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Inter professional education and practice in the health care setting: an innovative model using human simulation learning

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Inter professional education and practice in the health care setting: an innovative model using human simulation learning

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Content Running Head: INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE
Inter Professional Education and Practice in the Health Care Setting: An Innovative Model Using
Human Simulation Learning
Nancy Xenakis
Capstone Project
Doctor of Social Work
Suzanne Dworak-Peck School of Social Work, University of Southern California
December 2019
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE

Executive Summary

The health care delivery system in the United States is fragmented and with increased
demands placed on health care team members’ time and attention the most disadvantaged patients
are often left to fend for themselves, resulting in crisis management with poor health outcomes
(quality and cost). The concepts of inter professional education (IPE) and inter professional
practice (IPP) among health care disciplines has existed for several decades and formal, successful
attempts have been made to foster this, particularly in graduate school settings. However, health
care disciplines continue to learn and work within their own discipline for a variety of reasons.
Mainly because it is what they know and have always done. The medical model emphasizes
treatment of the acute illness with almost an exclusive focus on the physiological aspects of care
with little attention to the behavioral health and the social determinants of health. Time is also a
contributing factor-many heath care team members find that even allowing time to meet
informally and agree on care plans for complex patients can seem like an imposition and time not
well spent.
The proposed capstone innovation is an IPE program in the hospital setting where mixed
disciplines of Medicine, Nursing, Social Work and Spiritual Care learn IPP competencies together
using empirically based human simulation learning methodology-guided, interactive and reflective
learning, which teaches standardized IPP competencies using actual patient cases, expert
facilitation by the involved disciplines, use of trained actors to portray standardized patients (SPs)
and caregivers (SCs) and learners in small inter professional teams taking turns interacting with
each other and the SP/SC. Facilitators and SPs/SCs provide skilled, real time feedback and the
learners reflect on their experience individually and as a team. The program, called the
Partnership for Excellence in Inter Professional Education and Practice in Health Care (the
“Partnership”) has the basic premise, learn together to work together.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE

The Partnership is directly related to the Social Work Grand Challenge, Close the Health
Gap, which specifically outlines the need for a diverse, culturally competent and collaborative
inter professional workforce that can assess and identify a variety of patient needs: medical,
behavioral, social and environmental and develop interventions to foster better health outcomes,
especially among patients who are most vulnerable (Brown et al., 2017).
The scope of this issue is broad-IPE is being pursued by many universities’ graduate health
care programs, primarily Medicine and Nursing where IPE standards for accreditation now exist
and in health care practice settings where lack of IPP is a known problem with some limited
efforts to address. The transforming health care landscape-increased coverage and access, aging
population with chronic health conditions, workforce expected growth, high unnecessary costs,
poor quality outcomes, value-based payment system, shift to preventive and integrated care,
population heath and social determinants of health focus-underscores the timely importance of this
issue.
The innovation strategy will demonstrate impact on patient outcomes in the practice areas
where IPE has occurred using common metrics related to quality and cost and standardized
measurement instruments. The Partnership will expand to a “center” with a suite of IPE/IPP
offerings increasing its ability to scale as health care and other organizations will have options
available and determine what will work best in their settings. The 10x vision is that the host
hospital is considered a national center of excellence in IPE/IPP and that IPE/IPP is firmly rooted
in health care, primarily through continuous quality improvement initiatives. This will be a win-
win for both health care professionals (capstone “clients”) and patients (capstone “beneficiaries”).
Health care professionals’ workdays will be more efficient, their professional skills enhanced, feel
like valued members of their health care teams and be more effective in their care of patients.
Patients will be treated holistically—their medical, behavioral and social needs addressed together,
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE

as one affects the other and their care coordinated by their health care team from the beginning,
through the middle and at the end. This IPE/IPP model will ameliorate the fragmented care that
plagues the U.S. health care system today and improve patient care delivery and health outcomes.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE

Table of Contents
Page Number
Conceptual Framework
Social Problem: Prevalence, Incidence and Link to Social Work Grand Challenge 1
Known Research, Practice and Innovation 5
Resulting Gaps in Knowledge and Impact 8
Conceptual Framework and Theory of Change 9
General Description of Proposed Project 10
Important and Relevant Concepts Defined 10

Problems of Practice and Solutions/ Innovations
Explanation of Program Design 10
Justification of Innovation 13
Proposed Impact: Goals 13
Logic Model 14
Proposed Solution to Improve Social Work Grand Challenge 14
Feedback from Multiple Stakeholders on Proposed Solution and Feasibility 15
Analysis of Innovative Solution Positioning Within History, Policy and Public Knowledge 16
Evidence or Data to Show Impact 18
Description of Political, Organizational and Community Allies 19
Description of Political, Organizational and Community Obstacles 20
Analysis of Alternative Pathways 21

Project Structure, Methodology and Action Components
Implementation Plan and Timeline 22
Realistic Financial Plans and Staging 22
Measurement Outcomes Using Data or Community Input 24
Stakeholder Involvement Plan Including Relevant Constituencies 26
Communication Plan and Strategies to Engage Audiences 27
Dissemination Plan for Broader Impact 28
Ethical Concerns and Possible Negative Consequences 28
Summary of Program Plans and Conclusions 29

Conclusion, Actions & Implications
Implications of Program to Improve Practice or Policy 30
Acknowledgement of Limitations and Risks: Recommendations for Future Work 31
Capstone Program Advancement Plan 33

References

Appendices
Appendix A: Important and Relevant Terms
Appendix B: Prototype: Inter Professional Education Faculty User Guide
Appendix C: Inter Professional Education Collaborative Competencies/Sub-Competencies
Appendix D: Center for Inter Professional Education and Practice in Health Care Offerings
Appendix E: Logic Model
Appendix F: Implementation Timeline
Appendix G: Line Item Budget
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 1

Conceptual Framework

Social Problem: Prevalence, Incidence and Context to Social Work Grand Challenge

The health care delivery system in the United States (U.S.) is fragmented and with increased
demands placed on health care team members’ time and attention, the most disadvantaged patients
are often left to fend for themselves, resulting in crisis management with poor health outcomes
(quality and cost).
There is a wide range of large, multi-level efforts underway to fix this. The first, Healthy
People, a national health promotion and disease prevention initiative, now in its fifth edition that
aims to improves the health and well being of populations at the community level with ambitious,
quantifiable objectives and sharing progress. The second, the Patient Protection and Affordable
Care Act (PPACA) of 2010, is the most influential piece of health care legislation since the
establishment of Medicare and Medicaid in 1965. The PPACA laid the groundwork to improve the
country’s health care system by strengthening primary care and integrated health in the community
and reduce costs through financial opportunities for hospitals, health systems and physician
providers to form networks that simultaneously focus on its triple aim: improving the experience of
care, improving the health of populations, and reducing per capita costs of health care (Sparer,
2018; Berwick & Nolan, 2008; Gold, 2015). Although moving at a high speed, with innovative
ideas and gaining solid traction to a complete transformation of our health care delivery system, it is
a long road. Although health care team collaboration is needed to accomplish this, it seems more
fragmented now than ever before due to the need for health care providers to balance a multitude of
responsibilities-higher patient volume due to better health care access, many of them with more
complex conditions (health, behavioral health, and psychosocial), increased documentation
requirements for reporting, regulatory and billing purposes, among others.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 2

The U.S. has consistently ranked lowest among 11 other industrialized nations across
72 indicators that measure health care performance and delivery in five domains important to
policymakers, providers, patients, and the public: Care Process, Access, Administrative Efficiency,
Equity, and Health Care Outcomes (Schneider, Sarnak, Squires, Shah, & Doty, 2017). And, the
irony is that it spends more than double than many of those same nations on health care (Hathi &
Kocher, 2017). Currently the U.S. spends 18 percent of its Gross Domestic Product (GDP) on health
care and the forecast is bleak; by 2026 it is expected to grow to 20 percent (Centers for Medicare
and Medicaid, 2017; Abutaleb, 2018). New models of patient care involving inter professional
teams will help ameliorate the fragmented care that plagues the health care system today and result
in achieving the triple aim (Nester, 2016; Berwick, Nolan, & Whittington, 2008).
The ability to work with professionals from other disciplines to deliver collaborative,
patient-centered care is considered a critical element of professional practice requiring a specific set
of competencies, which now exist. However, there is a lack of a practical framework for how to
teach these in the health care setting and conceptual clarity of the “active ingredients” of
collaboration relating to quality of care and patient outcomes, which are also challenging to measure
effectively (Suter, et al, 2009). A 2018 joint project by the Commonwealth Fund, Harvard School of
Public Health and The New York Times showed the degree to which Americans with serious health
conditions are specifically not experiencing coordinated care. In the past three years, 13 percent of
adults surveyed (extrapolated to over 40 million adults) experienced a serious health condition.
Sixty-one percent of them (24.7 million adults) reported issues related to fragmented and
uncoordinated hospital care (received conflicting information from different health care
professionals, sent for duplicate tests/procedures by different doctors/nurses, hospital staff not
responsive to their needs, could not understand what was being done to them) (Schneider, Abrams,
Shah, Lewis & Shah, 2017). The incidence rates of low-income individuals and minorities are
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 3

higher within this group (Agency for Healthcare Research and Quality, 2017). These consumers that
are truly disadvantaged-with chronic medical and behavioral health conditions, and complex social
and environmental issues--slip through the cracks, their medical, mental and social determinants of
health (SDH) needs are not addressed and worsen. They visit the Emergency Department (ED)
when in crisis and are often admitted because their medical history is unknown. This also has a
severe negative financial impact on these patients/families, the health care system and this country.
American Hospital Association Survey data (2016) shows the inverse relationship between
the number of EDs and number of ED visits over an approximate twenty-year period nationally.
There is an 11 percent decrease in EDs now due to the proliferation of urgent care centers and
hospital mergers into health systems and 53 percent increase in ED visits overall (27 percent
increase per 1,000 visits to account for population changes). If the health care delivery system were
more patient centered and operated in a more coordinated way, ED visits should be trending down
as well. A 2013 database review of 6.5 million ED visits of the commercially insured population
under the age of 65 showed that 72% of these ED visits were avoidable and could have been treated
in another setting (Truven Health Analytics, 2013). It is estimated that there could be $8.3 billion in
overall savings annually of ED costs (Health Care Cost Institute, 2016).
Hospital readmission rates within 30 days are one common health outcome measure. Similar
to ED visits and discharges, inpatient hospital discharges are always considered a time of
transitional care when patients are most vulnerable and coordination by the inter professional health
care team is critical. Hospital readmissions within 30 days can inform us when transitions of care
did not go well.
There are hospital readmission rate penalties up to 3% of all Medicare reimbursements
based on an error readmission ratio for non-elective readmissions for six common health conditions.
In 2018, of 3,241 readmissions evaluated, 80 percent have penalties levied against them for
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 4

Medicare inpatient stays. This represents a reduction in reimbursements for hospitals of $564
million, up from the $528 million in 2017 (Hospital Readmissions Reduction Program, 2018). The
30-day all-cause readmission rate was consistently highest among patients with stays billed to
Medicare (17.1 per 100 index admissions in 2016), followed by those with Medicaid, uninsured
patients, and those with private insurance (8.6 per 100 index admissions in 2016) (Bailey, Weiss,
Barrett & Jiang, 2019).
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS),
considered the national standardized instrument for collecting and publicly reporting patients’
perspectives on their care and hospital health outcomes, reports low national percentages on
questions (“sometimes” or “never” responses) in three domains aligned with this specific problem
among 4,424 participating hospitals: Care Transition 47%; Communication Regarding Medicine
37%; Responsiveness of Hospital Staff 30%; Communication with Doctors and Nurses 19%;
Discharge Information 13%. The New York State averages (where capstone project is being
initially implemented) are higher (Centers for Medicare & Medicaid Services, 2019).
All of these data underscore the specific problem being addressed by this capstone project:
Patients in the U.S. receive fragmented and uncoordinated health care due to the lack of
collaboration among health care professionals (e.g. physicians, nurses, social workers) trained,
licensed and paid to do this and this contributes to poor health outcomes. This is a common and
important social problem most Americans face as consumers of health care, when navigating the
complexities of the U.S. health care delivery system. Patients and/or care partners are often left to
fend for themselves, especially at times when they are most vulnerable. Those with SDH inequities
are at higher risk.
This capstone problem and innovation project are directly related to the Social Work Grand
Challenge (SWGC) Close the Health Gap and one of its three themes: Strengthening Health Care
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 5

Systems: Better Health Across America and one of its ten priorities, Foster Development of an Inter
Professional Health Workforce (Spencer et al., 2018; Brashers, Phillips, Malpass, & Owen, 2015).
The American Academy of Social Work and Social Welfare through this SWGC priority
specifically outlines the need for a diverse, culturally competent and collaborative inter professional
workforce (Brown et al., 2017). It states assessment and identification of a variety of needs:
medical, behavioral, social and environmental must occur through collaboration among the inter
professional team with the patient/care partner to develop interventions to foster better health
outcomes, especially during transitions along the care continuum when patients are most vulnerable.
Known Research, Practice and Innovation

There are many national, state and local improvement efforts underway to address external
factors contributing to this problem. This capstone innovation explores another solution to improve
our health care delivery system by looking inward at how the health care teams function, which is
fundamental to providing quality care and connecting patients to providers and services they need.
The concepts of Inter Professional Education (IPE) and Inter Professional Practice (IPP),
essentially professional health care disciplines learning and practicing together, have existed since
the Institute of Medicine issued its first 1972 IPE conference outcomes report. In 2003, a landmark
report followed, Health Professions Education: A Bridge to Quality, which emphasized the need for
inter professional education and collaborative practice to improve patient health outcomes (safety,
quality and overall patient experience). There have been formal organizing/initiatives around these
concepts nationally and globally. American universities offering health care graduate education
provide IPE courses for their students, primarily Nursing and Medicine centered on learning
technical/clinical skills in medical emergencies and procedures often utilizing simulated high-tech
mannequins. Approximately 115 of these universities have actual Centers for IPE with more
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 6

structured requirements and curricula for students and some offerings for health care professionals
wishing to learn more about IPE.
There are three peer-reviewed journals related to IPE and IPP, two of which focus on the
health care field (Journal of Research in Inter Professional Practice and Education; Journal of
Inter Professional Care). There are three peer-reviewed journals related to simulation research and
learning and one of these (Simulation in Healthcare: The Journal of the Society for Simulation in
Healthcare) focuses on multiple health care disciplines and various types of learning simulation.
Some health care discipline-specific journals have published articles on IPE, IPP and learning
simulation as well.
There are two national organizations focused on IPE/IPP: the Inter Professional Education
Collaborative (IPEC) and National Center for IPP/IPE. IPEC, founded in 2009, and sponsored by
six (now 15) national associations of the schools of the health professions (including medicine,
nursing, social work), published core competencies for IPP, which are widely cited in the IPE/IPP
literature (over 550 citations) (Inter Professional Education Collaborative, 2016). The U.S. National
Center for Inter Professional Practice and Education, founded in 2012, based at University of
Minnesota and funded through a public-private partnership, is considered the national (and
international hub) for IPE resources and best practices. Known as the Nexus, the Center’s work is
focused on strengthening partnerships between health professions education and health care
delivery systems by encouraging them to work together to meet the demands of transforming
processes of care delivery and challenges in educating and training the next generation of health
care professionals. It maintains a first of its kind, unfiltered, national database of IPE programming
outcomes to demonstrate long-term impact of team based care on health. The Nexus also has a
1700+ digital library of IPE resources ranging from journal articles to presentations to reports
(National Center on Inter Professional Practice and Education, 2019).
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 7

An accrediting body for IPE was formed in late 2014 called Health Professions Accreditors
Collaborative (HPAC) by the independent accreditation bodies from the six IPEC-sponsoring
associations (Medicine, Pharmacy, Nursing, Public Health, Osteopathic Medicine and Dentistry) to
establish a standing relationship that enables stakeholders to readily communicate and engage
activities in support of IPE, with the shared goal of preparing graduates for meaningful
collaborative practice. The accreditation process for graduate programs in these disciplines includes
an IPE standard. The Council for Social Work Education (CSWE) is expected to include an IPE
requirement in its next set of standards scheduled for release in 2022.
The World Coordinating Committee (WCC) oversees the All Together Better Health
(ATBH) conference series and promotes knowledge about IPP and IPE worldwide. The committee
includes representation from five regional networks across the world: Australia, Europe, Japan,
North America and Sub Saharan Africa. There are 20 IPE organizations dispersed among these
regional networks including IPEC and the Nexus previously described.
Comprehensive research including literature reviews, interviews with subject matter experts
and a review of organizations’ websites has resulted in the conclusion that a lack of IPP is a
recognized problem in health care practice settings with some limited efforts to address, mainly in
the graduate health care setting and with 2-3 health disciplines, mostly Medicine and Nursing.
Learning outcomes and student competency data exists and continues to evolve. Health professions’
accreditation standards in the U.S. are referencing IPE to varying degrees.
The use of human simulation learning methodology (HSLM), guided, interactive and
reflective learning with actors portraying patients, began in 1964 (Barrows & Abrahamson, 1964),
is now widely used in the field of Medicine and part of the medical school curriculum in the U.S.
and Canada (Jones, Passos-Neto, & Braguiroli, 2015). HSLM has experienced successful but
limited use in graduate social work programs (Logie, Bogo, Regehr, & Regehr, 2013). The
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 8

