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Office of Academic Affiliations

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Centers of Excellence Primary Care Education

Transforming clinical education and preparing health professionals
to work in and lead patient-centered interprofessional teams

Coordinating Center Blast

Coordinating Center BLAST News Links                                                       January 3, 2013

ACTIONS:

All sites have received a copy of the Learning Visit Agenda. Please submit Option choice to Laurie Traylor by January 7th.

Attention CoEPCE Trainees!
We would love to share your experiences in our national BLAST!
Contact Laurie Traylor for information.

Centers of Excellence, Primary Care Education - A Year in Reflection

Can you believe it! 2012 - Come and gone!

Image of rainbowVictories and scars. As we chew upon our challenges and ponder our success and wonder what we have learned, most certainly (though we have learned a lot); we have also learned that we have a lot to learn.

In support of this contemplation we had good fortune (or perhaps good sense) to partner with VA's National Center of Organizational Development (NCOD). Over the past year, NCOD consultants worked with our CoEPCE teams throughout the year. VA's Boise, Cleveland, San Francisco, Seattle, West Haven and with the Long Beach, California based Coordinating Center staff and consultants to help us examine both our local and enterprise team culture. At the end of the year, NCOD's Dr. Steven White, as an exercise in growth, development and culture change, helped us think through what we feel we need for effective interprofessional teams and interdisciplinary training towards engaged, team based patient care. As we garner these thoughts and formulate a shared understanding of the challenges central to the programs we are creating, we realized, guess what? (In case you didn't know…) It 'ain't' easy!

Through this reflective exercise our CoE co-directors/leaders/pioneers provided an inside look at the ideal interprofessional leadership model in terms of the theories and strategies behind the program and advice to others who wish to develop similar models. NCOD shared summaries and facilitated discussion with our teams from the perspectives of the program's physician and nurse practitioner co-directors. All embracing, we learned that successful models would likely include regular, open communication and equal partnerships, shared decision making and responsibility, protected time for leadership and administrative activities, mentoring, coaching, training, learning opportunities, shared input to curriculum development and an organizational structure that supports and is in alignment with equal leadership access.

From the perspectives of our Nurse Practitioner colleagues we gained understanding around the importance for growth and the need for time related to administrative activities, academic pursuits, leadership and mentoring support. It was felt that leadership role recognition (in both pay and title) was important along with and shared face time (in which Co-Directors are seen as equal partners in the eyes of trainees and others) with system governance clearly defining the differences between preceptorship and the role of Co-director. Shared governance and knowledge around curriculum, budget, grants, reports and evaluation was seen as important to program success as were co-authorship opportunities and access to grants and funding. Importantly, self-development for Nurse Practitioner leaders was felt to be essential for the primary care education centers of the future.

Our physician colleagues believe that successful models will have passionately involved hard working staff willing to work untraditional hours. Proposed characteristics of staff include those with high energy in education, training, teaching and curriculum as was (again) shared decision making and time for administrative oversight. New programs would likely benefit from access to expertise in curriculum development, program implementation and evaluation and academic, education and leadership skill sets. Expertise in data management, evaluation and data extraction were also considered as important resources. Understanding and sensitivity to Academic Calendar demands were deemed key.

Finally a suggestion for a "Playbook" or instruction manual on how to make it all work might include guidelines for hiring, credentialing, contracting, role and skill set guidance, and garnering leadership support.

At the Coordinating Center, we too have learned that we need to be better and more efficient listeners and communicators, more considerate of our program leadership, staff and clinical partner's time, energy and competing priorities. We need to be timely with our requests, provide an easily accessible calendar of expectations and due dates and provide sufficient/advanced notice and turn-around time for requests. We need to be more knowledgeable of the day to day administrative and clinical challenges of the programs, have an in-depth understanding of the trainee schedules and academic requirements across programs.

