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Bridging the Clinical, Academic Gap Won't Be Easy

 |  By jcantlupe@healthleadersmedia.com  
   April 11, 2013

Although physicians and hospitals continue to push for more collaborative care with multidisciplinary teams, they have a number of hurdles to overcome before realizin g the holy grail of full-blown cooperation.

One of the root problems starts with the lack of integration between academic and clinical settings.

In January, the Josiah Macy Jr. Foundation, an organization that focuses on healthcare education, convened a meeting among educators and healthcare providers to discuss the need for "interprofessional education" with a focus for both sides on understanding each other's needs, perspectives, attitudes, and strategies to deliver better care.

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In a recent follow-up report, the Macy Foundation concluded that academics aren't communicating properly with practicing clinicians, and it's a serious problem. The result, the report says, is disjointed oversight of care that too often bypasses team-based care and too often fails to elevate the needs of patients and families—which is sorely needed to improve healthcare delivery models.

The blame extends beyond academicians and physicians; it also rests upon onerous regulatory requirements. As it now exists, healthcare education and healthcare delivery have "developed and functioned separately with little recognition that the two are inextricably linked," the Macy Foundation report states.

To make needed changes, the report indicates that healthcare professionals and academics must coordinate their goals and evaluate accreditation standards, data and clinical care focus. "Achieving this goal will require changing expectations for health professional competencies," the report states.

"Educational planning and care delivery planning need to be done together," George Thibault, MD, president of the Macy Foundation, told me. "A lot of positive things are happening in education and care delivery. But in most places, the educational change and discussion is happening in one place, and the care delivery discussions are occurring in the other. We need to integrate education and delivery. That's really the fundamental concept we are trying to get across. Up to this point, each group has been very focused on its own issues, but they need to understand the issues of the other group as well."

In a world beset by "silos," nowhere is that more apparent than in the academic and clinical settings, a division that must be overcome, Thibault says.

"Education is focused on the immediate product—the knowledge and skills of people they are training and sometimes it's a little divorced from what some would say is the real world, what's going on out there," Thibault adds.

"The people who are most focused on trying to get an efficient delivery system say, 'Well, education is going to slow us down, let us just focus on delivery of care.' That is a shortsighted view. They need to have the same set of unified goals and not be too separate," he explains.

While there is so much team-based care sought, it is sorely lacking in today's healthcare delivery system, the Macy Foundation report states. Healthcare delivery systems "must incorporate practice redesigns if we are to achieve enduring transformation," according to the report.

"People tend to focus on what they know best and what they are familiar with," Thibault says. "A bit of a cultural change is needed. Leaders of organizations will have to want this to happen. We need to really have one and the same set of unified goals, not separate."

Specifically, educators and healthcare providers should develop coordinated metrics to evaluate the impact of care models used in academic and clinical settings to improve population health management and reduce costs, the Macy report suggests.

Proper protocols need to be developed to advance the Triple Aim goals: better care, better health, and lower costs. The report further notes that there is now a "paucity of rigorous measures to evaluate the impact of linking interprofessional education and collaborative practice."

In addition, the report states that accreditation and certifications themselves pose barriers to efficient and effective team-based care. They attribute that, in part, to regulatory policies that generally "lag behind advances in healthcare education and clinical quality improvements."

While the report's language advocating change is strong, Thibault concedes that change will not come easily, in part, because education programs and clinical programs are now so entrenched.

"A whole lot of things need to change," he says. "We hear from some of the leaders of the integrated healthcare systems that are further along with delivery and they say 'trainees aren't prepared to work in these models, we have to retrain them.'"

Thibault proposes a solution: "My feeling is, 'Get them there in the first place, do their initial training in these care models, with their education."

As for the Macy Foundation, it suggests convening a national group to identify effective methods for patient and community engagement, beginning with a public-private partnership of federal agencies, and a private foundation.

Organizations that may be involved could include the Institute for Patients and Family Centered Care, the Institute for Healthcare Improvement, the Patient Centered Outcomes Research Institute, along with local and national healthcare systems. Others could be the National Center for Interprofessional Practice and Education, and the Robert Wood Johnson Foundation.

The foundation notes, of course, that healthcare scholarship and teamwork should include other fields, such as business. The Centers for Medicare and Medicaid Services, the National Institutes of Health and other organizations "should all share an interest in supporting this work in partnership with private foundations," the Macy Foundation states.

As it outlined the communication problems of academics and clinicians, the Macy Foundation acknowledged that a bridge to solutions would not be built overnight. "We do not underestimate the magnitude of the change in culture that will be required to accomplish all of these recommendations," the report concedes.

Still, there's no time like now to begin the process, says Thibault.

"I think we've got a moment in time in which change is around us. Almost no one can defend the status quo," he says. "Change is inevitable and we better figure out how to do it. If we miss this opportunity, some things may be imposed on us by the government and that won't be as good as what we do ourselves."

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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