Department of Social Work Services at the DSW student’s hospital developed three cases using
HSLM for its social workers (early career through advanced practitioner) with positive learner,
facilitator and supervisor feedback and attainment of social work competencies (Xenakis, 2017).
There is growing evidence that IPE/IPP can bring positive change to patient outcomes, quality and
cost of care delivery but more direct, consistent and tested measurement tools need to be developed
and evaluated and longitudinal studies need to occur related to its effect on patient health outcomes
(Brandt & Schmitz, 2017; Brashers, Phillips, Malpass, & Owen, 2015; Cox, Cuff, Brandt, Reeves &
Zierler, 2016; Gawande, 2011; Reeves & Hean, 2013; Reeves, Palaganas, & Zierler, 2015; Nesler,
2016; Thomas, 2011; Sandro, 2018; Zwarenstein, Goldman & Reeves, 2009).
It has been widely recognized that physicians cannot provide all of the clinical and
educational services that patients need in the new models of care. Instead, the system of care must
be re-engineered into well functioning inter professional teams which must include many types of
health care professionals (and ancillary staff) with shared values and align their expertise to help to
break down walls and convert fragmented care into integrated care. Ultimately, inter professional
teams that leverage information, experience, technology, and a culture of teamwork provide value
for patients and families and will change the health care experience and outcomes for patients
(Nester, 2016; Berry & Beckham, 2014).
Resulting Gaps in Knowledge and Impact
There are several gaps in knowledge and impact identified through this research. One, IPE
and IPP programming in the actual health care setting with working professionals from the primary
health care disciplines of medicine, nursing, social work appears non-existent. Two, IPE and IPP
interventions that have the potential to make long-term impact on patient health outcomes are
limited. Three, measurement attempts of health outcomes due to IPE/IPP are unsuccessful. Four,
simulation learning is confined to the disciplines of medicine and nursing focused mainly on
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 9

technical skills (how to respond to patient emergency situation, for example, a patient stops
breathing or conduct a medical procedure) with the use of technology (virtual avatars, videotapes,
robotic mannequins).
On the innovation continuum this capstone project is between incremental and disruptive.
Incremental in that the concepts of IPE and IPP have existed for over 40 years there has been formal
organizing/initiatives around these concepts nationally and globally, but in limited way. Disruptive
in that it will offer IPE in the actual health care work setting, it will use HSLM with original and
expanded cases focused on IPP with learners across a wider set of health care disciplines, including
social work, and there will be a link to practice and patient outcomes. It will challenge and
potentially displace longstanding professional hierarchies and alter the work culture of the health
care delivery system. Evidence shows that ‘learning together’ and ‘showing and doing, not telling’
is most successful (Inter Professional Education Exchange, 2018). This program is ready for prime
time given the major political, economic, social, educational and organizational shifts and
recognized necessary realignment of health care delivery today.
Conceptual Framework and Theory of Change
This capstone project has a strong theoretical base drawn from several published, widely
used theories: Social Learning Theory (Bandura, 1962) and Experiential Learning Theory (Kolb,
1984). It is most closely derived from Inter Professional Education Theory, the notion that
knowledge involves the co-construction of experience. By learning together, and improving the
understanding of team roles specifically, health care professionals will gain the capacity to manage
the complexity posed by patients more effectively through enhanced collaboration (Barr, Helme &
D’Avray, 2014). Social Psychology Theory and Complexity Theory explain the influence of the
dynamism and interaction of internal (cognitive) and external (environmental) factors upon learning
and set the stage for IPE. Theories related to professionalism and stereotyping, communities of
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 10

practice, reflective learning, and transformative learning appear central to IPE and guide specific
educational interventions (Sargeant, 2009).
General Description of Proposed Project
The capstone innovation methodology is a proposed change to practice in the health care
setting among health care professionals via the creation of an education program involving the
partnership of several health care disciplines. The proposed capstone innovation is to develop an
IPE program in the hospital setting (in New York City (NYC), Doctorate of Social Work (DSW)
student’s place of employment) where mixed professional disciplines of Medicine, Nursing, Social
Work and Spiritual Care (target population) learn IPP competencies together using live HSLM with
actual patient cases (HSLM) (Bogo, Rawlings, Katz, & Logie, 2014; The Morchand Center for
Clinical Competence, 2018).
Important and Relevant Concepts Defined
Appendix A provides complete definitions of the important and relevant concepts to this

capstone problem and project.

Problems of Practice and Solutions/ Innovations
Explanation of Program Design

This IPE program has health care professions learning together with the objective of
cultivating collaborative practice for providing patient-centered care. The program design’s basic
premise is learn together to work together.
Specifically, HSLM is used in each IPE session where small groups of learners from mixed
disciplines (doctors, nurses, social workers and chaplains) from the same health care teams/practice
areas learn and apply IPP skills through real-world patient cases developed around IPP
competencies in a safe and structured space. It uses standardized patients (SPs) and standardized
care partners (SCs) that are experienced, professional actors who are cast by the Morchand Center
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 11

for Clinical Competence (TMC) at Icahn School of Medicine at Mount Sinai (ISMMS) based on the
case description. They are trained to simulate the medical symptoms, psychosocial situations,
feelings, and reactions of patients with serious acute and chronic illnesses or care partners of these
patients. These SPs/SCs work with selected skilled and trained facilitators (IPE faculty) with
specific qualifications, representing the identified disciplines. The SPs/SCs and IPE faculty
demonstrate IPP competencies through structured case role-play (well done and not so well done)
and learners from mixed disciplines are assigned to small groups where structured
exercises/discussion and report-outs to the larger group occurs. At various points during the session
learners can practice IPP (and other clinical skills) with the SP/SC and receive feedback from the
faculty, SPs/SCs and peers and reflect on their skills. A lead facilitator(s) from the inter
professional leadership team that designed the program, open and close each session with key
framing and learning points and ensure that they follow the intended structure, curriculum and time.
A debrief with documents/strategies for application to practice conclude each session.
A standard, comprehensive faculty user guide is developed with some customization for the
two learning populations (“IPE for students” and “IPE for working professionals”) and patient
cases. Appendix B is the final prototype of the faculty guide for IPE session one for students. Prior
to the session, faculty is trained together as a team by lead facilitators (program leadership teams) to
ensure clarity around session expectations, their role (in their respective discipline) and how it is a
key part of the “faculty team.” The inter professional faculty training and session facilitation
(bringing health care leaders from different disciplines together to develop this program) actually
models the IPE process for learners and their IPP in their practice areas on their health care teams
treating patients. SPs/SCs receive separate training on their patient (care partner) character. Before
each session the faculty and SPs complete a beta session(s) or run-through(s) with a few selected
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 12

staff from each discipline that can provide constructive feedback and adjustments are made
accordingly.
Each interactive session is structured as follows: Premises (for IPE/IPP and why learning
through this modality is important), Goals and Objectives (this includes the IPEC IPP core
competencies and associated sub-competencies (Appendix C)), a focus on specific competencies in
each case/session and sometimes other learning objectives dependent on the case (motivation
interviewing, advance care planning, facilitating a family meeting)), Case Handout/Review, Case
Beats (scripted/improvisational role play by facilitators/SPs), Small Group Discussion (inter
professional, structured-questions and facilitation), Large Group Discussion (facilitated report out
of small groups; this sequence of Case Beat-Small Group-Large Group Discussion occurs several
times until case is completed), Debrief (on session and next steps for application to practice) and
Evaluation.
A direct practice session in small groups of 8-10 learners either follows or is incorporated
within the interactive session where each learner rotates interacting with the SP/SC and the other
disciplines on the simulated session case. The faculty or learners from each discipline can “time in
and time out” of the session at certain key points, feedback is provided (by faculty through
“productive inquiry” (asking learners to reflect on their experience through leading questions to
connect it with competencies), SP/SC and fellow learners), learners reflect on the feedback and the
session either picks up where the prior learner left off (and learner remains in the simulation or
learners switch) or may go back to a previous time in the case (“ a re-play”). Reflective learning
experience is invaluable preparation for both practice and the need to deal with uncertainty.
Learning to exercise reflective practice skills helps practitioners keep the door to learning open
throughout their careers (Ruch, 2002; Bogo, Rawlings, Katz & Logie, 2014).
The leadership teams for IPE/IPP for students and IPE/IPP for working professionals
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 13

developed their respective IPE/IPP program designs. There is commonality between program
designs but also distinctions due to the learning audience served, deliverables to senior leadership,
funder and/or regulatory body and logistical requirements. The capstone project is called The
Partnership for Excellence in Inter Professional Education and Practice in Health Care (“The
Partnership”).
For both learning populations, the creation of this program has been an extremely iterative
process-ensuring alignment with organizational values and priorities, being flexible with timing and
resources and considering what is important to key stakeholders and delivering on that while also
maintaining the program’s integrity.
Justification of Innovation
This capstone innovation was chosen because it addresses one of the key reasons for the
fragmentation of patients’ health care experiences in the hospital (host organization) setting. This
capstone innovation will disrupt the social norm: health care professions need to work within their
own professional discipline. The transforming health care landscape related to access, coverage,
population health, social determinants of health, professional workforce, regulatory requirements
and payment and delivery systems underscores the timeliness and importance of this innovation
(Brandt & Schmitz, 2017; Cox, Cuff, Brandt, Reeves & Zierler, 2016; Reeves & Hean, 2013;
Sandro, 2018).
Proposed Impact: Goals

The expected initial outcomes of this capstone innovation will occur on three levels:
learner/faculty, organization and patients/care partner. On the learner/faculty level, increased inter
professional knowledge, understanding and competence around roles/responsibilities, values,
communication and collaboration to plan, deliver and evaluate the health of patients and
populations. On the organizational level, achievement of the ISMMS’ 2019 re-accreditation
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 14

including its IPE standard, attainment of expected outcomes on a recently awarded Inter
Professional Exchange (iPEX) grant and alignment with the organization’s The Experience
initiative called Better Together, an existing system wide initiative focused on health system values,
including collaboration and teamwork across disciplines and departments to provide the best patient
centered experience, and improvement in patient quality and cost metrics. On the patient/care
partner level, an improved, coordinated patient experience with the health care team working
optimally with each other and the patient/care partner to address all patient needs. In the long term,
the first goal is to scale this IPE program to the other five hospitals within the health system, other
hospitals/health systems, graduate programs for health professions, community-based organizations,
and health care professional organizations in New York City and then to other urban areas. The
second goal in the long term is to expand the Partnership for Excellence in Inter Professional
Education and Practice in Health Care to a Center for Excellence in Inter Professional Education
and Practice in Health Care which will include expanded offerings in terms of variety, scope and
depth (Appendix D).
Logic Model

The Logic Model (Appendix E) maps the sequential flow between each IPE educational
program component of this capstone project (inputs, activities) and its corresponding targeted
outcomes (short, mid and long term) and demonstrates how these linkages work.
Proposed Solution to Improve Social Work Grand Challenge

This SWGC is based on the premise that dramatic health inequalities in the United States
exist across all dimensions of diversity leading to poor health outcomes. Despite increased attention
to such inequalities, the health care system has made insufficient progress in reducing these
disparities and creating greater health equity. With too little attention on the social determinants of
health—economic, social, and environmental factors—“whereby health disparities take root,
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 15

inequalities grow, and inequities reproduce“ (Spencer, Walters & Clapp, 2016, p.1). The SWGC
goal is to close this health gap by strengthening the health care system and the teams that work
within it so they can address the needs of patients across multiple dimensions. This capstone
innovation, an IPE program focused on IPP, is a proposed solution to directly eliminate the silos in
which different health disciplines function, thereby not collaborating to address patients’ needs fully
and accurately, which contributes to poor patient health outcomes.
Feedback from Multiple Stakeholders on Proposed Solution and Feasibility

Multiple internal and external stakeholders are involved in the capstone innovation

during phase one, have provided feedback on the program and its feasibility and will be

continuously involved in the process. There are a few to highlight due to their important

influence thus far and its expected continuation in the future. For IPE/IPP for students, an internal
stakeholder is ISMMS executive leadership has invested funding in the IPE/IPP program and the
program’s success will affect their medical school reaccreditation in fall 2019 and be included in
their student evaluation data, which they report to the Licensing Commission for Medical Education
(LCME, external) and the ISMMS Medical Board (internal). Their satisfaction with program
outcomes will influence future funding. An external stakeholder is the four MSW programs in NYC
that Mount Sinai Hospital (MSH) Department of Social Work Services contracts with to provide
field education since their students will attend IPE/IPP sessions in 2019-2020. An IPE standard will
likely be required in the 2022 Council for Social Work Education standards for reaccreditation and
there is the potential for MSH Department of Social Work Services to consult to/deliver IPE at
these four programs.
For IPE/IPP for working professionals, an internal stakeholder is the leadership of the MSH
Departments Social Work Services, Spiritual Health, Medicine-Oncology and Palliative Care,
Nursing Education that has consistently met, discussed and negotiated on the design, structure,
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 16

curriculum, implementation and evaluation components of the program to ensure the needs of each
discipline, the grant and overall program objectives are met (mirrors the process that different
disciplines experience in practice). A second critical internal stakeholder is the executive leadership
of MSH (President, Chief Medical Officer (CMO), Chief Nursing Officer) for positioning of this
capstone innovation after its pilot. The goal is for it to become part of the educational foundation for
new members of the health care professional workforce during their existing discipline specific
orientation (portion of it will bring together the health care professionals for IPE/IPP) and to
integrate it with The Experience initiative. Initial presentation by this DSW student in June 2019 on
this initiative as part of a larger, requested presentation at an Office of Patient Excellence
Committee meeting chaired by the CMO was well received.
Analysis of Innovative Solution Positioning within History, Policy and Public Knowledge
Historically, medical providers, at the top of the health care hierarchy, who highly influence
the culture of the inter professional team and practice setting, have feared the new pay for value
(quality and cost outcomes) payment structure as it will end the boldness, creativity and critical
thinking that the field of medicine has held and could affect their compensation. Medicine is not
structured for group work; making time to meet, even informally and agree on care plans for
complex patients can seem like an imposition and time not well spent. Other disciplines, like
nursing, collaborate within their own discipline at change of shift and follow doctors’ written
orders. Social workers, by the nature and training of their profession, would be most inclined to
collaborate, however, their lower status in the health care hierarchy coupled with the complex and
seemingly unsolvable social issues they deal with, keep them mostly working on their own.
However, challenging this social norm is the “value agenda” which restructures how
the health care system is organized, measured and reimbursed from its now fading fee-for-service
system, based on volume and profitability (Porter & Lee, 2013). Compounding this are several
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 17

factors. One, more Americans have health care coverage than anytime in history-91.2 percent in
2017 and are seeking health care, even if emergency care (Berchick, Hood & Barnett, 2018). Two,
the aging baby boomer population (for the first time in U.S. history the elderly population will
outnumber children), longer life expectancies, and growing rates of chronic conditions will drive
continued demand for healthcare services. Three, the U.S. is in last place among its peer nations in
health care quality and cost and current health care costs are unsustainable. Four, healthcare
practitioners and technical occupations are projected to be among the fastest growing occupational
groups during the 2016–26 projections decade (U.S. Department of Labor, 2018). Five, a PPACA
tenet, integrated care delivery systems, moves the U.S from fragmented approaches in which care is
provided by individuals in separate, siloed systems, with patient information exchanged on an as-
needed basis to integrated team practice where providers across disciplines share decision making
and care delivery with active, ongoing, consistent collaboration and communication.
Publicly, the pressure for health care systems and health care teams (especially medical
providers) to perform is extremely high. Inter professional practice is the only way to meet the
needs and demands of complex patients, the objectives and requirements of healthcare reform and
be a vehicle towards promoting efficient and effective operations, optimizing reimbursements and
reducing costs. It is a glide path to improving America’s health care status globally.
In terms of policy, some health care graduate programs and hospital accreditation bodies
have IPE/IPP measurement standards and a recently proposed bill, H.R. 2781 (D-IL) Educating
Medical Professionals and Optimizing Work Force Efficiency and Readiness for Health Act 2019,
focuses on inter professional education and practice (Schakowsky, 2019) in treating the geriatric
population, all of which support this capstone innovation’s timing and positioning.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 18

Evidence or Data to Show Impact
There are several indicators that will demonstrate the impact of “The Partnership.” Short-
term evidence, directly post session will be focused on the “clients” or learners (and faculty). This
includes strong voluntary attendance from the IPE/IPP for working professionals’ cohort, learner
satisfaction with the IPE program, faculty satisfaction with the IPE program teaching (and
retention), learner evaluation of IPP basic knowledge/skills (identified IPEC competencies/sub
competencies). Mid-term evidence, three or more month’s post-session(s), is learner application of
IPP in their respective practice settings. Long-term evidence, six or more months after the
session(s), is focused on the “beneficiaries” or patients. Data to show impact is an increase in
patient satisfaction related to care collaboration by the inter professional team, reduction in
unnecessary emergency department visits, reduction in 30 day readmission rates, increase in
primary care visit compliance post 30 day hospital discharge and improvement in disease specific
indicators (varies by practice specialty area).
A 2018 Cochrane Review examined five databases (CENTRAL, MEDLINE, CINAHL,
ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) and hand-searched
relevant inter professional journal articles including review of their reference lists until November
2015, to determine the effect of inter professional collaborative (IPC) interventions on professional
and health care outcomes, primarily in the United Kingdom and United States. The overall
conclusion was that the effect of IPE/IPP on health outcomes was inconclusive and the intervention
and measurement methods were flawed (Reeves, Pelone, Harrison, Goldman, Zwarenstein, 2018).
Although this formal review is not positive, it demonstrates what did not work and that there is an
opportunity for innovation in the IPE/IPP space in health care settings.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 19

