We’ve moved! Join us.

The National Center has a new home online: nexusipe.org. We’ll post future entries on our new website, so it’s time to update your bookmark. If you’d like to continue following my blog, please join our growing online community by creating a personal or organizational profile—just take a look at who is already there!

And when you create your profile, make sure you “opt in” to receive news and announcements from the National Center. We’ll share our monthly newsletter, blog posts and event announcements with you.

We’re relying on you—practitioners, educators, students, leaders, researchers, patients, families and communities—to help build this evolving online resource. We are listening to your ideas and feedback, so  tell us what you think by posting in our discussion forum dedicated to this very topic.

Thank you all for your enthusiasm and support during this first year. I look forward to continuing our conversation and bringing new voices into the dialogue.

Baby Edythe

I am of a certain age.  I became a grandma 15 weeks ago to baby Edythe.  Here is a picture of me the first time I held her.  She is wearing an outfit I knitted from the yarn I purchased in Sweden after the 2008 All Together Better Health conference.  I’m wearing my Minnesota Public Radio sweatshirt.  I must have been trying to send Edythe a message about how all children should behave.

You learn a lot from a baby’s birth.  My daughter and her husband unfortunately live a long way from Minnesota.  They have taken ownership of their family’s health and their role in it.  I was astounded at how many classes they attended to prepare for what we all called “Baby Question Mark’s” birth and for learning to parent together.  After only 15 weeks, I can already see the payoff in their preparedness and teamwork.  During my era, we just listened to our mothers (remember the sweatshirt) and trusted what the physician told us to do.

Valerie also experienced a women’s health team for her prenatal care and the birth.  During her pregnancy, the team made certain that she was examined by every member—midwives and obstetricians—for her prenatal care.  She was perfectly comfortable that a midwife would deliver her baby without the assistance of a physician.  She and Jeff and the anxious grandparents were prepared.

But it was not to be.  At 1:30 am after nearly twelve hours of labor, the parents were surprised when a team of seven health professionals were suddenly in the room for the delivery.  Because of complications, the obstetrician delivered Edythe with the team.  At nine pounds two ounces, Edythe was far larger than the seven pounds that technology predicted only a few days before—art and science, teamwork and a happy family.

They are into the next phase of parenting and trying to make sense of all of the bills.  Her husband is sorting through the fact that the anesthesiologist was “out of network,” as though patients pick their provider during a delivery in the middle of the night.  Because of the out of network provider, and because the epidural was administered on April 20 but Edythe was born on April 21, the insurance company rejected paying the bill twice. As Valerie said, “It was like no one had ever had a baby after midnight.” Valerie, Jeff and Edythe experienced both the best in collaborative care and the frustration that comes from our fragmented system—I’ll have more to say about that another day.

What a difference a year makes

One year ago on July 18, we submitted our application to the Health Resources and Services Administration (HRSA) to lead the National Center.  How our lives have changed in the short period of time since Secretary Sebelius made the selection announcement last fall!  The vision we shaped in to response to the funding opportunity is becoming a reality.   We’ve wrestled with ideas about how to make our midsummer words come alive, to meet our charge to provide leadership, scholarship, evidence, coordination and national visibility to advance interprofessional practice and education as a viable and efficient health care delivery model.

Each week I connect with five to ten new people or organizations that represent a wide variety of interests, desires and expectations.  All are searching for the same thing—better health as a result of better care with the assumption that interprofessional approaches are the best way to achieve it.  Each is in a different place on this journey.  They find themselves in chaos trying to make sense of it all, wanting me to help. Some are just getting started and want to know how to begin; others are saying just tell me what to do, and make it simple.  They ask, how do I start a new office of IPE?  Who should be involved?  How do we pay for it?  Is it just two professions at a clinical site teaching students together? Others are passionate about their agenda or program. Some, on the other hand, have been on the journey for a long time and are looking for like-minded colleagues and real evidence that they are making a difference.

At first I felt like I was in a constant tsunami, but I’m becoming accustomed to the new reality. It always feels like an awe-inspiring responsibility. At the National Center, we are asking questions about how we can best help and lead in a chaotic and uncertain environment.  We created this picture to communicate what we are hearing in education, practice and at the intersection of these two complex systems.   When I share this graphic with audiences, there is often laughter and usually a sigh of relief.  We are in this together.

I often go back to the words we wrote last year in our grant application to reconnect with that first view of our vision and purpose.

