Evaluation of patient perceptions of team based care in a Geriatric Oncology Clinic

Purpose: To measure patient perceptions of collaborative practice in an interprofessional team providing geriatric oncology assessments to older patients with cancer. Background: The Senior Adult Oncology Clinic (SAOC) at Thomas Jefferson University’s Kimmel Cancer Center utilizes an interprofessional team approach to provide comprehensive geriatric oncology assessments and treatment plans for older patients with cancer. The importance of team-based healthcare delivery is well documented, however, experts agree that there is a need for more tools to assess the skills required to become a high-functioning team and a need to study the impact of collaborative practice on patient reported outcomes and satisfaction. For this study, we sought to evaluate patients’ experience and perception of our SAOC team function. Description of Intervention: Upon completion of a SAOC visit, patients were asked to participate in a short voluntary survey to assess team performance. The Jefferson Teamwork Observation Guide (JTOG) is a validated survey used with learners that has been adapted to elicit patient perspectives of five domains of interprofessional collaborative practice, including communication (C), values/ethics (V/E), teamwork (T), roles/responsibilities (R) and patient-centeredness (PC). The Patient JTOG includes eight competency–based Likert Scale questions as well as one open-ended question. The survey was administered on secure mobile tablets by trained research assistants (RAs) who were not part of the healthcare team. The study received exempt approval by our Institutional Review Board. Results: A total of 13 patients completed the survey. Seven respondents were female, and six were male. Seven identified as Caucasian, four as African American and two as other. One hundred percent responded “Strongly Agree” to a global question about the importance of teamwork in patient care (mean 4.0). Overall satisfaction with the SAOC team was 3.92 out of 4.0. For the eight questions relating to each of the five collaborative practice competencies noted above, the team received an average score ranging from 3.69 to 3.77 out of 4.0, for a global score of 29.66 (out of 32 possible), placing this team in the highest quartile of teams surveyed at our institution to date (n=407). In addition, all 13 respondents completed the open-ended qualitative comments with 12 out of the 13 being positive with multiple references to effective listening and communication, team coordination, and patient-centered care. Conclusion: The SAOC has a relatively unique model of providing interprofessional geriatric oncology assessments. The Patient JTOG tool was easy to incorporate into a busy clinic and provided valuable feedback to our providers, demonstrating that our patient’s perceive the team as highly functioning and effective. Based on these early results, our high functioning interprofessional consultative team model may serve as a model for replication for team based care delivery at other institutions Relevance: Incorporation of an easy to use tool to assess interprofessional team function and patient perceptions of collaborative practice Learning Objectives: Define methods for evaluating patient perceptions of collaborative practice in an outpatient geriatric oncology practice (Knowledge) Describe a replicable model for interprofessional collaborative practice (Comprehension/Application) Apply lessons learned for engaging students in and preparing faculty for interprofessional team-based care delivery (Comprehension/Application

Enhancing Curricular Topics Shared Across Health Professions with Interprofessional Perspectives

Purpose: To describe the process of educating interprofessional health professions students on common topics across their curricula utilizing interprofessional perspectives. Background: The Alternate Clinical Education (ACE) day addresses academic and/or clinical issues previously unexplored in depth. Nursing faculty and IPE staff at an urban health sciences university organized an ACE day to creatively present a common healthcare topic, healthcare policy and fiscal responsibility. Capitalizing on the relevancy to the upcoming U.S. presidential election, this topic benefits healthcare students as future providers and as private consumers. Description of intervention or program: A small group of biomedical sciences, medicine, and pharmacy students voluntarily participated in the ACE day alongside a class of senior pre-licensure nursing students for whom the program was required and embedded into the curriculum. During the program, faculty presented a lecture on healthcare policy basics. Students then unfolded the effects of healthcare policy on patient case studies in small interprofessional groups, presenting their findings to the large group once finished. Experts from medicine, nursing, population health, and state government served on a panel, engaging students in active discussion about policy implementation and utilizing one’s health training to make a difference more broadly. Results: Interest in the ACE day activity was high, but attendance across professions indicated the importance of embedding IPE into curricula and involving faculty from other professions in planning, as supported by the literature. The outcome for student participants was an appreciation for their roles and those of other disciplines in practice and in healthcare reimbursement and policymaking and change. Conclusion: Students learn tenets of IPE firsthand by participating in interprofessional activities on common topics preparing them for practice. Mobilizing interprofessional faculty and students in the planning creates stronger programs from which more students can benefit. Relevance to interprofessional education: Conducting IPE around common curricular topics helps students appreciate similarities between professions as well as interprofessional perspectives on pertinent subjects. Two to three measureable learning objectives: Identify common topics across health professions curricula ripe for IPE Describe strategies for organizing IPE around common themes across health professions curricul

