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Partnering with Patients, Families, and Communities to Link Interprofessional Practice and Education Partnering with Patients, Families, and Communities to Link Interprofessional Practice and Education Proceedings of a conference chaired by Terry Fulmer, PhD, RN, FAAN and Martha (Meg) Gaines, JD, LLM April 2014 Arlington, Virginia September 2014 This monograph is in the public domain and may be reproduced or copied without permission. Citation, however, is appreciated. Fulmer, T & Gaines, M. Partnering with Patients, Families, and Communities to Link Interprofessional Practice and Education. Proceedings of a conference sponsored by the Josiah Macy Jr. Foundation in April 2014; New York: Josiah Macy Jr. Foundation; 2014 All photos by Kate Kunath Accessible at: www.macyfoundation.org Partnering with Patients, Families, and Communities to Link Interprofessional Practice and Education Proceedings of a conference chaired by Terry Fulmer, PhD, RN, FAAN and Martha (Meg) Gaines, JD, LLM Arlington, Virginia April 2014 Edited by Teri Larson Published by Josiah Macy Jr. Foundation 44 East 64th Street, New York, NY 10065 www.macyfoundation.org September 2014 CONTENTS Preface ......................................................................... 7 Introduction ..................................................................11 Conference Agenda ........................................................14 Conference Participants ...................................................20 Conference Conclusions and Recommendations ......................27 Commissioned Paper . 47 A Vision for Engaging Patients, Families, and Communities in Linking Interprofessional Education and Practice Case Studies .................................................................73 1. Université de Montréal: Partners in Interprofessional Education: Integrating Patients-as-Trainers. .73 2. University of Rochester Medical Center: Patient- and Family-Centered Care Initiative . 87 3. Veterans Health Administration (VHA): Engagement Strategies for Returning Combat Veterans. Veteran and Family Engagement and Interprofessional Education in Design and Implementation of VA Post-Deployment Care ..........................................105 4. Duke University: The Duke Health Leadership Program. .133 Highlights from the Conference Discussion . 151 Selected Bibliography ....................................................181 Biographies of Participants and Observers ..........................185 4 5 6 PR EFAC E GEORGE E. THIBAULT, MD This Macy Conference that was held April 3 to 6, 2014, in Arlington, Virginia was unique in many ways. It represented the Macy Foundation’s first formal initiative to bring together the worlds of health professions education, healthcare delivery, and patient and community advocacy. To do this we assembled a remarkable mixture of educators, healthcare delivery experts, patients, and patient advocates. And while the discussions at Macy Conferences are always robust, these discussions were particularly intense, vibrant, and uplifting. There was a shared sense of urgency, purpose, and hopefulness that we collectively can bring about the culture change that will enable true partnering and find the “sweet spot” that is depicted in the Conference Recommendations. This conference represented a logical progression in the work of the Macy Foundation over the last several years. Our major theme has been the alignment of health professions education with contemporary needs in order to better prepare health professionals for a changing healthcare system.(1, 2) The Macy Foundation has been supporting interprofessional education (IPE) as a major tool for that educational alignment.(3, 4) We have come to realize that IPE and other educational innovations will not have the transformative effect we want for patient care unless they are more closely tied to the ongoing reforms in the delivery system. The realization led to the January 2013 Macy Conference “Transforming Patient Care: Aligning Interprofessional Education with Clinical Practice Redesign.”(5) A major conclusion and recommendation from that conference was that patients, families, and communities must be engaged at each step in the process of linking education and practice redesign. This conference is a direct response to that recommendation. In order to lay the groundwork for this conference and bring all participants up to a common level of understanding of the issues, we commissioned a “vision paper” and four case studies. The paper “A Vision for Engaging Patients, Families and Communities in Linking Interprofessional Education and Practice” was written by Angela Coulter from the University of Oxford and Michael Barry from the Informed Medical Decisions Foundation in Boston. The four case studies were from the 7 Université de Montréal, the