofessional education: effects on professional practice and healthcare outcomes (update) (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M

24. Limitations of Traditional Training
Kathleen Gallo Ph.D, MBA, RN, FAAN
Senior Vice President
Chief Learning Officer
North Shore LIJ
Limitations of Traditional Training
Variable clinical experience amongst individuals during training
Limited experience of managing rare events
Ethical considerations of using patients for learning
Current environment difficult to discuss and learn from mistakes
Limited opportunities to acquire proficiency of skills in procedures

25. Simulation: Important
Kathleen Gallo Ph.D, MBA, RN, FAAN
Senior Vice President
Chief Learning Officer
North Shore LIJ
Simulation: Important
part of the Solution
Use simulation whenever possible for healthcare education
Train in teams, those who are expected to work in teams
Create new and realistic methods of learning without putting patients at risk

26. It’s Not About the Simulator
Kathleen Gallo Ph.D, MBA, RN, FAAN
Senior Vice President
Chief Learning Officer
North Shore LIJ
It’s Not About the Simulator
The power of individual or team training in a simulation environment lies in the integration of validated educational methods into the real simulation experience (Dunn, 2008)
Pre-Work
Simulation
Debriefing
Reflection

27. Advantages of Simulation
Kathleen Gallo Ph.D, MBA, RN, FAAN
Senior Vice President
Chief Learning Officer
North Shore LIJ
Advantages of Simulation
Deliberate practice of high risk, low incident events
Fosters the development of leadership, interpersonal skills and team behaviors
Minute by minute video and audio recording for reflective debriefing sessions and immediate feedback
Higher level of learning
- Teamwork
- Communication
- Critical Thinking
- Technical Skills

28. Interprofessional Education (IPE)
Kathleen Gallo Ph.D, MBA, RN, FAAN
Senior Vice President
Chief Learning Officer
North Shore LIJ
Interprofessional Education (IPE)
Interprofessional education occurs when learners from the health professions and related disciplines learn together about the concepts of health care and the provision of healthcare services toward improving the effectiveness and quality of healthcare
Essential Elements:
Collaboration
Respectful communication
Reflection
Application of knowledge and skills
Experience in interprofessional teams