A Qualitative Analysis of Student Understanding of Team Function Through the use of the Jefferson Teamwork Observation Guide (JTOG)

Background: Several early IOM reports identified the need to educate medical and health professions students in delivering patient-centered care as members of interprofessional teams (IOM, 2001; IOM, 2003). Evidence shows that conducting interprofessional education during education and training prepares student learners for collaborative practice when they enter the workplace, which in turn helps to achieve the Triple Aim of 1) enhancing the patient experience; 2) improving the health of populations; and 3) decreasing costs (WHO, 2010; Berwick, et al., 2008). One way to prepare students for collaborative practice is to have them observe real teams in action. Thus, the Jefferson Teamwork Observation Guide (JTOG) was created to serve as an educational tool in aiding students to better recognize the characteristics of effective teams. It has since been used to assess teams in the majority of clinical observation, simulation and collaborative practice activities offered by Jefferson Center for Interprofessional Education (JCIPE). The JTOG is a two-part assessment comprised of identifiable characteristics of well-functioning teams drawn from the literature about teamwork. The first part consists of Likert Scale questions (strongly disagree to strongly agree) regarding the behavior of the interprofessional team observed in the domains of Values/Ethics in Interprofessional Practice, Roles/Responsibilities, Interprofessional Communication, Teams and Teamwork, and Leadership (IPEC, 2011; IPEC 2016). The second part includes qualitative questions relating to team-based care, patient-centered care, and teamwork

The Patient\u27s Perspective: A Qualitative Study of Patient Perceptions of Teamwork Competencies

Purpose: To examine patients’ ability to evaluate the interprofessional core competencies of their healthcare teams using the Jefferson Teamwork Observation Guide (JTOG). Background: It is widely regarded that interprofessional team-based care improves patient outcomes and satisfaction.[i] To investigate that claim, the JTOG, a validated survey tool mapped to the Interprofessional Education Collaborative (IPEC) Core Competencies for Interprofessional Collaborative Practice (CP)[ii], was adapted to collect patients’ feedback on teamwork behaviors in the domains of: Communication, Values/Ethics, Roles/Responsibilities, and Teamwork. Description of Intervention or Program: Trained research assistants surveyed inpatients and outpatients about their perceptions of their health care providers’ teamwork. Patients were asked one qualitative and eight quantitative questions. Of all 302 qualitative responses, a small sample was coded by consensus and then all were coded by a trained research assistant for themes relating to the core competencies. Results: Of the 302 comments, 210 (70%) centered on communication and 134 (44%) focused on teamwork. 185 (61%) responses reflected multiple competencies, with 90 (30%) including both communication and teamwork and 85 (28%) highlighting communication and patient-centeredness, a sub-domain of values/ethics. Conclusion: Patients can perceive interprofessional core competencies displayed by their healthcare teams using the JTOG. Communication skills, especially combined with teamwork and values/ethics, were commonly articulated by patients when explaining their positive experiences. These findings support the interrelation of the IPEC domains, including some difficulty in distinguishing them from one another. Relevance to interprofessional education or practice: Growing evidence supports the importance of CP and of having standardized core competencies for CP education. Studying real-life interactions of CP teams is useful for further understanding of such concepts. 2-3 measurable learning objectives relevant to conference goals: Describe patients’ ability to evaluate their care team using the Jefferson Teamwork Observation Guide Discuss the extent to which patients identify the IPEC competencies in evaluating their care teams Identify the importance of patients’ perspectives in improving interprofessional team-based care [i] World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Geneva, Switzerland: WHO Department of Human Resources for Health. http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf. [ii] Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative. http://www.aacn.nche.edu/education-resources/ipecreport.pdf

