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Partnering with Patients in Education and Health Care Transformation
In April 2014, we had the privilege to attend the Josiah Macy Jr Foundation Conference on Partnering with Patients, Families, and Communities to Link Interprofessional Practice and Education. We were overjoyed to discover at the conference that many of the participants shared a similar vision of urgency to involve patients, families, and communities in the transformation of the healthcare system and of the educational system providing workers to this system. We are in total agreement with the idea that patients, families, and communities are key elements to link interprofessional practice and education.
At Université de Montréal (Montréal, Canada) we have involved patients as true partners in prelicensure education of health care students and in practice transformation initiatives in the University affiliated clinical settings since 2010. The process has been gradual and we now have a sound organizational structure supporting patients’ involvement. The Collaboration and Patient Partnership Unit, within the faculty of medicine, is co-directed by a patient (Mr. Vincent Dumez) and a physician (Dr. Paule Lebel). This Unit established strong links of collaboration with the interfaculty committee managing the Interprofessional Education Curriculum at our University and with the continuing education group within the faculty of medicine. This allows for the involvement of patients in the organizational structure, in health professions training, in collaborative practice optimization initiatives, and in research. We call it the Montréal Model.
At the beginning of the Macy conference, Dr Thibault pointed out the importance to find the sweet spot among: 1) Patients, families and communities; 2) Health professions education reform; and 3) Clinical practice reform, in the effort to create an interprofessional education and care continuum that meets the needs of the public. We believe we have found our sweet spot in Montréal. In the following paragraphs, we will highlight some recommendations that emerged from the conference and share examples from our experience illustrating how they can be implemented.
Recommendation 1.1: Develop a competency framework within health professions educational curricula focused on building effective partnerships with patients, families, and communities.
When a patient, Vincent Dumez, joined our IPE curriculum planning committee in 2010 our vision became teaching and promoting full partnership with patients and their families both in care and in education.
Our curriculum allows building of collaborative competence and is guided by a recognized Collaborative Competencies Framework (2010 Canadian Interprofessional Health Collaborative: National Interprofessional Competencies Framework). It uses a three stage process for competency development and ensures learners have the opportunity to participate in small, interactive discussions co-facilitated by a patient and health professional. We needed to adapt the patient-centered approach from the Canadian framework to an approach of partnership which gives, in our opinion, a more active role to the patient in his care. A collaborative group from our university wrote an implementation guide of “partnership in care and in services”. (Available in French only)
Recommendation 1.2: Develop a framework for educating patients, families, and communities about effective participation in classrooms and other settings, and about serving as co-educators of health professions students.
In order to follow a rigorous and systematic approach for recruitment, training and coaching of patients as co-educators, we developed a competency-based framework from which we were able to build a recruitment guide and a training programme. The systematization of these processes enabled us to develop a strong core group of patients to engage in our education pilot projects. From this basis, we then enlarged progressively this group and diversified its membership. Patients suffering from several different chronic diseases, or family members, are now full partners of our education and health care transformation initiatives. They come from a variety of socio-economic environments.
Recommendation 1.4: Design and teach both coursework and experiential offerings in the institutions that educate health professionals to produce the effective partnership competencies mentioned above.
Many faculties of medicine and allied health professions involve patients in some pedagogical activities. However, to our knowledge very few, if any, co-create courses with patients and consider them true partners in education. Our patients are involved in curriculum planning, building content, and facilitating workshops. By sharing their experiential knowledge with educators and students, patients can tremendously enrich learners’ experiences.
As of today patients co-facilitate in each of the three IPE courses taken by students from all 13 health sciences and psychosocial sciences programs taught at our university. This represents 1,500 students for each course.(1) Since our first pilot project we have recruited and trained a growing number of patients and now have a team of 142 trained patients and family caregivers.(2)
Recommendation 2.1: Leaders of both healthcare and health professions education organizations must create new vision and mission statements and operational processes that meaningfully incorporate patients, families, and communities as partners.
From our experiences, we learned that engaging patients and their families, and integrating them successfully as full partners, require compliance with a number of key factors, including:
- Promote a common and shared humanist vision of care facilitating patient engagement despite a paternalistic vision of care still present in some organizations;
- Assume a strong management leadership within institutions that embrace patient partnership to face this major cultural change and profound change in healthcare practices;
- Develop sustainable operational capacity within institutions (care, research and education) in which patients, families and health professionals are jointly engaged and assume a shared leadership;
- Finally, develop and apply systematically strong co-building methodologies and propose a lifelong learning curriculum on partnering and co-building for all partners.
Following those precepts, we have clearly observed that the experience-based knowledge of patients and families is an amazing source of innovation for overstretched health organizations seeking renewal of their care approaches. Healthcare, education, and research institutions that have experienced this new reality of partnering with patients and families on a regular basis no longer want to go back. Many argue: “it is vital.”
Recommendation 2.2: The governance of organizations involved in the transformation of healthcare and health professions education—ranging from local health providers’ offices to large, multi-organizational systems, academic health centers, and schools for the education of health professionals—should be restructured to integrate the principles of partnership.
Beside its involvement and integration in IPE education structure, the Collaboration and Patient Partnership Unit has also supported management and clinical teams of nearly 25 Quebec healthcare institutions to develop their patient partnership culture. The Unit has helped the institutions to structure patient and family engagement within their organization governance and quality improvement processes. Several research networks at the provincial and national level have also embraced this co-building challenge with the support of the Unit. Engaging patients in quality improvement processes as well as in research facilitate better systemic analysis and prioritization of population needs regarding health services, social, cultural and environmental issues. It also contributes to addressing specific day-to-day patient challenges such as self-management, treatment compliance, or social integration. Finally, patient engagement in research is recognized now as an important lever to knowledge translation.
Each year, 1,500 new health care and social services providers who have been systematically trained on patient partnership and complementary concepts such as empowerment, self-management, shared decision making, health education and clinical ethics, graduate from our university. We expect they will become agents of change in our provincial health care system. Our recruiting and training of tutors from university affiliated hospitals and clinics, and from the community also contributes to transformation of practices toward partnership with patients and their families. By 2020, we will have graduated approximately 13,000 new professionals from 13 different disciplines that went through our IPE curriculum. These new professionals will be knowledgeable of interprofessional collaboration concepts and ready to function in collaborative practice teams and create true partnership with patients and their families. In addition, our Collaboration and Patient Partnership Unit has been actively supporting transformation of practices at the level of clinical teams.
We believe the Montréal Model will make a difference in our healthcare system. We also believe the Montréal Model might inspire other educators and contribute to healthcare system transformation in other parts of the world. In the next months, we intend to invest more energy in faculties and clinical tutors partnership in care competency development.
Partnering with patients is about equal, respectful, and mutually beneficial partnership at every level and in every health-related endeavor, from designing educational curricula to setting research priorities to hiring faculty and leadership to operating healthcare organizations, and much more. It is about co-creating optimal health and health care.
Macy Conference 2014
(1) More information about the IPE curriculum and our Interfaculty group can be found in the J Allied Health paper by Vanier et al. 2014 and on our web site.
(2) More information on the approach used to involve patients in our IPE curriculum can be found in the full monograph of the 2014 Macy Conference (pp. 73-84).