University of Rochester Medical Center, the Veterans Health Administration, and the Duke University School of Medicine. Conferees met in plenary sessions and breakout groups over three days to generate the consensus recommendations in four broad areas: changes needed in the content and conduct of health professions education, changes needed in education and healthcare organizations, steps needed to build the capacity for partnerships, and reforms needed in regulations and payment. The conferees left the meeting energized by the commitment and insights of their colleagues and cautiously optimistic that we are on a track to improve the education of health professions, the performance of the healthcare system, and ultimately the health of the public by partnering with patients, families, and communities. In fact, they concluded unanimously that this is the only way to achieve these goals because patients, families, and communities are “the very reason our healthcare system exists.” Furthermore there is a great urgency that this must be done now to avoid more adverse consequences of a system that is not optimally integrated in a way to achieve the “partnership sweet spot”. Meg Gaines and Terry Fulmer provided extraordinary leadership before, during, and after the conference. The planning and writing committee shaped the conference and the report to result in this fine finished product. Every one of the conferees made valuable contributions at every step in the process, and I can truly say that all learned and all taught. We are looking forward to working with willing partners across all sectors in carrying this work forward. This kind of fundamental change is not easy, but the reward is “to further optimal health and wellness for all.” George E. Thibault, MD President, Josiah Macy Jr. Foundation 8 REFERENCES 1. Josiah Macy Jr. Foundation. 2009 Annual Report: Aligning Health Professional Education with Contemporary Needs. New York, NY: Josiah Macy Jr. Foundation; 2010. http://macyfoundation.org/docs/annual_reports/jmf_ annualreport_2009.pdf. 2. Josiah Macy Jr. Foundation. 2010 Annual Report: Preparing Health Professionals for a Changing Healthcare System. New York, NY: Josiah Macy Jr. Foundation; 2011. http://macyfoundation.org/docs/annual_reports/JMF_2010_ AnnualReport_web.pdf. 3. Josiah Macy Jr. Foundation. 2012 Annual Report: Accelerating Interprofessional Education. New York, NY: Josiah Macy Jr. Foundation; 2013. http://www. macyfoundation.org/docs/annual_reports/macy_AnnualReport_2012.pdf. 4. Josiah Macy Jr. Foundation. Conference on Interprofessional Education. New York, NY: Josiah Macy Jr. Foundation; 2012. http://macyfoundation.org/docs/ macy_pubs/JMF_IPE_book_web.pdf. 5. Cox M, Naylor M. Transforming Patient Care: Aligning Interprofessional Education with Clinical Practice Redesign. New York, NY: Josiah Macy Jr. Foundation; 2013. 9 TERRY FULMER, PHD, RN, FAAN MARTHA (MEG) E. GAINES, JD, LLM Amber Arnold 10 INTRODUCTION TERRY FULMER, PHD, RN, FAAN MARTHA (MEG) E. GAINES, JD, LLM CONFERENCE CO-CHAIRS The accelerated pace of change in health care requires a fundamental rethinking of our approach to the challenges and opportunities presented. Those who practice, administer, teach, and reform health care must commit to partner with those at the center of their efforts—namely patients, families, and communities—to co-create a healthcare system worthy of the American people in the 21st century. It is the responsibility of all who practice and benefit from health care—all of us—to inform the cost-benefit calculus with our own values. At a time when designer medicine, genetic reengineering, telehealth, and remarkable feats of bioengineering are transforming healthcare practice, little is known about how patients, families, and communities will value these changes, and how they might affect their choices, decisions, and ultimately their health. It is time for us to begin a more inclusive conversation about how health care should change going forward. There is an astonishing dearth of knowledge about what effective partnerships look like and how they are created; where the “sweet spot” for collaboration lies. Our conference sought to imagine a world where health professionals embrace partnering with patients, families, and communities as an essential aspect of achieving health, and where they are taught the skills and competencies to do so. From there, we explored what it would take to create such a world. The resulting recommendations comprise the work of a diverse group of patients, advocates, teachers, clinicians, administrators, and policy makers who worked intensively over three days to find common language, ground, and inspiration. We were united from the start by a shared sense of urgency and a shared vision that profound change is essential. The conference
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