The Role of Critical Case Analysis in Interprofessional Education

Goals for interprofessional education include preparing students to work in collaborative practice, teaching them how to work in teams and to asses and improve the quality of patient care. (Barr, 2007, Thibault, 2013). Four core competency domains have been established to inform interprofessional education (Interprofessional Education Collaborative Expert Panel, 2011). These are ethics/values, roles/responsibilities, interprofessional communication and teams/teamwork. Various pedagogical approaches have been used to help students meet these competencies. The Josiah Macy, Jr. Foundation (2013) recommends development and implementation of innovative models to link interprofessional education and practice. Thibault (2013) recommends students engage in “real work” as part of their interprofessional education experience

Bringing the Patient\u27s Voice into Teamwork Assessment Using the Jefferson Teamwork Observation Guide (JTOG)

Purpose: To test the feasibility of using the Jefferson Teamwork Observation Guide (JTOG) as a mobile application with diverse patients to gather perceptions of team-based care delivery. Background: A validated tool assessing IPE core competencies is a significant gap in the literature (IOM, 2015). Little research has demonstrated links between effective teamwork and improved patient outcomes. In 2015, a research team validated the JTOG tool to assess team function. This JTOG was then converted to a mobile application, and individual, patient, and caregiver versions were developed, allowing for 360° evaluation. Description of Intervention or Program: A research team piloted the Patient JTOG mobile application, asking patients to participate in a survey consisting of one open-ended and ten Likert scale questions. Items were tied to the domains of interprofessional collaborative practice – communication, values/ethics, teamwork, and roles/responsibilities (IPEC, 2011) – and one patient-centeredness (PC) domain. Results: Four hundred and forty three patients completed the JTOG, ranging in age from 18-90+. Of the diverse patient population, 52% were female and 39% male. Eighty-seven percent of patients responded “strongly agree” to a question about the importance of teamwork in healthcare. Teams received a mean score from 3.51 to 3.60 out of 4.0 for the eight IPE competency questions. Overall satisfaction with the teams evaluated was 3.83. Items were subjected to a principal axis factor analysis with varimax rotation and a screen plot inspection was used to determine the number of factors to extract. A Cronbach’s alpha was 0.93. Conclusion: Our study confirms the feasibility of using the Patient JTOG app to elicit patient perceptions of teams in inpatient and outpatient settings. By completing this survey, patients provided real-time feedback and summary reports were sent to care teams to improve team functioning. A full validation study of the Patient JTOG is now underway, and a multi-institutional study is planned to assess its use in other healthcare institutions. Relevance to interprofessional education or practice: Assessment strategies must incorporate the voice of the patient as we move forward in developing new tools to assess team function, identify behaviors consistent with effective teamwork, and demonstrate the impact of collaborative practice on patient outcomes. Learning Objectives: Two to three measurable learning objectives relevant to the conference goals. 1) Describe a new mobile tool for gathering patient feedback on patient-centered team based care 2) Apply lessons learned for 360° competency-based assessment of interprofessional education and collaborative practic

The Jefferson Teamwork Observation Guide: Reliability and Validity for Use in Education and Practice

