Jonathan Thigpen, PharmD
Annesha White, PharmD, MS, PhD
Carrie Blanchard, PharmD, MPH
At the end of this case, students should be able to
- Describe the Interprofessional Education Collaborative core competencies
- Discuss the importance of interprofessional collaboration in public health practice
- Identify different models or frameworks to build community partnerships and interprofessional collaborations in addressing public health needs
- Apply components of various models in creating and sustaining community partnerships to public health prevention initiatives
Research has identified effective healthcare teams as a factor in improved patient outcomes and reduction in medical errors.1 In order for health professions to learn to work together optimally, health profession higher education has placed increased emphasis on interprofessional education (IPE). The World Health Organization (WHO) defines IPE as the process in which “two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.”2 The Interprofessional Education Collaborative (IPEC), which consists of national health education organizations, has identified the following four core competencies common to healthcare professions that support effective team development and function.
- Values/ethics for interprofessional practice To work with individuals of other professions to maintain a climate of mutual respect and shared values
- Roles/responsibilities To use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of patients and to promote and advance the health of populations
- Interprofessional communication To 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
- Teams and teamwork To 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 equitable3
In regard to public health, building partnerships across health professions and community organizations is an important step in addressing complex health issues. Effective interprofessional collaboration is both necessary and critical, given the complexity of public health issues and the multiple stakeholders involved. Additionally, interprofessional collaboration in relation to public health often includes more disciplines than pharmacists typically see in clinical practice.
While these interprofessional teams can tackle complex public health issues, it is important that the team be moving in the same direction. A first step is conducting a community health needs assessment to identify and prioritize health issues.4 Once a need has been selected, the team can utilize various models that provide a blueprint for creating and sustaining partnership,5-7 such as the Creating and Maintaining Partnerships toolkit and the Developing a Framework or Model of Change toolkit from Community Toolbox.6,8 The Creating and Maintaining Partnerships toolkit provides an outline of questions and resources to consider when building partnerships across professions and with community-based organizations. The Developing a Framework or Model of Change toolkit helps in developing an overarching framework for the program, activities, and intended outcomes. Once a partnership has been forged between health systems and community-based organizations, useful resources, such as the Partnership Assessment Tool for Health (PATH), can assist collaborators in working together effectively to maximize the impact of the partnership.9 Further guidance is available on approaches to consider for successful health partnerships.10
It’s finally happened—you have your license to practice pharmacy! You’ve recently moved and accepted a residency position at a large teaching hospital downtown. On your first day at work, the residency director assigns a project she wants you to complete by the end of your one-year residency: developing a hypertension primary prevention interprofessional initiative in the surrounding community. The previous resident’s project was a community health needs assessment that found hypertension to be a prevalent and growing issue in the community. The community you now work and live in is underserved and located in an urban setting with low socioeconomic status, low health literacy, a high disease burden, and a high crime rate. Although the community has its struggles, it also has a strong community presence, including many people, organizations, and institutions that want to help. Being at an academic medical center located in a heavily populated community lends itself to many diverse and creative opportunities for collaboration.
1. Interprofessional/IPEC Which professional healthcare groups do you want represented on the team to help with the project? Why?
Although many healthcare professionals can help with hypertension prevention, the most influential include physicians, physician assistants, nurses, pharmacists, nutritionists/dieticians, and public health professionals. Each profession’s role is briefly described below. Students may include additional professions, which may be appropriate as long as they provide sound reasoning for their choices.
Here are some questions students should consider when selecting their team.
- How does each profession (including your own) contribute to the project?
- Why is a partnership needed to accomplish your goal?
- Why and how is the group in a position to make a difference?
Physicians As leaders of the healthcare team, physicians are primarily responsible for overseeing patient treatment plans and follow-up. Having physician input will help the team gain insight on the barriers faced by patients and appropriate clinical prevention strategies.
Physician assistants These professionals work closely with physicians (and often independently with physician oversight) to help oversee patient care. Physician assistants are becoming increasingly entrenched as primary care providers for patients, many of whom may be exclusively seen and cared for by these professionals.
Nurses Nurses are the lifeline of health care and have plenty of patient interaction and trust. They are also more numerous than other health disciplines and have a significant presence in health care. As patient advocates, nurses will provide a powerful ally that can help you gain better insight into the patient experience, including common barriers they face.
Pharmacists As drug experts, pharmacists are responsible for promoting safe and effective drug use. While this campaign specifically deals with primary prevention, pharmacists can help with details concerning hypertension medications. This profession is particularly important to discuss, since it will force pharmacy students to think about how they themselves, as future pharmacists, could contribute.
