The Institute of Medicine’s (IOM’s) Global Forum on Innovation in Health Professional Education is complemented by the work of four university- or foundation-based collaborations in Canada, India, South Africa, and Uganda. Known as innovation collaboratives (ICs), these country-based collaborations characterize innovators in health professional education through their demonstration projects on how schools of nursing, public health, and medicine can work together toward a common goal. The four ICs were selected by IOM leadership through a competitive application process that provides for certain benefits on the forum. These benefits include
- the appointment of one innovation collaborative representative to the IOM Global Forum;
- time on each workshop agenda to showcase and discuss the IC’s project with leading health interprofessional educators and funding organizations;
- written documentation of each collaborative’s progress summarized in the Global Forum workshop summaries published by the National Academies Press; and
- remote participation in Global Forum workshops through a video feed to the collaborative’s home site.
Each collaborative is undertaking a different 2-year program of innovative curricular and institutional development that specifically responds to one of the recommendations in the Lancet Commission report or the 2011 IOM The Future of Nursing report—reports that inspired the estab-
lishment of the Global Forum. These on-the-ground innovations involve a substantial and coordinated effort among at least three partnered schools (a medical school, a nursing school, and a public health school). As ad hoc activities of the Global Forum, the ICs are amplifying the process of reevaluating health professional education globally so that it can be done more efficiently and effectively and so that it will create increased capacity for task sharing, teamwork, and health systems leadership. The work of each of the collaboratives is detailed below.
Maria Tassone, M.Sc., B.Sc.PT
Sarita Verma, L.L.B., M.D., CCFP
University of Toronto
The Canadian Interprofessional Health Leadership Collaborative
The Canadian Interprofessional Health Leadership Collaborative (CIHLC) is a multi-institutional and interprofessional partnership whose goal is to develop, implement, evaluate, and disseminate an evidence-based program in collaborative leadership (CL) that builds capacity for health systems transformation. The CIHLC’s work is grounded in the principles of social accountability and community engagement and is embedded in a context of interprofessional and relationship-centered care. The program will be targeted at emerging health care leaders who are in positions that enable them to create sustainable change with their communities.
The CIHLC lead organization is the University of Toronto, partnered with the University of British Columbia, the Northern Ontario School of Medicine, Queen’s University, and Université Laval. The project is supported by the five universities as well as the Ontario Ministry of Health and Long-Term Care.
In the past year, CIHLC investigators completed foundational research to understand the concept of CL and design an educational program to develop collaborative leaders. The research involved
- a review of scientific and gray literature on the concept of CL for health systems change;
- a review of educational programs for the development of collaborative leaders in health care;
- an environmental scan of existing programs for the development of collaborative leaders; and
- the completion of key informant interviews with thought leaders in the health and education fields.
Across these four streams of research, the unique elements of CL (e.g., transformational leadership, social accountability, collaborative decision making) were identified. In addition, there was found to be broad consensus that CL is needed to support transformational system change within the health system to better meet the needs of patients, care providers, communities, and health system sustainability.
During the past 6 months (May through October 2013), the CIHLC
- has designed the CIHLC education program;
- has begun to develop modules for in-class and online learning;
- has been developing the framework for a capstone project;
- is establishing the organization of online content for program delivery;
- has developed a communication strategy for the program and launched a website; and
- has conducted a process evaluation to ensure that next steps are conducted efficiently and effectively.
The CIHLC is in the process of creating
- a community engagement toolkit,
- an evaluation framework to measure program quality and impact, and
- a searchable repository of existing leadership programs.
Key Developments: May–October 2013
Design of the CIHLC Education Program
Through an iterative process, the CIHLC has designed the Collaborative Leadership pilot program. The program targets emerging leaders who have completed general leadership courses and are looking for advanced specialized training in collaborate leadership grounded in community engagement and interprofessional practice. The program combines both face-to-face and online learning, including a capstone project in which the learners engage communities to develop, implement, and evaluate a community-centered project that meets the needs of an underserved community.
The curriculum includes change leadership, strengths-based leadership, and transformational leadership. Skills for community engagement will be embedded throughout the course to enable the learners to co-create a
shared vision with their communities and implement a project to achieve that shared vision. Feedback from learners participating in the pilot will ensure that the modules continue to evolve to maximize quality and impact.