Background & Purpose Interprofessional education (IPE) is fast becoming an integral part of the education of health professions students. To meet this aim, it is important to provide students with the skills needed for interprofessional success, but also to use reliable and valid measures to help students and clinicians to recognize characteristics of well-functioning teams. The Jefferson Teamwork Observation Guide (JTOG) was created for health professions students to evaluate teams in action by rating behaviors indicative of good team work. The JTOG, mapped to the 2011 Interprofessional Education Collaborative Expert Panel (IPEC) core competencies, was developed over two years to help health professions students understand the characteristics of high functioning teams and to fill a gap in the literature around validated, competency-based assessment tools. The tool contains 14 Likert scale items and three qualitative items. The purpose of this presentation is to describe the JTOG’s reliability and validity to support its use in education and practice. Poster presented at NLN Education Summit in Orlando Florida.https://jdc.jefferson.edu/nursingposters/1001/thumbnail.jp

The Jefferson Teamwork Observation Guide (JTOG) Using a Mobile Application Platform to Assess Behavior of Interprofessional Teams

Objectives: 1. Explain the value of assessing students\u27, preceptors\u27, and patients\u27/caregivers\u27 understanding of team approaches to patient care. 2. Describe the JTOG tool as a method to measure interprofessional education competencies in educational, simulation, and practice settings. 3. Prepare to implement the JTOG mobile application prototype in settings with students, preceptors, and/or patients and caregivers. Presentation: 54:3

Creating a Large-Scale Interprofessional Student TeamSTEPPS® Curriculum with Simulation

Purpose: To create a large-scale longitudinal interprofessional TeamSTEPPS® curriculum incorporating simulation. Background: TeamSTEPPS®, developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense, is an evidence-based framework for enhancing teamwork and communication skills to reduce medical errors and improve patient safety. Description of Intervention or Program: Throughout two years, faculty and staff at an urban health sciences university piloted TeamSTEPPS® programs with 124 interprofessional students involving didactic, simulation, debriefing and reflection components. Coordinators developed patient cases and student and facilitator guidelines, allowing for facilitated role play to apply the skills learned. A modified version of this program was then piloted with 240 medical students to test the ability to scale it up while maintaining the integrity of the learning objectives. Previously-trained medical students served as co-facilitators. Results: The average scores for evaluation items related to the extent to which students acquired specific communication and teamwork skills were consistently high for all workshops. Ninety-eight percent of all interprofessional respondents agreed or strongly agreed that their notions of the roles of other professionals improved as a result of the workshop. Eighty percent of all medical students recommended repeating the workshop the following year. Unsolicited, 18% of medical school respondents indicated the training would be more valuable if conducted interprofessionally. Conclusion: Given positive results and the desire to conduct the training interprofessionally, an interprofessional longitudinal TeamSTEPPS® curriculum involving simulation is being developed. Medical, nursing, pharmacy and physician assistant students (~520) will be included in the first year. A train-the-trainer approach will be employed, adding clinical/patient/client complexity for more advanced students. Relevance to Interprofessional Education or Practice: At a time when an estimated 100,000 hospitalized patients die yearly due to medical errors (Institute of Medicine, 1999) and two thirds of sentinel events originate from poor communication (The Joint Commission, 2007), students must be equipped with tools to help them support interprofessional team members in delivering safe, patient-centered care once in practice. Seminar outline/timeframe of presentation and interactive discussion: 3 minutes: Introductions 22 minutes: Project overview and brief TeamSTEPPS® didactic presentation with videos 5 minutes: Break into small groups and prep volunteer patients and care team members 15 minutes: Simulation in small groups 5 minutes: Small group debrief 10 minutes: Whole group debrief and lessons learned 5 minutes: Wrap-up and evaluation Two or three measureable learning objectives relevant to the conference goals: Identify the benefits and challenges of implementing TeamSTEPPS® on a large scale with multiple professions Describe methods for implementing effective interprofessional TeamSTEPPS® training curricula Explain the value of role play/simulation in helping students apply TeamSTEPPS® skills Citations: The Institute of Medicine (IOM). (1999) To err is human: Building a safer health system. Washington, DC: National Academies Press. The Joint Commission (JCAHO). (2007). Improving America’s hospitals: the Joint Commission’s annual report on quality and safety. The Joint Commission. Retrieved from http://www.jointcommission.org/assets /1/6/2007_Annual _Report.pdf