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Building Culture of Collaboration: Interprofessional Education and Practice

Abstract

It is hard to imagine that for decades the importance of a major public health problem like oral health and its relation to overall health has gone virtually unnoticed in the professional education and practice of physicians, nurse practitioners, midwives, physician assistants, and pharmacists, the most likely health professionals to play a leadership role in advancing patient-centered care.
It is hard to imagine that for decades
the importance of a major public health
problem like oral health and its relation
to overall health has gone virtually un-
noticed in the professional education and
practice of physicians, nurse practition-
ers, midwives, physician assistants, and
pharmacists, the most likely health
professionals to play a leadership role in
advancing patient-centered care.
Identified in Healthy People 2020 (US-
DHHS, 2011) as one of the 10 Leading
Health Indicators, oral health all too
often remains a domain for the profes-
sional preparation of dentists and dental
hygienists, disconnecting the mouth from
the rest of the body as an integral dimen-
sion of overall health. In fact, for physi-
cians, nurse practitioners, and physician
assistants, even the traditional physical
examination of the head and neck
acronym, HEENT, does not signify in-
clusion of the oral cavity in a way that
HEENOT would! Using the HEENOT
approach means that primary care edu-
cators and clinicians CANNOT omit
oral health from the assessment, diagno-
sis, and management of their patients’
overall health.
We are at a jumping-off point, a point
ripe for ending professional content and
practice silos! Publication of recent In-
stitute of Medicine reports (2011a;
2011b), which documented the need to
build interprofessional (IP) oral health
workforce capacity, provided support for
developing interprofessional oral health
core competencies for primary care
providers. The new Interprofessional
Education Competencies (IPEC, 2011)
and interprofessional accreditation stan-
dards for dentistry, nursing, medicine,
and pharmacy have created momentum
for educators to begin to reach across
academic silos. Rapid changes in the
healthcare paradigm have been propelled
by anticipation of healthcare reform:
integrated healthcare delivery systems,
accountable care organizations, primary
care medical homes, and patient-centered
care have all challenged educators and
clinicians alike to prepare our graduates
to function effectively in this healthcare
environment, competent to deliver on the
Institute for Healthcare Improvement’s
(IHI, 2014) “Triple Aim,” illustrated in
the figure on the next page. As faculty,
we need to commit to preparing gradu-
ates who are practice-ready to work in
teams to improve the patient experience,
improve the health of populations, and
reduce the cost of health care. Oral-
systemic health is poised to become the
perfect example of interprofessional
competencies in order to build an IP
workforce that can actualize the “Triple
Aim.”
Health professions education pro-
grams that are committed to transform-
ing their curricula to develop IP
competencies confront multiple chal-
lenges at the student, faculty, and organi-
zational levels. Foremost is the
organizational challenge for the leader-
By Judith Haber, PhD, APRN,
BC, FAAN
Associate Dean for Graduate
Programs
The Ursula Springer Leadership
Professor in Nursing
College of Nursing
New York University
12 SPRING
BUILDING A CULTURE OF COLLABORATION:
INTERPROFESSIONAL EDUCATION AND PRACTICE
“The new Interprofessional Education Competencies
(IPEC, 2011) and interprofessional accreditation
standards for dentistry, nursing, medicine, and
pharmacy have created momentum for educators
to begin to reach across academic silos.”
ship of each academic or clinical unit to
examine their values about: a) the im-
portance of oral health and the links to
overall health, b) the
commitment to an
IP culture change,
and c) the allocation
of resources to sup-
port building IP in-
frastructure and
curriculum/practice
implementation.
Signaling support
from the leadership
team is essential to obtaining internal
stakeholder “buy-in” and cultivating IP
change champions who will play formal
and informal leadership roles. Resource
allocation communicates organizational
support about faculty interprofessional
competency development as a strategic
priority.
Another challenge is deciding the
number of professions that will partici-
pate in IP oral health experiences. Profes-
sional egos need to be checked at the
door; participants need to assess their IP
Teamwork IQ. Making IP experiences
“fun” is key to early successes; “wins” are
important in sustaining the enthusiasm
of early adopters. Engaging a small
group of key stakeholder schools or de-
partments as partners is more pragmatic.
Because faculty tend to teach and prac-
tice the way they were prepared, faculty
development is essential. For dental
education faculty who most commonly
practice in a private practice environment
outside of healthcare organizations, it
may be a challenge to embrace IP and
general health competencies themselves,
much less be role models of them for
their students. Nursing and medical
school faculty, whose education and
practice reflect a dearth of oral health
content and clinical focus, will have to
meet the challenge of developing an IP
oral health knowledge base and clinical
competencies as well as the IP competen-
cies. In order to maximize the likelihood
that the “Implicit” IP curriculum does
not undermine the “Explicit” IP curricu-
lum, both IP and oral health messaging
need to be consistent so that students
have effective IP
role models in den-
tal, nursing, and
medical classroom
and clinical set-
tings. Faculty
development is a
critical factor in
promoting culture
change. It pro-
motes relationship
building across the professions, as well
as ownership and accountability for the
success of the IP initiative(s), in turn
creating an IP support network and a
critical mass of change champions.
