Frederick Chen MD, MPH, is Senior Advisor to the Bureau of Health Professions in the Health Resources and Services Administration (HRSA). The bureau supports a wide-range of training programs and curricular innovations for health professions students and practitioners, with the ultimate goal of improving access to health care. HRSA recently selected the University of Minnesota Academic Health Center to lead a new coordinating center for interprofessional education and collaborative practice.
Macy: Why is interprofessional education (IPE) important to HRSA?
Chen: IPE is an idea that’s been around since the 1970s. It’s the idea that if we get different health professions to work better and more closely together, we can improve health care. With the passage of the Affordable Care Act (ACA) there is new incentive to advance interprofessional practice.
More people will be insured under the ACA, so one of the first things we have to address is how can we expand access to care? The ACA is also changing how we pay for care, introducing new reimbursement models and financial incentives. These payment changes are in turn driving changes in how we organize care, demanding better coordination between different health care settings and providers. For example, at a system level, we’re creating accountable care organizations; at a clinical level we’re implementing patient-centered medical homes. Interprofessional team-based care is a key feature of these new delivery models.
This is where IPE becomes important. We need to ensure our health professionals are trained to work effectively in these new delivery systems. That means training health professions students and trainees in a different way and in different models—teaching them what it means to work together and giving them practical experience in clinical settings where interprofessional practice is happening. In this way, IPE is very much aligned with our national strategy to create a better health system.
Macy: What spurred HRSA to create a center for interprofessional education and practice?
Chen: Last year, HRSA partnered with the Macy Foundation and other groups to develop a set of core competencies for interprofessional collaborative practice. As we rolled out these competencies, there was an important discussion among the groups involved—HRSA, several foundations and a number of health professions associations—about how we promote interprofessional education and practice. The idea started to form around a national center that could coordinate interprofessional activities and spur action around the country.
In September, we set up a cooperative agreement with the University of Minnesota Academic Health Center to lead the center. HRSA has been involved in interprofessional training before, supporting a number of different programs. The unique aspect of this project is its national stature and the expectation that the center will be a leader in interprofessional training and practice.
Macy and three other foundations (John A. Hartford, Robert Wood Johnson and Gordon & Betty Moore) have jointly pledged $8.6 million in grants to support the center. We’re very excited about the relationship with the four foundations and how committed they are to the success of the center. It means access to more resources for the center—not just financial but also the expertise and connections that the foundations each bring to the partnership.
Macy: The center has an explicit focus on interprofessional practice. Why is that?
Chen: Health systems have started to really understand how vital interprofessional practice is to good health care. But we’re hearing from health systems that trainees coming out of the existing education system don’t know how to work in a team or how to take leadership of a team.
IPE is still very rooted in classroom-based instruction. Students are taught that it is important to work together but when they get to their clinical training, they have a very different experience. They go into the hospital and quickly realize that there are barriers between doctors and nurses; that they’re working in silos.
Trainees and students are not being exposed to interprofessional practice in their clinical education. Some school leaders think interprofessional practice doesn’t exist, but what we’ve learned is that there are great examples of collaboration and teamwork in clinical practice. In geriatrics, for example, interprofessional practice has shown to provide the best care for patients. Community health centers also have a real emphasis on interprofessional practice, where doctors and nurses are co-located with dentists, social workers and other health professionals.
The advances we’ve seen in clinical settings have been remarkable but schools have been left behind—they don’t know how to get their students into those interprofessional settings. Schools are still stuck trying to figure out the scheduling and other logistics of teaching health professions students together. We can’t let that hold us up. We hope the center will help schools get up to speed.
Macy: How will the center help bridge this gap?
Chen: One of the key outcomes we’re looking for from the center is better dialogue between the education and delivery systems. Even in their own institutions, educators are not talking to the people responsible for the health care delivery at their university’s hospital.
In Minnesota, the health delivery systems have sat down at a table with the health professions schools to talk about what they need to do to prepare students for practice. This is a dialogue that needs to happen in communities across the country and we hope the center will be an exemplar of how to engage the clinical system and ensure health professions educators and the healthcare delivery system are working in conjunction with each other.
Macy: What is your ultimate vision for the center?
Chen: The center is rightfully focused on the triple aim: better health care, better care experience, lower cost of care. I hope that, in the next five years, the work of the center will become automatic and integrated into our health care system—it will be understood that providing care in teams improves quality, expands access and uses the right amount of resources.