Learning Management System (LMS) for Program Delivery
Taking into account the various modalities of course delivery and learner needs, the CIHLC has organized the course structure through the Blackboard LMS. This multilingual, internationally available platform will allow the CIHLC to provide distance education through online tools such as webinars, act as a depository for multimedia and interactive resources for the learners, and provide online assessment tools for educators. It will also facilitate the availability of the program internationally.
The project has developed a comprehensive communications strategy and has established a wide online and offline presence through various social media outlets and print. Currently, information about the CIHLC and the Education Program under development can be obtained through press releases (http://cihlc.ca/news), Facebook (www.facebook.com/cihlc), Twitter (https://twitter.com/cihlc), LinkedIn (http://www.linkedin.com/company/3200229), and pamphlets. The official CIHLC project website (http://cihlc.ca) provides information on project activities and collaborative members. It is also being used to recruit, register, and direct learners to the CIHLC program; provide information on instructors and learning resources; and facilitate ongoing engagement of alumni in the years following the pilot program.
The CIHLC is using a developmental evaluation approach to guide the development of the program and assess its quality and impact. Learners participating in the pilot test will be asked to provide ongoing feedback that will be used to improve the program to better meet the needs of the learners and support system transformation. As part of its own reflective processes, the CIHLC recently conducted a process evaluation to provide greater insight on the CIHLC team functioning. Results showed that supporting the development of relationships and fostering innovation leads to a valued collaborative.
During the next 6 months, the collaborative will complete the development of the program and launch the pilot cohort. Feedback from participants and continual scanning of the literature will be used to refine and enhance the program, while additional funding is being sought for the marketing and knowledge dissemination phase of the project.
Sanjay Zodpey, M.D., Ph.D.
Public Health Institute of India
Building Interdisciplinary Leadership Skills Among Health Professionals
in the 21st Century: An Innovative Training Model
Progress Report (April 2012–July 2013)
The Lancet Commission report on Education of Health Professionals for the 21st Century discusses three generations of global educational reforms. It elaborates on transformative learning, focusing on development of leadership skills and interdependence in health education, as the best and most contemporary of the three generations (Frenk et al., 2010). The purpose of this form of education reform is to produce progressive change agents in the field of health care. The Future of Nursing report also strongly focuses on transformative leadership, stating that strong leadership is critical for realizing the vision of a transformed health care system (IOM, 2011). The report recommends a strong and committed partnership of nursing professionals with physicians and other health professionals in building leadership competencies to develop and implement the changes required to increase quality, access and value and deliver patient-centric care.
Leadership is a complex multidimensional concept and has been defined in many different ways. In the field of health care, leadership serves as an asset to face challenges and is an important skill to possess. In order to reach this goal, common leadership skills must be looked for among students applying for health professional education, including medical, nursing, and public health professionals (Chadi, 2009). The Lancet Commission report’s recommendations are targeted at a multidisciplinary and systemic approach toward health professional education. In India, the lack of and need for professional health care providers has been discussed for the past many decades. The education system for health professionals in India is
strictly compartmentalized and there are strong professional boundaries and demarcations among the various health professions (medical, nursing, and public health); there is recognized need for integrating these three streams. Moreover, the current health professional education system in India focuses minimally on the development of leadership competencies to address public health needs of the population.
Rationale for the Initiative
Health professionals have made enormous contributions globally to health and development over the past century. The demand of 21st-century health professional education is mainly transformational, aiming to help the professionals strategically identify emerging health challenges and innovatively address the needs of the population. The need of the hour in India is to amalgamate the skills and knowledge of the medical, nursing, and public health professionals and to develop robust leadership competencies among them. This initiative proposed to identify interdisciplinary leadership competencies among doctors, nurses, and public health experts necessary to bring about a positive change in the health care system of the country.
Objectives of the Initiative
- Identification of interdisciplinary health care leadership competencies relevant to the medical, nursing, and public health professional education in India.
- Conceptualization of and piloting an interprofessional training model to develop physician, nursing, and public health leadership skills relevant for the 21st-century health system in India.
Partners of the Innovation Collaborative
The Innovation Collaborative is a partnership between the following three schools:
- Public Health Foundation of India, New Delhi—public health institute
- Datta Meghe Institute of Medical Sciences, Sawangi, Wardha—medical school
- Symbiosis College of Nursing, Pune—nursing school
These schools teamed up to further the objective of the Innovation Collaborative. Table C-1 provides basic information of the three schools.
