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05/12/2016
1
Pam Thompson, MD, CCFPMay 12, 2016
“Never doubt that a small group of thoughtful,
concerned citizens can change the world. Indeed it is the only thing that ever
has.”-- Margaret Mead
Acquire a framework to develop and implement an interprofessional community health initiative
Learn an approach to include service learning in project design and implementation
Learn techniques to build collaborative partnerships
Explore key elements to successful collaborative project design and development
Review the clinical structure of the SHOW integrated care clinic
© 21st Century Collaborative
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Stages in our Project Design
Success Defined: How do you know when you’ve made it? How do you measure success? What outcomes do you seek?
Stage
1
Stage
2
Stage
3
Stage
4
Stage
5A Way Forward: What is the action plan for change? How do you work collaboratively to implement change?
What to Do: What is working? Are there examples of models of success? What does the research and evidence have to say? Do policies and practice align? How will you design your project to address the problem? What do you need to succeed?
Those Affected: Who in the community is affected by the problem? Who can partner with you for change? What partners are key to change? Who will lead the way?
The Problem to Solve: What is the problem you want to solve? Define the goal for change. Is there a desire for change? What are the shared vision/values of the community for change? Why is solving the problem important? What does success look like?
Mission & Vision
Program Model
Partners
Education & Training
Technology
Funding
Evaluation
Elements of Project Design & Plan
Collaboration and Partnershipsare the future of health and make
change possible
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What is SHOW?
• Student Health Outreach for Wellness (SHOW) Community Health Initiative and Free Clinic
• Arizona’s first tri-university collaborative project • Run by students and guided by faculty• Diverse backgrounds: traditional health care disciplines,
business, journalism, law, global health, and computer science
• Unites students, faculty, community providers, community & government organizations, and underserved populations
• Mission: to provide holistic, client-centered health care services
• Interprofessional team-based care model
Where Did We Start?
Our small start-up began with a small group of students and faculty coming together with a big idea…improve the health and wellness of the those experiencing homelessness!
We took initiative and struck out to develop relationships with “THE BIG GUYS” – Arizona State University, Northern Arizona University, University of Arizona, Maricopa County Department of Public Health, Central Arizona Single Shelter (CASS), Human Services Campus (HSC)……
– in a relatively short time!
What did we do to sell the benefits of the program? Create a WIN – WIN opportunity for our partners!
Institutions…
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… are people
Student Leadership
Organizational Chart
CommitteesCommunications & Public RelationsFund Development & Sustainability
Programming & Special EventsResearch & Quality Assurance
Clinical OperationsTechnology
Volunteer Management & Human Resources
Program Director Elizabeth “Liz” Harrell DNP, PMHNP-BC
Medical DirectorSarada “Soumya” Panchanathan MD
MANAGEMENT TEAM
Nursing Director
Rita Wermers MSN, ANP-BC
Administrative DirectorMichelle DiBaise MPAS, PA-C
Program InnovatorPam Thompson MD, CCFP
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Project Partners
Collaboration
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How Did We Manage the Collaborative Process?
At Program Design & Start Up:
1. CASS and the HSC - CHAMPIONED the program and encouraged collaboration
2. We made a STRONG BUSINESS CASE for the program, looked for what we could do for partner organizations (win-win) and built accountability into the program design
How Did We Manage the Collaborative Process?
At Program Design & Start Up (cont.):
3. We NETWORKED to find partners that would also benefit from the implementation of this kind of program (shelters, community agencies, etc.)
4. We got BUY IN from decision makers within these organizations by addressing strengths, opportunities, and perceived threats at both administrative and front-line levels
How Did We Manage the Collaborative Process?
Ongoing Program Development:
5. Finding ways to TAILOR the program to meet the needs of the underserved individuals, community agencies, academic institutions, and government agencies
6. Building on current RELATIONSHIPS and developing new ones with a multitude of different types of organizations
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Joining Together for Success
How Did We Manage the Collaborative Process?