Standardizing the curriculum so that
all students are exposed to multiple
“Rapid changes in the healthcare paradigm have been propelled
by anticipation of healthcare reform: integrated healthcare
delivery systems, accountable care organizations, primary care
medical homes, and patient-centered care have all challenged
educators and clinicians alike to prepare our graduates to
function effectively in this healthcare environment, competent to
deliver on the Institute for Healthcare Improvement’s
(IHI, 2014) ‘Triple Aim.’ ” (Illustrated below.)
Institute for Healthcare Improvement’s Triple Aim
(adapted diagram)
Population Health
Per Capita
Cost
Experience
of Care
The IHI Triple Aim
2 0 1 4 13
14 SPRING
“doses,” delivered in an incremental,
timed sequence across the curriculum, is
consistent with the long-term goal of
creating an IP oral health culture change,
but it represents another IP challenge.
Interprofessional initiatives that are in-
termittent and/or rely on volunteers tend
to attract a skewed faculty and student
sample of “true believers,” who may be-
come change champions but don’t reflect
the organizations general enthusiasm for
or commitment to oral health and/or IP
curriculum integration. Faculty are chal-
lenged to be innovative facilitators rather
than “talking heads” in developing and
implementing IP classroom and/or clini-
cal experiences. For decades, we have had
students from across the health profes-
sions in the same basic science courses,
but students typically interact only with
members of their own profession. Inter-
professional clinical experiences that cap-
italize on
existing courses,
clerkships, and
clinical rotations
are optimal for
weaving oral-
systemic health
and IP compe-
tencies into the
curriculum with-
out creating
“extra courses or
rotations.” They
also make a case
for clinical com-
petency development which sets the stage
for a post-graduation approach to imple-
menting the “Triple Aim.”
In making this paradigm shift, faculty
are asked to embrace the role of facilita-
tor and use educational technology to
bring students together in virtual and
face-to-face experiences using simula-
tion, standardized patients, virtual cases,
telehealth, debates, and service learning
experiences, to mention a few options.
For example, the Smiles for Life inter-
professional, web-based oral health
curriculum for primary care providers
(www.smilesforlifeoralhealth.com) can
be used for faculty development and cur-
riculum integration. The use of technol-
ogy is also an effective way to engage a
generation of students for whom this is a
preferred learning modality, as well as a
vehicle to transcend the administrator
and faculty trauma of conflicting aca-
demic calendars and schedules.
The final challenge is to determine
how we will know that integrating IP
oral health core competencies and/or IP
competencies makes a difference in the
patient experience, in the quality of pop-
ulation health outcomes, or in the afford-
ability of health
care. Evaluation is
essential. Health
professions schools
and faculty must
commit to evaluat-
ing development of
oral health and IP
competencies. Use
of educational
technology, includ-
ing simulation and
the electronic
health record, are
effective tools for
documenting clinical competencies.
Course evaluations with specific and
sometimes customized items about the
integration of oral health and IP compe-
tencies are effective, and there is an array
of measurement tools that assess percep-
tion of IP competence, attitude change,
and team building. Having an evidence
base that indicates we have prepared
graduates from dentistry, nursing, medi-
cine, and other health professions who
are competent to meet the nations IP
oral health population health needs is an
important outcome.
Data that reveal our graduates con-
tinue to use an interprofessional practice
framework to positively impact patient
experiences, improve population health,
and reduce the cost of health care will be
the ultimate test of IP effectiveness. As
Ryunosuke Satoro wrote, “Individually,
we are one drop. Together, we are an
ocean.” It is in building a culture of col-
laboration that we will have a collective
impact in interprofessional oral health
education and practice.
“The final challenge is to
determine how we will know
that integrating IP oral health
core competencies and/or
IP competencies makes a
difference in the patient
experience, in the quality of
population health outcomes,
or in the affordability of
health care. Evaluation is
essential.”
References
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Leawood (KS): Society of Teachers of Family
Medicine; 2010. Available from:
http://www.smilesforlifeoralhealth.com
Interprofessional Education Collaborative Expert
Panel. Core competencies for interprofessional
collaborative practice: report of an expert panel.
Washington, DC: Interprofessional Education
Collaborative; 2011.
Institute for Healthcare Improvement (IHI). The
IHI triple aim [Internet]. Initiatives. Accessed
from: http://www.ihi.org/Engage/Initiatives
/TripleAim/Pages/default.aspx
Institute of Medicine. Advancing oral health in
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health for vulnerable and underserved popula-
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U.S. Department of Health and Human Services.
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... The interprofessional education competencies 22 provided significant momentum for interprofessional oral health leaders to capitalize on the "perfect storm" created by the confluence of seminal reports to propose that oral---systemic health is a perfect population health exemplar to illustrate the interprofessional competency domains across health professions curricula. 23,24 However, the science of performing a physical examination, initially established by Hippocrates more than 3000 years ago and refined in the 13th century with the resumption of the dissection of human bodies for education, does not focus on the oral examination. 25 Health care providers have performed physical assessment of the head, ears, eyes, nose, and throat (HEENT) in the same fashion since its inception centuries ago. ...
