Interprofessional Education Expert Seeks to Improve Health Care

Scott Reeves, PhD, director of UCSF’s Center for Innovation in Interprofessional Education, this week received a grant to study team-based care in intensive care units and will serve as co-chair of an Institute of Medicine workshop that aims to improve health care.

Scott Reeves, PhD, director of UCSF’s Center for Innovation in Interprofessional Education, will take the national spotlight in Washington, DC, this week as co-chair of an Institute of Medicine (IOM) workshop that aims to improve health care.

Reeves, professor of Social and Behavioral Sciences and editor-in-chief of the Journal of Interprofessional Care, is co-leading a two-day public workshop, “Improving Health by Linking Education Practice Using Interprofessional Education” at the Keck Center of the National Academies. He has been part of the IOM planning committee for this workshop, which is a part of the Global Forum on Innovation in Health Professional Education founded by the Bill & Melinda Gates Foundation.

Coincidentally, his expertise on interprofessional education will be tapped in a study on intensive care units (ICUs) as part of a new national Patient Care Program announced Aug. 28. Launched by the Gordon and Betty Moore Foundation, that program seeks to eliminate all preventable harms to patients by improving teamwork of health professionals in acute-care settings.

The Patient Care Program will focus on both engaging patients and their families in their own health care and developing a systems approach that reorganizes interprofessional teams, processes and technology to support that engagement and focus on patient safety. The work is also expected to decrease health care costs.

Michael Gropper, MD, PhD

Reeves, a world-renowned British social scientist who came to UCSF last year, will receive a Moore Foundation grant of $2.1 million to conduct a multi-site study of ICUs, including two at UCSF. He will work with co-investigator Michael Gropper, MD, PhD, director of critical care medicine at UCSF Medical Center, to better understand the nature of team-based care and patient involvement in ICU settings.

While en route to Washington, DC, Reeves answered these questions about the ICU study and the IOM workshop on interprofessional education.

What is the problem that your multi-site study on ICUs will tackle?

We know there is a need for effective team-based care to reduce duplication of effort, restrict clinical errors, improve safety and enhance the quality of patient care. It is also widely acknowledged that a range of professional, organizational and cultural factors can impede efforts to ensure care is responsive, timely and effectively delivered to patients.

What is the research focus of the ICU study?

The project will focus on exploring, in depth, intensive care units. Given their position in the delivery of care, ICUs are arguably the ‘heart’ of contemporary hospital-based care. Indeed, due to the complex nature of care provided in these units, they not only subsume a significant proportion of a hospital’s total expenditure, but demand that team-based care is provided in an effective manner to meet the critical care needs of patients. They are also an area where we have a limited empirical insight into the nature of team-based behaviors and the construction of different ICU cultures and how these affect the delivery of care.

What are the goals of the project?

This project will focus on the following goals:

1. To comprehensively explore, through the use of ethnographic methods, the team-based cultures of eight ICU settings in six hospital sites based in the US and Canada.
2. Based on the rich ethnographic work, identify an empirically based readiness/diagnostic tool that can provide an indication of whether optimal collaborative team-based care is being delivered.
3. Develop iteratively, a set of ICU interventional activities that focus on strengthening team-based care and patient involvement in their care delivery.

When will the ICU study begin and which UCSF ICUs will be involved?

This study will be starting in the next few weeks. At this point, we have not selected which UCSF ICUs we will be working with, as we are currently exploring possibilities here. Our choices will need to take into account the other ICU sites involved in this study — Johns Hopkins Hospital in Baltimore (led by Peter Pronovost, MD) and Toronto, Canada (led by Simon Kitto, PhD). I am really pleased to say that I have a great team to work with on this study, including two excellent researchers Elise Paradis and Myles Leslie.

The IOM interprofessional education (IPE) workshop will discuss the “triple aim” of better health, higher quality and lower cost through IPE. Is this aim now more important given the looming expansion of health care through the Affordable Care Act?

I really think so. As I previously mentioned, this act will mean the inclusion of 30 million more people into the US health care system. This will mean that health professionals need to collaborate and communicate more effectively than they currently do. As a result, we will need an expansion of IPE across the country to ensure that professionals have the competencies to be effective collaborators — a core feature in achieving the triple aim.

One of the objectives of the workshop is to discuss how to “fundamentally change health professions curricula, pedagogy and culture, human resources.” That sounds like a tall order. Do you think there is the will to make this happen?

