In contemporary health care, interprofessional collaboration is a
marker of excellence. Evidence links effective collaborative practices
with the best patient outcomes, patient satisfaction, and staff satisfaction.
According to the American Organization
of Nurse Executives
(AONE), “Excellent working relationships
between nurses and physicians
are key to creating a productive, safe,
and satisfying practice environment.
The patient and the patient’s family
benefit from care delivered by a team
practicing within this environment.”

Outcome competencies for health profession programs highlight collaboration
and high-quality care—the underlying skills for which must
be fostered purposefully. Yet few students
have opportunities to interact
with students in other health professions.
Not surprisingly, they learn
the skills for clinically relevant teamwork serendipitously,
rarely with targeted training or mentoring.

Defining interprofessional education

Interprofessional education (IPE) occurs when two
or more professions learn with, from, and about
each other to improve collaboration and quality.
IPE develops and strengthens interprofessional relationships.
In a 2003 report, the Institute of Medicine
endorsed IPE as a strategy to improve the overall
quality of health care.

In healthcare settings, the point of care is our
playing field, so to speak—where the healthcare
team comes together to deliver care. Members of a
sports team execute new plays best when they’re
able to learn and practice together on the playing
field. Healthcare teams are no different. Our players
need the opportunity to learn and practice
together on the playing field so they can develop
collaborative skills to execute the best possible
care practices.

IPE isn’t easy to implement. It involves much
more than just putting students from differing
health professions in a classroom together. True IPE
promotes sharing ideas and decision making as
crucial to interactive learning.

Quality and Safety Program for Students

The Quality and Safety Program for Students at
Geisinger Medical Center in Danville, Pennsylvania
(part of Geisinger Health System and a Magnet®-
designated hospital) was designed for health profession
students. Its innovative approach nurtures
interprofessional teamwork in a hospital setting
and offers education in basic quality-improvement
tools and opportunities to apply skills to clinical
problems. The program gives students a safe opportunity
to learn about teams by working on teams
Faculty includes nurses, physicians, and educators,
who draw from their own partnerships to mentor
and model interprofessional quality teams.

The program is a modification of a quality improvement
(QI) training program for physicians
and nurses in acute-care settings. Our facility has offered IPE courses since 2006 to encourage collaboration
and improve quality of care. Two members
of our core faculty participated in the first offering.
They emerged highly motivated to undertake quality
projects and energized to refine the course.

Over the next 4 years, the QI
training course was revised each
time it was offered in an attempt
to emphasize benefits and address
shortfalls. Clinician feedback
clearly conveyed that QI training
was valued for its suitability to
practice settings. For most nurses
and physicians, this was their first
formal QI course as well as their
first experience with IPE. Participants
expressed surprise at the
complexity of others’ clinical responsibilities
and appreciated the
training activities as opportunities
to share perspectives.

Despite the benefits, everyone
agreed the IPE training model is
difficult to incorporate in an
acute-care setting. Nurses and
physicians continuously face the
demands of clinical practice and
hectic workflows, which can limit
the time available for thoughtful
discussions. Yet they all endorsed the salience of IPE
as preparation for the competencies required for
professional practice, including QI and teamwork
skills. That’s how the Quality and Safety Program
for Students came into being.

Program goals

Program goals are to foster QI skills and professional
relationships and to instill the importance of role
collaboration before students enter professional
practice. Course content focuses on teamwork and
communication, QI, and patient safety. The program
is offered annually to health profession learners
in programs affiliated with our health system. To
date, 127 upper-level students have participated,
each enrolled in a nursing, medicine, pharmacy, or
physician’s assistant program at an educational institution.

The program is designed around three unique
components:

• use of the hospital as a teaching/learning laboratory
• engagement of clinicians as faculty
• real-time clinical issues that provide relevant
  topics for instruction.

