Two Birds and One Stone: Integrating Education and ...GME. In many clinical learning environments,...

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Two Birds and One Stone: Integrating Education and Clinical Redesign to Achieve the Common Mission (#4098) Kelly Caverzagie, MD, FACP, FHM Associate Dean for Education Strategy, UNMC Vice-President for Education, Nebraska Medicine Lois Colburn, Executive Director UNMC Center for Continuing Education

Transcript of Two Birds and One Stone: Integrating Education and ...GME. In many clinical learning environments,...

Page 1: Two Birds and One Stone: Integrating Education and ...GME. In many clinical learning environments, GME is largely developed and implemented independently of the organization’s other

Two Birds and One Stone:

Integrating Education and Clinical

Redesign to Achieve the Common

Mission (#4098)

Kelly Caverzagie, MD, FACP, FHM

Associate Dean for Education Strategy, UNMC

Vice-President for Education, Nebraska Medicine

Lois Colburn,

Executive Director

UNMC Center for Continuing Education

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Disclosures

Neither presenter has any conflicts of interest to disclose

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Objectives

Identify the importance of integrating education and clinical redesign efforts

Identify how residency training requirements can catalyze efforts at clinical redesign

Develop a business plan to support clinical and educational integration

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Outline

1. Changing Landscape of Health Care and Medical Education

2. UNMC and Nebraska Medicine

3. OHPE – Facilitating Alignment

4. OHPE – Business Plan Development

5. Conclusions

OHPE = Office of Health Professions Education

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Outline

1. Changing Landscape of Health Care and Medical Education

2. UNMC and Nebraska Medicine

3. OHPE – Facilitating Alignment

4. OHPE – Business Plan Development

5. Conclusions

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Changing Landscape of Health Care

“Fundamental, sweeping redesign of entire health delivery system.”

“Requires changing the structure and processes of the environment in which health professionals and organizations function.”

IOM Crossing the Quality Chasm: A new

health system for the 21st century. c2001

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Changing Landscape of Health Care

Six Aims for Improvement

• Safe

• Effective

• Efficient

• Patient-Centered

• Timely

• Equitable

IOM Crossing the Quality Chasm: A new

health system for the 21st century. c2001

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Changing Landscape of Health Care

Framework that describes an approach to optimizing health system performance

Institute for Healthcare Improvement:

The IHI Triple Aim. c.2007

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Changing Landscape of Medical Education

“Medical education is at a

crossroads: those who teach

medical students and residents

must choose whether to continue

in the direction established over a

hundred years ago or to take a

fundamentally different course,

guided by contemporary

innovation and new

understandings about how people

learn.”

Cooke M, Irby DM, O’Brien BC

Carnegie Foundation, c2010

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Changing Landscape of Medical Education

CLER Pathways to Excellence

• Patient Safety

• Health Care Quality

• Supervision

• Care Transitions

• Health Care Disparities

• Fatigue Management,

Mitigation and Duty

Hours

• Professionalism

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Changing Landscape of Medical Education

“While the medical education system alone cannot solve all of these problems, ensuring that the nation’s physicians are response to the changing needs and expectations of Canadians is a vital part of the solution.”

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Future of Medical Education in Canada

Recommendation #3 • Create positive and supportive learning and

work environments

Recommendation #5 • Ensure effective integration and transitions

along the educational continuum

Recommendation #9 • Establish effective collaborative governance in

PGME

Recommendation #9

“Recognizing the complexity of PGME and the health

delivery system within which it operates, integrate the multiple bodies (regulatory and certifying colleges,

educational and healthcare institutions) that play a role in PGME, into a collaborative governance structure in order

to achieve efficiency, reduce redundancy, and provide clarity on strategic directions and decisions.”

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Bottom Line: Clinical learning environment

influences knowledge and judgment

Sirovich et al.

JAMA Int Med;

2014

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Chen et al.

JAMA; 2014

Bottom Line: Clinical learning environment patient care

expenditures are reproduced in clinical practice of

graduates. Effect persists up to 15 years after

graduation.

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Asch et al.

JAMA; 2009

Bottom Line: Clinical learning environment impacts

patient care outcomes. Effect persists up to 15 years

after graduation.

