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"Historic Interprofessional Collaboration" for Team Care: A Boon for CAM/Integrative Disciplines? PDF Print E-mail
Written by John Weeks   
Saturday, 07 May 2011

"Historic Collaboration" for Interprofessional Education and Team Care: A Boon for CAM/Integrative Disciplines?

Summary: The process of "integration" is often opportunistic. A huge door swung open on May 10, 2011 with announcement of a "historic collaboration." The focus was bettering health care and preventing medical errors and deaths. The focus: move health professions education and practice out of silos and into teams through enhanced competencies in interprofessional education/care (IPE/C). The Interprofessional Healthcare Collaborative consists of leaders from national academic organizations for medicine, nursing, dentistry, public health, pharmacy and osteopathy. The administrator of HRSA endorsed the initiative. Executives with the Robert Wood Johnson Foundation and Josiah Macy Foundation guaranteed muscle in dissemination. The participants referred to it as "transformative" and necessary for true health reform. Can such a patient-centered initiative not include the integrative practices and the licensed "CAM" disciplines? Can "integrative medicine" advance if IPE/C fails?
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Image
Carol Aschenbrener, MD
How can U.S. health care prevent the over 100,000 deaths a year caused by U.S. medicine?


To Err is Human: Building a Safe Health System
teed up this question in 2000. The report, published by the Institute of Medicine
, startled nearly everyone with the finding that routinely performed medicine ranked behind heart disease and cancer as one of the nation's most prolific killers.

On May 10, 2011, Carol Aschenbrener, MD, executive vice president of the Association of American Medical Colleges referenced the IOM report
before a packed room at the National Press Club. With Aschenbrener were executives from parallel academic organizations for nursing, pharmacy, public health, dentistry and osteopathy.

The team behind this: 6 academic organizations, 3 foundations and HRSA

Image
George Thibault, MD
These 6 organizations had engaged what speaker after speaker referenced as a "historic collaboration" to combat a major flaw in US health care. The flaw was directly identified in the IOM's 2001 follow-up to To Err, Crossing the Quality Chasm. Professionals are educated in silos.
Members of distinct disciplines disrespect each other. They are poorly trained to work as teams. The result: discontinuities of care and inappropriate or over treatment that lead to error and death.

To set a healing course, the 6 organizations had formed the Interprofessional Education Collaborative late in 2009
. Powering this collaboration are the nation's 2 most significant foundations that back health professions education: Robert Wood Johnson and Josiah Macy Jr. The president of the latter, George Thibault, MD, framed the purpose of the collaboration this way:
"We have good evidence that health care delivered in teams is more efficient and more effective, yet we continue to educate our health professionals in silos. We will not have health reform unless we change the way we imprint our students. We cannot change healthcare unless we change education."
Declarations of core competencies and strategies

The media event, described in
this release, marked the publication of the first two products of the historic collaboration. The central offering is Core Competencies for Interprofessional Collaborative Practice. These include a set of guiding principles and 38 individual competencies. The competencies are organized in the following 4 domains:

  • Work with individuals of other professions to maintain a climate of mutual respect and shared values.
  • Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served.
  • Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease.
  • Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-/population-centered care that is safe, timely, efficient, effective, and equitable.

Image
Mary Wakefield, PhD, RN
The second product is a report
entitled Team-based Competencies: Building a Shared Foundation for Education and Clinical Practice rom a February 2011 meeting. Most of the same stakeholders were present. Among the "Action Strategies" identified are: establish the business case; create a clearinghouse of resources; prepare faculty; and forge new collaborations. "Restraining factors" that may inhibit these developments are a lack of role models, reimbursement, and frank resistance. "Reinforcing factors" include health reforms' focus on the patient and on care quality, the aging society and the financial incentives for care coordination in the Affordable Care Act.

Mary Wakefield, PhD, RN, the administrator of the U.S. Health Resource Services Administration (HRSA), kicked off the media event. HRSA was a co-sponsor of the February meeting. She described ways the Obama administration and the Affordable Care Act supported IPE/C. Among these are the promotion of patient-centered medical homes.

