News and Commentary “How are you going to sustain it when the grant runs out?”

This has to be the most common and critical question with every grant-funded initiative. It was a question that we took very seriously six years ago when we applied to the Josiah Macy Jr. Foundation for the funding to undertake a dramatic expansion of our IPE program.

At the time, we had over a dozen year’s experience providing an IPE Ethics course for our students and had just finished building a new health sciences campus that was fundamentally interprofessional in its design. We also had a local funder (The Colorado Health Foundation) that was interested in talking with Macy about jointly funding our start-up.

In a discussion with our program officer from the Colorado Health Foundation, the question of sustainability came up. That conversation ended with an agreement that our institution would submit a maintenance-of-effort letter with our grant application. The letter would be signed by all of our Deans and our Vice Chancellor of Health Affairs and would commit us to continuing a comprehensive, longitudinal IPE program after the grant dollars were spent. That formal, up-front commitment proved extraordinarily valuable. The letter gave each of the Deans a degree of ownership of the program that I don’t think we would have achieved otherwise. Over the course of our grant, two of the signing Deans retired and we acquired a new Vice Chancellor but in each case, their predecessor’s commitments were honored—the group as a whole ensured it.

Since the grant was awarded, as the IPE director, I’ve met roughly quarterly with the Dean’s Coordinating Council to update them on the progress of the IPE programs. At each of those presentations, I reviewed the finances and projected the date when our roughly $600,000 annual budget from the combined Macy and Colorado Health Foundation grants would become their responsibility.

As our grants wound down, a few things became apparent. Some of the Deans felt that the structure we established under the grants didn’t give them enough ownership and stake in the program. That structure, which made perfect sense for the grants, consisted of a director (the grant PI) and an associate director for each of the 3 core components of the program. Each component in turn had a committee and we had an interprofessional advisory board that oversaw the whole. In hindsight, our chief organizational challenge was that the advisory board opined from a distance and didn’t really have operational ownership of the programmatic whole. When problems inevitably arose with our programs’ integration with the schedule or curriculum, the fault was assigned to our central IPE faculty and staff for not communicating enough or not anticipating the problem.

As part of our sustainability plan, we reorganized our structure. Each of the Deans committed resources to sustaining the program, but a key part of their commitment was a 20% position for a faculty member to serve as their representative to a newly formed IPE Council. The Director would now chair the Council and the program and curriculum would be a product of the Council as a whole. This structure has proved remarkably effective. Each member of the Council is responsible for communicating with their own Dean and faculty and ensuring the needs of their students are met. They are also accountable for the curriculum itself as well as for any scheduling or logistical problems that arise for their students.

Our founding grants expired two years ago. Under this new structure, we reorganized our foundational course into a two-semester, 16 week course that is required for over 700 students. This course is seamlessly integrated with the simulation experience that follows. Finally we are starting to gain traction on our long-term goal of integrating IPE organically into our clinical education experiences.

It’s not just our IPE program that has been transformed by our experience over the last 6 years, our entire campus has moved. IPE is now a key recruiting tool for each of our professional programs. Perhaps most telling are the number of students who cite IPE as a reason for choosing our campus over others they are considering and the number of student-driven initiatives that are interprofessional in their leadership, structure, and purpose. Six years ago, student driven interprofessional efforts were rare. Now they are commonplace.

“How are you going to sustain it when the grant runs out?”

When we started this chapter of our IPE journey six years ago, we couldn’t have answered that question with any detail. All we could do was solicit a promise from campus leadership that we would sustain it. We now have a more detailed answer to that question that involves not only a commitment to resources, but a structure to ensure shared leadership and accountability. The results, we believe, speak for themselves.

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