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Impact on Academic Health Centers

Health System Redesign

• Patient experience

• Population Health

• Value (high benefit, low cost)

• Interprofessional teamwork

• Transitions of care

• Informatics and data management

• Evidence-based standards

• Etc…

Medical Education Redesign

• New assessment frameworks

• New curricular content and

structure

• New curricular delivery

approaches

• New learning experiences

• Interprofessional education

• Emphasis on learning

environment

• Etc…

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Impact on Academic Health Centers

Increasing pressure to:

• Demonstrate value in health care delivery

• Demonstrate value in health professions education

• Align clinical and educational missions

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Small Group Activity #1

At your program, think of an example of an educational redesign. What is the purpose of that redesign?

Does that redesign effort align with institutional/clinical (i.e. health system) needs and priorities?

How do you know? How could you know?

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Outline

1. Changing Landscape of Health Care and Medical Education

2. UNMC and Nebraska Medicine

3. OHPE – Facilitating Alignment

4. OHPE – Business Plan Development

5. Conclusions

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Relationship existed between educational

units and clinical delivery system

Health System Leader: “Isn’t that (education) what the University

does?”

Academic Leader: “What do they (hospital) care about education?”

Relationship? Goal is a

partnership!

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Why alignment?

Competent systems cannot

exist without

competent providers

Training competent providers

requires that they train in

competent systems

Asch, et. al. JAMA, 2009

Partnership is a “win-win” relationship

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Outline

1. Changing Landscape of Health Care and Medical Education

2. UNMC and Nebraska Medicine

3. OHPE – Facilitating Alignment

4. OHPE – Business Plan Development

5. Conclusions

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Office of Health Professions Education (OHPE)

Who: Small staff (3-4) with key roles to drive strategic areas of focus and facilitate alignment in context of education

What: Support, facilitate, prioritize, advocate, partner

When: July 2015

Where: Accountable to VP for Education, Nebraska Medicine

Why: Facilitate the alignment of Nebraska Medicine, UNMC and its affiliates and partners in context of education

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Office of Health Professions Education (OHPE)

How: • Understand strategic needs for all involved

• “Connect-the-dots” between people, programs and resources to help them achieve their goals

• Demonstrate value to education and clinical leaders

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OHPE Areas of Focus

‘Areas of focus’ were based upon strategic needs, opportunity and potential impact:

A. Continuing Education for Health

Professionals

B. Clinical Quality and Education

C. Interprofessional Practice and Teamwork

D. Rural / Community Development

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OHPE Facilitation – Cont Ed Example

Center for Continuing Education (CCE)

• Housed within UNMC (i.e. not health system)

• Goal: CE to be viewed as a strategic resource (i.e. something to leveraged as opposed to a cost/liability that needs to be tolerated)

• OHPE facilitated alignment and integration

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CCE Examples of Alignment

• Access to health system strategic planning and business priorities

• Heart Failure

• Geriatric Oncology

• Access to quality data for use in developing focused and/or strategic education

• Regularly scheduled series (e.g. Grand Rounds) with refined standards

• CCE Director part of health system leadership team

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CCE Examples of Alignment

• Wide variety of educational opportunities to enhance faculty, staff and resident knowledge, skills and attitudes while improving care:

• Sepsis

• Patient Experience

• Health Equity

• High Value Care

• Milestones and CBME

• Handheld ultrasound

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OHPE Facilitation – Quality Example Nebraska Medicine Quality Office

• Data Analytics, informatics, expertise

• Dashboard development

• Implement identified solutions

UNMC Residency Program

• Identification of quality need

• Trainee and faculty education

• Engage in improvement to propose solution

OHPE

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Health Literacy

Experiential Learning

Background Learning

Curriculum

Faculty/Staff Development

Enhanced Care Systems

Interprofessional Teams

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Small Group Activity #2

Using the example that you identified in Activity #1, how might you align efforts at educational redesign with institutional/clinical priorities?

What “dots” can you connect in order to achieve that goal?

(Hint: think from the perspective of the educator as well as the hospital administrator.)

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Theme #1:

Clinical learning

environments vary in their

approach to and capacity

for addressing patient

safety and health care

quality, and the degree to

which they engage

residents and fellows in

these areas.

Overarching National Themes of CLER

Theme #2:

Clinical learning environments vary in their approach to implementing

GME. In many clinical learning environments,

GME is largely developed and implemented

independently of the organization’s other areas of strategic planning and

focus.

Theme #3:

Clinical learning

environments vary in the

extent to which they invest

in continually educating,

training, and integrating

faculty members and

program directors in the

areas of health care quality,

patient safety, and other

systems-based initiatives.