Description of Political, Organizational and Community Allies

There are many allies for The Partnership. Politically, since the passing of the PPACA, the
need to significantly reduce health care costs and increase quality (improve the U.S.’s global rating
in these areas) with the growing, aging American population has garnered political capital.
Organizationally, it operates in the private not-for-profit sector and its institutional base will be the
MSH within the Mount Sinai Health System (MSHS). It will operate under the auspices of the
MSHS Executive Board of Directors. Given that the MSHS is a large organization with a long
history of being a leader in health care delivery transformation, IPE/IPP for students received
immediate approval from the executive leadership of the Division of Medical Education at the
ISMMS and the MSH Department of Social Work Services. The rationale for this is that these are
the two professional disciplines represented, the leadership of both is involved in its development
and both are co-funding it (with ISMMS funding being the majority due to its re-accreditation
need). IPE/IPP for working professionals received immediate approval from the senior leadership of
the following Departments of the MSH: Social Work Services, Spiritual Care, Medicine-Oncology
and Palliative Care and Nursing Education to submit a grant to iPEX for funding and if awarded, for
its leadership team to pursue this initiative, acknowledging the need for IPP and its alignment with
The Experience initiative. In the community, the four schools of social work have supported
IPE/IPP for students as it is anticipated that the CSWE will include an IPE standard required for
reaccreditation in its 2022 release so this is helpful exposure and they perceive it as added value to
their MSW students’ field learning experience. Professional organizations in NYC (e.g. Greater
New York Hospital Association, United Hospital Fund) are allies in that their core mission is
helping hospitals deliver the finest patient care in the most cost-effective way with which the
Partnership is aligned.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 20

Description of Political, Organizational and Community Obstacles
There are several complicating political, organizational and community-based factors
and constraints that have and could affect program planning, implementation and diffusion related
to time, replicability and sustainability. Politically, there is still unrest related to the PPACA-the
possibility of it being repealed and the ongoing lack of bipartisanship to forge durable
improvements to our health care system. On the New York State level, prior to the start of each
fiscal year, there is the risk of health care state funding reductions that will directly impact the
hospital and cause financial instability making programs like this capstone, unlikely to be supported
(cost, time, effort).
Organizationally, there is the possibility that despite the commitment of executive leadership
in the targeted disciplines for phase one, that there will be an inability to support phase two of The
Partnership due to competing priorities and resource limitations. Although there is literature
supporting the positive impact of an inter professional approach to patient care (improved patient
satisfaction, staff satisfaction and retention, improved efficiency of work, reduced unnecessary
utilization (emergency department visits and hospitalizations), increased compliance with primary
care visits and medication adherence) and the host organization has robust information technology
platforms for data collection/reporting on metrics, there is not a strong evidence base connecting
this intervention/practice directly to actual health outcomes. Also, for this program to reach critical
mass at the hospital, it will take some time given the need to offer it in small groups by practice area
compounded by coverage needs during program participation.
There may be resistance from various levels of leadership and learners among the disciplines
that this program is truly necessary given that the terms inter professional collaboration and
interdisciplinary collaboration are often conflated (D’Amour, Ferrada-Videla, Rodriguez &
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 21

Beaulieu, 2005) and many practice areas may think they already know how to work well together to
care for patients.
In the community, there are the labor unions representing some of the health care
professions, that can pose a risk due to a sense of marginalization of their power and control over
their members (and their professional development) or if their members think IPE/IPP makes their
profession less prominent.
Analysis of Alternative Pathways
There are alternative pathways to consider should the program encounter obstacles centered
on time, culture and alignment with an immediate regulatory need. For IPE/IPP for students, after
the four IPE/IPP sessions in this academic year are completed, there is a possibility that the ISMMS
dean may not want to fund this at all for year two (in-kind resources and actual dollars for SW
faculty) or the Art and Science of Medicine (ASM) faculty who design the medical school
curriculum may wish to offer it for another medical school year (instead of/in addition to second
year which was thought to be the best match in terms of patient experience with the second year
social work students). An alternative would be for the MSH Department of SWS to absorb the cost
of SW faculty through another existing fund designated for professional development and to work
with ASM faculty to find a mutually beneficial way to offer IPE/IPP to both medical and social
work students (several negotiations occurred this year in developing the IPE/IPP program). Second,
if there is no organizational support (financial, time and effort) to support IPE/IPP for working
professionals beyond year one as a large initiative that the entire health care professional workforce
will participate in by practice area, other options could be to complete the mass training by practice
area in smaller doses, which would take more time to reach critical mass, offer it only as
foundational learning upon hire/start of medical residency during existing discipline specific
orientations (find common time during this and schedule IPE/IPP sessions), or videotape the
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 22

IPE/IPP sessions and post on the existing Learning Management System for self-study or training
use by leadership in practice areas. The IPE program could also be used for Continuous Quality
Improvement (CQI) initiatives in the hospital, which are required by regulatory bodies and if
successful, packaged (existing faculty user guide and training videos) and marketed to other
hospitals for their CQI purposes. This could be a method of diffusion and revenue generation. All of
these alternatives, while certainly feasible, alter the program’s model and/or methodology and
perhaps impact so each would be carefully considered.
Project Structure, Methodology and Action Components
Implementation Plan and Timeline
A Gantt chart (Appendix F) utilizing the Availability, Responsiveness and Continuity
(ARC) Model by Glisson & Schoenwald (2005) outlines the implementation plan and timeline,
which spans Quarter Three 2018 through Quarter Four 2020.
Realistic Financial Plans and Staging
The overall revenue strategy for this program based in a private not-for-profit organization
will be exploration of revenue sources such as grants, fees, contributions and organizational
funding. The goal is to have the revenue as unrestricted as possible to allow for greater operational
flexibility. This program has three funding sources for its first full year of operations. First,
ISMMS Medical Education operating funds to cover the pilot of IPE sessions to medical and social
work students and second, the iPEX grant to cover IPE sessions for working professionals in
Medicine, Nursing, Social Work and Spiritual Health. Third, were in-kind contributions from the
host organization given the program’s launch and alignment with the organization.
As the program scales, supplemental funding will be sought in the form of foundation grants
focused on IPE/IPP (Gordon and Betty Moore Foundation, John A. Hartford Foundation, Josiah
Macy Jr. Macy Foundation, New York Community Trust, New York Health Foundation, Robert
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 23

Wood Johnson Foundation, United Hospital Fund), private donors (the MSH Department of Social
Work Services has existing funds donated by former leaders towards “professional development of
social workers in a health care setting” that could be leveraged) and internal funding (MSH and
ISMMS operating funds, Mount Sinai Auxiliary Board annual gifts for innovative programming).
Revenue can also be generated by offering the IPE/IPP program to graduate programs for health
care professions to satisfy the IPE re-accreditation standards (serve as consultant or actually deliver
the program), to the external health care workforce for CEUs (evening/weekend sessions) or for
other health care organizations (hospital and community based organizations either in a consultant
capacity, delivery of the actual program, packaging for Continuous Quality Improvement (CQI)
initiatives). Mount Sinai Innovation Partners (MSIP), which assists with translation of innovations
into health care products and services offered assistance with the commercialization aspect.
Exploration of partnerships with professional education accrediting organizations and labor
unions will also occur in pursuit of general support and funding streams. Although government
grants (local, state, federal) would not be a top funding choice due to their restrictive nature, the
Health Resources & Services Administration (HRSA) and Agency for Healthcare Research and
Quality (AHRQ), have both funded IPE/IPP work and can be considered if other funding options do
not materialize. The MSHS Office of Development is a strong resource to identify funding
possibilities that the MSH Department of Social Work Services qualifies for and in the application
process.
Appendix G is the IPE/IPP program line item budget with a budget cycle of January 1-
December 31, which includes revenue, costs and bottom line. Projected total revenue and costs are
balanced for year one, and these calculations are serving as actual (versus projected) calculations
since the program’s year one has started. There is always the remote possibility that the expected in-
kind contributions could decrease and affect the program’s bottom line. Contingency planning
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 24

would include a different department representing one of the targeted disciplines absorbing some of
the Other Than Personnel Salaries (OTPS) costs that was originally being funded by another
department’s operating budget. Also, post year one, as the program scales, these in-kind resources
will not be available to the same extent and will need to be accounted for with the other revenue
streams described.
Measurement Outcomes Using Data or Community Input
Several outcome metrics, related to both clients (learners) and beneficiaries (patients), and
measurement instruments exist for this program. First, program leadership developed a short 10-
question program evaluation tool to measure learner program satisfaction and basic knowledge and
understanding of IPP competencies (short-term outcomes) for both initiatives. This tool utilizes a 5
point Likert Scale and a few free text questions, models other program evaluation tools at the host
organization and was reviewed/approved by the Director, Evaluation and Assessment, Department
of Medical Education. Second, program leadership decided to use the Inter professional
Socialization and Valuing Scale (ISVS)-21, a 21 self-report, 7-point, standardized instrument with
strong validity and reliability, intended for both health care students and practitioners (King,
Orchard, Khalili & Avery, 2016). This tool measures learners’ perceptions of what they have
learned in the session about working with professionals from other disciplines related to the IPP
competencies and how they will apply this learning to practice (short-term outcomes). On both
tools, demographics will be self-reported (gender, race, age, discipline, years of professional
practice, prior IPE experience) so that data can be sorted and tested in a variety of ways. The
measurement goals are a 95 percent overall program satisfaction rate and a 95 percent response rate
of to a very great extent (7) or to a great extent (6).
Mid to long term outcomes of patients include several metrics and measurement tools. First,
unnecessary utilization-emergency department (ED) visits and all-cause 30 day readmission rates
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 25

measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a
standardized instrument developed in 2006 by the National Quality Forum, an organization
established to standardize health care quality measurement and reporting, which provides a broad,
customized set of hospital-specific reporting and compares that to one’s own, regional, state and
national averages. The target outcome metric is to reduce unnecessary ED visits by 5 percent and
all-cause 30-day readmissions by 5 percent.
Second, patient satisfaction on key topics, several of which are related to a coordinated
experience of care due to collaboration of the health care team: communication with doctors,
communication with nurses, responsiveness of hospital staff, communication about medicines,
discharge information and transition of care, measured by the HCAHPS patient self reporting
survey (Centers for Medicare & Medicaid Services, 2019). The outcome goal is to reach 90 percent
response ratings of usually or always in these categories.
Third, Primary Care Visit Compliance (post discharge follow-up); Reportable Disease
Specific (Biological/Physiological) Indicators (depending on specialty area: blood pressure, heart
rate, hemoglobin A1C, depression and anxiety levels); Wait Times, Length of Stay, Duration of Visit
(depends on specialty area), all of which have attribution to the health care team. The selected
measures and target values will be determined with the key stakeholders in each specialty area.
Demographic distinctions (age, primary diagnosis, insurance payor, zip code, psychosocial and
medical risk levels (interface with Lumeris, a software platform that integrates with electronic
medical record (EMR) clinical/organizational data turning it into actionable data to provide quality
care at the right time/right place) will also be applied. These data will be collected and reported via
EMR archival reporting and comparison to administrative data sets (billing codes for diagnostic
related groups and national scorecards (Centers for Medicare & Medicaid, Agency for Health Care
Research & Quality).
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 26

Once patient level outcomes data is analyzed, there will be a focus on “high risk” patients in
terms of utilization, cost and medical and psychosocial complexity—to determine IPP interventions
that can reduce risk level and measure if they are successful.
Stakeholder Involvement Plan Including Relevant Constituencies
The plan to involve additional stakeholders in this program includes:
-The MSHS Community Board as a potential vehicle for community leadership networking and
funding. Once this capstone innovation has pilot results to share, a request can be made to present at
a meeting.
-The Mount Sinai Prospective Provider System (MS PPS), which has 85 partners (MSHS hospitals
and community based organizations (CBOs) in Brooklyn, Queens and Manhattan), is working on a
five year New York Medicaid delivery system reform ($7.4 billion federal waiver program). There
is an opportunity to offer the IPE/IPP program to these CBOs in alignment with MS PPS
performance measures and draw down dollars if achieved. Post MS PPS, there is an opportunity to
offer IPE/IPP to these CBOs and their networks for a fee. It is an opportunity to expand the IPE/IPP
program beyond MSH/MSHS.
-New York State Office of the Professions (NYSOP) reviews education course and programs for
continuing education units (CEUs). The MSH is an approved provider for CEUs for Medicine and
Social Work, which are required for these professions to maintain licensure. The aim is to submit
the program curriculum and faculty to NYSOP for approval and offer CEUs for attendance. This
will be an incentive to learners to participate and will help position the program for future revenue
streams (e.g. offer IPE/IPP sessions for CEUs after work hours to health care professionals for a
fee).
-New York State Nursing Association (NYSNA) and 1199 are the labor unions for all of the MSHS
nurses and social workers. There are annual training funds reserved for continuing education. Once
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 27

the IPE/IPP program is established, exploration with both unions will occur regarding a partnership
to provide IPE/IPP to union members at MSHS and beyond.
Communication Plan and Strategies to Engage Audiences
The communication plan to engage the wider internal audience in MSHS is different for
each IPE/IPP initiative since they impact different areas and learners. For IPE/IPP with students, it
will involve sharing the feedback on the IPE program with the program faculty, senior leaders at
ISMMS at one of their regular meetings (where initial program proposal was presented), with ASM
faculty at ISMMS and Directors of Field Placement at the four schools of social work MSH
contracts with as each entity oversees the course/field curriculum for their students. The aim is to
obtain funding approval for phase 2 and expand it beyond second year medical and social work
students (there seems to be potential for this based on discussions around the initial proposal).
Inclusion of this IPE/IPP program on the ISMMS (Medical Education) and MSH (Social Work)
websites would also be pursued. For IPE/IPP for working professionals, communication with senior
leadership in Nursing (Administration, Education), Social Work, Medicine (Office of Patient
Excellence, President’s Office, Office of Physician Well Being and Resilience, clinical
departments) and Spiritual Care would occur in the form of meeting (s) and sharing of program
materials and evaluation data after phase one is completed. Alignment with The Experience will be
critical. Initial, individual discussions with certain individuals related to this have occurred. If there
is organizational support, then broader messaging to the MSH workforce can occur via the weekly
Employee Update broadcast e-mail and the MSHS intranet site.
Both initiatives will have an advisory group comprised of consumers/clients (learners from
each discipline) and other key stakeholders to build ownership. They will collectively provide
feedback on their IPE experience and its application to practice with patients, ideas for future
programming and assistance with the organizational discourse/messaging on this. These groups will
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 28

expand to include beneficiaries (patients) in later program phases.
Dissemination Plan for Broader Impact
The dissemination plan for impact beyond the host organization is presentations at
conferences (presented at 9th International Conference of Social Work in Health and Mental Health
in July 2019), professional meetings (presented at iPEX annual grantee meeting in March 2019) and
co-authoring peer reviewed IPE/IPP publications. Development of a short form video including
excerpts from an IPE session to demonstrate its innovativeness during presentations and on a public
facing website that will be created. The use of social media (blog, podcasts, Twitter) to share the
advancements in this work will also be employed. The program leaders will conduct targeted
networking with leaders in the IPE/IPP professional organizations nationally and health care
graduate programs that have experience in this space. Focused communication with leaders in the
various disciplines from the other hospitals in the health system and with health care graduate
programs will expand the program beyond MSH’s walls.
Ethical Concerns and Possible Negative Consequences
Although ethical concerns or negative consequences seem unlikely with this IPE program
and its application, there are possible secondary effects. One, the professional health workforce’s
feeling that its discipline’s professional identity is somehow diluted and less important. Research
shows the importance of having a thorough grounding in one’s own profession, identification with
the values of one’s organization and knowing when and where other professionals’ expertise need
to be sought to optimize patient care (Bronstein, 2002; Myers, Sweeney & White, 2002). Two, labor
unions that represent some of these professions feel marginalized in either their role to provide
professional development to their members or that their members feel that their professional role is
compromised and will look to their union to defend it (and otherwise will threat to leave the union
or not pay their dues). Ethically, each profession maintains a code of ethics and the understanding in
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 29

IPP is that those codes continue to prevail. However, even though social work practice is grounded
in a code of ethics that requires treatment equity for all vulnerable populations, and this standpoint
can inform inter professional teams to address health disparities, there is a power differential in
health care settings where patients may be treated as “passive recipients of professional directions”
(i.e. patients must comply with professionals’ instructions) (Iachini, Bronstein, Mellin, 2018, p. 97).
Increasingly though patients are empowered to be active partners in care and an inter professional
approach promotes patients’ ability to self-manage their health care (Browne & Merighi, 2010),
which should help in addressing this issue.
Summary of Project Plans and Conclusions
The project plan is to successfully implement both IPE/IPP initiatives by the end of the first
quarter 2020 and review program evaluation data with key stakeholders, primarily senior
leadership, regarding expansion of the program into phase two. Phase two will include more
learners across a wider range of practice areas and conducting program participation in existing
teams (working professions) and inclusion of additional medical students (beyond second year,
possibly residents). Advisory groups for both initiatives will be developed that will include those
currently involved, representing different backgrounds/expertise, and actual learners to get their
feedback particularly on the effect of the IPE program on IPP within their teams in providing
patient care/services. Obtaining CEU accreditation will also be critical to enhancing learner
participation and satisfaction and credibility of the program.
The innovation strategy beyond phase two is to demonstrate impact on patient outcomes in
the practice areas where IPE has occurred using the metrics (utilization, satisfaction, compliance
and disease management) and measurement instruments described previously. This will provide
further leverage for funding opportunities in the areas cited previously and to move the IPE program
beyond MSH into the other MSHS hospitals and to the other many hospitals/health systems in New
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 30

York City and eventually, health care graduate programs and community based organizations in
NYC. Once “the partnership” expands to a “center” with a variety of IPE/IPP offerings, the ability
to scale will be greater as health care organizations will have a suite of IPE/IPP options available to
them and can choose what will work best in their setting considering level of experience/skills of
workforce, culture, funding and time.
The 10x vision is that MSH is considered a national center of excellence in IPE/IPP
and that inter professional teams and practice is firmly rooted in health care. IPE training begins at
the graduate level and IPP is part of one’s practice training and professional development
throughout one’s career. As a result, more individuals enter the health care workforce, a true
necessity in society today and the near future, and there is higher retention within teams,
organizations and professions. These inter professional teams do not replace the discipline specific-
patient relationship, but rather enhance it—creating a more comprehensive, efficient, and tailored
health care experience. Given the complexity of today’s health care environment, no single
discipline is equipped to fully address patients’ physical and behavioral health conditions and social
determinants of health factors and coordinate the multitude of providers who make up the care
team. This IPE/IPP model will ameliorate the fragmented care that plagues the U.S. health care
system today and improve patient care delivery and health outcomes.
Conclusion, Actions and Implications

