Temple Ratcliffe, MD, FACP, of University of Texas Long School of Medicine at San Antonio, discusses the ingredients for fostering collaborative care and education.
The science of healthcare is more advanced now than ever before, yet our patients’ outcomes continue to lag behind. Clearly, making tweaks at the edges of healthcare delivery won’t be sufficient. A paradigm shift in healthcare is needed; a shift in both the way patients are cared for and how students learn to treat those patients.
Team practice environments remain quite challenging for the next generation of health professionals. Despite these challenges, I believe the most straightforward way to improve collaborative care and education is to engage students, professionals, patients and their families in real time and in authentic settings.
Collaborative care: Where interprofessional practice and education meet
At my institution, we are transforming our inpatient practice into a collaborative care model, one team at a time. Our collaborative care team differs from usual inpatient care, and from other iterations of interprofessional care, in several ways. Most fundamentally, the very nature of who is on the team is redefined. In collaborative care, decisions move from the hallway or physician workroom into the patient room and are co-created among physicians, nurses, pharmacists, care coordination staff, physical therapists (as well as the students from these professions), and patients and families. This allows for the creation of shared goals among teams (with patients and families considered team members) that promote safety, better care transitions, and improved experiences. In addition, teams set aside daily time for reflection in order to foster improved communication and enhance team dynamics.
From a patient’s perspective, everyone is there at once and decisions are made together. These decisions are transparent because they are updated daily on large boards in the room. Dialogue continues throughout the day as family members come in and update the board with their questions and concerns, until the team reunites the next day.
This model provides excellent patient care and is a great learning environment, but is not without its challenges.
Challenges with introducing collaborative care
My Macy Faculty Scholars Project focuses on challenges that health professionals in training face with collaborative care. With the help of a prior Macy Foundation grant, we interviewed students and providers across levels and professions to identify their needs in this novel care environment. The following needs were most prevalent:
- The need for clear educational goals that align with the collaborative model of care
- The need for developing interprofessional curricula and assessment tools that align with these educational goals
- The need to better orient students to their roles in this new team setting
I have been working with my local and national Macy mentors to address these challenges.
Working with leaders from local residency programs, I am developing educational goals that are specific to the different health professions. While these goals will largely align with national competency frameworks (e.g., ACGME, IPEC), they will be contextualized to our setting and will provide a roadmap for students.
I am very excited about our approach to assessment, which has been influenced by my time at the Harvard Macy Institute. Our team includes a PhD colleague with a background in communication who has been observing our collaborative care team during rounds to describe and categorize communication behaviors amongst all team members, including students, patients and their families. We will bring these observations to small groups of health professionals and patients who have been involved with collaborative care to first vet them, provide feedback, and then use them to build new assessment tools.
The Road Ahead
We continue to move forward with our initiative and are making good progress. This spring, a second inpatient team of students transitioned to the collaborative care model. This is an important milestone for us and is particularly exciting because this team is housed on a geographically localized unit that we hope will naturally foster collaboration more organically throughout the day. We are curious to see what new innovations grow out of this environment.
The Macy Foundation has been instrumental in our efforts. The national mentorship and faculty development opportunities have moved this work forward in new and unexpected directions. We are excited to see what grows out of this collaboration next. More than ever, it is important that we engage our students and patients in care environments that foster learning, communication, and are not “patient-centered,” but rather “patient-partnered.”