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Full-text available
Improving oral health is a leading population health goal; however, curricula preparing health professionals have a dearth of oral health content and clinical experiences. We detail an educational and clinical innovation transitioning the traditional head, ears, eyes, nose, and throat (HEENT) examination to the addition of the teeth, gums, mucosa, tongue, and palate examination (HEENOT) for assessment, diagnosis, and treatment of oral-systemic health. Many New York University nursing, dental, and medical faculty and students have been exposed to interprofessional oral health HEENOT classroom, simulation, and clinical experiences. This was associated with increased dental-primary care referrals. This innovation has potential to build interprofessional oral health workforce capacity that addresses a significant public health issue, increases oral health care access, and improves oral-systemic health across the lifespan. (Am J Public Health. Published online ahead of print January 20, 2015: e1-e5. doi:10.2105/AJPH.2014.302495).
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Access to oral health care is essential to promoting and maintaining overall health and well-being, yet only half of the population visits a dentist each year. Poor and minority children are less likely to have access to oral health care than are their nonpoor and nonminority peers. Older adults, people who live in rural areas, and disabled individuals, uniformly confront access barriers, regardless of their financial resources. The consequences of these disparities in access to oral health care can lead to a number of conditions including malnutrition, childhood speech problems, infections, diabetes, heart disease, and premature births. Improving Access to Oral Health Care for Vulnerable and Underserved Populations examines the scope and consequences of inadequate access to oral health services in the United States and recommends ways to combat the economic, structural, geographic, and cultural factors that prevent access to regular, quality care. The report suggests changing funding and reimbursement for dental care; expanding the oral health work force by training doctors, nurses, and other nondental professionals to recognize risk for oral diseases; and revamping regulatory, educational, and administrative practices. It also recommends changes to incorporate oral health care into overall health care. These recommendations support the creation of a diverse workforce that is competent, compensated, and authorized to serve vulnerable and underserved populations across the life cycle. The recommendations provided in Improving Access to Oral Health Care for Vulnerable and Underserved Populations will help direct the efforts of federal, state, and local government agencies; policy makers; health professionals in all fields; private and public health organizations; licensing and accreditation bodies; educational institutions; health care researchers; and philanthropic and advocacy organizations. © 2011 by the National Academy of Sciences. All rights reserved.
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Though it is highly preventable, tooth decay is a common chronic disease both in the United States and worldwide. Evidence shows that decay and other oral diseases may be associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease, and diabetes. However, individuals and many health care professionals remain unaware of the risk factors and preventive approaches for many oral diseases. They do not fully appreciate how oral health affects overall health and well-being. In Advancing Oral Health in America, the Institute of Medicine (IOM) highlights the vital role that the Department of Health and Human Services (HHS) can play in improving oral health and oral health care in the United States. The IOM recommends that HHS design an oral health initiative which has clearly articulated goals, is coordinated effectively, adequately funded and has high-level accountability. In addition, the IOM stresses three key areas needed for successfully maintaining oral health as a priority issue: strong leadership, sustained interest, and the involvement of multiple stakeholders from both the public and private sectors. Advancing Oral Health in America provides practical recommendations that the Department of Health and Human Services can use to improve oral health care in America. The report will serve as a vital resource for federal health agencies, health care professionals, policy makers, researchers, and public and private health organizations. © 2011 by the National Academy of Sciences. All rights reserved.
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Abstract This resource addresses how adult oral health is impacted by factors such as disease, aging, medication, and substance use. Clinicians review risk factors and etiologies of oral conditions, as well as appropriate treatment and referral procedures. Additionally, this module addresses how to effectively promote oral disease prevention, coordinate dental care for patients requiring antibiotic prophylaxis, and collaboratively manage anticoagulation in patients undergoing oral procedures. This resource is designed as an interactive educational tool for both individuals and groups from all aspects of the health care profession. It is a part of the series Smiles for Life: A National Oral Health Curriculum, the nation's most comprehensive and widely used oral health curriculum designed for primary care clinicians. The eight-module course covers the relationship of oral to systemic health, child oral health, adult oral health, dental emergencies, oral health in pregnancy, fluoride varnish, and the oral examination.
Smiles for life: a national oral health curriculum): Society of Teachers of Family Medicine Available from: http://www.smilesforlifeoralhealth.com Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: report of an expert panel
  • Mb Clark
  • Ab Douglass
  • R Maier
  • M Deutchman
  • Jm Douglass
  • W Gonsalves
Clark MB, Douglass AB, Maier R, Deutchman M, Douglass JM, Gonsalves W, et al. Smiles for life: a national oral health curriculum. 3rd ed. Leawood (KS): Society of Teachers of Family Medicine; 2010. Available from: http://www.smilesforlifeoralhealth.com Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: report of an expert panel. Washington, DC: Interprofessional Education Collaborative; 2011.