Implications of Program: Practice or Policy Improvement
This program will diffuse and anchor so that nationally there will be practice improvement
resulting in a person centered health care environment. Health care professionals will deliberately
work together by exhibiting inter professional qualities: communication, understanding and respect
of each discipline’s knowledge, skills, attitudes, and values and aligning them to provide person-
centered care. This will create a win-win: health care professionals will profit from this as it will
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 31

ultimately make their workday more efficient, enhance their professional skills, make them valued
members of the care team and be more effective in their care of patients. Overall job satisfaction
will increase and there will be more Americans entering the health care profession, especially to
work in underserved communities and there will be an increase in retention in these positions.
The ultimate beneficiaries are patients who will win too; hopefully even more. They will be
treated holistically—their medical, behavioral and social needs addressed together, as one affects
the other, they will be listened to, respected, understood, have their questions answered, their care
coordinated from the beginning, through the middle and at the end. Those who are most vulnerable
and need more care and supportive services from their health care team will receive that. Every
health care encounter will a person centered experience. People will lead longer and healthier lives
and maintain their independence in their own communities.
The U.S. as a nation will have a more efficient and effective health care system that
exclusively has a value based payment structure that all insurance payors align with, that rewards
patient quality outcomes (not merely volume) and cost outcomes (lower is better). As a result,
America will be the top health care leader among industrialized nations. An America will exist
where the health care team collaboratively treats the whole patient and it will be widely accepted
that “zip code is a stronger predictor of health than genetic code” (Agency for Health Care Research
& Quality, 2017) with efforts to improve living conditions in underserved communities.
Acknowledgement of Limitations and Risks: Recommendations for Future Work

There are several limitations to this program reaching its ultimate goal of IPE/IPP being
foundational and mainstream in health care settings. They center on professional/work place culture
and time, cost, trust, scalability, replicability, outcomes measurability and sustainability in both the
inner and outer contexts.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 32

Health care professionals can demonstrate resistance to the efforts that make this possible,
especially medical providers, at the top of the health care hierarchy who fear loss of control and
highly influence the culture of the inter professional team and practice setting. There is often a lack
of pre-existing trust among health care professionals of different disciplines and the ‘best to do it
myself’ mentality prevails (versus deference to the team) especially now with increased pressure to
not make mistakes, have favorable quality outcomes and adhere to higher documentation standards
often in multiple systems, all of which are closely measured and linked to cost and compensation.
IPP is also based on different values than the ones many health care professionals have traditionally
been trained on and held. They include humility, an understanding that no matter who you are, how
experienced or smart, you will fail. They include teamwork, the recognition that others can save you
from failure and contribute to your success, no matter who they are in the hierarchy. Although there
has been a positive shift, traditional professional norms and autonomy that favor individual
professional judgment patient by patient, especially by physicians, are followed over clinical
practice guidelines involving team collaboration (Brownson, Colditz & Proctor, 2017).
Health care organizations (including the host organization after the pilot phase) may have
other, competing priorities and be unable to allow the required time and resources for this even if
they realize its multiple benefits to the organization-improving patient satisfaction and outcomes,
lowering health care costs and raising professional staff satisfaction and retention.
Funding can also be a barrier. In the inner context, although it was secured for phase one, it
is still unclear what the revenue source will be for its growth and sustainability beyond that--
government (federal, national, local) grants, support from foundations, individual donors,
organizational funding and/or revenue from organizations that are willing pay for this program as
they think its intrinsic benefit is a priority and/or individual or teams in health care come to learn
and receive their required CEs.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 33

Scalability is also an issue as this IPE model’s signature is small group skills learning using
HSLM with SPs/SCs, which takes time and effort to scale. However, if the IPE program is
packaged and sold to teach others within their organizations to lead it then it would scale more
rapidly. A caveat of this replicability is the IPE program’s integrity and quality as it moves away
from its primary source of knowledge and expertise. However, this is the case when scaling any
product and service and quality measures will be added to assist with retaining program integrity to
the degree possible.
Program outcomes measurement, particularly related to actual patient health outcomes is
challenging to measure as many factors contribute to these. This limitation could affect
sustainability primarily in terms of funding. Review of the current literature and discussions with
content experts around IPP/IPE measurement efforts of patient outcomes and examination of
Implementation Science methodology related to outcomes will provide guidance.
Capstone Program Advancement Plan
There are several ways that this capstone program can advance. Appendix B lists the

expansion of IPE/IPP offerings that go beyond the current IPE/IPP program being piloted to

ensure there are a variety of options to the host organization and external organizations that can

meet their needs.

Once pilot program data is collected and analyzed, internally, the plan is to expand the
IPE/IPP program for students to additional medical school years and for residents and to add other
disciplines (nursing, pharmacy). The IPE/IPP program for working professionals will include teams
of learners from different champion practice areas (HIV, Acute Rehabilitation, Palliative Care,
Oncology, Geriatrics). IPE/IPP will be included in each discipline-specific orientation for new hires
so it is part of the institution’s foundational learning. The plan is to then expand to the other seven
health system hospitals in the New York City metropolitan area.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 34

The IPE/IPP Program leadership will create a video(s) to supplement the IPE/IPP faculty
guide and work with MSIP to register the copyright, package, market and commercialize the
product nationally. It can be used to meet IPE accreditation standards (health care graduate
programs), staff professional development (including offering of CEUs to staff) or continuous
quality improvement (CQI) projects required of most hospital departments.
MSH will join various professional organizations, present at conferences and publish its
work on IPE/IPP. One example is the Nexus Innovations Incubator Network comprised of 11
academic institutions with the purpose to implement large-scale IPE initiatives—whether focused
on classroom learning, on-site training, clinical practice or a combination of all three—to improve
health. The goal is to collect hard data to convince stakeholders that team-based care and education
can truly make a difference in the health of patients, families and communities.
The main theme of Atul Gawande’s famous 2011 article in The New Yorker, Cowboys and
Pit Crews resonates with this capstone innovation. The article posits that the U.S. has amazing
clinicians and technologies but little consistent sense that they come together to provide an actual
system of care, from start to finish, for people. By a system, Gawande means that the diverse people
actually work together to direct their specialized capabilities toward common goals for patients.
They are coordinated pit crews (not the cowboys we train, hire and pay doctors to be). To function
this way, however, he states that we must cultivate certain skills, which are uncommon in practice
and not often taught. There is indication, however, that where people in health care can combine
their talents and efforts to design organized service to patients, extraordinary change can result. This
IPE/IPP program will fill the current void and impact the health system by getting colleagues to
work together and function as “pit crews” for patients through the creation of a model where IPE is
part of the foundation and a core element in the professional development of care team members.
This IPE/IPP model will ameliorate the fragmented care that plagues the U.S. health care system
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 35

today and improve patient care delivery and health outcomes. Americans will lead longer and
healthier lives and maintain their independence in their own communities.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 36

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Appendix A: Important and Relevant Terms
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 43

Inter Professional Education (IPE): “When students from two or more professions learn about,
from and with each other to enable effective collaboration and improve health outcomes.” (World
Health Organization, 2010)
Inter Professional Practice (IPP): “When multiple health workers from different professional
backgrounds work together with patients, families, and communities to deliver the highest quality of
care.” (World Health Organization, 2010)
Social Determinants of Health (SDH): The conditions in which people are born, grow, live, work
and age. These circumstances are shaped by the distribution of money, power and resources at
global, national and local levels. The SDH are mostly responsible for health inequities - the unfair
and avoidable differences in health status seen within and between countries. (World Health
Organization, 2018)

Simulation Based Learning (SBL): A technique for practice and learning that replaces and
amplifies real experiences with guided, interactive ones. In health care, SBL can develop health
professionals’ knowledge, skills, and attitudes while protecting patients from unnecessary risks. The
realistic, facilitated case scenarios in a safe and structured setting allow for feedback and reflective
practice while attaining specific competencies in a procedure or skill. (Society for Simulation in
Health Care, 2018)

Triple Aim: The United States will not achieve high-value health care unless improvement
initiatives pursue a broader system of interdependent goals. In the aggregate, those goals are called
the “Triple Aim”: improving the individual experience of care; improving the health of populations;
and reducing the per capita costs of care for populations. Changes pursuing any one goal can affect
the other two, sometimes negatively and sometimes positively (Berwick, D.M., Nolan, T.W. &
Whittington, J., 2008)

Appendix B: Final Prototype: Faculty User Guide
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 44

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and
Social Work Students

Faculty Guide
2019-2020

Developed by
Beverly Forsyth, MD, Emma Sollars, LCSW, Jennifer Weintraub, MD, Nancy Xenakis, LCSW, MS

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 45

Faculty Guide

Table of Contents

Topic Page
Overview of the Day for Faculty 3
Interactive Session Agenda 4
Introductions/Orientation to the Session 4
Distribute Case Handout 5
Beat 1 – Script 6
Beat 1 – Discussion 9
Beat 2 – Script 10
Beat 2 – Discussion 15
Beat 3 – Script 16
Attempt 1 17
Attempt 1 Discussion 19
Attempt 2 20
Attempt 2 Discussion 25
Debrief Discussion with Whole Group 26
Feedback/Evaluation 26
Split into Small Groups 26

Appendices
Appendix A – IPE/IPP Overview attached
Appendix B – Premises attached
Appendix C – Goals and Objectives attached
Appendix D – Case Handout attached
Appendix E - Detailed Character Background for SP attached
Appendix F – Venn Diagram attached
Appendix G – Stages of Change attached
Appendix H – Motivational Interviewing Principles attached
Appendix I – Evaluation Form attached

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 46

I. Overview of the Day for Faculty

Today both second year Medical (Med) Students and second year Social Work (SW) graduate
student interns will learn about Inter Professional Practice and its importance in healthcare
through a case related to smoking cessation that utilizes motivational interviewing.

Prior to this session, all students will have either attended or viewed a recording of Dr. Jenny Lin’s
lecture on Motivational Interviewing and Smoking Cessation. It is a prerequisite for attendance at
this interactive session.

9-11a: Part 1 - Interactive Session
- The class will be divided into 4 large groups of approximately 40 people each for this session.
- Each group will contain a mix of med students and SW students.
- There are many more med students than SW students, so there may be only 6-7 SW students
in each group.
- Each group will be facilitated by a Lead Facilitator (one of the session developers listed on
cover page), as well as one Social Work and one Physician Faculty member.
- There is also one Standardized Patient (SP) per room, casted by the Morchand Center for
Clinical Competence.

11a-12p: Part 2- Small Group Practice Sessions
- At this point the disciplines will divide.
- Med students will reconvene with MD faculty to practice the skills learned in small groups.
- SW students will reconvene with SW faculty to debrief and reflect on the session and skills
learned.

Total Time: 3 Hours

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 47

II. Interactive Session Agenda

1. Introductions/Orientation to the Session (15m)
2. Case Handout (5m)
3. Beat 1 (5m)
4. Discussion (10m)
5. Beat 2 (5m)
6. Discussion (15m)
7. Introduction to Beat 3 (3m)
8. Beat 3 – Attempt 1 (5m)
9. Discussion (10m)
10. Report outs and discussion (5m)
11. Beat 3 – Attempt 2 (5m)
12. Discussion (10m)
13. Report outs and discussion (5m)
14. Debrief as a full group (10m)
15. Split into small groups (Med Students and SW students separately)
16. Obtain Feedback (10m) – first part of small group practice session

Total 118m

III. Introductions/Orientation to the Session (15m)

• Lead Facilitator, Social Work Facilitator and Physician Facilitator introduce themselves.
• The students get a group assignment (1, 2 or 3) when they enter the room and will sit with
their group. At this point, they turn to their group members and do an
introduction/icebreaker. Students introduce themselves to each other by:
o Stating their name
o Identifying as a med student or a SW student
o Naming the best TV show, book, movie, play, music, etc., that they saw/read/heard
recently.
• The groups reconvene as one large group when done with introductions (though they will
remain in their seats).
• Lead Facilitator launches the PowerPoint (Appendix A) and provide background on IPE/IPP.
• Lead Facilitator reviews the session premises, goals and objectives (Appendices B and C).
• Lead Facilitator explains how the session will run and what to expect.
• Lead Facilitator addresses any questions.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 48

IV. Distribute Case Handout (5m)

a. The case description is projected onto the screen. It is distributed to the learners at
this time. (It is also included in this guide as Appendix D).
b. Lead Facilitator reads it aloud:

Mr. Harris is a 55yo man who speaks English. He is homeless and has a primary diagnosis of
Chronic Obstructive Pulmonary Disease (COPD). He is a lifelong smoker, with no prior attempts to
quit. Mr. Harris has been living in the Andrews Safe Haven shelter for the last 10 months; prior to
that he was in and out of the Wards Island temporary shelter for about a year. Mr. Harris is
currently hospitalized for a COPD exacerbation. This is his third hospitalization in the last six
months. He has been in the hospital for 6 days now and is medically stable for discharge today.
During the hospitalization, he nearly required intubation but was able to improve on BiPAP1,
steroids2, nebulizers3, and antibiotics4. He is on maximal medical therapy with multiple inhalers
and still has low oxygen. The medical team says he is on the borderline of needing oxygen all the
time at home. At the start of this encounter, the attending MD and SW speak in unit hallway
before meeting with Mr. Harris to collaborate and discuss the next steps in his care.

c. Terms in superscript are defined at bottom of case handout for learners.
d. Field any pressing questions, otherwise go right into roleplay.
e. Appendix E provides detailed character background for the SP.

1 BiPap – Bilevel Positive Airway Pressure. Electronic breathing device that pushes air into the lungs to keep the airways open when
patients are very sick and in the hospital.
2 Steroids – A class of medications used to relieve swelling and inflammation. Used when people have asthma/COPD exacerbations
(amongst other things – there are many uses). Examples are prednisone or cortisone.
3 Nebulizers – A drug delivery device to administer medication in the form of a mist inhaled into the lungs. Commonly used for
treatment of asthma, COPD and other respiratory diseases or disorders.
4 Antibiotics – Drugs used to treat bacterial infections.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 49

V. Beat 1 – Script (5m)

Attending MD and SW speak in unit hallway before meeting with Mr. Harris to collaborate on
discharge plan and how to approach Mr. Harris.

Summary of Key Points for Facilitators:
• Attending MD and SW have worked together before; they are in the hallway discussing
discharge planning and how to approach Mr. Harris before entering the room
• Interactions: SW calls MD “Dr Last Name” while MD refers to SW as “first name”. MD also
did not read the Epic notes written by the SW – these are both real life/notable to discuss
with the students. Medical jargon/abbreviations are used during the conversation to show
that SW has learned medical terms like O2, nebulizers, PO meds, etc.
• Medical: Mr. Harris is 6 days into hospitalization for COPD exacerbation. He is no longer
requiring oxygen and has switched over to oral medications. Has not smoked since
admission began 6 days ago but concern is that if he continues smoking, his COPD will
worsen and he will eventually require home oxygen.
• Social: Mr. Harris is currently homeless and living in a shelter and cannot return to shelter
on oxygen. If oxygen is needed, he will likely need subacute rehab and then may need a
different long-term placement.
• MD and SW agree to go into the patient room to discuss the above and use motivational
interviewing for smoking cessation.

Verbal Nonverbal (tone, volume of voice, eye
contact, distractions)
MD Hi, First Name, so can we just chat for a
minute or two about Mr. Harris?
Respectful, collaborative, but busy

IPP: They address each other differently –
why?
SW Hi, Dr. Last Name, yes, I think that would
be helpful.
Respectful, collaborative, but busy
MD Great. So, I saw in Epic that it looks like
you met with him a few times – but I
didn’t get a chance to read all your notes
– can you fill me in on where we stand
with the DC plan?
IPP: Acknowledges didn’t read SW notes,
doesn’t really own that (apologize) and
asks SW to now fill him in.
SW Yes, I’ve met with him a few times since
his admission and we’ve been talking
about his plan. He lives in a shelter and
has a case manager there who is working
with him to try to get permanent housing.
He can return to the shelter, but they
can’t accept him back if he needs home

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 50

02. He also has be able to ambulate and
climb stairs independently. How is he
doing today? I saw in Epic that he’s off 02
– that’s good…..
MD Yes, he is, for now. I’m hoping we can get
him out today, he’s doing a lot better. We
switched him to PO this morning and he’s
been OK on room air. Of course, he hasn’t
smoked a cigarette in 6 days since he’s
been here – I’m worried he will smoke
again as soon as he leaves here and need
to come right back. He’s on a patch here
but I have a feeling once he leaves he’ll
smoke again right away.

SW I agree, it’s concerning. He’s not supposed
to smoke at the shelter at all, actually. I
think he smokes outside. It’s hard to get a
clear sense from him about it – I’m not
sure he’s really aware of how much he
smokes and how dangerous it really is for
him.
IPP: There is shared concern here for the
pt’s well-being. Both MD and SW are
genuinely concerned and well-intentioned.
MD He’s improved a lot in the last couple of
days but he will really decompensate if he
continues smoking. He will need home 02,
or need to be intubated or worse. He’s at
a really critical point with his COPD – if he
stops smoking now he has a real chance
to remain independent. What are his
options if he ends up needing home 02?
IPP: MD seeking SW expertise on options.
SW He’d probably lose his spot at the shelter.
We’d need to do a new shelter application
for him for a medical shelter – but those
tend to have long waiting lists and he’d
probably need to go to a SAR in the
meantime. It’d be a tough placement
without a clear DC plan and the smoking
would definitely be an issue – he might
end up needing long term placement. But
he’s really pretty young for that -
hopefully we can get him back to the
shelter.
IPP: They are using jargon/abbreviations
to one another.
MD I’d like to go in and talk to him together
about quitting smoking. I’m hoping we
can impress upon him how serious it is. I
IPP: MD soliciting SW help and inviting her
into discussion. This sends a message that
SW collaboration is valued.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 51

can explain the medical part – he really
could die if he doesn’t quit. Do you think
he understands that he will lose his
housing if he doesn’t quit?
SW I’m not sure – I’ve mentioned this in our
conversations but I’m not sure it’s sunk in.
I think it would be helpful to talk to him
together.

