Teaching interprofessional teamwork

Workplace silos are a professional byproduct of many organizations. Though physicians, nurses, pharmacists and social workers share the common goal of improving patient outcomes, hospitals and healthcare institutions often fail to break down those silos to allow professionals to work across — and with — other disciplines.

Research shows that coordination and collaboration positively impact patient care and outcomes, and the College of Community and Public Affairs (CCPA) is working with other schools at Binghamton University to spearhead interprofessional education, bringing healthcare professionals together in teams — starting in the classroom.

The Interprofessional Education Collaborative (IPEC), a national organization that connects healthcare disciplines for better care, was formed in 2009 to advance interprofessional learning opportunities for healthcare professionals. Binghamton University now has IPEC affiliations in the disciplines of pharmacy, nursing and social work.

CCPA Dean Laura Bronstein says the healthcare field is ideal for fostering interprofessional education and collaboration, as social work research demonstrates.

Her local study proves the point. “We did a study at UHS hospitals with a social work intervention to reduce hospitalizations with two phone calls and one home visit within a month, and we had staggering results. Patients need someone to say, ‘Where are your pills? How do you get them? Do you have food?’ All the things that matter.”

Deans Gloria Meredith of the School of Pharmacy and Pharmaceutical Sciences and Mario Ortiz of the Decker School of Nursing agree about the importance of modeling this in the classroom.

“Interprofessional education is a requirement of pharmacy schools and a fair number of health-care professionals,” Meredith says. “If you’re a pharmacy student, this is an exciting development because it means, from the day you walk in the door, you’re going to learn how to work in a healthcare team. For us, interprofessional education means learning about, from and with other professionals.”

Ortiz says interprofessional education is required for nursing students because working on teams is one of nine “essentials” — areas of core knowledge — required at the baccalaureate and master’s levels of nursing. Other essentials include patient-centered care, evidence-based practice, patient safety and practice across the lifespan.

Ortiz says members of healthcare teams need interprofessional acumen in order to deliver holistic patient care and understand their complex needs.

“We call it living quality. What is the patient’s living quality? We’ll ask the patient what it is. Instead of coming in and asking patients if their pain is a nine out of 10, our nurses will say, “How is your pain today?’” Ortiz says. “We teach our students nursing as well as how we can help the patients live their quality of life in the way that they choose. Our students need to say, ‘We have all of these medications ready to go home with you, but what are your concerns for when you get home?’ When the patient says, ‘I don’t know,’ we can say ‘Let’s break it down.’”

Binghamton University established the Interprofessional Education Curriculum and Assessment Committee (IPECAC) early in 2016, with founding members Victoria Rizzo (social work), Nicole Rouhana (nursing), Judith Quaranta (nursing) and Gail B. Rattinger, committee chair (pharmacy). Since then, the committee has worked to develop a three-course graduate-level sequence covering interprofessional communications, healthcare delivery and healthcare ethics as well as simulation opportunities. Students will be assigned to teams in all three courses and, where possible, team assignments will facilitate longitudinal learning across the courses. The committee is also charged with assessing whether students meet IPEC competencies across the four domains: values/ethics; roles/responsibilities; communication; and teams and teamwork.

The communications course will set the stage for social work, nursing and pharmacy students to learn about each other’s professions, Meredith says, and will culminate in students’ participating in a poverty simulation. “Student teams will be given a set amount of money and will have to decide how to use it,” she says. “Students will become highly aware of choices that families and individuals in poverty must make on a daily basis about their well-being and survival.

Instead of coming in and asking patients if their pain is a nine out of 10, our nurses will say, ‘How is your pain today?’” Ortiz says. “We teach our students nursing as well as how to help patients live their quality of life in the way they choose. Our students need to say, ‘We have all of these medications ready to go home with you, but what are your concerns when you get home?’ When the patient says, ‘I don’t know,’ we can say ‘Let’s break it down.’”

Moving forward

Binghamton University established the Interprofessional Education Curriculum and Assessment Committee early in 2016; Victoria Rizzo (social work), Nicole Rouhana (nursing), Judith Quaranta (nursing) and Gail Rattinger, committee chair (pharmacy) are founding members. Since then, the committee has worked to develop a three-course graduate-level sequence covering communications, healthcare delivery and healthcare ethics as well as simulation opportunities. Students will be assigned to teams in all three courses and, where possible, team assignments will facilitate longitudinal learning across the courses. The committee is also charged with assessing whether students meet IPEC competencies across the four domains: values/ethics; roles/responsibilities; communication; and teams and teamwork.

The communications course will set the stage for social work, nursing and pharmacy students to learn about each other’s professions, Meredith says, and will culminate in students’ participating in a poverty simulation. “Student teams will be given a set amount of money and will have to decide how to use it,” she says. “Students will become highly aware of choices that families and individuals in poverty must make on a daily basis about their well-being and survival. Do they pay rent or do they go to the free clinic and try to receive medications and other medical services? How will they get to the store for groceries or to the free clinic?”

In the healthcare delivery course, social work, nursing and pharmacy students will work in groups to recommend appropriate health insurance coverage to patients of various ages and economic and health statuses, Rattinger says.

“Specifically, students will need to identify health insurance options ranging from typical managed-care plans, Medicare and Medicaid options, and incorporate a patient’s medical needs — including mental health and access to care — within their recommendations.”

The course content for healthcare ethics was being developed at press time.

Bronstein sees interprofessional education, which is a curricular recommendation for master of social work students, as the way of the future.

“People have increasingly realized that we can’t address health, education or social issues in silos, and we need to bring together a wide range of people with different expertise and use each in appropriate ways,” she explains.

“Binghamton clearly recognizes the need for interprofessional education and is positioning itself at the forefront,” Bronstein says. “We’re looking to establish a Center for Interprofessional Education here.”

An added benefit, she says, is that it can help build the workforce. “If we can create opportunities in the Southern Tier that are cutting-edge, graduates are going to want to stay here and practice. For those who don’t stay in the area, we know they will be sought after for job opportunities because they will have been educated at Binghamton in model interprofessional health-care approaches for the 21st century.”

Meredith has already seen the enthusiasm in students, including local medical students who will also be learning as part of Binghamton University’s interprofessional healthcare teams. “I met some of the third-year medical students from Upstate Medical University. All of them came over to me and said ‘I wish you had students now.’ They were really enthusiastic, and the students we are interviewing are excited for learning to work in a healthcare team. Their enthusiasm is palpable.

“Together we are better than our parts,” Meredith adds. “We can make a difference in the healthcare in this region. I’ve never had that feeling before.”