Stories From The Nexus

Our guest blogger is Lee Wilbur, MD, director of inteprofessional education, University of Arkansas for Medical Sciences (UAMS). Prior to joining UAMS, Dr. Wilbur was a member of the National Center’s Nexus Innovations Incubator Network in Indiana.

What is the ultimate goal for health professions education? 

At the University of Arkansas for Medical Sciences (UAMS), we say it is to meet the Triple Aim of enhancing the patient experience, improving population health and reducing cost1. Each department, division or individual at UAMS is working to meet at least one component of the Triple Aim and that’s why it is a strong unifying principle for the leadership, faculty and learners across our six health professions colleges, clinical delivery system and research enterprise.

It also served as the motivation for our Office of Interprofessional Education to align its vision, initiatives and resources to help move toward meeting the Triple Aim for our institution, our state and our nation. 

The Five-Pillar Model

To track our progress as an institution, we are creating a Triple Aim Executive Leadership team, with subteams focused on five-pillars -- Curriculum Implementation/Evaluation, Development (fundraising), Scholarship, Faculty Development and Collaborative Practice -- that are essential to strategically meet the Triple Aim at UAMS.

This is a horizontal organizational model embedded onto the vertical institutional organizational chart. Each team includes individuals that have an institutional perspective, objective and influence, which allows them to map existing initiatives and resources while implementing new ones. One early example of success from the Curriculum Implementation/Evaluation team is the creation of the “Triple Aim Curriculum.”  We propose this as a graduation requirement for all 2,800 health professions students since all are unified by the Triple Aim.

Developing the Triple Aim Curriculum

In proposing the Triple Aim Curriculum the team used the following guiding principles: 

1. It must be longitudinal for all learners;
2. It must CONTRIBUTE TO the institutional mission rather than exist INDEPENDENT FROM it; and
3. It must be highly flexible for both colleges and learners.

This curricular structure eliminates many traditional barriers of implementation, including a common calendar, while providing empowered faculty the opportunity to teach across all colleges. We focused on building the architecture for them, rather than each faculty member being reliant on universal content integrated across a very complex system.

As shown in the figure, the three-phase curriculum incorporates novice, intermediate and advanced learners into the exposure, immersion and competence phases. At each phase, each type of learner has specific activities that leverage patients, faculty and community resources.

• Novice learners - During “exposure,” these students will receive a high-impact workshop on the relevance of the Triple Aim delivered by patients and key faculty from UAMS that represent offices advocating for the social determinants of health. 
• Intermediate learners - For “immersion,” these students will compete in interprofessional teams to complete Triple Aim project proposals solicited from UAMS departments and community organizations while participating in a simulation encounter focused on error disclosure.
• Advanced learners - These individuals will show “competence,” by serving as junior educators to their novice colleagues and participate in a half-day workshop to actively learn concepts important to practicing as a collaborative workforce immediately following their education. 

Lessons Learned

There were many lessons learned in advancing interprofessional education (IPE) and collaborative practice (IPC) at UAMS, but chief among them was the success in using the Triple Aim as a unifying principle. It helped challenge skeptics because they simply could not refute how his or her individual efforts were not related to the Triple Aim.

Additionally, a needs assessment was critical to the development of our strategic vision and plan for implementation. This lead to an understanding of how to best leverage assets, including leadership support, which helped us build the five-pillar model.

It was also important be creative in how we marketed the IPE and IPC initiatives by using language that spoke to different groups. For example, we used “patient safety” and “quality improvement” with practitioners, but used “service learning,” “accreditation,” and “time and effort efficiency” with educators. 

Lastly, it is important to pre-plan, plan, pilot and then plan some more before implementation. Our philosophy is that we have many chances to succeed but only one chance to fail.  We know the common analogy that IPE/ IPC implementation is often compared to building the plane while flying it simultaneously; however, we have a remarkable team of “mechanics” that devoted a ton of hanger time before our “Triple Aim plane” began its ascent. 

Read more about the development of the UAMS program by visiting Dr. Wilbur’s profile on the National Center Resource Exchange.The Triple Aim framework was developed by the Institute for Healthcare Improvement in Cambridge, Massachusetts (www.ihi.org).