MD Great – I plan to try to use some MI
strategies. I use these a lot with my
patients who smoke. I think the fact that if
he doesn’t quit smoking he will lose his
housing might really be a tangible
motivating factor for him.
IPP: The MD is laying out expectations for
the upcoming meeting with the patient.
This helps the SW or any other team
members know what is expected of them
and how best to collaborate to advance pt
care.
SW I agree – so we can talk about this with
him. And hopefully if he’s motivated we
can schedule follow-up with him and get
him some smoking cessation support.

MD OK, so let’s go in and start with his
understanding of his illness, if that sounds
OK with you?

IPP: MD asking for SW approval of
communication plan with Mr. Harris.
SW Great.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 52

VI. Beat 1 – Discussion (10m)

The Lead Facilitator will facilitate with assistance from the MD/SW facilitators. Questions for this
section to be asked to the larger group:

1. How did the MD and SW address one another? What did you notice?
2. At the start of the conversation, how are the MD and SW respectively informed about one
another’s work with the patient?
3. Where do you see the MD and SW roles coinciding? Where do you see them differing?
4. Why do you think the MD needs the SW for this conversation? Why do you think the SW needs
the MD for this conversation?

Points for the Facilitators to Address:
• The MD and SW address each other differently. Why? What feelings/thoughts does this
bring up, if any?
• MD leads discussion. Why? Is this typical in a hospital setting?
• Why hasn’t the MD read the SWer’s note? IPP point – this is sometimes typical/common,
especially when providers are busy. It happens in the reverse as well.
• The cross-understanding of terminology (Bipap, SAR, etc) is important for both providers.
• The MD is more focused on the medical outcomes, the SW on the psychosocial outcomes
(appropriately). Both are important.
• The MD and SW share power and expertise well in this initial interaction. They are
respectful and collaborative. They both speak about their respective areas of expertise and
have a shared set of goals about the upcoming meeting and the patient’s best interests.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 53

VII. Beat 2 – Script (5m)

MD and SW meet with Mr. Harris at bedside to frame the discussion and express concerns about
both medical adherence and the discharge plan.

Summary of Key Points for Facilitators:
• Overview: Mr. Harris has seen many faces during his hospitalization, and his main goal is to
go home to the shelter (name of shelter is Andrews) so he can take care of his belongings.
MD and SW want patient to understand that smoking is making his COPD worse, and if it
progresses he may need to be on oxygen all the time, and he cannot be on oxygen at his
current shelter.
• When MD/SW enter, pt is unsure who they are so MD/SW reintroduce themselves. MD
accidentally says they are here to talk about “getting you home” which patient corrects
since he is currently in a shelter
• MD reviews hospital course with Mr. Harris. First has Mr. Harris explain his understanding
of the hospitalization. Then MD confirms that he had a COPD exacerbation. Explains what
COPD is and that it developed from smoking, and if it worsens he may need home oxygen.
Mentions need for medication adherence and follow up with pulmonology. Uses basic,
non-jargon language.
• SW moves on to discharge logistics. Confirms that his case manager is holding patient’s
spot at the shelter, but emphasizes that if he ends up needing an oxygen tank, he will not
be able to go back to the shelter. Also needs to be able to walk up 3 flights of stairs.
• End conversation by asking permission to discuss smoking cessation.

Verbal Nonverbal (tone, volume of voice,
eye contact, distractions)
MD Good morning, Mr. Harris! Speaks loudly, seems to startle Mr.
Harris who was awake but resting.
SW Hi, good morning! Mimics MD’s tone
MD How are you feeling today?
Pt OK. Pt barely looks up – not clear if he
really knows who’s in the room.
MD Mr. Harris, I’m Dr. XXXXX, I’m the doctor
taking care of you here in the hospital.

Pt What happened to the other doctor? Is
that you?
Points at Social Worker
SW Mr. Harris, I’m XXXXXXXXXX, the social
worker. We’ve met a few times – we talked
yesterday about getting you back to
Andrews Safe Haven – do you remember?

Pt Yeah, OK….. Not sure if he really remembers.
MD You might have been thinking of my
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 54

resident, Dr. XXXX – I’ve been in charge of
your care while you’ve been here in the
hospital. We met a few times but I know
you’ve been pretty sick and probably met a
bunch of doctors while you’ve been here.
Pt Yeah, a lot of people.
MD I know. So I’m the doctor and XXXX here is
the social worker on our team. We work
together and we wanted to talk to you this
morning about your health and hopefully
we can get you home today.
IPP: MD and SW roles clarified and
explanation of other MDs involved
in Mr. Harris’ care.
Pt You mean the shelter?
MD Yes, sorry, that’s what I meant, back to the
shelter.

Pt Well, I’m not gonna stay in the shelter. I’m
waiting to get my own apartment.

SW Yes, that would be great, but now we want
to talk to you about leaving the hospital,
going back to the shelter, and about your
health. Would that be OK?

Pt Yeah, OK. You wanna sit down?
MD Sure, yes, let’s sit down. Pulls up a chair, SW does the same
SW I’m just going to pull your curtain closed so
we don’t disturb your neighbor, OK?
Pulls room divider curtain closed
Pt So, I’m leaving today? Unsure if this is a good thing or
not. Seems a bit confused.
MD Well, we hope so but we’d like to talk a bit
first and find out a little bit more about you
and make sure we have a good plan so that
you don’t get sick again and have to come
back to the hospital. But first, I want to
make sure we’re on the same page. Can
you tell us your understanding of why you
were in the hospital for the past few days?

Pt Well my lung problems got bad like they
always do when I get sick. So I came in, I
got my meds and nebs and I guess now I’m
ready to get out of here.

MD Yes, that’s right. You probably had a cold
and that made your lung problems flare up.
Have you heard the term COPD?

Patient Yes I’ve heard that before. I know I have
lung problems.

MD Yes, you have COPD – that’s a disease of
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 55

the lungs and it can be caused by smoking.
When it gets bad, it can make it very hard
to breathe. Sometimes, when COPD gets
very bad, people can’t breathe without an
oxygen tank, which they need to use
everywhere they go. When you came to
the hospital, you needed oxygen and
medication to breathe. Now you’re doing a
lot better, and you don’t need oxygen
anymore.
Patient Am I going to need it again?
MD Not yet, but we’re concerned that after a
few more hospitalizations you will need
oxygen – all the time. In fact, we
considered it now but we think there’s a
little more time.

Patient A little more time? I never knew it was that
bad. I don’t understand. Pause. I take my
meds.
Concerned

MD Yes, that’s good but there are some things
you can do to keep you from needing
oxygen when you leave, especially because
you can’t go to the shelter with an oxygen
tank.

Patient OK…But I feel better now. That’s good,
right? Can’t I just go back there? Do they
know I’m here? My stuff is there. I don’t
want them to give my bed away. Or let
people touch my stuff.
Agitated about his belongings and
his spot at the shelter.
SW Mr. Harris, I talked to Claudia, your case
manager at Andrews – they are holding
your spot and you are welcome to go back
there when you leave here. They are
expecting you.

Patient OK, OK, good. Relieved
SW Yes, that part is good, but this is what we
wanted to talk to you about today. Mr.
Harris, I don’t know if you heard what Dr. X
said earlier- that you cannot go back to the
shelter on oxygen. I mean, with an oxygen
tank. The shelter doesn’t allow it.

Pt But I don’t need an oxygen tank anymore! Exasperated. Feels like he’s going
in circles.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 56

SW We are concerned that you might need it in
the future.

Silence

Also, at the shelter, you have to walk up 3
flights of stairs?

Beat
Pt contemplates this for the first
time.
MD When it gets hard for you to breathe, is it
hard to climb those stairs?

Pt Pause

Sometimes.

SW We want to help you stay healthy so that
you will be able to go up and down the
stairs on your own In case of emergency.
It’s a rule of the shelter.

Pt So where are you going to send me? I have
nowhere…..
Defeated, very worried about this.
SW We’re not sending you anywhere that you
don’t want to go. You’re going back to
Andrews. They are waiting for you there.
You have your bed and all your stuff is
there. You do not have to worry about that
right now. But we are concerned about the
future. That’s why we’re bringing all of this
up.
Reassuring him.

MD We talked about how medications can help
with your COPD, and how it can be
triggered but a cold or another virus or
infection, but aside from medications and
following up regularly with a lung doctor,
we would also like to talk to you about how
your smoking could be affecting your
COPD. Can we talk about this with you
today?

Pt My smoking. OK. Contemplating, realizing he might
need to do something about this
situation.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 57

VIII. Beat 2 – Discussion (15m)

The Lead Facilitator will facilitate with assistance from the MD/SW facilitators. Questions for this
section to be asked to the larger group:

(1) What are the various concerns of the MD, Pt and SW? Are they similar or different, why or why
not?
(2) What is each person’s goal in this conversation?
(3) What words and specific language did the MD/SW team use to introduce the topic of smoking
cessation? To engage the patient? Did you find it effective?
(4) Based on what you’ve observed, understood so far, what would you ask next? The answers to
this question elicited from students should be written on a whiteboard by MD or SW facilitators.

Points for the Facilitators to Address:

• Why did it take them so long to bring up smoking? They were attempting to engage the
patient and assess his understanding of his situation before bringing it up. Could they
address smoking without doing this? (Not effectively). They needed to make him safe and
comfortable to discuss what might be a difficult conversation.
• The MD and SW again, shared power and space in the meeting. They were respectful of
each other as well as the patient. The MD focused on medical concerns and the SW
focused on psychosocial concerns, appropriately. Both relate to the pt’s smoking.
• Did the MD and SW use patient-centered language? Where could they have done this
better?

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 58

IX. Beat 3 – Script (see timing of sub-sections below)

Explore student responses to “what should we do next?” to move patient from pre-contemplative
to contemplative. Ask learners to think about the stages of change as they watch encounter.

Introduction: (3m)
• Lead facilitator projects Venn Diagram on screen (Appendix F) – Discuss Target of
Encounter
• Lead facilitator projects Stages of Change on Screen and leaves up during roleplay
(Appendix G). Encourage learners to refer to it as needed throughout next part of
encounter.
• Break learners into groups
o Group 1 – will attend to the MD perspective
o Group 2 – will attend to the SW perspective
o Group 3 – will attend to the pt perspective
o Ask each group to identify a reporter
o Explain that each small group will have one of the facilitators join them after the
role play to “micro-facilitate.”

Reminder of Principles for Facilitators (Appendix H):
o General MI Principles
▪ Express Empathy
▪ Develop Discrepancy
▪ Roll with Resistance
▪ Support Self-Efficacy
o Micro Skills
▪ Affirmation
▪ Reflective listening
▪ Open-ended questions
▪ Summarizing
▪ Elicit change talk
o OARS = open-ended questions, affirmations, reflective listening & summarizing
o MI Pitfalls
▪ Question-answer trap: patterns of question/answer
▪ Expert trap: providing direction without first helping to determine goals
▪ Labeling trap: applying labels to the situation
▪ Blaming trap: blaming either the patient or others for the issue
▪ Premature action planning: jumping too quickly into planning when
commitment to change has not been strengthened
▪ Fix-it trap: putting in own perspectives and solutions

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 59

Attempt 1 – The “wrong” way - Assuming the wrong motivation (5m)

MD and SW make assumptions about patient’s readiness and motivation to quit smoking. Assume
that patient knows smoking is bad for his health and that he wants to quit. Patient is pre-
contemplative and is focused mostly on discharge so cuts off conversation early.

Verbal Nonverbal (tone,
volume of voice, eye
contact, distractions)
MI Notes IPP Notes
MD I know you must really
care about your health.
I’m sure you don’t want
to be sick like this again.
Labeling trap
SW What do you think is
getting in the way of
quitting smoking?
Labeling trap
Pt Quitting smoking? Confused
MD Yes, COPD doesn’t have
to be life-threatening,
we really want to help
you to feel better. So we
should really talk about
you quitting smoking. It’s
the most important
thing you can do for your
health right now.
Labeling trap
Fix-it trap
Expert trap

SW What’s worked for you
before? Have you ever
tried to quit in the past?
I’m sure it’s been
challenging for you.
Pt seems to be
thinking about an
answer, but the social
worker is offering a
response before he
can say it.
Fix-it trap The social
worker is
answering her
own questions
and not giving
the pt a
chance to
answer.
Pt Pause

I never really thought
about it before.
Confused as to where
this is going and antsy
to get out of the
hospital.

MD You know that smoking
is bad for you, right? It
makes your COPD much
worse?
Expert trap The MD is
assuming
what the
patient knows
and wants.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 60

Verbal Nonverbal (tone,
volume of voice, eye
contact, distractions)
MI Notes IPP Notes
Pt And that’s why I can’t
breathe?

MD Yes. COPD is
exacerbated by
smoking….

Pt Interrupts
OK, I really need to get
back to the shelter to get
my stuff. Maybe I can
come back and we can
talk about this another
time.
Pt doesn’t know what
“exacerbated” means,
is frustrated.

SW We will get you back to
the shelter today – but
talking about your health
is important too. We
want to work with you
on that.
Missing the point, not
hearing where the pt
is…

Labeling trap
Fix-it trap
expert trap
The SW is not
hearing what
is important
to the patient.
Pt I need to go today. Pt is frustrated. Just
wants to get back to
his life in the shelter.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 61

Attempt 1 – Discussion (10m)

After the role play, the 3 facilitators (Lead, SW, MD) will join the small groups to pose the following
questions and enable to students to discuss the below points. Student reporter will take notes.

Questions to each group after Attempt 1 (open-ended):
1. What did you observe in this encounter?
2. What went well?
3. What didn’t go so well?
4. What stood out to you?

(Additional questions below to be used as prompts for facilitators, if needed)
5. Can you identify non-verbal communication skills/responses that were effective? (MI
perspective, IPP perspective)
6. Can you identify specific verbal communication skills/responses that were effective? (MI
perspective, IPP perspective)
7. What did you notice about Mr. Harris’ [body language, speech, demeanor] when the subject
of smoking cessation was introduced?
8. What did you learn about Mr. Harris’ motivation to quit smoking?
9. What is the goal for each: patient, SW, MD? [Venn diagram]

Points for the Facilitators to Address:
• The providers are assuming what Mr. Harris’ motivation is instead of asking him what it is.
• The providers are talking at Mr. Harris and answering his questions with their own thoughts
instead of listening.
• They are not asking open ended questions
• There is no partnership with Mr. Harris – they are dictating to him what he should do (will not
be effective).
• From IPP perspective – MD and SW are working together but not effectively – they are
reinforcing each other’s mistakes and not hearing Mr. Harris.

After the discussion, the Lead Facilitator will reconvene the session and invite each group reporter
to share a brief recap of what they discussed. (5m)

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 62

Attempt 2 - The “right” way – Open-Ended Exploration (5m)

In this “correct” attempt, the MD and SW speak equally, and the conversation begins with an open-
ended, non-judgmental exploration of the pt’s history with smoking. The MD and SW learn that the
pt’s goal is different than what they expected, and capitalize on his motivation to discuss smoking
cessation.

Verbal Non-Verbal (tone,
volume of voice, eye
contact,
distractions)
MI Notes IPP Notes
MD So, Mr. Harris, we’ve
covered quite a bit
here already but it
would help us if we
could spend a few
minutes talking about
your smoking. Our goal
is to really understand
more about it from
your viewpoint.

Sitting next to
patient, making eye
contact, voice exudes
genuine interest. Use
of “we” and “our”
(alignment of IP
team and pt).
• Summarizing
• Open-ended
questions
• Support Self-
Efficacy

Using “we” and
collaborative
language. Inviting
partnership with
the patient.
Pt OK Hesitantly, looking
out past foot of bed,
no eye contact

SW So (pause) maybe you
can help us. We want
to understand a little
more about your
smoking. Can you tell
us when you started
smoking?
Sitting next to
patient, opposite
MD. Exploring with
soft voice.
• Open-ended
questions

Prioritizing the
patient’s
experience.
Aligning with
MD’s concerns
and presenting as
a collaborative
team.
Pt It’s been a part of my
life since high school.
It’s what I’ve always
done-like eating and
drinking.

Matter of fact in
quiet voice, looking
out past foot of bed,
no eye contact.
Coughs afterwards.

SW Since high
school….That’s helpful
to know. Have you ever
Expressing validation
and Exploration
• Reflective
listening

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 63

Verbal Non-Verbal (tone,
volume of voice, eye
contact,
distractions)
MI Notes IPP Notes
thought about
quitting?
Pt No, not really. It’s just
part of my routine. It’s
what I do.

Matter of fact in
quiet voice, looking
out past foot of bed,
no eye contact.
Coughs afterwards.

MD We can understand
that. So if you stop, a
big part of your life will
change. What do you
think would happen if
you quit?
Expressing empathy
and alignment as
inter professional
team (MD & SW with
patient). Further
exploration.
• Elicit change
talk

Pt I really don’t know.
That’s hard for me to
imagine. I can count on
having my cigs. It’s
something steady in my
life. There’s haven’t
been too many things
that are steady in my
life.
Hesitancy in voice,
pondering the
question looking out
past foot of bed, no
eye contact.

MD So you rely on it MD is using a
reflective statement
to elicit change talk
Not rushing to a
solution.
Allowing time to
build rapport and
hear from pt
about his own
concerns and
priorities.
Pt Well, I never really
thought about it. I
guess it calms me
down. It’s just…it’s
what I do to relax.
Pauses to think
about it for a minute.