TABLE C-1 Innovation Collaborative Partners
|Name of School||Address||Administrative Point of Contact||Members of Working Group|
|Public Health Foundation of India||Public Health Foundation of India, ISID, 4 Institutional Area, Vasant Kunj, New Delhi 110070, India||Prof. Sanjay Zodpey||
• Dr. Preeti Negandhi
• Ms. Kavya Sharma
• Dr. Himanshu Negandhi
• Ms. Ritika Tiwari
|Jawaharlal Nehru Medical College—constituent college under Datta Meghe Institute of Medical Sciences (Deemed University)||Paloti Road, Sawangi Meghe, 442004, Wardha District, Maharashtra State, India||Pro-chancellor Dr. Vedprakash Mishra||
• Dr. Abhay Gaidhane
• Dr. Zahir Quazi
|Symbiosis College of Nursing—constituent of Symbiosis International University||Symbiosis College of Nursing (SCON) Senapati Bapat Road, Pune, 411 004, Maharashtra (India)||Col. Jayalakshmi N.||
• Dr. Rajiv Yeravdekar
• Mrs. Meenakshi P. Gijare
Innovation Collaborative Activities—Update
The three partner institutes collaborated to address the major objectives of this initiative. A formal approval of the proposal was obtained by the IOM, following which the team members conducted various outlined activities.
1. Constitution of the collaborative: A team was formed including members from all three partner institutes. Prof. Sanjay Zodpey, Director-PHE, PHFI represents the Collaborative as the National Program Lead along with Col. Jayalakshmi N., Principal, Symbiosis College of Nursing and Dr. Vedprakash Mishra, Pro-chancellor, Datta Meghe Institute of Medical Sciences as Regional Program Leads. The team also included other member representatives from each partner institute.
2. Constitution of a Technical Advisory Group (TAG): The TAG was formed, comprising of renowned experts in the field of health professions education. All these members were contacted for seeking
their consent to be a TAG member to oversee and provide guidance to the activities of the Collaborative. Regular meetings were held with the TAG members and their guidance was sought on various aspects of the project.
3. Identification of interdisciplinary health care leadership competencies: The initial activity undertaken by the Collaborative was an exhaustive literature search by the working group under the guidance of the Program Leads to understand need for and genesis of leadership competencies as a part of education of health professionals. Published evidence, both global and Indian, was included in the literature search to look for key interdisciplinary leadership competencies, the need for an interdisciplinary training of health professionals and the current scenarios in interprofessional health education. The literature search strategies included journal articles from electronic databases, medical journals, grey literature, newspaper articles, and papers presented in conferences. The search was not restricted by the period of publication or language. The electronic search was complemented by hand searching for relevant publications/documents in their bibliographies. A process of snowballing was used until no new articles were located.
4. Expert group meetings: Once the literature search was complete, the working group summarized the findings of the search and prepared a formal report. This report was reviewed by all senior members and finalized. This was followed by a consultation with experts from various disciplines of health professional education, where the findings of the literature search were presented.
5. Development of training model: The next activity of the project was the development of the training model for the pilot. The training model was conceptualized based on the findings of the literature search and the recommendations of the expert group at the consultation. A training manual was developed for use in the trainings by the working group along with the team leaders.
The trainings are aimed at health professionals across the country from the medical, nursing and public health fields. The long-term objective of this training model is its integration into the regular curriculum of the medical, nursing and public health students, with an aim to develop interdisciplinary leadership skills among them.
To align with the objectives of the Innovation Collaborative, the training model was pilot-tested on some in-service professionals
and students across the three streams. For this, a detailed agenda and the training material were prepared based on the content of the training manual.
6. Piloting the training model: The pilot trainings commenced in April 2013 and were completed in the first week of May 2013. These trainings were conducted in batches at three different sites:
• State Institute of Health Management and Communication, Gwalior (SIHMC)
• Indian Institute of Public Health, Bhubaneswar (IIPHB)
• Datta Meghe Institute of Medical Sciences, Sawangi (DMIMS)
The duration of each training batch was 3 days. Resource faculty from the three partner institutes actively trained the participants. IIPHB had 25 participants for the training, while SIHMC and DMIMS had 16 and 25 participants, respectively. The average age of the participants across all the three batches was 32 years. The total number of males in the three batches was 40, while there were 26 females.
The group for each batch of the training workshop was mixed, with participants from different disciplines. The training was aimed at bringing the three disciplines (medical, nursing, and public health) together to build interdisciplinary leadership skills. Details of participants are mentioned in Table C-2.