“In the past two years, with the surge in interest in IPE as a result of the release of the historic IPEC competencies, there has been an explosion of activities, education, training, etc.  This impressive portfolio of opportunities will advance the field and should be encouraged and leveraged.   The coordinating center for interprofessional education and collaborative practice will need to work with partners to get the work done, while setting the vision for interprofessional education and collaborative practice (CC-IPECP) with them in a collaborative and non-competitive manner.  This partnership and definition of roles and responsibilities will be essential.  Therefore, strategies will need to be deployed that map out what will be handled centrally by the CC-IPECP and what will best be distributed to maximize resources, retaining the important unbiased role.”  

Now when we explain this concept, people understand that we are striving to take a “horizontal approach” to supporting and connecting the dedicated people already advancing our vision of the Nexus across the country.  Last year, we laid out the pathway (below) we planned to take to get where we want (and need) to go—better care, added value and healthier communities.

Our first dedicated staff came on board in late spring, and new members with new ideas have since joined our team. We are working hard to make the words in our proposal come alive and become a reality. We will launch our new interactive website, a platform to convene around our common goals,  over the next several weeks. We need you to help fulfill our midsummer night’s dream by shaping this new online community. Be sure to watch your email for an announcement about the website and I encourage you to follow us on Twitter (@nexusipe) and join our new LinkedIn Group for the latest information about where we’re headed.

Serendipity and the Nexus

I’m often asked how we settled on using the term “the nexus” for a concept that is defining some of the National Center’s work.  More than a few people have shared with me that there are other successful programs, and even hair products, that use the term.  I can truly say that whatever one thinks of it, the word “nexus” does make people stop and think…including me recently.  I’m finding the “nexus” everywhere, filled with symbolism, and I think it’s more than coincidence.

Last month the National Center staff who attended the Collaborating Across Borders (CAB) IV conference in Vancouver couldn’t help but laugh as these signs welcomed us to Canada.  For the past several months we’ve been intensely focused on the Nexus in our own work and, suddenly, it’s an international trend.

The U.S. – Canadian nexus is about making entry between the two countries easier.  When I arrived at the Vancouver airport, the attempt to improve the process of travel between the two countries was clearly visible. On the way home, after going through the new nexus procedures, I entered an area of the YVR airport with a sign that said “You are entering the United States” on Canadian soil.  I simply walked off the plane as usual in the Minneapolis-St. Paul airport. Customs had already been handled in the designated U.S. area in Canada.

Since 2001—like it or not—new laws, regulations, and paperwork had made the old, simpler ways more cumbersome and complex, sometimes getting in the way of a friendly relationship.  While I’m certain each regulation and process had a reason, new protections and concerns replaced seamless travel between our two countries, making it more difficult to work together.

Today, each country is working to adapt and thrive within its own borders and globally.  Some goals are the same; some are different.  Simple solutions cannot address such complex problems. Despite that complexity, the U.S. – Canadian nexus communicates a willingness to create a functional and innovative way of working together while meeting the individual needs of each country.

That’s the “Nexus” concept we are adopting for the National Center.  Health systems and health professions schools are evolving rapidly and navigating through ambiguity. They are incorporating new ways of thinking and responding to emerging demands within their own systems.  At the National Center, we see innovation and opportunity in these challenges. With so much confusion in today’s health care environment, we must strive to reconnect the disparate pieces of our complex systems.  The Josiah Macy Jr. Foundation recently released conference proceedings that explore the concept of the Nexus, including relevant case studies and recommendations. I encourage you to take a look at this report.

Is the proliferation of the nexus concept just coincidence? I don’t think so.  I believe there is a reason more than a few organizations are using this term. For example, check out the NEXus project in nursing education. This is great example of how the Nexus describes the kind of connection, partnership and shared responsibility for progress that we need today.

Finally, I have to share one more serendipitous moment from my recent trip to Vancouver. A colleague at CAB IV referred me to a nearby art gallery, telling me I must purchase this pair of earrings with a design that the artist had named “Nexus” based on a Canadian First Nations legend. But that’s another story for another day.

I’ll be exploring these issues more deeply in my next few blogs and in papers I am now writing with colleagues.  We are working through our meaning of the Nexus, and we need your help to tell the story. Tell us what the Nexus means to you. Where have you seen the concept of a “nexus” in your own experiences?  What are the opportunities to reconnect health professions education and the transformation of care delivery in your own organizations?

Role Modeling IPC at the Seneca Nation – A Teaching and Learning Opportunity

As we continue to build an interprofessional culture, we look to role models and advocates to lead the way. It’s our job to find those who are doing it, and link with those who want to do it, expanding the network of IPCP which in turn expands the network for IPE opportunities.

We are fortunate to have those role models in Western New York. The Seneca Nation Health System, providing healthcare to the Seneca Nation of Indians, the largest Native American Nation in New York State, is a role model for interprofessional practice – they understand and act upon the need to provide holistic care through a team approach.