SW It sounds like smoking
has been helpful to you
at various times in your
life—helping you cope
with ups and downs…
Reflective listening • Reflective
listening
• Summarizing

Reflecting what
we’ve learned
from the patient –
also demonstrating
that he is being
heard.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 64

Verbal Non-Verbal (tone,
volume of voice, eye
contact,
distractions)
MI Notes IPP Notes
Pt Yeah
SW What do you think
might happen if
smoking wasn’t a part
of your life?
Exploring pt’s
thoughts/feelings
• Open-ended
questions

Pt I don’t know. Hesitant voice
SW Mr. Harris, earlier Dr.
______ talked about
your smoking really
affecting your health
and how you will need
extra oxygen if you
don’t stop. We
understand that was a
lot to hear. How are
you feeling about that?
Direct but supportive
voice. Confronting
the issue. Use of
word stop v. quit.
Empathy. IP
alignment.
Exploration.
• Affirmation
• Reflective
listening
• Open-ended
questions
• Summarizing

SW is honing in
on the pt’s
motivation.
Pt Not so good. I still don’t
understand why now.
I’ve been able to
handle it until now.
Worn down. Coughs
at the end.

MD Well, we think the
years of regular
smoking just caught up.

Pt Yeah, I guess so.
MD So, given what we’ve
talked about today, just
to get an idea of where
you’re at, how ready do
you feel to give up
smoking right now?
Assessment of where
pt is in terms of
behavioral change
• Affirmation
• Reflective
listening
• Open-ended
questions
• Summarizing

Pt Right now?
MD Well, on a scale of 1- 10
with 1 being not ready
at all and 10 being
totally ready….what

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 65

Verbal Non-Verbal (tone,
volume of voice, eye
contact,
distractions)
MI Notes IPP Notes
number would you
choose?
Pt I guess about a 6
because I need to stay
at Andrews. I can’t be
looking for new
housing.
Unconvincing but
realistic tone

SW Wow, that’s great.
What do you think
made you pick 6
instead of 3?
• Affirmation
• Elicit change
talk

Pt Well, I just really need
to stay at Andrews. I’ve
been through other
shelters before. And at
this place they treat me
pretty good, and the
lady that works there,
Claudia, says I am on a
waiting list for an
apartment. If I get
kicked out because of
some oxygen tank I’ll
go back to the bottom
of the list. I just can’t
do that again. So…. I’ll
do what it takes to stay
there.
Pt is explaining his
motivation.

MD OK a six. It sounds like
maintaining your
current housing is a
motivating factor for
you.
Enthusiastically.
Reflective listening.
• Reflective
listening

MD and SW are
aligned,
collaborating,
and sharing
space in the
intervention
effectively. Both
are aligned in
using their
expertise to
support pt’s
motivation.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 66

Verbal Non-Verbal (tone,
volume of voice, eye
contact,
distractions)
MI Notes IPP Notes
Pt Yeah, I cannot lose my
place on the waiting
list. No way. So what
do I gotta do next?
Flatly but inquiring
SW Let’s work together to
develop a plan that you
like, and that will work
best for you. It is
challenging to quit but
many people are able
to do it when they
want to.
IP team and pt
alignment.
Summarizing.
Validating.
Normalizing.
Collaborative
language.
MD Mr. Harris. It sounds
like you are at a point
where you want to
attempt to quit. We are
glad to hear that and to
help you do that. We’ll
give you a chance to
rest and come back
early afternoon to
discuss some options.
Does that sound OK?
Reflective listening,
empowering, joining,
aligning,
summarizing.
• Affirmation
• Summarizing

Checking in with
the patient.
Pt Yes. Is the plan for me
still to go back to
Andrews today?
Flatly but inquiring
SW Yes, they have your
room ready and if
you’re medically
cleared you will be
discharged. We will
develop a plan though
to quit smoking and
provide some supports
so you can do that after
you leave.
Confirming,
summarizing.
• Affirmation
• Summarizing

Pt OK. Nods solemnly.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 67

Attempt 2 – Discussion (10m)

After the role play, the 3 facilitators (Lead, SW, MD) will join the small groups to pose the following
questions and enable to students to discuss the below points. Student reporter will take notes.

1. What did you notice about the patient’s [body language, speech, demeanor] when the
subject of smoking cessation was introduced?
2. What did you learn about the patient’s motivation to quit smoking?
3. What is the goal for each: patient, SW, MD? [Venn diagram]

(Additional questions below to be used as prompts for facilitators if needed)
4. Can you identify non-verbal communication skills/responses that were effective? (MI
perspective, IPP perspective)
5. Can you identify specific verbal communication skills/responses that were effective? (MI
perspective, IPP perspective)

Points for the Facilitators to Address:
• The MD and SW both used open ended questions to assess Mr. Harris’ motivation. They
listened to his answers and reflected them back to him to ensure understanding and
partnership with the patient.
• The MD and SW both used empathy and reflective listening effectively.
• The MD and SW shared power, space and both utilized their own expertise effectively in this
intervention.
• Mr. Harris felt heard and his concerns were acknowledged.
• The MD and SW capitalized on the strengths that Mr. Harris presented. Mr. Harris really
wants to stay in his current shelter – this is the springboard for other positive life changes
(quitting smoking). The MD and SW acknowledged his motivation as a strength.
• Will he quit smoking? Unsure, but the seed for change was planted effectively because it
stemmed from the pt himself and the motivations that were important to him – not
because someone told him what to do.
• Did it seem like this took longer? It actually was only 3 minutes. It doesn’t have to take long
to do this kind of intervention. It feels longer because it involves tolerating some ambiguity
with the patient and not rushing to a solution. But it is more effective in the long run.

After the discussion, the Lead Facilitator will reconvene the session and invite each group reporter
to share a brief recap of what they discussed. (5m)

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 68

X. Debrief Discussion with Whole Group (10m)

The larger group will reconvene and the Facilitators will lead discussion of the questions below.

1. How did this encounter make you feel?
2. Where did you see the MD/SW collaboration work well? Work not as well?
3. What is the unique contribution of the MD? Do they have a unique contribution?
4. What is the unique contribution of the SW? Do they have a unique contribution?
5. What was the most challenging aspect of the encounter?
6. What would be your next step(s)?

XI. Evaluation Form (10m)

The disciplines will then split into small group sessions from 11a-12p.

Please leave 10 minutes for every participant to fill out an evaluation form (Appendix I) in the
beginning of the small group session.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 69

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix A – IPE/IPP Overview

Welcome to our second inter professional education session this semester with both 2nd year
medical and social work students. All of you were together for Dr. Lin’s lecture last week on
Motivational Interviewing and its use in smoking cessation. Today we’ve divided everyone into
four different classrooms for an interactive session that will build on what you’ve learned about
motivational interviewing and smoking cessation and add a piece on inter professional practice
between medicine and social work. Today’s session will be very interactive and feature human
simulation learning through a case role play, followed by small group and large group discussions, a
debrief and then the ability to practice.

Inter Professional Education Session
Medicine & Social Work

Inter Professional Practice and
Motivational Interviewing

November 13, 2019

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 70

First we’d like to provide some background that some of you may be familiar with related to our
health care system. This graph shows data from a 2017 report issued by the Commonwealth Fund. It
compares health care system performance with spending of 11 high-income, industrialized
countries, inc. the United States. The analysis is based on 72 indicators that measure health care
performance and delivery in five domains important to policymakers, providers, patients, and the
public: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes.
Spending is based on percentage of Gross Domestic Product. As shown in this graph, the United
States is ranked lowest in performance and highest in spending and well below the 11-country
average for both. This has been the trend for quite some time. Something needs to change. As we
know many efforts are underway nationally and locally to change this since the passage of the
Patient Protection and Affordable Care Act (PPACA).

Health Care System Performance Compared to Spending
Performance:
72 indicators in 5
domains:
-Care Process
-Access
-Administrative Efficiency
-Equity
-Health Outcomes
Health Care Spending as % Gross Domestic Product

Commonwealth Fund Report, 2017
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 71

One issue that contributes to poor health outcomes is different disciplines in the health care setting,
such as doctors and social workers, working in silos and as a result patients often are not receiving
comprehensive, integrated and coordinated care. Many of us can think of times when we were
patients or caregivers when this was unfortunately the case and we had to get involved to inform
members of the health care team what was happening and coordinate, at a time, when we’re often
most vulnerable.
It seems logical that in 2019, in the United States that everyone deserves comprehensive,
integrated, and coordinated health care…so, why doesn’t it happen?
The reasons are many and complex. They reflect longstanding, systemic issues, as well as values.
Our idea is to focus on our health care delivery system and the people who staff it… specifically,
doctors, nurses, and social workers. And to look at how our health care teams are functioning.
Our proposed solution is the Partnership for Excellence in Inter professional Education and
Practice in Health Care. The basic premise is learn together to work together. One part of this effort
is with medical and social work students.
ONE ISSUE
Patients are not receiving comprehensive,
integrated and coordinated care

due to silos in which different disciplines
function in the health care setting

this can lead to poor health outcomes
SOURCE Atomic Spin Image
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 72

Our idea is to focus on our health care delivery system and the people who staff it… specifically,
doctors, nurses, and social workers. And to look at how our health care teams are functioning.
Our proposed solution is the Partnership for Excellence in IPE and Practice in HC. The basic
premise is learn together to work together. One part of this effort is with medical and social work
students.
The national conversation about the need for inter professional collaboration began when the
Institute of Medicine first discussed the merits of team-based care and inter professional education
in 1972.
The passage of the Recovery and Reinvestment Act in 2009 and the Patient Protection and
Affordable Care Act of 2010 emphasized the importance of inter professional practice within the
primary care environment.
This groundwork along with the current health care landscape shifting from a pay for volume
(supply based) to pay for value based, our regulatory requirements becoming IPP focused and the
alarming statistics shared earlier makes it prime time to implement IPE and IPP.
Partnership for Excellence in Inter Professional
Education and Practice in Health Care
SOURCE: Image: WHO
Proposed Solution
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 73

In 2009, the Inter Professional Education Collaborative (IPEC) was established, which included
fifteen health care professions (inc. SW) to promote and encourage efforts that would advance
substantive inter professional learning experiences. It developed four core inter professional
competencies all with sub competencies, value/ethics (10), role/responsibilities (10),
communication (8) and team/teamwork (11).
In 2014, the Health Professional Accreditor’s Collaboration (HPAC) was formed and five
professional education accrediting commissions joined and now have inter professional practice
standards; Liaison Committee on Medical Education (LCME) is one of them and as of 2019,
requires that medical schools meet a standard of Inter professional Collaborative Skills in order to
be re-accredited. Social Work is expected to follow in 2022 when the Council for Social Work
Education releases their next set of standards.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 74

!
The$ Art$ and$ Science$ of$ Medicine$
Inter$ Professional$ Education$ for$ Second7Year$ Medical$ and$ Social$ Work$ Students$ 7$ Faculty$ Guide$
1$
!
1. Both$physicians$and$social$workers$in$a$health$care$setting$often$need$to$promote$
behavioral$change$with$patients$to$impact$their$health$and$well7being.$Motivational$
Interviewing$is$a$technique$to$promote$behavioral$change$that$is$evidence7based$
and$ widely$ used$ in$ both$ disciplines.$
$
2. Effective$ inter$ professional$ practice$ results$ in$ improved$ patient$ and$ staff$
satisfaction,$ coordination$ of$ patient$ care$ delivery$ and$ there$ is$ growing$ evidence$ that$
it$ can$ have$ a$ positive$ impact$ on$ patient$ outcomes.$
$
$
3. By$educating$students$of$different$disciplines$together,$they$will$be$able$to$
understand$each$other ’s$professional$roles$and$learn$how$to$deliberately$work$
together$ to$ provide$ better$ patient$ care.$
$
Session Premises
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 75

Session Goals and Objectives
! IPE$ Session$ Learning$ Objective$
By# the# end# of# this# motivational# interviewing# large#
group# IPP# session,# second# year# medical# students# and#
social# work# students# will:#
Related$ Competency$ Area$
1" Identify"and"describe"the"roles"and"responsibilities"
of"physicians"and"social"workers"as"part"of"an"inter"
professional"care"team"in"a"critical"care"context."
"
Inter"professional"Roles"and"
Responsibilities"
2" Recognize"and"implement"use"of"patient>centered"
language"that"is"common"to"all"care"team"members"
and"understandable"by"patients."
"
Inter"professional"
Communication"
3" Recognize"and"explain"the"process"of"team"
development"and"team"dynamics"in"a"healthcare"
setting,"including"concepts"of"shared"accountability"
for"patient"outcomes"and"identification"of"one ’s"
professional"role"on"the"team."
"
Inter"professional"Teams"and"
Teamwork"
4" Describe"and"evaluate"the"ethical"frameworks"that"
guide"health"care"professions"and"person>centered"
care,"recognizing"commonalities"and"differences"in"
values"among"care"team"members"and"between"
care"team"members"and"patients."
"
Inter"professional"Values"and"
Ethics"
!
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 76

Session Goals and Objectives
! IPE$ Session$ Learning$ Objective$
By# the# end# of# this# motivational# interviewing# large#
group# IPP# session,# second# year# medical# students# and#
social# work# students# will:#
Related$ Competency$ Area$
1" Observe"the"principles"of"motivational"interviewing"
demonstrated"in"a"patient"care"scenario"
"
Motivational"Interviewing"
and"Behavior"Change"
2" Identify"the"stages"of"behavioral"change"in"a"patient"
care"scenario"
"
Motivational"Interviewing"
and"Behavior"Change"
3" Observe"the"physician"and"social"worker"approach"
when"working"with"a"patient"in"each"stage"of"
change"and"patient ’s"active"role"in"a"behavioral"
change"encounter"
"
Motivational"Interviewing"
and"Behavior"Change"
4" Discuss"effective"communication"techniques"
utilized"in"motivational"interviewing"
"
Motivational"Interviewing"
and"Behavior"Change"
5" Articulate"some"of"the"challenges"in"motivational"
interviewing"
"
Motivational"Interviewing"
and"Behavior"Change"
6" Reflect"on"how"the"approach"of"the"physician"and"
social"worker"adjusts"when"working"with"a"patient"
towards"behavioral"change"
"
Motivational"Interviewing"
and"Behavior"Change"
!
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 77

Mr. Harris is a 55 y.o. man who speaks English. He is homeless and has a primary
diagnosis of Chronic Obstructive Pulmonary Disease (COPD). He is a lifelong
smoker, with no prior attempts to quit. Mr. X has been living in the Andrews Safe
Haven shelter for the last 10 months; prior to that he was in and out of the Wards
Island temporary shelter for about a year. Mr. Harris is currently hospitalized for a
COPD exacerbation. This is his third hospitalization in the last six months. He has
been in the hospital for 6 days now and is medically stable for discharge today.
During the hospitalization, he nearly required intubation but was able to improve
on BiPAP, steroids, nebulizers, and antibiotics. He is on maximal medical therapy
with multiple inhalers and still has low oxygen. The medical team says he is on
the borderline of needing oxygen all the time at home. At the start of this
encounter, the attending MD and SW speak in unit hallway before meeting with
Mr. X to collaborate and discuss the next steps in his care.

BiPap – Bilevel Positive Airway Pressure. Electronic breathing device that pushes air into the lungs to keep the
airways open when patients are very sick and in the hospital.
Steroids – A class of medications used to relieve swelling and inflammation. Used when people have asthma/COPD
exacerbations (amongst other things – there are many uses!) Examples are prednisone or cortisone.
Nebulizers – A drug delivery device to administer medication in the form of a mist inhaled into the lungs. Commonly
used for treatment of asthma, COPD and other respiratory diseases or disorders.
Antibiotics – Drugs used to treat bacterial infections.
Case Summary
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 78

This Venn diagram depicts the target of the encounter that we aim for in IPP-where the patient,
physician and social worker collaborate and align.
Patient
Physician Social Worker
Target of
Encounter
Venn Diagram
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 79

Pa ents are not even
thinking about making
a change
Pa ents are beginning to consider making a change, but are not
yet ready to make a commitment

Pa ents are preparing
for ac on to change in
the foreseeable future
Pa ents are
ac vely
implemen ng a
plan for change
Pa ents are maintaining
healthy lifestyle changes
they have made.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 80

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix B – Premises

1. Both physicians and social workers in a health care setting often need to promote
behavioral change with patients to impact their health and well-being. Motivational
Interviewing is a technique to promote behavioral change that is evidence-based and
widely used in both disciplines.

2. Effective inter professional practice results in improved patient and staff satisfaction,
coordination of patient care delivery and there is growing evidence that it can have a
positive impact on patient outcomes.

3. By educating students of different disciplines together, they will be able to understand
each other’s professional roles and learn how to deliberately work together to provide
better patient care

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 81

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix C – Goals and Objectives

General IPE Session Learning Objectives and Competencies
IPE Session Learning Objective
By the end of this motivational interviewing large
group IPP session, second year medical students and
social work students will:
Related Competency Area
1 Identify and describe the roles and responsibilities
of physicians and social workers as part of an inter
professional care team in a critical care context.

Inter professional Roles and
Responsibilities
2 Recognize and implement use of patient-centered
language that is common to all care team members
and understandable by patients.

Inter professional
Communication
3 Recognize and explain the process of team
development and team dynamics in a healthcare
setting, including concepts of shared accountability
for patient outcomes and identification of one’s
professional role on the team.

Inter professional Teams and
Teamwork
4 Describe and evaluate the ethical frameworks that
guide health care professions and person-centered
care, recognizing commonalities and differences in
values among care team members and between
care team members and patients.