Program Evaluation and Communication:
7. EVALUATION & REFLECTION: We are actively engaged in quality improvement practices; we respond to our partners’ concerns when they are voiced and reflect on ways to improve our program and relationships with our partners
8. We regularly UPDATE the community and our partners, in addition to our funders, to let them know what our challenges and successes have been
“What gets measured gets done;
If you don’t measure results, you can‘t tell success from failure; If you can’t see success you can‘t reward it; If you can’t reward success, you’re probably rewarding failure;If you can’t see success, you can’t learn from it;If you can’t recognize failure, you can’t correct it;If you can demonstrate results, you can win public support”.
Osborne & Gaebler in Utilization Focused Evaluation, 4th Edition. Michael Quinn Patton, 2008
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Summary of Collaborative Techniques
Get BUY IN from key
stakeholders
FIND A CHAMPION NETWORK
PROGRAM DEVELOPMENT
BUILD RELATIONSHIPS
EVALUATE & REFLECT
UPDATE & COMMUNICATE
Identify partners and
BUILD the CASE for a
Win-Win
TAILOR program to
meet client & community
partner needs
Work with multiple levels within a
partner organization and look for WAYS TO
MEET THEIR NEEDS
Consistently REVIEW your
PROGRAM (Quality Improvement) and
its RELATIONSHIPS in the community
REPORT OUT to the community, partners, and
clients regularly through a variety of ways (e.g. website,
reports, etc.)
1 2 3
4 5 6
The animation automatically begins.
Collaborating for Success
Key Partnerships: How We Cooperate
Three State Universities: Established a Memorandum of Understanding to outline relationship and
shared responsibilities
Creates a ‘Learning laboratory’ for interprofessional education
Creates opportunities for shared research endeavors
Provides opportunities for students to do: internships, job skill development, community development, clinic management, research, conference presentations, project and program development
Provides a shared opportunity to have a positive impact in the community on social issues (homelessness, health disparity, poverty)
Provides an opportunity to engage and create relationships with a diverse group of community, business and government organizations
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Key Partnerships: How We Cooperate
Maricopa County Department of Public Health: Provides SHOW the opportunity to offer services on weekends to extend
homeless patients access to health services by providing use of their clinic site
Provides SHOW the ability to offer additional services to the shared patient population (Audiology, Behavioral Health, wellness programs etc.)
Partnership allows for shared access to client health records to ensure continuity of care
Provides SHOW the opportunity to offer potential access to research support and population health data
Provides a shared opportunity to collaborate in keeping the focus on issues related to homelessness
Key Partnerships: How We Cooperate
Human Services Campus (HSC) and Central Arizona Singles Shelter (CASS):
SHOW provides an opportunity for clients staying in the shelter to receive health services on the weekends which prevents unnecessary emergency department visits
SHOW provides access to additional health services and programs to the campus (e.g. yearly health fair on the HSC)
SHOW assists CASS and HSC to access resources and supports through the academic institutions (e.g. student interns, research)
HSC and CASS provide SHOW access to space and classrooms for health and wellness programs at no cost
Key Partnerships: How We Cooperate
Mercy Maricopa Integrated Care: Provides funding and support for workforce development and evaluation
Provided support for Health Fair (community booth and funding)
Provides assistance with building relationships with community health organizations
SHOW prepares an educated workforce of future health care professionals prepared to work in integrated care environments
Bruce and Diane Halle Foundation: Provides funding support for SHOW operations
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Key Partnerships: How We Cooperate
National Center for Interprofessional Education: Provides SHOW the opportunity to be part of a national data
repository on interprofessional education
SHOW provides the National Center data in support of their research
Macy Study: Offers students in SHOW an opportunity to take part in the Macy
study which is focused on advancing work in Interprofessional Education (IPE)
Provides funding to support SHOW as one of Macy’s integrated care sites (computer tablets)
How Do the Pieces Fit Together?