The first three sessions are structured using a detailed
outline, team-based table work, and out-ofclass
assignments. Teaching methods include brief
lectures and online learning modules; most are interactive.
Simulated cases based on actual clinical
incidents and current hospital QI projects provide
relevant clinical problems. The “QI Toolbox” is
used to identify priority issues, consider appropriate
goals, and develop effective interventions and
outcome measures. The toolbox includes huddling,
brainstorming, “fishboning” (a problem-solving
method to identify potential influences), templates
to create basic and detailed process flow charts,
and the PDSA (Plan-Do-Study-Act) cycle. Activities
surrounding use of the toolbox and simulated QI
projects promote teamwork and understanding of
teammates’ professions.

Students’ creativity and systematic planning,
evaluation, and completion of simulated QI often
convey their readiness to do more. So in the second
semester, students get the opportunity to put their
skills to work with actual clinical issues. Typically,
this challenge is undertaken by about 40% of firstsemester
participants. Each student team is paired
with a staff-level mentor who provides assistance,
guidance, and support to address substantive issues.

In 2011, real-time QI projects included:

• improving patient hand-offs in the cardiac
  catheterization lab
• preoperative patient education on postoperative
  pain in the outpatient surgical setting
• medication-override review using an interprofessional
  education approach.

Program sustainability

This program is an exemplar for advancing an educational
model of interdisciplinary collaboration.
Our institution has supported its sustainability in
several ways.

• The program coordinator is a nurse, with dedicated
  time, office space, and resources.
• Program developers from nursing and medicine
  increasingly serve as leaders in interprofessional
  education and training.
• Nursing and medical education departments
  work with program leaders to develop IPE QI
  courses for staff across the health system and to
  involve advanced-practice and graduate students.

Evidence of sustainability also exists among colleagues
in health profession programs. Nursing
students’ participation is seen as a component of
leadership course content and projects. Medical students’
program faculty have encouraged incorporating
program projects into residency applications.
Partnerships and synergy surrounding this program
reflect a changing educational paradigm directly
aligned with a culture of interprofessional
practice.

To deliver the highest-quality health care, interprofessional
relationships must be promoted, nurtured,
and sustained. The future of nursing compels
us to partner with other health professionals
to design processes that strengthen outcomes and
emphasize safety. As nurses, we must leverage
and exploit new learning opportunities and redesign
clinical learning activities. (See Evaluation
and outcomes by clicking the PDF icon above.)

The Josiah Macy Jr. Foundation helps support
Geisinger’s Quality and Safety Program for Students.
Our program strives to exemplify the goals
described by Foundation President Dr. George
Thibault: “Unless we move to a more collaborative
model of education and care and unless we fully
use all health professionals’ skills, we will not be
able to respond to the challenges facing our health
care system today.”

Selected references

American Organization of Nurse Executives. AONE Guiding Principles
for Excellence in Nurse/Physician Relationships. 2005. www.aone.org/
resources/PDFs/AONE_GP_Excellence_Nurse_Physician.pdf. Accessed
January 21, 2013.

Berwick DM. Continuous improvement as an ideal in health care. N
Engl J Med. 1989;320(1):53-6.

Buring SM, Bhushan A, Broeseker A, et al. Interprofessional education:
definitions, student competencies, and guidelines for implementation.
Am J Pharm Educ. 2009;73(4):59.

Committee on the Health Professions Education Summit; Greiner AC
and Knebel E, eds. Health Professions Education: A Bridge to Quality.
Washington, DC: National Academies Press; 2003.

Institute of Medicine. The Future of Nursing: Leading Change, Advancing
Health. Washington, DC: National Academies Press; 2011.

Thibault, GE. Interprofessional education: an essential strategy to accomplish
the future of nursing goals. J Nurs Educ. 2011;50(6):313-7.

Christine M. Raup is Interprofessional Program Coordinator and Adele M. Spegman is
director of nursing research at Geisinger Health System in Danville, Pennsylvania.