Theme #4:

Clinical learning

environments vary in the

degree to which they

coordinate and implement

educational resources

across the health care

professions.

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CLER Pathways to Excellence

• Patient Safety

• Health Care Quality

• Supervision

• Care Transitions

• Health Care

Disparities

• Fatigue Management,

Mitigation and Duty

Hours

• Professionalism

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OHPE and CLER

• Facilitate Resident Quality and Safety Committee (RES-Q)

• Just-in-time Supervision Monitoring

• Health Equity Symposium

• Continuing Education as a Strategic Resources

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Small Group Activity #3

What imperative can you leverage to help

you work towards alignment and achieve

your goal?

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Outline

1. Changing Landscape of Health Care and Medical Education

2. UNMC and Nebraska Medicine

3. OHPE – Facilitating Alignment

4. OHPE – Business Plan Development

5. Conclusions

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Rogers’ Organization Innovation Process

(Rogers, 2003)

Agenda Setting / Gap

Diagnosis Matching Redefining Clarifying Routinizing

DECISION INITIATION IMPLEMENTATION

Define your need for change

Describe how innovation matches your need

Re-define the innovation to stakeholders, restructure organization to fit innovation, communicate

Make roles and tasks associated with innovation clear

Hard-wire: develop business plan, policies, procedures, job descriptions, performance appraisals

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Agenda / Gaps

Jan – March 2014

Recognize opportunity and establish need

Carpe diem!

Key Facilitator: CLER site visit in Feb 2014

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OHPE - Why Now?

Strengths • Leadership Support

(Chancellor Gold) • Champion with authority • Existing infrastructure for

most of desired changes

Weaknesses • Poor coordination between

clinical and educational units • Educational silos across

continuum • COM only early participant

Opportunities • Changes in senior leadership • Changes in organizational

orientation • Changes in local health care

environment • Timely CLER visit

Threats • “Isn’t that (education) what the

University does?” “What do they (hospital) care about education?”

• Redundancy and bureaucracy • Turf wars

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Matching April – Nov 2014

Sell vision, understand the environment, build relationships with stakeholders

Consistent message: Support, facilitate, prioritize, advocate, partner

Key Facilitator: Incorporate into UNMC Strategic Plan

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Potential individuals to engage

Chief Quality Officer (CLER)

Health Services Researchers (Data generators) Chief Financial Officer

($$$)

Human Resources (Effective on-boarding)

Continuing Education (MOC and quality)

Associate Deans (Educational Programming)

I/O Psychologists (Organizational Understanding)

Informatics (Documentation)

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Rogers’ Organization Innovation Process

(Rogers, 2003)

Agenda Setting / Gap

Diagnosis Matching Redefining Clarifying Routinizing

DECISION INITIATION IMPLEMENTATION

Define your need for change

Describe how innovation matches your need

Re-define the innovation to stakeholders, restructure organization to fit innovation, communicate

Make roles and tasks associated with innovation clear

Hard-wire: develop business plan, policies, procedures, job descriptions, performance appraisals

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Redefining

Dec 2014 – Jan 2015

‘Area of focus’ workgroups established

Expand stakeholder network

Key Facilitator: Convergence around common themes

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OHPE Areas of Focus

A. Continuing Education for Health Professionals

B. Clinical Quality and Education

C. Interprofessional Practice and Teamwork

D. Rural / Community Development

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OHPE Workgroups

Broad and multi-professional representation

58+ individuals

12+ constituencies

Total of 6 one-hour meetings

Defined charge

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Charge to Workgroups

Question #1: Identify opportunities where alignment is desired or needed

Question #2: What needs to happen in order to achieve alignment with respect to these opportunities?

Question #3: What are the recognized barriers / potential solutions to achieving alignment? What are strategies to overcome barriers?

Question #4: What resources are necessary to facilitate alignment?