Wakefield pointed to the repeating pattern of logos of the 6 organizational on the wall-paper backdrop for the event: "This is perhaps the first time these organizations have worked on any shared goal - certainly on this one." The work is needed, Wakefield said, "to better prepare our workforce for team care."


Inclusion of "CAM" disciplines and integrative practices?

Image
Polly Bednash, PhD, RN
But what of the other professions such as physical therapists and psychologists? Is this Big 6 just a new oligarchy replacing the prior MD kingdom? And what of the licensed "CAM" disciplines such as chiropractic medicine and acupuncture and Oriental medicine and massage therapy and naturopathic medicine?

When the event opened to questions and comments, these questions immediately came forward. An individual who said he represented "allied health" congratulated the group. Then he said he and the rest of allied health would like to be involved.

This provided an opening to another attendee who said he represented the Academic Consortium for Complementary and Alternative Health Care (ACCAHC).* He too congratulated the 6 on their collaboration. Then he noted he represented 5 licensed "CAM" fields with federally-recognized accrediting agencies. These had collaborated to develop the Competencies for Optimal Practice in Integrated Environments. Their disciplines, the speaker said, were looking to be at the table too. Given consumer use, he added, wouldn't it be appropriate in a
patient-centered initiative like this to have these disciplines at the table?

Geraldine "Polly" Bednash, PhD, RN, FAAN, CEO of the American Association of Colleges of Nursing fielded the remarks on behalf of the panel. Bednash said she appreciated the comments and that "we will be inviting others in and looking for ways to communicate."

Now is the time

Image
Mary Joan Ladden, PhD, RN
IPE/C was variously referred to not only as a historic initiative but one that is "necessary" and "transformative" and "part of a dream we all share for safe, patient-centered care."


Maryjoan Ladden, PhD, RN, with the Robert Wood Johnson Foundation spoke of "the urgency here." RWJF has an "action plan for a durable campaign to make sure all stakeholders work together to ensure all health professions students" are trained as teams.

Lucinda Maine, PhD, RPH, speaking on behalf of the American Association of Colleges of Pharmacy stated: "While intuitively obvious, it's not easy."
The so-called "restraining factors" are many.

Hanging over the public celebration of this initiative was the specter of a 1972 IOM report on the same subject with parallel recommendations. That study had negligible effect. The foundation representative guaranteed that these reports would not remain on the shelf. The associations were pushed to formally endorse the competencies developed by their appointed leaders.

The question in the room, even at this kick-off, was whether this unique collaboration in this moment of time in healthcare history will create a more successful outcome.

_____________________

Comment
: Corrine Bayley, RN, an early colleague in "CAM" integration then with St. Joseph's Health System, explained her reason for leaving the field this way: "There will be no CAM integration if MDs and nurses can't talk to each other."

   

Notably, the definition of "integrative medicine"
says one must integrate not just the best of all
therapies but also of "health professionals
and disciplines." 

   
Thibault's comment is out of this broader lens. We will have no true health reform until our education of health professionals leaves a different "imprint" on clinicians.

Imagine if the sole-practitioner-as-God paradigm - whether the god be MD or ND or AOM practitioner or DC - is utterly discarded. Instead, health professions education focuses, from the moment of orientation, on graduating practitioners who feel in their bones that they are not whole unless surrounded by a team that reflects the breadth of patient choice.

Notably, the definition of "integrative medicine" endorsed by the Consortium of Academic Health Centers for Integrative Medicine affirms this. According to their definition, one must integrate not just the best of all therapies but also of "health professionals and disciplines."

The interprofessional curriculum poses special problems for disciplines that are not located in academic health centers. Single-purpose silos are the principle venues for educating CAM practitioners. How can these geographic and cultural chasms be overcome?

This IPE/team care initiative is not only a challenge for the big 6 in this "historic collaboration." Integrative medicine and CAM disciplines education need to focus special attention here. The door for a rich and potentially transformational collaboration is identified, if not yet precisely open.
Now is the time to be knocking.

*  I happened to be in the Beltway on other ACCAHC business and was able to attend and speak up.


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for inclusion in a future Integrator.



Last Updated ( Thursday, 12 May 2011 )
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