Nutritionists/dieticians Hypertension is largely attributed to poor lifestyle choices, including poor diet and lack of exercise. Nutritionists and dieticians can educate and encourage patients to make healthier choices, so as to prevent and/or manage hypertension.
Public health professionals Partnering with these professionals (particularly graduates of Master’s and PhD programs in public health) will be beneficial in understanding the population you intend to work with; they can likely help with data analysis, as well as with developing a public health–based program.
These professionals may already oversee various programs (including nonprofit organizations) in the city and can, as a result, help mobilize efforts and build your program on a large scale.
2. Interprofessional/IPEC How would the team identify and communicate about each member’s functions or roles, responsibilities, and accountabilities? How will the team communicate about the project’s goals and progress?
The answer should primarily follow the Interprofessional Collaborative Practice competency concerning “Roles/Responsibilities Behavioral Expectations,” which urges team members to “use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served.” When focusing on communication, students’ answers should describe ways in which their team will
- Communicate their roles and responsibilities clearly to patients, families, and other professionals.
- Recognize their limitations in skills, knowledge, and abilities.
- Explain the roles and responsibilities of other care providers and how the team works together to provide care.
- Communicate with team members to clarify each member’s responsibility in executing components of a treatment plan or public health intervention.
- Forge interdependent relationships with other professions to improve care and advance learning.
- Engage in continuous professional and interprofessional development to enhance team performance.
3. Stakeholders/partners Using the Creating and Maintaining Partnerships toolkit, which stakeholders and partners (other than healthcare professionals) do you want to include in this project? Why? How will you include them?
Students should focus on Steps 1 and 2 provided in the Creating and Maintaining Partnerships toolkit (https://ctb.ku.edu/en/creating-and-maintaining-partnerships).
- Step 1 Describe the multiple organizations that have come together in common purpose. Who are you and why is a coalition needed to accomplish your purpose?
- Step 2 Assemble the coalition’s (group’s) membership, keeping your broad goals in mind.
Students’ answers should address the following considerations.
- Describe who the stakeholders are. Who is represented in your group, including those most affected by the issue? Why and how is the group in a position to make a difference?
- Describe why creating a partnership is needed to accomplish your goal. Some possibilities include the following.
- Your organization’s efforts cannot effectively accomplish your goal.
- The problem or goal is complex and is influenced by multiple factors.
- Related agencies are duplicating efforts and, as a result, resources are not being used to their potential.
- Your goal is significant improvement in community-level outcomes, and multiple sectors of the community will need to be engaged for success.
- Who in the community that you are serving can be effective in bringing about change in areas affecting or being affected by the issue or problem?
- Who is already involved in the formation of the collaborative partnership, and what roles are they playing? What roles need to be filled or created, and who might best fill them?
- Where would these members be found?
- Why would you choose one or another individual or organization? What resources would they bring to the table?
- Is this the right time for them to be recruited to join the coalition?
- How could they be involved in the collaborative partnership’s planning and activities?
- What potential barriers exist (including financial) to recruiting these partners, and what strategies can help overcome those barriers?
4.Shared goal/vision Using the Creating and Maintaining Partnerships toolkit, create an overall shared goal/vision for the project.
Students should follow Steps 3 and 4 provided in the Creating and Maintaining Partnerships toolkit (https://ctb.ku.edu/en/creating-and-maintaining-partnerships).
- Step 3 Outline your partnership’s vision and mission with the assistance of your newly assembled partners and community members affected by the issue or problem.
- Step 4 State the objectives or goals, needed resources and relationships to accomplish your objectives, and key agents of change in the partnership.
Students’ answers should address the following considerations.
- Vision Summarize your coalition’s dream for the future. The vision should be
- Easy to communicate to potential new members.
- Uplifting and inspiring, clearly communicating your hopes for the community.
- A reflection of the perspective of the community it represents.
- Mission State your collaborative partnership’s mission. It should include
- A statement of what it is going to do and why.
- Widely inclusive language to avoid limiting potential new members and strategies with which to bring about the vision.
- Summarize the anticipated results of the group’s activities. What would be different in your community when you have reached your goals? Who will have what done by when?
- Describe community-level indicators you will utilize.
- Explain the possible impact and/or consequences of achieving your goal.
- Identify available resources and relationships that will be needed to bring about change.
- Describe how networks are organized within the community and how you plan on utilizing them to intervene in the community.
- Research the community projects currently in progress. What does this tell you about what the community sees as valuable, and what clues does this provide that might help you be successful?
- Determine who the target populations are that you most want to affect and those in your community whose actions can influence them, either directly or indirectly.