What else have we learned over the year? Just a sample:

We have learned that professionals of varying disciplines share many of the same goals and objectives, but that each perspective brings a little something extra to the table towards patient care. We have learned that to fully understand this, we need to sit back and be active listeners and use introspection and mutual respect to help support these mutual goals. We know that how we model our programs is helping to set standards for our trainees and our future VA and community leaders and professionals. We have learned that faculty development was critically important, and that engaged faculty are central to ideas along these lines. We have learned that interprofessional team huddles are important in efficient coordinated care.

We have learned that many of our trainees believe that they have a significantly better educational experience than peers in other primary care settings, and we have heard that our patients are pleased with our models and the attention they receive from our trainees. We understand that our trainees have differing backgrounds and readiness for clinical care and that we need to adjust our models to best fit their requirements because we have learned that these trainees can make excellent VA clinicians and providers and truly make a difference to our patients. We have learned that we have champions in our trainees who already are providing significant resource and outstanding contributions writing professional articles, helping to develop programs and curriculum, working on quality improvement initiatives, winning awards, and changing our culture.

We have also learned that not everything works out in the way that we predicted. With wounded egos, reflection and recovery, we have learned that we can make mistakes, redesign and rediscover and that this is all okay and part of the process. We have learned we need to be creative and think outside of the box and find solutions for problems or system gaps that might not be solvable with existing or available resources. We have learned that we don't have enough space to get the job done as we would like to, but we are somehow doing a good job and accomplishing many of our goals. We have learned about the need for sustainability and that we still have a long way to go.

We know that working in teams sometimes isn't easy, but we know it is the way to go and we carry on.

So what have we done? (Again, just a sample)

Over the course of a year, a small sample of our accomplishments include developing administrative and clinical infrastructure, creating unique learning strategies both face to face and virtually, curriculum and activities with a focus on our four domains (shared decision making, sustained relationships, interprofessional collaboration and performance improvement). We had team-building and planning retreats and meetings, we put considerable effort and resources into seeking and understanding our program outcomes. We have focused on performance improvement. We have piloted evening clinics and developed both micro and macro huddles.

We have developed specially populated workgroups to tack challenges around strategy, policy and practice in the Coe's around Performance Improvement, Evaluation and Scholarly Activities. We have established new registries and developed panel management strategies to help our learners manage high risk patients, we have created curriculum for new learners and have explored curriculum mapping to support the needs of learners in varying trajectories. We have developed processes to enhance experiential learning through clinical and curriculum interface. Even though we are sometimes short of space and could improve our programs with more space to accomplish interprofessional activities, we have somehow been able to accomplish much this year. We have hired staff and faculty and engaged preceptors and developed administrative processes and policies. We have met with our leadership and shared our stories and have the attention of our VA and external colleagues and organizations through numerous special projects and professional presentations. We have expanded our professional expertise through collaborative opportunities with pharmacy and psychology and other very important disciplines and important other stakeholders within and outside of VA. We have met with academic leadership and other stakeholders to partner on innovative projects and look for ways to share resources. We have developed new relationships with VACO and facility leaders, leaders in primary care and within associated health and enhanced relationships with important other staff in contracts Human Resources. We have developed nurse practitioner fellowships, and other unique trainee models and we are expanding the reach and value of our programs through program and trainee growth and associated health expansion.

Quite a list!

In reflection, what a job! Sometimes it isn't pretty, often it is difficult, and mostly it is without thanks.

Hear this.
In closing and on behalf of the Office of Academic Affiliations and the Coordinating Center team we offer thanks to the many the dedicated staff, faculty trainees and countless others who have contributed so much to birthing this important program. You are at the center of the development and discovery of a program that will have great influence on Veterans, their families, our healthcare system and our communities for many years to come. Congratulations. What a place to be!

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Coordinating Center Staff

Stuart Gilman
Program Director
562.826.5323

Kathryn Rugen
Nurse Consultant
312.569.6933

Judith Bowen
Physician Consultant
503.771.3560

Deborah Ludke
Administrative Officer
562.826.5492

Laural Traylor
Program Manager
Blast Editor
562.826-5974

Kim Uhl
Management Analyst
562.826.5996