Inter professional Values and
Ethics

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 82

Case-Specific IPE Session Learning Objectives and Competencies
IPE Session Learning Objective
By the end of this motivational interviewing large
group IPP session, second year medical students and
social work students will:
Related Competency Area
1 Observe the principles of motivational interviewing
demonstrated in a patient care scenario

Motivational Interviewing
and Behavior Change
2 Identify the stages of behavioral change in a patient
care scenario

Motivational Interviewing
and Behavior Change
3 Observe the physician and social worker approach
when working with a patient in each stage of
change and patient’s active role in a behavioral
change encounter

Motivational Interviewing
and Behavior Change
4 Discuss effective communication techniques
utilized in motivational interviewing

Motivational Interviewing
and Behavior Change
5 Articulate some of the challenges in motivational
interviewing

Motivational Interviewing
and Behavior Change
6 Reflect on how the approach of the physician and
social worker adjusts when working with a patient
towards behavioral change

Motivational Interviewing
and Behavior Change

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 83

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix D – Case Handout

Mr. Harris is a 55 y.o. man who speaks English. He is homeless and has a primary diagnosis of
Chronic Obstructive Pulmonary Disease (COPD). He is a lifelong smoker, with no prior
attempts to quit. Mr. X has been living in the Andrews Safe Haven shelter for the last 10
months; prior to that he was in and out of the Wards Island temporary shelter for about a
year. Mr. Harris is currently hospitalized for a COPD exacerbation. This is his third
hospitalization in the last six months. He has been in the hospital for 6 days now and is
medically stable for discharge today. During the hospitalization, he nearly required intubation
but was able to improve on BiPAP5, steroids6, nebulizers7, and antibiotics8. He is on maximal
medical therapy with multiple inhalers and still has low oxygen. The medical team says he is
on the borderline of needing oxygen all the time at home. At the start of this encounter, the
attending MD and SW speak in unit hallway before meeting with Mr. X to collaborate and
discuss the next steps in his care.

5 BiPap – Bilevel Positive Airway Pressure. Electronic breathing device that pushes air into the lungs to keep the
airways open when patients are very sick and in the hospital.
6 Steroids – A class of medications used to relieve swelling and inflammation. Used when people have
asthma/COPD exacerbations (amongst other things – there are many uses!) Examples are prednisone or
cortisone.
7 Nebulizers – A drug delivery device to administer medication in the form of a mist inhaled into the lungs.
Commonly used for treatment of asthma, COPD and other respiratory diseases or disorders.
8 Antibiotics – Drugs used to treat bacterial infections.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 84

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix E – Detailed Character Background for SP

Mr. Harris

Demographics
Mr. Harris is a 55 yo. man who speaks English. He is homeless and has a primary diagnosis of
Chronic Obstructive Pulmonary Disease (COPD). He is a lifelong smoker, with no prior
attempts to quit. Mr. Harris has been living in the Andrews Safe Haven shelter for the last 10
months; prior to that he was in and out of the Wards Island temporary shelter for about one
year.

Appearance/Demeanor:
Mr. Harris appears reasonably well-groomed, despite wearing worn clothing. He often
appears tired and haggard, and he typically smells of cigarette smoke. He has a raspy cough.
He is not a big talker, but is respectful, with a slightly flattened affect. He is a bit suspicious
and appears apathetic at times; his apathy stems from skepticism that anyone in the health
care “system” is going to be able to help him. At times, he exhibits some embarrassment about
his situation.

Medical Situation:
• 3 hospitalizations for COPD in the last 6 months
• Current symptoms are:
o Cough, chronic and non-productive, with frequent coughing fits
o Shortness of breath with minimal exertion. Unable to walk more than 1-2 blocks
without stopping to catch his breath
o Slow weight loss of 10 pounds over the past year, notes that his clothes are
looser
• Current hospitalization:
o He has been in the hospital for 6 days now
o Presented to the hospital after a stranger on the street saw that he was unable
to catch his breath after going up a hill on a cold day
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 85

o Nearly required intubation but was able to improve on BiPAP9, steroids10,
nebulizers11, and antibiotics12
o He is on maximal medical therapy with multiple inhalers and still has low
oxygen
o Doctors at the hospital say he is on the borderline of needing oxygen all the time
at home
• Smoking cessation is a must
o If he doesn’t stop smoking, his COPD and shortness of breath will continue to
get worse. He may need to be intubated at his next hospitalization and it is
unlikely that he will be able to be weaned off a breathing machine. He also may
die sooner from his COPD if he does not stop smoking.
• Home medications: fluticasone-salmeterol inhaler13 twice a day, tiotropium inhaler14
twice a day, and ipratropium15 as needed

Social Stressors:
• Homelessness
o Shelter requirements
o –No smoking onsite
-No 02 allowed on site
-Must be able to climb stairs

If he doesn’t quit smoking, he will jeopardize his shelter bed and prospects for stable housing.

Other stressors/psychosocial factors:
• Lack of social support
• Paranoid
• Hx of distrust of medical system
• Stigma (of disease, of culture, race, etc.)

9 BiPap – Bilevel Positive Airway Pressure. Electronic breathing device that pushes air into the lungs to keep the airways open
when patients are very sick and in the hospital.
10 Steroids – A class of medications used to relieve swelling and inflammation. Used when people have asthma/COPD
exacerbations (amongst other things – there are many uses!) Examples are prednisone or cortisone.
11 Nebulizers – – A drug delivery device to administer medication in the form of a mist inhaled into the lungs. Commonly used
for treatment of asthma, COPD and other respiratory diseases or disorders.
12 Antibiotics – – Drugs used to treat bacterial infections.
13 Fluticasone-Salmeterol inhaler – Combination steroid-beta agonist that works to reduce inflammation and open up airways
for patients with asthma or COPD. Patients take this twice a day to keep their breathing controlled.
14 Tiotropium inhaler – An anticholinergic inhaled medicine that works to keep the airways open
15 Ipratropium - An anticholinergic inhaled medicine that works to keep the airways open, comes in nebulizer form
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 86

Employment, Insurance and Finances
Mr. Harris is currently unemployed and supported by SSI16 and his care is covered by
Medicaid17.

Family History/Other Personal Background:
Childhood History

• Grew up in NYC projects.
• Youngest of three – has two significantly older sisters.
• He grew up with family instability – his parents died when he was a teenager. His
father and mother both smoked heavily. His father did odd jobs and died suddenly in a
factory accident. His mother died about a year later from breast cancer, when Mr.
Harris was 14. His eldest sister helped care for him for few years but became less
involved over time.
• He is now estranged from his siblings. They live far away and he has no contact with
them.
• He has an aunt who lives in NJ and helped him out from time to time. She is now elderly
and unable to assist.

Smoking History
• Started smoking at 15.

Family Supports:
• Mr. Harris is socially isolated.
• Always been a loner, which he appears OK with, but he had one serious relationship in
his 30s. He used to live with a woman, but once the relationship ended, he lost his
home and that’s when he found the bodega arrangement, which was in the
neighborhood where he’d lived.
• He has an elderly aunt in New Jersey but hasn’t seen her in about ten years.
• He never married and has no children.

Education/Work History
• Dropped out of high school after 10th grade
• Employed for many years at loading dock in a Garment District factory, unloading truck
deliveries. Forced to leave his job due to health deterioration.

16 SSI – Supplemental Security Income - Supplemental Security Income (SSI) is a Federal income program designed to help
aged, blind, and disabled people, who have little or no income; it provides cash to meet basic needs for food, clothing and
shelter.
17 Medicaid - Medicaid is a social health care program for low income individuals including children, non-disabled adults,
pregnant women and Individuals with disabilities.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 87

Homelessness
• Most recently, he worked off the books in a bodega, had a small room in the back. He
stocked shelves, cleaned, took care of things in exchange for a small room. Bodega
closed due to neighborhood gentrification, and he lost both his job and his home.

Hx of alcohol/substance use
• Limited coping skills – smokes for comfort. Not an active choice; it’s what he does.
Drinks beer regularly in moderation.

Established primary and pulmonary care
• Hx of distrust of MDs/system
• Episodic primary care – comes when he’s getting worse. Health decline over 40 years.

Spiritual Hx:
• Grew up loosely Christian – aunt in NJ took him to church occasionally
(denomination?)
• He believes in God but not connected formally to any spiritual supports.

Presenting Situation:
• Pt being discharged back to shelter after third hospitalization for Chronic Obstructive
Pulmonary Disease (COPD)18 exacerbation in 6 months.
• Attending Physician and Social Worker on the inpatient unit meet with Mr. Harris t at
the bedside to discuss his discharge plan (finish IV antibiotics today and be discharged
back to shelter tomorrow).
• Attending physician and social worker have worked together for several months on
this inpatient unit.

SP goals/intentions
• Just wants to go back to shelter
• Afraid of losing shelter bed (again)
• Wants to get life back on track and get stable housing

MD goals/intentions
• Convey importance of quitting smoking/ risks if he does not quit smoking
• Convey importance of adherence and follow-up
• Collaborate w/pt and SW to assess pt’s readiness to quit and formulate plan to do so

SW goals/intentions
• Explore pt’s understanding and agreement w/DC plan
• Advocate for pt’s needs and values w/medical team

18 Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable respiratory disease
that affects more than 5% if the population and is associated with high levels of sickness and death. Common
symptoms are chronic cough, sputum, and shortness of breath. Often develops after years of smoking, though can
have genetic causes as well.
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 88

• Collaborate w/pt and MD to assess pt’s readiness to quit and formulate plan to do so

Background on Disease:

COPD
• COPD stands for Chronic Obstruction Pulmonary Disease
• It is a common, preventable, and treatable respiratory disease that affects more than
5% if the population and is associated with high levels of sickness and death
• COPD is the third ranked cause of death in the United States
• The most important risk factor for COPD is smoking cigarettes
• Common symptoms include chronic cough, shortness of breath, wheezing, sputum
production, and fatigue
• COPD is not reversible. It is treated with a variety of inhalers to decrease symptoms,
and with smoking cessation to slow progression of disease. When COPD is severe,
patient may have chronically low oxygen and require supplemental oxygen at all times

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 89

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix F – Venn Diagram

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 90

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix G – Stages of Change

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 91

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix H – Motivational Interviewing Principles

Reminder of Principles for Facilitators:
o General MI Principles
▪ Express Empathy
▪ Develop Discrepancy
▪ Roll with Resistance
▪ Support Self-Efficacy
o Micro Skills
▪ Affirmation
▪ Reflective listening
▪ Open-ended questions
▪ Summarizing
▪ Elicit change talk
o OARS = open-ended questions, affirmations, reflective listening & summarizing
o MI Pitfalls
▪ Question-answer trap: patterns of question/answer
▪ Expert trap: providing direction without first helping to determine goals
▪ Labeling trap: applying labels to the situation
▪ Blaming trap: blaming either the patient or others for the issue
▪ Premature action planning: jumping too quickly into planning when
commitment to change has not been strengthened
▪ Fix-it trap: putting in own perspectives and solutions

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 92

The Art and Science of Medicine:
Inter Professional Education for Second-Year Medical and Social Work Students
Faculty Guide
Appendix I – Evaluation Form

Please complete the following form to share your related experience for this position. All
fields are optional.

Gender: Race:
Male American Indian or Alaska Native.
Female Asian
Non-Binary Black or African American
Native Hawaiian or Other Pacific Islander
White

Discipline: Age:
Medicine 21-30 years old
Social Work 31-40 years old
41-50 years old
Over 50 years old

Prior learning in Inter Professional Education (IPE) with mixed disciplines

Yes Date(s): _________________________ No

If yes, describe:
____________________________________________________________________________________________

____________________________________________________________________________________________

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 93

Part I: Program Evaluation
Using the scale below, please record your feelings about the below statements. You can place a
checkmark in the box that best corresponds to your response.

5
Strongly
Agree
4
Agree
3
Neither
Agree
nor
Disagree
2
Disagree
1
Strongly
Disagree
1. The lead facilitator was
effective in guiding discussion
and providing feedback.

2. The acted scenario was
realistic and effective in
portraying the medical and
psychosocial needs of patients.

3. The level of challenge of
today’s session was
appropriate to my future role
as a physician or social worker.

4. The post-simulation debrief
was helpful to me.

5. Working with students from
another health profession
enhances my education.

6. Participating in educational
experiences with students
from another health profession
enhances my future ability to
work on an inter professional
team.

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 94

Part II: IPP Knowledge and Skills Assessment
Using the scale below, please record your feelings about the below statements. Please
describe the extent to which your understanding of the below items was enhanced by this
session. You can place a checkmark in the box that best corresponds to your response.

As a result of this session, I am
better prepared to:

5
Strongly
Agree
4
Agree
3
Neither
Agree
nor
Disagree
2
Disagree
1
Strongly
Disagree
1. Identify and describe the roles
and responsibilities of
physicians and social workers
as part of an inter professional
care team.

2. Recognize and implement use
of patient-centered language
that is common to all care
team members and
understandable by patients.

3. Recognize and explain the
process of team-based care,
including concepts of shared
accountability for outcomes
and identification of one’s
professional role on the team.

4. Describe and evaluate the
ethical frameworks that guide
health care professions and
person-centered care,
recognizing commonalities and
differences in values among
care team members and
between care team members
and patients.

5. Identify the stage of behavioral
change in this patient care
scenario

6. Discuss effective
communication techniques
utilized in motivational
interviewing

7. Articulate some of the
challenges in motivational
interviewing

8. Reflect on how the approach of
the physician and social

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 95

worker differs when working
with a patient towards
behavioral change

9. The most valuable takeaway from my experience today was:

__________________________________________________________________________________________________________

10. What was least valuable about today’s session?

__________________________________________________________________________________________________________

11. Please add any additional comments:

__________________________________________________________________________________________________________

12. I am willing to participate on a future advisory board (brief time commitment) to
provide further feedback on this program, especially how what I’ve learned applies to my
practice.

Note: Inter professional Socialization and Valuing Scale—21 (ISVS-21) will replace Part II for
this form after first session (on following pages).
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 96

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 97

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 98

Appendix C: Inter Professional Education Collaborative (IPEC) Competencies/Sub Competencies
Core Competency Sub Competencies
VALUES AND
ETHICS
Work with individuals
of other professions to
maintain a climate of
mutual respect and
shared values.
1. Place interests of patients and populations at center of inter professional health care
delivery and population health programs and policies, with the goal of promoting health
and health equity across the life span.
2. Respect the dignity and privacy of patients while maintaining confidentiality in the
delivery of team-based care.
3. Embrace the cultural diversity and individual differences that characterize patients,
populations, and the health team.
4. Respect the unique cultures, values, roles/ responsibilities, and expertise of other
health professions and the impact these factors can have on health outcomes.
5. Work in cooperation with those who receive care, those who provide care, and others
who contribute to or support the delivery of prevention and health services and programs.
6. Develop a trusting relationship with patients, families, and other team members
(CIHC, 2010).
7. Demonstrate high standards of ethical conduct and quality of care in contributions to
team-based care.
8. Manage ethical dilemmas specific to interprofessional patient/population centered care
situations.
9. Act with honesty and integrity in relationships with patients, families, communities,
and other team members.
10. Maintain competence in one's own profession appropriate to scope of practice.
ROLES &
RESPONSIBILITIES
Use the knowledge of
one's own role and
those of other
professions to
appropriately assess
and address the health
care needs of patients
and to promote and
advance the health of
populations.
1. Communicate one's roles and responsibilities clearly to patients, families, community
members, and other professionals.
2. Recognize one's limitations in skills, knowledge, and abilities.
3. Engage diverse professionals who complement one's own professional expertise, as
well as associated resources, to develop strategies to meet specific health and healthcare
needs of patients and populations.
4. Explain the roles and responsibilities of other providers and how the team works
together to provide care, promote health, and prevent disease.
5. Use the full scope of knowledge, skills, and abilities of professionals from health and
other fields to provide care that is safe, timely, efficient, effective, and equitable.
6. Communicate with team members to clarify each member's responsibility in executing
components of a treatment plan or public health intervention.
7. Forge interdependent relationships with other professions within and outside of the
health system to improve care and advance learning.
8. Engage in continuous professional and inter professional development to enhance team
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 99

performance and collaboration.
9. Use unique and complementary abilities of all members of the team to optimize health
and patient care.
10. Describe how professionals in health and other fields can collaborate and integrate
clinical care and public health interventions to optimize population health.
INTER
PROFESSIONAL
COMMUNICATION
Communicate with
patients, families,
communities, and
professionals in health
and other fields in a
responsive and
responsible manner
that supports a team
approach to the
promotion and
maintenance of health
and the prevention and
treatment of disease.

