Health, safety, & wellness

In an era of healthcare reform, organizations are beginning to implement interprofessional team-based care as a strategy to deliver high-quality care more effectively and efficiently. In 2011, the Interprofessional Education Collaborative Expert Panel defined interprofessional team-based care as “care delivered by intentionally created, usually relatively small work groups in health care, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients.” Furthermore, the Agency for Healthcare Research and Quality (AHRQ) identified team-based care as “a highly effective care delivery model that promotes safe, effective, and efficient health care.” And in 2012, the Institute of Medicine called interprofessional team-based care critical to supporting a Learning Health System and improved outcomes.

Evidence-based models of interprofessional education and patient care

Interprofessional initiatives have demonstrated improved care delivery outcomes. For instance, the Department of Veterans Affairs (VA) funded five Centers of Excellence in Primary Care Education with the goal of creating interprofessional and team-based educational and patient-centered delivery models. Teams include nurse practitioner students, physician residents, pharmacy residents, and psychology interns and fellows. The centers employ four core curricular domains in their training program: shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement. Early results are promising. The VA Connecticut Healthcare System center, for example, reported a doubling of productivity in patient care and improved access for patients after just 1 year.

Interprofessional education has the potential to break down silos and change the current discipline-centric educational paradigm of healthcare professionals. One program at the Vanderbilt School of Medicine and Nursing, supported by the Josiah Macy Jr. Foundation, involves a 2-week combined orientation course for all students. The course focuses on team building, communication, and healthcare systems. Evaluations of interprofessional educational initiatives have demonstrated improved communications and teamwork skills. Furthermore, this approach has been received enthusiastically by students and faculty, and participants have reported a newly developed appreciation of the other professions.

Engaging patients and families

The National Quality Strategy identified patient and family-centered care and engagement as a national priority. As such, the Partnership for Patients (PfP) recognized the need for high-performing interprofessional teams to engage patients and families to improve patient safety outcomes, including reduction of hospital-acquired conditions and readmissions. The PfP outlined core structures and processes to be used to better engage patients and families as integral team members. Other recommendations come from the Nursing Alliance for Quality Care, which published principles and a white paper focused on patient and family engagement.

The roles of nurses

Nurses play integral roles in the formation and success of interprofessional team-based care and possess core competencies in interprofessional team-based care, including care coordination. Care coordination is a traditional strength of the nursing profession. Nurses have the “critical history, knowledge, and expertise needed to assure that care coordination achieves the goals set forth for it in the national quality agenda,” author Gerri Lamb reports in Care Coordination: The Game Changer—How Nursing Is Revolutionizing Quality Care. Nurses have developed specialized knowledge and skills in emerging roles in interprofessional teams, such as the nurse navigator role. Nurses have also been leaders in identifying health information technology as a structural support necessary for care coordination and interprofessional team-based care.

References
American Nurses Association. Nursing: Scope and Standards of Practice. 2nd ed. Silver Spring, MD: Author: 2010.

Agency for Healthcare Research and Quality. (2013). Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care. July 2013. www.ahrq.gov/workingforquality/nqs/nqs2013annlrpt.htm. Accessed August 3, 2014.

Brown C, Cantril C, McMullen L, et al. Oncology nurse navigator role delineation study: an oncology nursing society report. Clin J Oncol Nurs. 2012;16(6):581-5.

Cipriano PF, Bowles K, Dailey M, et al. The importance of health information technology in care coordination and transitional care. Nurs Outlook. 2013;61(6):475-89.

Institute of Medicine. The future of nursing: Leading change, advancing health. October 5, 2010. http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/IOM-Future-of-Nursing-Report-1. Accessed August 3, 2014.

Best care at lower cost: The path to continuously learning health care in America. Institute of Medicine. September 6, 2012. http://www.nationalacademies.org/hmd/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx. Accessed August 3, 2014.

Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice. Washington, DC: Interprofessional Education Collaborative; 2011.

Lamb G. Care coordination–The Game Changer: How Nursing Is Revolutionizing Quality Care. Silver Spring, MD: American Nurses Association; 2013.

Long T, Dann S, Wolff ML, Brienza RS. Moving from silos to teamwork: integration of interprofessional trainees into a medical home model. J Interprof Care. 2104;28(5):473-4.

Paquette J. U of M becomes nation’s sole Coordinating Center for Interprofessional Education and Collaborative Practice. Health Talk. September 18, 2012. www.healthtalk.umn.edu/2012/09/18/u-of-m-becomes-nations-sole-coordinating-center-for-interprofessional-education-and-collaborative-practice. Accessed August 28, 2014.

National Quality Forum. Critical paths for creating data platforms: Care coordination. Washington D.C: Author; 2012.

Rugen KW, Watts SA, Janson SL, et al. Veterans Affairs Centers of Excellence in Primary Care Education: transforming nurse practitioner education. Nur Outlook. 2014;62(2):78-88.

Sofaer S, Schumann MJ. Fostering successful patient and family engagement: Nursing’s critical role. Nursing Alliance for Quality Care; 2013. www.naqc.org/Main/Resources/Publications/March2013-FosteringSuccessfulPatientFamilyEngagement.pdf. Accessed August 3, 2014.

Thibault G. Interprofessional education: an essential strategy to accomplish the future of nursing goals. J Nurs Educ. 2011;50(6):313-7.

Wagner D, McGann P, Poindexter E, Bodden C. Best practices and collaborations to foster successful patient and family engagement. Presented at the Nursing Alliance for Quality Care Informational Conference Call, March 18, 2014.

Maureen Dailey is a senior policy fellow in Health Policy and Jaime Murphy Dawson is a senior policy analyst in Nursing Practice and Work Environment at ANA.

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