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

How to ‘Count’ Interprofessional Education Programming Across Professions at a Health Sciences University

Purpose: To describe the process a health sciences university is undergoing to establish recognizing student achievement in interprofessional education (IPE) and collaborative practice (CP). Background: A large health sciences university (greater than ten different professions) is establishing a new process to certify IPE/CP programming delivered on its campus. As accreditation bodies for various professions are requiring IPE programming, there is a desire to certify that the students have completed programming to meet these requirements and document competency achieved in collaborative practice. Description of Program: A curriculum committee of members from the various stakeholder professions assigned a workgroup to address IPE programming evaluation and student certification. The workgroup reviewed existing IPE evaluation rubrics from other institutions and is developing its own rubric based upon these models. Using this new rubric, faculty developing new IPE programming will be able to complete an online submission, which will then be reviewed by the IP curriculum committee. The workgroup is identifying the quantity and level of IPE/CP participation required by each profession to determine how certification will be achieved. Preliminary Results: The workgroup has met over the course of one academic semester and has developed an IPE evaluation rubric to be piloted in the 2016-2017 academic year. The curriculum committees from each of the various professions are assessing individual IPE needs relative to program-specific goals, objectives and accreditation requirements. Relevance to IPE: With increasing requirements for IPE by most health professions accreditation organizations, it is necessary to identify a standardized system for evaluating IPE/CP programming and develop a process for recognizing that students have met the desired outcomes (quantity and quality). Recommendations for Future: It is anticipated that this system will need to be continually evaluated, updated and refined to address the dynamic nature of health professions education and team-based collaborative care. Two to three Learning Objectives: Identify a process for evaluating IPE/CP programming for quality control purposes. Describe a process for identifying IPE/CP needs among the various health professions

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

Examining Health Mentor Perceptions of Student Teamwork

Purpose: To evaluate how community lay teachers, or Health Mentors (HMs), perceive student teams over time by using the Jefferson Teamwork Observation Guide (JTOG), a survey based upon interprofessional education (IPE) core competencies. Background: Our academic health center offers a unique, two-year program emphasizing delivery of patient-centered care and IPE core competency skill development by pairing interprofessional student teams with a HM. The HM is an adult community volunteer with one or more chronic health condition(s). Student teams include representatives from couple and family therapy, medicine, nursing, occupational therapy, pharmacy, physical therapy, and physician assistant. Description of Intervention or Program: HMs were invited to complete the JTOG survey in Spring 2015 and again in Fall 2015. This survey asked them to evaluate their student team members’ ability to work together based on IPE core competencies and solicited information from the HM about participating in the program. Student demonstration and attainment of IPE core competencies were evaluated using a Likert scale. Open-ended comment sections were included for the HM to describe specific observations or examples. Results: A total of 50.4% of HMs completed the surveys for both semesters. There was a significant difference in knowledge gained by the HM pertaining to wellness from Spring 2015 to Fall 2015, t=-2.463 (df=54), p=0.017, d=0.27. There was also a significant negative correlation between worse health and neutral HM comments during the Spring of 2015, ρ=-0.410 (n=36), p=0.13. Conclusion: Results were compiled and analyzed to evaluate HM perceptions of team functioning, including student engagement, friendly interaction, and respect for the HM. There were small changes between the Fall and Spring responses; most were not statistically significant. The HMs learned more about wellness and caring for themselves through this program. Relevance to interprofessional education or practice: Results will be used as feedback to better educate students and identify areas for improvement in this interprofessional program. Learning objectives: 1. Describe methods of evaluating teamwork among interprofessional students in the HM program. 2. Apply strategies to engage HMs as partners in developing and improving new models of interprofessional education and care

The Validation of the Patient Jefferson Teamwork Observation Guide (JTOG) Tool

Mapped to the Interprofessional Education Collaborative’s (IPEC) Core Competencies for Interprofessional Collaborative Practice (teamwork, roles/responsibilities, communication, values/ethics, and patient-centeredness, a subdomain of values/ethics), the Patient Jefferson Teamwork Observation Guide (JTOG) has the potential to improve the patient experience by adding the patient’s perspective on the functioning of medical teams. The purpose of this study was to validate the Patient JTOG by showing that patients without any formal background in interprofessional education (IPE) could not only use this survey to differentiate successfully between good and bad medical team interactions, but also could do so with the same discernment as IPE experts. Sixty-one patients were asked to watch four videos displaying good and bad medical team interactions in the inpatient and outpatient settings. Using the Patient JTOG, these participants were asked to rate these interactions as if they were the patient shown in the video. Eleven IPE experts were also given these instructions, and their responses were used as the benchmark by which to compare the patients. The Global scores (the sum of the Patient JTOG’s five quantitative questions) for the good vs. bad inpatient and outpatient videos were significantly different from each other for the patients and expert participants using the Patient JTOG. Additionally, with the exception of one video, there was no significant difference between the Global scores of the patients and expert participants in these different settings. These results suggest that patients were able to use this tool to distinguish accurately between good and bad medical team interactions, and even to the same degree as IPE experts. By integrating the patient’s perspective into both practice and education, the Patient JTOG will be invaluable in improving the interprofessional teamwork displayed by medical teams, thereby improving the overall patient experience

From the Editors

Here at JCIPE, another semester has flown by. And again, the Center has been busy expanding and integrating our programs on campus and beyond. This fall, as we welcomed our tenth cohort into the Jefferson Health Mentors Program, we introduced a revised curriculum which is more heavily focused on the social determinants of health and integrates the Social Ecological Model. We also added an eighth profession, Medical Laboratory Sciences, to the mix, expanding our total student enrollment to more than 1400 students! Building on this foundation, this fall we also expanded our more advanced interprofessional TeamSTEPPS® training program. During the course of four workshops, the Center and 16 volunteer interprofessional facilitators from four different professions led 554 students from five professions through simulated case scenarios through which they applied their TeamSTEPPS® skills. Though reportedly pushed outside their comfort zones, students described learning valuable lessons about teamwork, effective communication, leadership, experiential learning and the value of working with other professions. They also reported feeling better prepared for clinicals and “real-world” scenarios. Check out some student feedback in this edition! As many of you know from having joined us, we hosted our fifth biennial conference on October 28 and 29. One hundred seventy attendees hailed from Canada, Israel and 27 different states. Our keynotes addressed issues of global interprofessional education and practice; the history of Medicare and its impact on our ability to deliver patient-centered, interprofessional care; and the importance of teams in maximizing value in healthcare. A range of oral and poster presentations showcased the advancement of interprofessional education and practice, with innovative pilots becoming integrated with more depth and breadth. Along the lines of this theme, the Journal of Interprofessional Education & Practice (JIEP) plans to publish a special conference edition this spring featuring works from the conference and John H. V. Gilbert, C.M., Ph.D., LLD (Dalhousie), FCAHS as guest editor. Finally, many congratulations to Deirdre Yarosh, MA, a Jefferson Pharmacy student, who received JIEP’s Student Award for her peer paper presentation “Examining Health Mentor Perceptions of Student Teamwork.