1. Choose effective communication tools and techniques, including information systems
and communication technologies, to facilitate discussions and interactions that enhance
team function.
2. Communicate information with patients, families, community members, and health
team members in a form that is understandable, avoiding discipline-specific terminology
when possible.
3. Express one's knowledge and opinions to team members involved in patient care and
population health improvement with confidence, clarity, and respect, working to ensure
common understanding of information, treatment, care decisions, and population health
programs and policies.
4. Listen actively, and encourage ideas and opinions of other team members.
5. Give timely, sensitive, instructive feedback to others about their performance on the
team, responding respectfully as a team member to feedback from others.
6. Use respectful language appropriate for a given difficult situation, crucial
conversation, or conflict.
7. Recognize how one's own uniqueness (experience level, expertise, culture, power, and
hierarchy within the health team) contributes to effective communication, conflict
resolution, and positive inter professional working relationships (University of Toronto,
2008).
8. Communicate the importance of teamwork in patient-centered care and population
health programs and policies.
TEAMS &
TEAMWORK
Apply relationship-
building values and the
principles of team
dynamics to perform
effectively in different
team roles to plan,
deliver, and evaluate
patient/population-
centered care and
population health
programs and policies
that are safe, timely,
efficient, effective, and
1. Describe the process of team development and the roles and practices of effective
teams.
2. Develop consensus on the ethical principles to guide all aspects of team work.
3. Engage health and other professionals in shared patient-centered and population-
focused problem- solving.
4. Integrate the knowledge and experience of health and other professions to inform
health and care decisions, while respecting patient and community values and
priorities/preferences for care.
5. Apply leadership practices that support collaborative practice and team effectiveness.
6. Engage self and others to constructively manage disagreements about values, roles,
goals, and actions that arise among health and other professionals and with patients,
families, and community members.
7. Share accountability with other professions, patients, and communities for outcomes
INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 100

equitable.
relevant to prevention and health care.
8. Reflect on individual and team performance for individual, as well as team,
performance improvement.
9. Use process improvement to increase effectiveness of inter professional teamwork and
team-based services, programs, and policies.
10. Use available evidence to inform effective teamwork and team-based practices.
11. Perform effectively on teams and in different team roles in a variety of settings.
Adapted from Inter Professional Education Collaborative (2016)

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 101

Appendix D: Center for Inter Professional Education and Practice in Health Care Offerings
Center for Inter Professional Education and Practice in Health Care
1. e-Learning Modules in host organization’s Learning Management System
(LMS) for self-study
2. Website (internal facing for staff on intranet and public facing on internet)
3. Videos (of HBSL cases, featured IPP topics, stories by learners post-session,
inter professional teams in practice areas and patients/care partners about
their experiences)
4. Podcasts (with subject matter experts, expo day/conference features,
learners, patients/care partners, health care professionals)
5. Articles (external and those written by host organization)
6. Customized interventions (HBSL cases/other) by specific practice areas
7. Expo (information tables, poster session, grand rounds, internal/external
speakers inc. teams at host/other organizations)
8. Student Programs (Medicine, Nursing, Social Work, Spiritual Care)
9. Course Offerings (Live or e-Learning) for CEs (internal and external
audiences)
10. Curriculum in MS for Health Care Leadership, Masters in Public Health
Program (at host organization)
11. Foundational Course for Care Team Members (as part of discipline
specific onboarding for new hires, mixed discipline learning audience)
12. Annual Staff Competency in IPE/IPP (using IPEC Core Competencies, in
LMS)
13. Part of MSHS Core Values (in New Beginnings (main orientation-day 1 of
work for all staff), and for rating in annual Performance Appraisal)
14. External Requests for Consultation (by other health care organizations,
community based organizations, graduate schools; mutiiple consulant
options)

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE

24

Appendix E: Logic Model
Program: Partnership for Excellence in Inter Professional Education and Practice in Health Care

Goal: Improve the inter professional practice skills of health care professional workforce and graduate students to provide comprehensive, coordinated and integrated health care to
patients, especially those with social determinants of health inequalities through inter professional education.
INPUTS ACTIVITIES OUTCOMES
What we invest What we do Who we reach
Why this project: short-
term results
Why this project: intermediate
results
Why this project: long-
term results
-Hospital and School of Medicine
(H/SOM) Senior Leadership in
Targeted Disciplines
(Strategy/Positioning)

-Leadership in Targeted Disciplines
Time & Expertise (8; Program Design
& Development)

-Session Faculty (10; Facilitators in
Targeted Disciplines)

-Actors (10; Standardized Patients-SPs)

-Space (Conference/Class Rooms)

-Funding (Grant/Organization (Medical
Education $, In-Kind))

-Partners (Internal/External; Subject
Matter and Technical Experts)

-Literature, Media, Meeting/Interview
Findings
-Meetings between program
& organizational leadership
(ensure support, positioning
& alignment with other
organizational initiatives)

- SWOT (Strengths,
Weaknesses, Opportunities,
Threats) analysis of
organizational current state
related to IPE/IPP

- IPE Program Prototyping &
Final Program Design

-IPE Content: Curriculum
Development, Faculty User
Guide & Measurement Tools

-Recruitment & Training of
Faculty

-Casting/Training of 10 SPs

-Marketing, Recruitment &
Enrollment of Learners

-Conduct IPE Sessions (9)
-32 Health Care
Workforce
(Learners)

-169 Health Care
Graduate
Students
(Learners)

-28 Faculty
(Leads,
Facilitators &
Actors)

-Senior
Leadership

-H/SOM
Leadership

-Patients /Care
Partners

-H/SOM Senior Leadership
Support (current program goals
& offer ideas, insights,
connections to resources)

-Program Leadership Alignment
& Participation

-10 Faculty Hired and 10 SPs
Casted; Training on HBSL
Methodology Related to IPP
Cases

-User Guide Completed for
Facilitators & SPs

-9 IPE Sessions Launched

-Information Technology in
Place for Data Collection &
Analysis

-H/SOM Senior Leadership: Invested in
Program & Foster Linkages to
Organizational Initiatives, Networking
Opportunities, Alternative Funding

-Program Leadership: Collectively
Evaluating Program Outcomes, Making
Quality Improvements and Planning for
Future Program Expansion

-Faculty: High Satisfaction with Program &
Teaching; 100% Faculty Retention

-Learners: Positive Evaluation Data (95%
overall program satisfaction; 95% rating
“very great/great” extent IPP Knowledge,
Understanding & Application to Practice;
High Registration/Attendance Rate
(Voluntary Learners)

-Targeted Number of IPE Learning Sessions
(9) with Targeted Number of Learners (201)
Completed

-Robust Data Collection and Analysis
(standardized instrument: Inter Professional
Socialization &Valuing Scale (ISVS-21)

-Copyright the IPE/IPP product through
Mount Sinai Innovation Partners
-Culture Shift and Public
Discourse on IPE/IPP Benefits in
Organization

-New SWOT Analysis of
Organization Demonstrates
Improvement in IPE/IPP State

-School of Medicine Receives
Re-accreditation by Liaison
Committee for Medical Education

-Inter Professional Exchange
(iPEX) Grant Goals Achieved

-Strategic Planning for Year 2 of
IPE/IPP Program

-Improvement in Patient Health
Outcomes: Hospital Consumer
Assessment of Health Care
Providers (HCAHPS) and
Electronic Medical Record
(Epic): decrease ED visits by 5%;
decrease all cause 30 day
readmissions 5%, 90% Patient
Satisfaction Rating
“usually/always” on key
indicators related to IPP;
improvement in disease specific
metrics (type/target set w.
practice areas)

Assumptions
-Senior leadership in host organization is supportive of IPE/IPP program
-Discipline specific leadership committed to time and collaborative effort to
develop and evaluate IPE/IPP program
-Facilitators and learners will actively participate in IPE/IPP sessions
External Factors
-Transforming health care landscape (increased coverage/access, aging population with chronic
health/behavioral health conditions, health care workforce expected growth, regulatory requirements,
high unnecessary costs, poor quality outcomes, change from volume to value-based payment system,
shift to preventive and integrated care, population heath and social determinants of health focus)
-Organized expansion of IPE nationally and globally (i.e. part of accreditation standards for health care
graduate schools)

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 25

Appendix F: Implementation Timeline
ARC
COMPONENTS
ARC PHASES Q3
2018
Q4
2018
Q1
2019
Q2
2019
Q3
2019
Q4
2019
Q1
2020
Q2
2020
Q3
2020
Q4
2020
PHASE 1: PROBLEM IDENTIFICATION
Building
Organizational
Leadership
- Meet with Medical Education and Social Work senior
leadership formally meet to discuss siloed approach to care
and its consequences, joint IPE/IPP program, requirements
and expectations. (IPE/IPP for students)
-Meet with Medical, Nursing, Social Work, Spiritual Health
to discuss problem and application for iPEX1 Grant and
embark on IPE/IPP initiative. (IPE/IPP for working
professionals)

Building Personal
Relationships
-Develop two work groups with selected leadership to
explore problem and brainstorm solutions based on
knowledge, experience and ideas.

Accessing &
Facilitating
Organizational
Networks
-Explore other key stakeholders internally and externally
who experience this problem and/or are interested/could
benefit from the solution or are already working on IPE/IPP
in some regard.

Building Teamwork
in Front Line
Clinical Teams
-Assess how well inter professional teams are functioning
in select practice areas among workforce and exposure in
field placements/rotations (students) and what baseline
knowledge of IPE/IPP exists.

Providing
Information &
Training Related to
Clinical Innovation
-Conduct research on existing problem and IPE/IPP
programs/models (journal articles, web based, interviews
internally/externally with subject matter experts)
-Review IPE Re-Accreditation Standard for LCME2 and
ensure adherence
-Review iPEX grant requirements

Team Decision-
making & Technical
Support
-Finalize leadership membership for both IPE/IPP
initiatives
-Apply for iPEX grant on web portal
-Explore measurement tools for IPE/IPP
-Determine key stakeholders for program development
=Develop budget and secure funding for Phase One
-Conduct SWOT3 Analysis of organizational readiness for
program

Establishing a Data
Feedback
Mechanism
-Develop regular method of communication among
leadership groups and with key stakeholders (e-mail
updates, meetings, Google shared docs)

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 26

ARC
COMPONENTS
ARC PHASES Q3
2018
Q4
2018
Q1
2019
Q2
2019
Q3
2019
Q4
2019
Q1
2020
Q2
2020
Q3
2020
Q4
2020
PHASE 2: DIRECTION SETTING
Accessing &
Facilitating
Organizational
Networks
-Participate in iPEX grant webinars, in person workshop
with grant leadership and other grantee teams and Webinars
with iPEX assigned advisor to satisfy grant requirements

-Conduct regular meetings with leadership for both
initiatives to develop detailed work plan (categories, steps,
ownership & timeline)

Building Teamwork
in Front Line
Clinical Teams
-Determine learners in both initiatives (students, workforce,
practice areas)

-Determine facilitator qualifications for program, post
opportunities and recruit

-Reach out to identified clinical staff for case examples of
IPP in different settings as needed

Providing
Information &
Training Related to
Clinical Innovation
-Review existing ASM4 simulation cases/curriculum and
SW simulation learning materials & determine
appropriateness for IPE/IPP (IPE/IPP for students)

-Review models for IPE/IPP from iPEX seminar and
internal methods for discipline specific work and decide
which to use (Geri Talk, Onco Talk, Team STEPPS, SW
Partnership, etc.)

-Conduct research on existing problem and IPE/IPP
programs/models (journal articles, web based, interviews
internally/externally)

-Identify case elements for IPE case (e.g. pre-requisite
reading, learning objectives, IPP competencies,
standardized patient description, script, case beats, debrief)
-Develop all IPE/IPP case elements (10)

Team Decision-
making & Technical
Support
-Develop program design and curriculum
-Collaborate with leadership from the Morchand Center for
Clinical Competence for SP5 casting and training
-Identify any other technical support needed (space,
computers, software, projectors, printers)
-Collaborate with the Medical Education-Data and Statistics
for guidance/assistance

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 27

ARC
COMPONENTS
ARC PHASES Q3
2018
Q4
2018
Q1
2019
Q2
2019
Q3
2019
Q4
2019
Q1
2020
Q2
2020
Q3
2020
Q4
2020
Establishing a Data
Feedback
Mechanism
-Determine validated/reliable existing measurement tool(s)
for objective and process outcomes (CPAT6, ISVS-217 and
possibly an internal tool for specific program evaluation)
-Determine statistical analysis resources needed to
aggregate and analyze data
-Determine best methods to disseminate program feedback
to key stakeholders

Implementing
Participatory
Decision making in
Front Line Teams
-Involve internal leadership staff champions in program
development as needed for awareness, buy-in, clinical/other
expertise
-Involve external IPE/IPP or HSLM experts from external
settings in program development

Resolving Staff
Conflicts
-Manage any differing opinions among leadership work
group members in program design and content, availability
of time/resources towards program

Goal Setting and
Continuous Quality
Improvement
-Determine program goals and outcomes
-Develop and refine work plan (ongoing)
-Develop methods for implementation monitoring including
fidelity and adaptation

PHASE 3: IMPLEMENTATION
Providing
Information &
Training Related to
Clinical Innovation
-Conduct beta sessions on IPE/IPP for both initiatives
(facilitators, SPs, leadership and selected learners) and
refine session format/content as needed
-Conduct IPE/IPP sessions as scheduled (7)
-Administer measurement tools

Team Decision-
making & Technical
Support
-Secure statistical analysis resources needed to aggregate
and analyze CPAT, ISVS-21, possible program evaluation
and other implementation monitoring data
- Review program results with team and discuss barriers
and facilitators and program revisions

Establishing a Data
Feedback
Mechanism
-Report on implementation data to key stakeholders
including barriers/facilitators and future plans

-Present at 9th Annual Conference in SW in Health and
Mental Health (York, UK) on IPE/IPP work to date

-Participate in iPEX webinars with grantor sponsor and
grantee teams to discuss implementation, best practices

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 28

ARC
COMPONENTS
ARC PHASES Q3
2018
Q4
2018
Q1
2019
Q2
2019
Q3
2019
Q4
2019
Q1
2020
Q2
2020
Q3
2020
Q4
2020
Implementing
Participatory
Decision making in
Front Line Teams
-Share results of IPE/IPP sessions with learners and other
staff champions
-Conduct focus groups with learners at certain intervals
post-session to reflect on impact of learning and
incorporation into practice

Resolving Staff
Conflicts
-Manage any differing opinions among leadership work
group members in program implementation and evaluation
-Manage any differing opinions/issues that arise among IPE
faculty and/or learners during IPE/IPP sessions

Goal Setting and
Continuous Quality
Improvement
-Develop and refine work plan (ongoing)
-Refine methods for implementation monitoring including
fidelity and adaptation

Redesigning Jobs -Determine how IPE/IPP sessions can redefine health care
professional roles within their teams internally
-Determine if IPE/IPP can be a greater portion of existing
leadership member(s)’ regular role/responsibilities (vs. add
on)
-Identify if additional roles need to be added for session
implementation that were not already identified

PHASE 4: STABILIZATION
Implementing
Participatory
Decision making in
Front Line Teams
-Meet with Medical Education and Social Work Senior
Leadership, faculty co-leads and leadership group members
to discuss all components of future planning for IPE (run
same case in next year, medical/SW practice partnerships to
follow patients in dyads, develop new case to add to case
library, timing of IPE/IPP in medical school years 1-4)
(IPE/IPP for students)
-Meet with leadership (Medical, Nursing, Social Work,
Spiritual Health) to discuss all components of future
planning for IPE (IPE/IPP for working professionals)
-Participate in iPEX webinars with grantor sponsor and
grantee teams to discuss implementation successes and
failures and opportunities for improvement

Resolving Staff
Conflicts
-Manage any differing opinions among leadership work
group members in program design and content,
implementation, availability of time/resources towards
program
-Negotiate any differing opinions about program among
other key stakeholders

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE 29

1= Inter Professional Exchange Grant
2= Liaison Committee of Medical Education
3= Strengths, Weaknesses (internal), Opportunities, Threats (external)
4= Art and Science of Medicine Faculty
5= Standardized Patients
6= Collaborative Practice Assessment Tool
7= Inter Professional Socialization and Valuing Scale

ARC
COMPONENTS
ARC PHASES Q3
2018
Q4
2018
Q1
2019
Q2
2019
Q3
2019
Q4
2019
Q1
2020
Q2
2020
Q3
2020
Q4
2020
Goal Setting and
Continuous Quality
Improvement
-Evaluate program goals and outcomes against actual
implementation and refine as needed (adaptation)
-Evaluate methods for implementation monitoring
including fidelity and adaptation and refine as needed
-Apply for and secure funding for Phase 2
-Meet with senior leadership in organization to determine
how IPE can become foundational (orientation, Patient
Experience Initiative, large scale roll out)
-Determine Phase 2 goals/outcome measures with eye
towards scaling
-Finalize copyright for IPE/IPP materials with Mount Sinai
Innovation Partners

Redesigning Jobs -Determine how IPE/IPP sessions can redefine health care
professional roles within their teams internally
-Determine if IPE/IPP can be a greater portion of existing
leadership member(s)’ regular role/responsibilities (vs. add
on)
-Identify adopters of IPE/IPP to assume role of change
agent

Ensuring Self-
Regulation and
Stabilization
-Identify champion practice areas and individuals who have
completed IPE/IPP program and role in public discourse
-Determine plan for dissemination of implementation
findings and presence in IPE/IPP community (intranet,
internet, grand rounds)

INTER PROFESSIONAL EDUCATION AND PRACTICE IN HEALTH CARE

24
Appendix G: Line Item Budget
Partnership for Excellence in Inter Professional Education and Practice in Health Care
Year One
Revenues Budget FY2019
In-Kind Contributions $259,300
Foundation Grant $10,000
Organizational Funding $20,000
Total Revenues $289,300

Expenses
Personnel Services
Program Leadership $160,000 (8 leaders, 4 disciplines)
Fringe Benefits (29%) $46,000
Facilitators $20,000 (10-SW, MD-Initiative One)
Learners (coverage during training) $9,000 (8 MDs, 8 RNs, 4 SWs)
Actors/Standardized Patients $12,000 (10)
Total Personnel Services $247,000

Other Than Personnel Services (OTPS)
Space $10,000
Computer Equipment $4,000
Technology Software $5,000
Telecommunications $1,000
Office Supplies $200
Printing Services $200
Cleaning Supplies $200
Consultants/Subject Matter Experts $2,000 (2-external, 6-internal)
Catering $500
Program Leadership Travel $4,000 (4 to iPEX conference)
Utilities $5,000
Marketing Materials $200
Total OTPS $32,300

Total Expenses $279,300

Surplus/Deficit $0

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Asset Metadata

Creator Xenakis, Nancy (author)

Core Title Inter professional education and practice in the health care setting: an innovative model using human simulation learning

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 12/11/2019

Defense Date 12/09/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag close the health gap,health care,inter professional education,inter professional practice,inter professional team,OAI-PMH Harvest,social determinants of health,Social Work,social work grand challenges

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Lewis, Jennifer (committee chair), Feuerborn, William (committee member), Katz, Irvin (committee member)

Creator Email Nancyxenakis@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-251829

Unique identifier UC11675207

Identifier etd-XenakisNan-8042.pdf (filename),usctheses-c89-251829 (legacy record id)

Legacy Identifier etd-XenakisNan-8042.pdf

Dmrecord 251829

Document Type Capstone project

Rights Xenakis, Nancy

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA