By Nicole Fauteux
The Supreme Court’s 2012 decision to uphold key provisions of the Affordable Care Act (ACA) has provoked various reactions from the states. While a few are doing everything they can to resist the rising tide of health care reform, others are moving ahead, albeit reluctantly. Yet some states, such as Oregon, are setting the pace by undertaking bold steps forward that may soon provide useful lessons for the entire nation. As the leading institution charged with educating the state’s health care workforce, the Oregon Health & Science University (OHSU) faces a monumental task. Not only must it continue to produce competent health professionals, it must also prepare graduates to perform well in a dynamic practice environment that will continue to evolve even after they enter the workforce.
The Oregon Health Plan creates coordinated care organizations—described by one observer as “accountable care organizations on steroids”—for its Medicaid and Children’s Health Insurance Program (CHIP) enrollees. Because these community-based providers will be responsible for meeting patients’ medical, dental and behavioral health needs, interprofessional education (IPE) seems a fitting way to prepare students to deliver this coordinated care.
According to Dr. Jennifer Boyd, Assistant Vice Provost for Strategic Planning and Program Development at OHSU, the state’s health reform plans, coupled with OHSU’s commitment to educate a health care workforce equipped to deliver collaborative, patient-centered care, have been key drivers of OHSU’s Interprofessional Initiative (IPI).
“We see this as really transformative and a culture change,” says Dr. Boyd. “We’re trying to put IPE into context and make sure it is truly creating better care, and that ultimately, the patient will be the winner from all this.”
That is a tall order, one that OHSU is trying to fill in a methodical way. The university’s Provost, Dr. Jeanette Mladenovic, set the stage by putting OHSU’s schools on a single common calendar. She also established an IPI steering committee made up predominantly of faculty members, and supported by the expertise of high-level individuals in her office. Finally, she established an advisory committee composed primarily of deans from the various schools who meet with the steering committee monthly.
Dr. Jeffery Stewart, Associate Professor of Pathology at the OHSU School of Dentistry, co-chairs the IPI steering committee with Dr. Boyd. He says the committee began its work by mapping the learning objectives of OHSU academic programs. The committee then created a set of 10 shared core competencies that all of the programs’ curriculum committees have endorsed. Not surprisingly, some of these shared competencies reflect those developed by the Interprofessional Education Collaborative (IPEC), of which ADEA is a member.
“We expect all OHSU graduates to demonstrate their mastery of the OHSU Core Competencies at the time they complete their various programs,” Dr. Stewart says.
The committee also set up task forces to develop IPE curriculum. Thus far, they have planned four experiences for first-year learners. The initial event, scheduled for this August, focuses on professional identity formation. At OHSU, professional identity formation will have two distinct dimensions: what it means to be a professional in one’s own discipline and what it means to be a professional collaborating with other health professionals.
“We want to understand from a biological, psychological and learning theory basis, how people develop these identities,” says Dr. Stewart. “We want to be sure we employ techniques during our IPE experiences that will foster the development of these identities so that they are embedded within each student’s concept of what it means to practice interprofessionally.”
While the IPI task forces are developing additional experiences, construction is taking place at the university’s South Waterfront campus on the banks of the Willamette River. A new Collaborative Life Sciences Building will unite most of OHSU’s health professions programs under one roof starting in the fall of 2014. The facility will include 20,000 square feet of new simulation space, allowing OHSU to make its already well-established use of simulation truly interprofessional. It will also include substantial research space that will allow for cross-disciplinary collaboration among graduate students. Flat classrooms have replaced traditional tiered lecture halls to make the spaces more conducive to team-based learning.
Once the building is operational, OHSU will have eliminated two of the fundamental obstacles that impede IPE at many institutions—physical isolation of programs and conflicting schedules—and it will a have a full year of the new curriculum in place. Nevertheless, much work will remain. From Dr. Boyd’s perspective, the largest challenge is changing the culture. During some of the early steering committee meetings, she noted that each profession had its own specialized vocabulary and that the same words often conveyed different meanings to members of the different professions.
“How do we overcome the areas where there are communications breakdowns?” she asks. “We need to develop a common lexicon so that when a dental student says something or a nursing student says something or the faculty member says something, there is a common understanding across professions. A lot of IPE is really about speaking a common language, and communicating effectively and respectfully.”
Fortunately, OHSU can build on its current track record of establishing successful interprofessional initiatives. Its Global Health Center, for example, offers a community-based elective, the Inter-Professional Community Health and Education Exchange (iCHEE). iCHEE allows students to interact across professions while working with Portland-area refugees and other underserved patients. Health professions students also organize a yearly Health Care Equality Week, during which they provide care to Portland’s uninsured and homeless populations.
“Students plan the event, and it has very interprofessional participation,” says Dr. Boyd, “but when they actually deliver the care, they tend to deliver it in profession-based groups. With the impact of IPE, the students are now asking, ‘Could we do this interprofessionally to provide more effective and efficient patient-centered care?’”
Last fall, OHSU received an interprofessional collaborative practice grant from the Health Resources and Services Administration (HRSA). The grant is allowing the university to expand its off-site IPE collaborative practice offerings. The grant, associated with HRSA’s Nurse Education, Practice, Quality and Retention program, puts nursing and medical students together in safety net clinics. At their current downtown location, students are coordinating the care they provide and gathering longitudinal data to see if care coordination reduces use of emergency services and improves access to and compliance with care. Next fall, OHSU will expand the program to a second clinic and engage dental and pharmacy students in this interprofessional activity.
This wealth of IPE experiences should help prepare graduates for Oregon’s practice climate in the years ahead. Although the IPI is continually evolving, as is the state’s ambitious plan to bring coordinated care to more Oregon residents, a culture of collaboration has taken root at OHSU. As the faculty and students continue to embrace this culture and carry it into the practice arena, the goal of better serving patients through interprofessional collaboration should be well within reach.