To learn from the Seneca Nation, UB’s School of Public Health and Health Professions and the Empire State Public Health Training Center hosted a workshop at Roswell Park Cancer Institute on June 6, 2013 focused on healthcare and American Indians.

The workshop kicked off with a moving introduction to principles of the Seneca Nation as told through stories by prominent Seneca leader Flip White, and a talk about historical trauma and its impact on health by Dr. Randy John, Curator of the Seneca Iroquois National Museum. With this as background, participants gained a deeper understanding of the very rich culture from the Seneca perspective from Exercise Specialist at the Seneca Nation Health System, Seneca Nation member and UB alumna Andrea John-Ortego. As part of her presentation, Andrea shared an inspiring gift of corn and cloth, both valued by Senecas, with each participant to represent new knowledge gained and relationships built.

Central to healthcare for the Senecas is the medicine wheel integrating physical, mental, emotional and spiritual health, all areas that could be addressed through interprofessional collaborative practice. Capping an exciting day of storytelling and information-sharing, Dr. Michael Kalsman, Medical Director of the Seneca Nation Health System, talked about healthcare for members of the Seneca Nation through interprofessional provider teams. As one provider noted, “Native Americans are typically at higher risk for health issues which leads to many other community-wide problems and negative health outcomes. Healing from trauma and reconnecting with traditional culture can buffer against health problems and social issues.” The Seneca Nation Health System works under this premise, and a team approach is the model they’ve adopted. It’s a concept that most, if not all, would agree makes sense.

The workshop led to providers asking to learn more about interprofessional care for their agencies – the outcome we hoped for.

Asking the big questions

I’ve just returned from a wonderful Collaborating Across Borders Conference (CAB) IV in Vancouver.  Over 800 people attended this meeting–a remarkable growth in interest since 250 people gathered at the first CAB meeting in Minneapolis in 2007.  The sophistication of the work in practice and education grows exponentially.  I’m very impressed.

One of the questions I’m most often asked (and there are many!) is about how to measure interprofessional learning outcomes. I had conversations with many of you on this exact topic last week. How do we know if all of the work we are doing in interprofessional education and collaborative practice is making a difference?  This question is at the core of the National Center’s work. I’m glad it’s something I hear about so often; it’s center’s role to ask and help answer those difficult questions.

At CAB, we heard colleagues such as Amy Blue of the Medical University of South Carolina, Andrea Pfeifle of the University of Kentucky, and Kevin Lyons and Carolyn Giordano of Thomas Jefferson asking that question as they presented their important work in evaluation and assessment. We have much to learn from each other.

Back at the National Center, we’re asking the same questions, together with many experts and colleagues, with a specific goal in mind: sustainability. Given the pendulum of interest and investments in interprofessional education and teamwork over the years, what tells us that it is “making a difference?”  We know that for interprofessional practice and education to survive and thrive, we have to demonstrate that it “works” and we need feedback to move beyond theories and build upon each other’s progress. We’re coming at this from multiple angles.

First, at a minimum, the National Center’s role is to help those of you working in the area of evaluation and assessment to connect with each other.  I receive many calls and emails each week from colleagues around the world, and often I hear about funded efforts to answer those questions about impact. We are working on strategies to help colleagues identify each other and connect in this important work.

Fortunately, our Canadian colleagues have already delved into complex issues such as economics and impact.   At CAB IV, we heard from Ivy Oandason and Eddy Nason and about a model for measuring what the experts call return on investment, or ROI, for interprofessional education and collaborative practice. To achieve the Triple Aim, we must validate the financial impact of our work to show that we can lower costs and add value while simultaneously improving health of people, families and communities. We’re engaging Ivy, Eddy and our Canadian colleagues to learn more from their model.

And we’re convening teams from around the country who will serve as “applied laboratories” for new interprofessional practice and education models. We will test, and collect and share data about, how new models work on the ground. Together with these national experts, we’re carefully constructing and prioritizing our research questions so we can build the evidence base for interprofessional practice and education.

I will be writing more about this over the next few weeks. We believe that our role as a National Center is to drive sustainable change in health, health care delivery and health professions education. Measuring and communicating our impact—on care, cost, and population health—is the foundation of that sustainability. A recent comment from a faculty expert sticks in my mind: “If we don’t define the measures, someone else will.” With the National Center gaining momentum, we can use our collective wisdom to define those measures, demonstrate value and ensure a strong future for better health in the United States.

