To hospital patients in America, it may seem obvious that their care team – doctors, nurses, technicians, social workers and many other staff – works together to ensure they’re getting proper treatment and monitoring during their stay. But this relationship – often referred to as “interprofessionalism” – has not always been so obvious. Efforts are now under way across the nation to encourage it to flourish in all levels of medical education and hospital care and to foster it in a way that most benefits patients.
In 2010, the Institute of Medicine released a report called “The Future of Nursing: Leading Change, Advancing Health.” One recommendation: “Schools of nursing, in collaboration with other health professional schools, should design and implement early and continuous interprofessional collaboration through joint classroom and clinical training opportunities.”
This month, the keynote speaker at Penn’s second symposium on interprofessionalism agreed – but up to a point. Jordan Cohen, MD, former president of the Association of American Medical Colleges, spoke in favor of better understanding and cooperation among the health professions, but he argued that classroom settings were not the best sites for teaching interprofessionalism. He believes that simulation centers, where situations can more closely resemble real-life settings and standardized patients can be used, are more practical and more educational.
Later in the recent symposium, teams from other universities presented findings on the use of simulations to facilitate interprofessional education. Emphasizing that 70 percent of errors in health care are due to problems in communicating, Brenda Zierler, PhD, RN, at the University of Washington, described its “All Professions Day.” On that day, students in the different professional schools are placed in simulated scenarios where they have to communicate and work as a team to succeed. There are three cases in one day, involving different skills and different levels of crisis. The teams are debriefed after the cases, and they are meant to learn from errors. According to Zierler, the simulations are very popular with the students, who prefer training that seems closer to the real world and less of “an academic exercise.”
While expressing great interest in what can come of greater interprofessionalism in education and practice, Jordan Cohen and other speakers felt that more evidence is needed to support the claims made about interprofessionalism – that it can provide better overall care at lower costs. Cohen also asserted that the culture of traditional medicine would have to change before greater interprofessionalism could be achieved. The traditional sense has been that doctors were always on top of the hierarchy of professions and that women were presumed not to be leaders.
At Penn, work toward breaking down professional silos is well under way. Among the students in the graduate and professional schools, Bridging the Gaps has been a big draw since its founding more than 20 years ago. The multi-disciplinary program links academic health centers in Pennsylvania and New Jersey with community agencies with the goal of providing health-related supports and education within local communities. Speaking of the program, Donald Schwarz, MD, MD, MPH, Health Commissioner and Deputy Mayor for Health and Opportunity for the City of Philadelphia, described “a shared purpose” among the schools both at Penn and elsewhere. Ann O’Sullivan, PhD, professor of Nursing, noted, “Knowing how each profession sees itself in the community and working side by side with dental, medicine, and social-policy students allows nursing students to demonstrate their approach as a team member to a variety of community interactions.”
At an earlier symposium on interprofessionalism in November, Richard Horton, MD, editor of The Lancet, stated his admiration for “the collaborative spirit” he saw at the University of Pennsylvania. He especially praised LIFE (Living Independently for Elders), a service of the Penn Nursing Network. The LIFE care team comprises primary care physicians, nurse practitioners, registered nurses, social workers, therapists, personal care workers, and other dedicated staff.
At this month’s symposium, another of Penn’s success stories was presented – a multi-specialty acute-care unit at the Hospital of the University of Pennsylvania that has been able to raise its level of care because of interprofessional collaboration. The guiding spirit for this and several other units at HUP was the Health System’s Blueprint for Quality and Safety and in particular, the Unit Based Clinical Leadership (UBCL) initiative that joins staff members from various disciplines to tackle vexing issues throughout the hospital. As Victoria Rich, PhD, HUP’s chief nurse executive, put it, in earlier days some of the clinical staff worked side by side but didn’t know each other or their respective areas of expertise. There was an urgent need for more trust and better communication. The UBCL initiatives focused on providing both, bringing together a physician leader, a nurse leader, and a project manager for quality in a three-way partnership. And the results, thus far, have been impressive: Vivek Ahya, MD, associate professor of medicine and medical director of the Lung Transplantation Program at HUP, pointed out that his unit reduced hospital-acquired infections by 90 percent in five years.
A telling exchange came during the brief question-and-answer period. The questioner wanted to know who was the ultimate coordinator of care on the unit. It is a true partnership, replied P. J. Brennan, MD, chief medical officer of Penn’s Health System, “but the nurse is the center of care.” Ahya was then asked, “Do you accept that?” “I do!” Ahya said, drawing some applause from the audience.
In his opening remarks for the symposium, Larry Jameson, MD, PhD, executive vice president of the University of Pennsylvania for the Health System and dean of the Perelman School of Medicine, noted that a number of successful models of increased interprofessionalism already exist, particularly in the field of geriatrics. “Those teams have been an example of better outcomes with lower costs,” he said. But he also emphasized that changing the culture and having “the right structures and the right people in place” are essential if interprofessionalism is to flourish.