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Clarifying

Feb - March 2015

Compile feedback from workgroups to clarify expected services and products of OHPE

Justify budget required to build team

Key Facilitator: Prior engagement of stakeholders

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OHPE – Organizational Structure

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Rogers’ Organization Innovation Process

(Rogers, 2003)

Agenda Setting / Gap

Diagnosis Matching Redefining Clarifying Routinizing

DECISION INITIATION IMPLEMENTATION

Define your need for change

Describe how innovation matches your need

Re-define the innovation to stakeholders, restructure organization to fit innovation, communicate

Make roles and tasks associated with innovation clear

Hard-wire: develop business plan, policies, procedures, job descriptions, performance appraisals

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Routinizing March 2015

Finalize business plan, complete job descriptions and start hiring

Maintain focus areas but accept accountability for specific tasks in the context of education

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Small Group Activity #4

Think about your institution or program: a. What are the opportunities where alignment is needed

or desired? (Think about the needs for resident education and needs for clinical improvement.)

b. What needs to happen in order to achieve alignment with respect to these opportunities?

c. What are the recognized barriers / potential solutions to achieving alignment? What are the strategies to overcome the barriers? Who can facilitate or hamper the process?

d. What resources will be necessary in order to facilitate alignment?

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Common Mission

We are Nebraska Medicine and UNMC.

Our mission is to lead the world in transforming lives to create a healthy future for all individuals and communities through premier educational programs, innovative research and extraordinary patient care.

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OHPE – Example Business Plan

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Outline

1. Changing Landscape of Health Care and Medical Education

2. UNMC and Nebraska Medicine

3. OHPE – Facilitating Alignment

4. OHPE – Business Plan Development

5. Conclusions

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Facilitators to Alignment

Common missions and common needs

Tying OHPE to strategic plans

Top leadership is academic focused

Engaging all health professions education

Formal leadership roles in both camps

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Barriers to Alignment

Constant evolution of everything around OHPE

Too many initiatives – too many opportunities!

Perceived (or real?) redundancy

Perceived (or real?) threat to others

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Lessons Learned

1. Use clinical redesign imperatives to your advantage – think broadly to leverage redesign beyond the accreditation standard

2. Be strategic!

3. Sell vision, build relationships and understand the environment

4. Iterative process – identify vision, be flexible and keep working towards that goal

5. Build trust - be transparent about potential risks/benefits to education and clinical stakeholders

6. Look for opportunities for alignment

7. Involve others who have the skill set to help you to succeed

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References

1. Institute of Medicine: Crossing the Quality Chasm: A new health system for the 21st century. Washington, DC: The National Academies Press; 2001.

2. Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.

3. Cooke M, Irby DM, O’Brien BC. Educating physicians: A call for reform of medical school and residency. 2010. The Carnegie Foundation for the Advancement of Teaching.

4. Weinberger SE, Pereira AG, Iobst WF, et. al. Competency-based education and training in Internal Medicine. Ann Int Med. 2010;153: 751-6.

5. Institute of Medicine. Health Professions Education: Bridge to Quality. Washington, DC: The National Academies Press; 2003.

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References

6. Frank JR, Snell LS, ten Cate O. Competency-based medical education: Theory to practice. Med Teach. 2010; 32: 638-45.

7. Caverzagie KJ, Iobst, WF, Aagaard EM, et. al. The Internal Medicine Reporting Milestones and the Next Accreditation System. Ann Int Med. 2013;158: 557-9.

8. CLER Pathways to Excellence: Expectations for an optimal clinical learning environment to achieve safe and high quality patient care. Accreditation Council for Graduate Medical Education. c. 2014.

9. American Medical Association: Accelerating change in medical education initiative. http://www.ama-assn.org/sub/accelerating-change/overview.shtml. Accessed: 2/26/15.

10.Asch DA, Nicholson S, Srinivas S, Herrin J, Epstein A. Evaluating Obstetrical Residency Programs Using Patient Outcomes. JAMA. 2009;302:1277-83.

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References

11. Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press; 2004.

12.Famiglio LM, Thompson MA, Kupas DF. Considering the Clinical Context of Medical Education. Acad Med. 2013; 1202-5.

13.Rogers, E. Diffusion of Innovation. Multiple sources.

14.Using Logic Models to Bring Together Planning, Evaluation and Action. Logic Model Development Guide. W.K. Kellogg Foundation. c.2004.

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Questions?