Going “Back to the Future” at Collaborating Across Borders

As many of us prepare to travel to Vancouver next week for Collaborating Across Borders IV, we are already looking forward to the next installment of this premiere conference on interprofessional practice and education. Today, the American Interprofessional Health Collaborative (AIHC) announced the selection of the Virginia Tech Carilion School of Medicine and Research Institute as the host for Collaborating Across Borders V in fall 2015.

Virginia Tech Carilion is a new medical school and research institute formed in 2007. An innovative public-private partnership, VTC joins Virginia Tech’s strengths in engineering, the basic sciences, computation, the life sciences, informatics, and behavioral science with Carilion Clinic’s highly experienced care team and rich history in health professions education. Partnerships like this illustrate how genuine collaboration between practice and education offers new opportunities to prepare students for a rapidly changing health marketplace.

New schools offer unique opportunities for innovation to incorporate interprofessional learning and collaborative practice in creative ways.  Except for the differences in geographical settings, their vision and enthusiasm reminds me of my early career in a new medical school at the University of Illinois in the late 1970s and early 1980s.  I will be sharing those interprofessional education experiences with CAB IV participants in the “Back to the Future” plenary session next week.

We hosted the first Collaborating Across Borders conference in 2007 here at the University of Minnesota. Since that time, the bi-annual conference has become a leading North American venue for practitioners, scholars, educators, health system leaders, and students to gather, reflect on our progress and challenges, and learn from one another. The CAB I (in Minneapolis), CAB II (in Halifax), and CAB III (in Tucson) websites offer a look into the history of collaboration with our Canadian colleagues, along with some astonishing evidence of how far we’ve come together. The field of interprofessional practice and education is absolutely exploding. CAB I had 250 participants; CAB IV is expecting more than 700. At the National Center, we’ve received interest, ideas, and support from every corner of health care and education. It’s an exciting time, and I look forward to continuing this important conversation in person in Vancouver next week, in Pittsburgh at All Together Better Health 7 in June 2014, and in Roanoke in just two short years.

UB Gains Speed in Bridging Education and Practice

We all know the importance of interprofessional education and practice. What we need to learn is how to transform an academic curriculum so that it strengthens health students’ collaborative practice skills, demonstrates how to employ those skills in a professional environment, and fosters practice settings that not only welcome, but thrive on interprofessional and collaborative care. To this end, our task at hand is to marry interprofessional education with practice for current and future practitioners.

Advancing this agenda, Schools of UB Academic Health Sciences and the School of Social Work sponsored Educating Health Professionals in Interprofessional Care (EHPIC). This three-day course, held May 14 – 16, brought together health professionals, educators and leaders to collectively advance interprofessional learning by strengthening skills to teach and practice collaboratively across all domains that touch a patient. Participants included more than 40 faculty, researchers, physicians, pharmacists, nurses, social workers, dentists, physical and occupational therapists, program directors, and others from the Buffalo Psychiatric Center, Erie County Medical Center, Roswell Park Cancer Institute, Erie County Department of Health, University at Buffalo, University of Rochester, Brothers of Mercy Nursing and Rehabilitation Center, and New York State Area Health Education Center System.

Facilitated by experts of the Centre for Interprofessional Education at the University of Toronto, EHPIC provided participants with interactive and hands-on activities presenting essential tenets of interprofessional education (IPE) and interprofessional collaborative practice (IPCP). Activities armed leaders with tools to implement critical components of collaborative care, and provided them with real-world learning opportunities for collaborative practice.  Leaders took part in a simulated interprofessional patient encounter, emphasizing the importance of reflection and debriefing where much of the learning takes place in simulation.

“Bringing together academia and research with professionals from such a wide array of agencies brought into focus the opportunity before us, and the benefit of bridging interprofessional care from the academic to the practice setting,” observed a University at Buffalo participant. Following the workshop, a physician educator noted “we knew IPE made sense, but we didn’t know how to teach it; now we have tools and techniques from experts that we know will work.” The workshop closed with a collective agreement that “we simply must do it.”

With this momentum and the new tools gained, the academic and practice communities in Western New York understand the importance and benefit of IPE/IPCP for patient care and see the way forward. This new community of health leaders trained in educating professionals in interprofessional care is our platform for sharing opportunities, lessons learned and best practices in IPE and IPCP. It’s another major step forward in our progress.

What are your experiences in moving concepts of interprofessional care from education to practice? Share your thoughts and insights below.

Introducing the national advisory council

The National Center for Interprofessional Practice and Education has selected 16 leaders from the fields of health practice and policy, business, learning and education, and academic research to serve as inaugural members of the center’s national advisory council. The council is a critical part of our effort to create a new alignment, or Nexus, between the practice and education communities to achieve improved health in a rapidly transforming marketplace.