5. Initiative Using the Developing a Framework or Model of Change toolkit, develop a feasible initiative concerning hypertension primary prevention in your community.
Students should follow Steps 3 through 6 in the Developing a Framework or Model of Change toolkit (https://ctb.ku.edu/en/4-developing-framework-or-model-change).
- Step 3 State the objectives of your initiative or effort.
- Step 4 Describe the appropriate scope or level of your framework or model of change.
- Step 5 Identify all components to include in the logic model or model of change.
- Step 6 Using the components, draft a picture of the framework or model of change.
Students’ answers should address the following considerations.
- Summarize all of the specific measurable results of your initiative or program that you anticipate. These should include behavioral changes and related community-level outcomes.
- State your assumptions and hypotheses regarding the personal and environmental factors contributing to the problem or goal.
- Describe the overall initiative; this may include all strategies and relationships used to affect change and bring about improvement for the overall problem or goal.
- Describe a particular initiative or program; this may include only the components and elements of a specific aspect of the overall effort (for example, education programs or policy change).
- Develop a specific work plan for an action or model for cooperation among stakeholders or participating agencies.
- Identify and describe the following components.
- What the group is going to do and why
- The context and conditions under which the problem or goal exists and which may affect the outcome (for example, the history of the effort, broad cultural and environmental factors, the political situation, or economic conditions)
- Inputs: available resources and supports, as well as constraints or barriers to meeting the initiative’s objectives
- Activities or interventions: what the initiative or program does to bring about change and improvement (for example, enhancing support or modifying access)
- Outputs: direct results or products of the group’s activities (for example, the number of people trained or activities conducted)
- Effects: more broadly measured outcomes or results (these may include immediate, intermediate, and longer-term effects)
- Draft a picture of the framework or model of change, including the following.
- An expected time sequence (what occurs before what) to arrange the components and elements of the framework or model
- Arrows or other elements to communicate directions of influence and sequences of events. (Some arrows may point in both directions to show interaction or mutual influence.)
The multifaceted nature of public health requires a sound, interprofessional approach in addressing issues. Tackling public health issues requires a team-based approach, often with disciplines pharmacists are not typically familiar with. Such collaborations are necessary but are also difficult to establish and maintain. Taking the time to carefully and purposefully choose an interprofessional team, where each member brings unique connections, knowledge, and/or skills, is critical for success. Once you have your team, it is equally important that you are all on the same page, so as to promote open communication and engagement among members. Ensuring that your initiative is clear, impactful, and feasible can help team members fully engage in the project and prevent unnecessary barriers from impeding progress. Utilizing tools (such as those included herein) aimed to create impactful initiatives, establish and maintain interprofessional teams, and establish a shared vision among teams, can be extremely helpful when pursuing public health initiatives.
- We recommend that this activity be a group project.
- Answers may vary widely, depending on how students tackle the problem and whom they include as part of the team and stakeholders.
- We chose particular models/toolkits that we like. You should feel free to highlight or utilize other models/frameworks as you see fit.
- When utilizing the models/toolkits, we recommend using only parts of them to save time. If you have more time, feel free to expand on our recommendations and utilize more parts. Also, models and their parts/steps may overlap with other models. Consult and review the models/toolkits and their steps so that you will know how to direct students so that they’re not answering the same questions multiple times.
- You can tailor the case to your students’ particular needs. Does the class need to learn about interprofessional practice and the roles/responsibilities of various professions? Do they need more practice identifying and including stakeholders? Or do they need practice developing a shared goal and initiative?
- Instead of hypertension prevention, faculty members may choose any topic they want students to address and learn about.
- Faculty members may want to pick a different city or location, rather than the setting provided in the case.
- We encourage faculty members to inject small activities and active learning while the students are working on the questions. For example, you could ask students to share with the entire class what health professions they chose to include on their team and why. Some groups will likely choose professions that other groups didn’t choose. This can be an interesting topic for discussion and debate, as students explore the roles/responsibilities of other professions and the misconceptions they may have. Don’t wait until the end of the project to debrief students—you can debrief and discuss as you go along.
Patient Approaches and Opportunities
When developing an interprofessional team, it is important to be both creative and critical, so as to include a wide range of professionals who can contribute in unique, meaningful ways. Establishing relationships with stakeholders, especially those from the community, is critical toward building trust and a strong foundation for resulting initiatives. Following a patient-centered paradigm of seeking to include patients (or, in this case, “community members”) in the design, implementation, and closure of a project, will lead to better-designed and, likely, more impactful programs. Utilizing toolkits and models (such as those included here) can help practitioners create and implement, in a logical, step-by-step fashion, an interprofessional public health initiative.