Kelly Caverzagie

[email protected]

Lois Colburn

[email protected]

mailto:[email protected]
mailto:[email protected]
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Early examples of facilitating alignment

A. Clinical Quality and Education

– GMEC and CLER

B. Interprofessional Practice and Teamwork

– Planning for iEXCEL (Interprofessional

Experiential Center for Enduring Learning)

C. Rural / Community Development

– Partnerships with Nebraska Health Network

(NHN) and Regional Provider Network (RPN)

D. Continuing Education for Health Professionals

– “The Nebraska Ebola Method” on iTunes

University

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Other opportunities for alignment

CME/MOC and quality improvement

On-boarding of new trainees (education) and employees (human resources)

Tele-medicine and tele-education

Patient-centered care (e.g. Health Literacy)

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Health Literacy

Greater than 1/3 of American adults lack sufficient health literacy

People who understand health instructions make fewer mistakes, get well sooner and can better manage chronic conditions

Simple strategies to combat health literacy exist

Health Literacy Tip Sheet, TMF Health Quality Institute.

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10 Attributes of a Health Literate Organization

#2) Integrates health literacy into planning, evaluation measures, patient safety and quality improvement

#3) Prepares the workforce to be health literate and monitors progress

Health Literacy Tip Sheet, TMF Health Quality Institute.

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OHPE Early Wins

Remove Redundancy

• Competing leadership development programs

Foster Relationships

• Connecting CCE with local / regional partners

• Who is across the table?

New Culture

• Recognition that someone else may be able to help -

we are all involved with education and patient care

• Integration of strategic plans

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The Logic Model

Systematic and visual way to present and share relationships among the resources available to operate a program, activities planned and anticipated changes or results.

W.K. Kellogg Foundation, 2004

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Achieving a Common Mission

Opportunity to:

Improve clinical care

Improve educational experience

Aligned missions will result in:

Better practitioners

Better systems of care and training

Better care for patients / populations

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IOM Competencies for Health Professionals

IOM Health Professions Education: Bridge to Quality. c.2003.

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Competency-Based Medical Education

CBME is an outcomes-based approach to the design, implementation and evaluation of a medical education program using an organizing framework of competencies.

The International CBME Collaborators

Frank et al. Med Teach, 2010

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Internal Medicine Milestones

Caverzagie et al. Ann Int Med, 2013

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American Medical Association: Accelerating change in medical education

http://www.ama-assn.org/sub/accelerating-change/overview.shtml

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Imperative for Education Redesign

Medical education has not sufficiently responded to:

• Shifting patient expectations and demographics

• Quality improvement

• Use of new technologies

• Changing health delivery systems

Summary: Medical education is

not meeting the nation’s health care needs

Weinberger et al. Ann Int Med, 2010

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Efforts at Health System Redesign

• Patient experience

• Population Health

• Value (high benefit, low cost)

• Interprofessional teamwork

• Transitions of care

• Informatics and data management

• Evidence-based standards

• Others

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Efforts at Medical Education Redesign

• New assessment frameworks

• New curricular content and structure

• New curricular delivery approaches

• New learning experiences

• Interprofessional education

• Emphasis on learning environment

• Others

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Why alignment?

WE HAVE THE SAME GOALS!

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Clinical and Curricular Integration

Effective integration of medical education with high-performance health care delivery can be enhanced with conventional curriculum development tools applied in unconventional ways.

Breakthroughs in clinical care translated into curricular “streams”

Famiglio LM, et. al. Acad Med. 2013


GME LAND RADIOS

GME LAND RADIOS

Purifiers Gme

Purifiers Gme

Medicare and Medicaid GME Funding Presentation to GME Program Coordinators April 2014

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GME TX3400 User Manual

GME TX3400 User Manual

Gme fitzhugh mullan

Gme fitzhugh mullan

GME CB RADIO CATALOGUE

GME CB RADIO CATALOGUE

Reflective Feedback in GME

Reflective Feedback in GME

GME Policy

GME Policy

GME Multi-Brand Strategy Jonathan Browning, GME Vice President Sales, Marketing and Aftersales Jonathan Browning, GME Vice President Sales, Marketing and.

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GR350BT - GME

GR350BT - GME

MT603FG EPIRB - GME

MT603FG EPIRB - GME

INSTRUCTION MANUAL - GME

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XRS CONNECT - GME

XRS CONNECT - GME

GME Application

GME Application

GME Manual and User Guiderepo.isis.vanderbilt.edu/GME/GME Manual and User Guide... · 2018. 8. 14. · GME Manual and User Guide 8 • Model Browser: Shows either the aggregation

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NAVY GME BRIEF

NAVY GME BRIEF

TX6600S - GME

TX6600S - GME

The GME Committee

The GME Committee

GME INI Reference

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MasterBase® - GME

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