The national advisory council provides independent, expert advice and guidance—grounded in the broad perspectives and experiences of its members—to advance the field of interprofessional practice and education. Members of the council are strategic thought partners, collaborators and catalysts for action. Together, we are driving sustainable national change in health and health care delivery.

National advisory council members include:

• Marilyn Chow, DNSc, RN, FAAN, Vice President, National Patient Care Services, Kaiser Permanente

• Elizabeth Clark, PhD, ACSW, MPH, Senior Advisor and Immediate Past CEO, National Association of Social Workers

• Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement

• Kathleen Gallo, PhD, MBA, RN, FAAN, Senior Vice President and Chief Learning Officer, North Shore – Long Island Jewish Health System

• Paul Grundy, MD, MPH, FACOEM, FACPM, Global Director of Healthcare Transformation, Global Well Being Services and Health Benefits, IBM Corporation, and President, Patient-Centered Primary Care Collaborative

• Leslie Hall, MD, Interim Dean, School of Medicine and Professor, Department of Internal Medicine, University of Missouri

• Maryjoan D. Ladden, PhD, RN, FAAN, Senior Program Officer, Human Capital Portfolio, Robert Wood Johnson Foundation

• Lois Margaret Nora, MD, JD, MBA, President and CEO, American Board of Medical Specialties

• Stephen Parente, PhD, MPH, MS, Director, Medical Industry Leadership Institute and Minnesota Insurance Industry Chair of Health Finance, Carlson School of Business, University of Minnesota

• Scott Reeves, PhD, Director, Center for Innovation in Interprofessional Education and Professor of Social and Behavioral Sciences, University of California, San Francisco, and Editor-in-Chief, Journal of Interprofessional Care

• Dennis Rivera, Healthcare Chair, Service Employees International Union (SEIU), and Secretary, Partnership for Quality Care

• Leo E. Rouse, DDS, FACD, Dean, College of Dentistry, Howard University, and Immediate Past President, American Dental Education Association

• George Thibault, MD, President, Josiah Macy Jr. Foundation

• Donna Thompson, RN, MS, Chief Executive Officer, Access Community Health Network

• Peter H. Vlasses, PharmD, DSC (Hon.), BCPS, FCCP, Executive Director, Accreditation Council on Pharmacy Education

• Steven Wartman, MD, PhD, President and CEO, Association of Academic Health Centers

We are grateful for their service and are honored to have these extraordinary leaders on our National Center team.

40 years from now

It was the year of Apollo 13, the official breakup of the Beatles, and the invention of the floppy disk. It’s been 43 years, but a 1970 report from the University of Minnesota—outlining students’ perspectives about team-based care—seems almost more relevant today.

“Discussions with students disclosed the desire to see far more emphasis on the ‘team’ approach to providing health care. Students assert that if future health care delivery systems require a team approach to provide the necessary services, today’s health student must be exposed to the approach in his educational experience. Students recognize the impossibility of training all professionals in the same courses and program, emphasize the necessity of integrated training when practical.”– Report of the External Committee on Governance of University Health Sciences, University of Minnesota, February  1970

I recently attended the annual CLARION case competition—a national student-led and student-run event based at the University of Minnesota. Nine interprofessional teams from across the country traveled to Minneapolis to showcase their approach to reducing readmissions and improving care for COPD patients. As I spoke to the students, I again heard a strong desire for interprofessional, team-based training and care. In fact, they expect to work on teams once they enter practice. One student spoke about the role of interprofessional practice for the CLARION case as if it was a “no-brainer,” noting that a complicated condition like COPD really requires collaborative, well-coordinated care. Their particular case solution involved a physician, nurse, pharmacist, care ambassador, social worker, and respiratory therapist—truly an interprofessional team.

Below: students share their research at the CLARION national case competition poster session on Saturday, April 20.

   

The national center is taking a cue from these energetic students, engaging them more formally in our work. We’re developing student consultancies and practicums to explore interprofessional practice and education issues, with our first student rotation scheduled for this summer. Next year, we will develop a student advisory council connected directly to the national CLARION competition. And we will invite a student representative, on a rotating basis, to join our national advisory council; they will serve alongside some of the country’s best minds in health care practice and education.

I often think of that 1970 quote as we begin creating the Nexus—the shared ground, shared conversation, and shared language necessary for true collaboration between education and practice. It’s what the students in 1970 wanted, and it’s what today’s students view as absolutely critical to their ability to function in the new health care marketplace.

Without students, the Nexus doesn’t work; they must have a voice in that shared conversation. The national center is making sure those student voices are heard so that, in another 40 years, we’ll marvel at how far we’ve come instead of how little has changed.