Pharmacists play an important role in public health. As medication experts, we understand the nuances associated with the ramifications of widespread medication use in our society, including issues of nonadherence, medication safety, adverse events, overdoses, and pharmacoeconomics (costs). Your value as part of the interprofessional team is crucial. However, it can be difficult at times to integrate your knowledge and opinions in an interprofessional setting and/or team and, ultimately, show your value. Becoming a more effective team member takes practice. As you improve leadership and communication skills, your ability to work with others will improve. In addition to hands-on practice, resources are available to improve interprofessional teamwork skills. These resources are diverse and include articles, toolkits/models, surveys, reflections, modules, and curricula.
Related chapters of interest:
- Communicating health information: hidden barriers and practical approaches
- The ‘state’ of things: epidemiologic comparisons across populations
- Agency for Healthcare Research and Quality, “TeamSTEPPS,” https://www.ahrq.gov/teamstepps/index.html.
- Interprofessional Education Collaborative, “Resources,” https://www.ipecollaborative.org/resources.html.
- National Center for Interprofessional Practice and Education, home page, https://nexusipe.org.
- US Department of Labor, Bureau of Labor Statistics, “Occupational Outlook Handbook,” https://www.bls.gov/ooh/healthcare/home.htm.
- Robert Wood Johnson Foundation, “Lessons from the Field: Promising Interprofessional Collaboration Practices,” white paper, 2015.
- Stergios T. Roussos and Stephen B. Fawcett, “A Review of Collaborative Partnerships as a Strategy for Improving Community Health,” Annual Review of Public Health 21 (2000): 369–402.
- Steven A. Schroeder, “We Can Do Better—Improving the Health of the American People,” New England Journal of Medicine 357 (2007): 1221–28.
- Matthew K. Wynia, Isabelle Von Kohorn, and Pamela H. Mitchell, “Challenges at the Intersection of Team-Based and Patient-Centered Health Care: Insights from an IOM Working Group,” Journal of the American Medical Association 308, no. 13 (2012): 1327–28.
- Center for Health Care Strategies, Inc., “Partnership Assessment Tool for Health,” https://www.chcs.org/resource/partnership-assessment-tool-health/.
- Centers for Disease Control and Prevention, “Assessment & Planning Models, Frameworks & Tools,” https://www.cdc.gov/stltpublichealth/cha/assessment.html.
- Centers for Disease Control and Prevention, “Community Health Assessments & Health Improvement Plans,” https://www.cdc.gov/stltpublichealth/cha/plan.html.
- Community Tool Box, “Creating and Maintaining Partnerships,” https://ctb.ku.edu/en/creating-and-maintaining-partnerships.
- Community Tool Box, “Developing a Framework or Model of Change,” https://ctb.ku.edu/en/4-developing-framework-or-model-change.
- Robert Wood Johnson Foundation, “The Secret to Successful Health Partnerships,” https://www.rwjf.org/en/blog/2015/02/the_secret_to_succes.html.
- National Association of County and City Health Officials, “Mobilizing for Action through Planning and Partnerships (MAPP),” https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp.
- Practical Playbook, “Building a Partnership,” https://www.practicalplaybook.org/section/building-partnership.
- Roussos ST, Fawcett SB. A review of collaborative partnerships as a strategy for improving community health. Annu Rev Public Health. 2000;21:369-402.
- World Health Organization. (2010) Framework for action on interprofessional education & collaborative practice. Geneva. World Health Organization.
- Interprofessional Education collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.
- Centers of Disease Control and Prevention. Community Health Assessments & Health Improvement Plans. https://www.cdc.gov/stltpublichealth/cha/plan.html. Accessed October 15, 2018.
- National Association of County and City Health Officials. Mobilizing for Action through Planning and Partnerships (MAPP). https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp. Accessed October 15, 2018.
- Community Tool Box. Creating and Maintaining Partnerships. https://ctb.ku.edu/en/creating-and-maintaining-partnerships. Accessed October 15, 2018.
- Practical Playbook. Building a Partnership. https://www.practicalplaybook.org/section/building-partnership. Accessed October 15, 2018.
- Community Tool Box. Developing a Framework or Model of Change. https://ctb.ku.edu/en/4-developing-framework-or-model-change. Accessed October 15, 2018.
- Center for Health Care Strategies, Inc. Partnership Assessment Tool for Health. https://www.chcs.org/resource/partnership-assessment-tool-health/. Accessed October 15, 2018.
- Robert Wood Johnson Foundation. The Secret to Successful Health Partnerships. https://www.rwjf.org/en/blog/2015/02/the_secret_to_succes.html. Accessed October 15, 2018.