I n gre d i e n t s fo r S u c c e s s
Buy in from community
Case for Change
Being Adaptive
Risk-taking
Champions of Change
Masterful/High Level Facilitation
Shared Vision/Agenda
Network of Partners
Knowledge/Data
Communication
Training
Evaluation/Reflection
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O v e r c o m i n g O b s t a cl e s
NIMBY
Communication
Differing Agendas/Goals
Bureaucracy
Managing Change
Implementing New Practices
Personalities
Financial
Expectations/Outcomes
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Managing information and communicating effectively often
becomes an obstacle
Community Partnerships
Change Relationships
Mobilize resources
Influence Systems
Catalysts for Change
Coordinate Efforts
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Passion for health. Compassion for people.
SHOW Clinical ModelStudent Health Outreach for Wellness
Clinic Management
Student Management
Shift Manager
Dispensing Manager
Lab Manager
Navigator Lead
Faculty Management
Program Director
Medical Director
Administrative Director
Nursing Director
ResearchLead
Management teams operate side by side (flattened hierarchy)
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Patient
Management Team
Navigator Team
Teaching Team
Provider Team
Clinic Structure: Patient‐Centered Care
Navigator Team
• Comprised of undergraduate and social work students
• Advocate for patients
• Direct patient flow
• Connect patient to ongoing program activities
• Collect data for clinic improvement
Teaching Team‐ Integrated, Interprofessional
General Medicine
NursingPhysician Assistant
Behavioral Health
Physical Therapy
AudiologySpeech
PathologyOccupational
Therapy
Health professional students
• Responsible for patient assessment, diagnoses, treatment, planning,
and evaluation
Preceptors: Licensed Faculty & Community Providers
• Responsible for facilitating and mentoring the Teaching Team in
developing diagnoses and treatment plan for patients
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Clinic Structure‐ Integrated, Interprofessional
Waiting Room
• Patient fills out forms
• Entered into EMR
• Social Work forms filled out
Initial Exam
• Health Professional Students conduct triage/initial exam
Final Exam
• Provider conducts final visit with assistance of health professional students
Patient Surveys
• Navigator follow‐up
• Patient satisfaction surveys
Patient Leaves Clinic
Teaching Team Huddle #1
Teaching Team Huddle #2
Clinic Structure‐ Integrated, Interprofessional
Interprofessionalism is encouraged by:
1) interdisciplinary assessment 2) team huddles and 3) post‐shift huddles
The “Team Huddle” is crucial to interprofessional (IP) care in SHOW • Team leader (preceptor) facilitates
discussion regarding patient case
• Occurs intentionally three times throughout visit
1. After vitals, patient history, and chief complaint are collected
2. After initial examination
3. After patient’s visit has ended (to review the case)
SHOW Rapid Cycle Quality ImprovementIncorporates PDSA
Plan (Post‐Shift Huddles)
What are we doing now and how can we improve it?
Create process for improvement
Do
Implement solution
Study
Did plan lead to improvement?
Any unexpected effects?
Adjust
Make changes to further improve plan
Internal “Customers”‐ Students, preceptorsExternal “Customers”‐ Community Partners, patients
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IP Teamwork Example: Triage/Initial Exam
Plan
Triage is conducted by nursing, leaving these students in a silo lacking interprofessionalism
How can SHOW make triage more interprofessional?
Do
Merge triage into initial exam, so nursing students can work collaboratively with other
health professional students; more interprofessional practice
Study
Are nursing students benefitting from working with health professional students?
Has the quality of triage increased or decreased?
Adjust Adjust roles of health professional students in triage/initial exam
Passion for Health. Compassion for People.
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Future Directions
Formal Integrated, IP Education for Preceptors
IP Dose Tracking
Student Leadership Measures
Increase Formalized Quality Measures
AcknowledgementsFaculty and staff at Arizona State University,
North Arizona University, University of
Arizona
SHOW students and volunteers
Community Preceptors
Partner Organizations: Maricopa County
Department of Public Health, CASS, Human
Services Campus, Crossroads, Mercy
Maricopa Integrated Care, Macy grant, and
Bruce and Diane Halle Foundation