This is a very good question. From a national perspective we are in an excellent position to begin making some significant changes. Currently, one can see a groundswell of support from a number of national bodies such as IOM, HRSA, Kaiser, the Veterans Affairs which are all interested in making profound changes to health education systems. In many respects, we are poised to begin some very exciting work — the recent announcement to establish a national coordinating center for interprofessional education and practice is a good marker of how well poised the US is in making serious in-roads here. My aim is that the UCSF IPE Center will be involved in these national developments to help shape them as much as possible.

UCSF has four separate professional schools and a new faculty-led group set on integrating IPE into curriculum. What are the main challenges in doing so at this  University?

There are a number of challenges with integrating IPE into a university. These include: organization-based factors, such as scheduling across different schools and obtaining accreditation from different bodies; faculty-based factors such as recruitment and preparation of facilitators; and student-based factors such as providing conducive interprofessional learning environments. Having spent nearly 20 years working in the interprofessional field, these factors are well known to me. Developing and implementing high quality IPE is a challenge. To be successful it involves a commitment to change the things we have been doing for many years, to engage in a new way of doing things. Such changes can seem daunting and even threatening. However, we have some great minds, and a great level of support across UCSF, so I am optimistic we can move forward to achieve our aims.

Students last year helped organize an elective course on the impact of health care reform at UCSF. How can students get involved in advancing IPE at UCSF?

Students are critical to our success as a center. I’m proud to say UCSF has evolved a tradition of student-centered IPE — championed by the center’s Faculty Leads, who represent the different professional schools such as Tina Brock (Pharmacy), Susan Hyde (Dentistry) and Kimberley Topp (Physical Therapy). This is a tradition Karen Hamblett, IPE center manager, and I am keen to nurture: not only as there is a lot to do setting up a new center, and so all help is welcome, but also involving students (with good faculty mentorship) helps ensure our IPE curricula development work is informed by those who are its key recipients. This is important for developing high-quality IPE.

What kind of assessment and evaluation metrics can be used to measure success?

Generally, the interprofessional field has not done well with assessment and evaluation activities. For many, the implementation of an IPE course is the end-point — for us, it’s a point from which we can understand the impact of our IPE. This is an area the UCSF IPE center is keen to focus on to ensure we gather robust evidence for the things we do. This help us understand the quality of curricular and faculty development programs we offer in order to fine-tune, if needed. Also, it allows us to disseminate our scholarly work to advance the IPE field on a national and international level. For example, with evaluation, we are planning to undertake a longitudinal, mixed-methods study to understand the processes and outcomes of the IPE we deliver at UCSF. To help ensure we do this in a robust way, we will be employing realistic evaluation, which can generate a holistic insight into the nature of the learning context, teaching processes as well as range of outcomes produced by IPE.  

What are some of the new developments that the UCSF IPE center will be rolling out this year?

We have lots planned for the upcoming year, including an expanded IPE curriculum for all incoming first-year students that involves four new interactive sessions designed to improve the students’ collaborative competencies. These sessions also have a connecting theme this year — tobacco cessation — which has been led by Lisa Kroon, PharmD, (Pharmacy) working closely with a small dedicated group of students from the Student Ambassador Program. Second-year students will be participating in a new IPE session focused on Simulated Disaster Management led by Chris Stewart, MD, (Medicine), supported by a small number of students. We will also be re-running our highly successful Interprofessional Standardized Patient Exercise, led by Maria Wamsley (Medicine), for third-year students this year held in the Kanbar Center. 

In addition, we are also developing a new interprofessional faculty development course “Interprofessional Education and Practice 101” to provide faculty with an introduction to the underpinning concepts, theories and evidence. This will be the first of a number of interprofessional faculty development courses the IPE center aims to design and implement. 

Nationally and internationally, we will be disseminating our scholarly work at the upcoming conference “All Together for Better Health” in Kobe, Japan, where we had nine presentations and posters accepted. Later in the year, I will give keynote talks on IPE at the International Congress for Educators in Complementary and Integrative Medicine (again in Washington, DC) and also at the Third Swiss Conference on Standardized Patients and Simulation in Health Care in Switzerland.

And finally, I am pleased to announce we will be welcoming our first international scholar — a nurse from Brazil who is going to be working with me on a project around the use of theories in IPE.

This is only a small selection of our work, but as you can see, there is lots going on at the IPE center!

Photo by Susan Merrell