The pilot training workshops included didactic sessions as well as group discussions. The didactic sessions were aimed at giving the trainees an understanding of leadership skills and their importance in health care. The aim of the group discussions was to train them to innovatively apply interdisciplinary leadership competencies in their local health care settings.
At the end of the pilot trainings, the trainees were asked to fill out a feedback form about various aspects of the training. Positive responses from the participants were many, ranging from good coordination of the training, suitable content, good pedagogy to friendly atmosphere. A few negative points, such as short duration of the training, more theoretical, less group discussions/practicum were also emphasized.
Following the pilot trainings, a formal report was prepared by the working group and shared with the Global Forum at the IOM.
7. Preparation and dissemination of findings: The Innovation Collaborative is currently in the process of revising the training model
TABLE C-2 Participants at Training Workshop
|Name of Institute||Participants from Medical, Nursing, and Public Health||Total Participants|
|Indian Institute of Public Health, Bhubaneswar (IIPHB)||14-medical, 2-nursing, 9-public health||25|
|State Institute of Health Management and Communication, Gwalior (SIHMC)||11-medical, 4-nursing, 1-public health||16|
|Datta Meghe Institute of Medical Sciences, Sawangi, Wardha (DMIMS)||14-medical, 8-nursing, 3-public health||25|
based on the feedback of the trainees of the pilot tests. This revised model will be shared with members of the Technical Advisory Group for their inputs and accordingly finalized.
The findings of the initiative will be published as a monograph as well as in peer-reviewed journal. The Collaborative will also present the findings of the initiative to the Global Forum on Innovation in Health Professional Education.
Table C-3 summarizes the activities mentioned above.
TABLE C-3 Innovation Collaborative Activities—Update Summary
|Constitution of the Collaborative||Completed||Team formed comprising of members from three partner institutes|
|Constitution of the Technical Advisory Group (TAG)||Completed||Regular meetings held and advice sought from members regarding project|
|Conducting a literature review||Completed||Report has been shared with the Institute of Medicine (IOM) earlier|
|Expert group meetings and consultation||Completed||Inputs taken from experts from the field|
|Developing training model||Completed||Training manual has been shared with IOM earlier|
|Piloting the training model||Completed||Trainings were completed in May 2013|
|Preparation of report based on pilot findings||Completed||A formal report was prepared and shared with IOM|
|Finalization of training model||Ongoing||The training model is being revised to incorporate the changes suggested by the participants of the pilot trainings|
|Report preparation and dissemination||To be done||Will be done after finalization of training model. Inputs will be sought from TAG for the final report|
Juanita Bezuidenhout, M.B.Ch.B., M.Med., Ph.D.
Julia Blitz, M.B.B.Ch., MPraxMed Marietjie de Villiers, Ph.D., M.B.Ch.B., M.Fam.Med.
South African Partnership on Innovation in Health Professional Education Update from the Leadership Team
The South African collaborative involves Stellenbosch University, the University of the Western Cape, and the University of the Free State collaborating on two overlapping yet distinct projects in innovation in health professional education.
The South African Collaborative’s work focuses on leadership through transformative learning and interdependence, and the purpose of the project is to determine the relevant competencies that are required for transformational and shared leadership in the context of health teams.
For that purpose, the IC has approached its work in a qualitative way, interviewing leadership across the faculties from the level of residents to faculty management.
In the process, they have generated 1,000 pages of transcriptions and have just completed an analysis. In brief, they have identified an understanding of leadership that has emerged from the interviewed, but is still being complied. However, two quotes that highlight the definition of leadership from the interviews are “I see the diversity, opportunities, doing things differently, which creates much more vibrant teaching environments where we develop leadership that interacts with communities and interacts with people,” and “We should have a strong philosophy for change and leading beyond this but we are not doing that, and that leadership is not a positional appointment but that anybody can be a leader.” Also, there was a strong feeling that there should be training, and the purpose of the
training is for people to understand leadership, to understand teamwork, and to become better leaders.
A set of attributes that were identified or related to enabling the environment are a strong value system, building relationships, the ability to create meaning, being strategic thinkers, and being able to communicate. In a review of the literature about leadership, all of these attributes were present in the data.
Several leadership strategies emerged and are shown in Figure C-1. The strategies that were most commonly expressed were the use of role models and mentors and inclusive, collaborative, and interdependent strategies.
As always, there are many challenges. And one of the challenges is the challenge of interdependence, to be collaborative and inclusive. Also, there is resistance to change, which we always experience. Then there are always challenges in capacity, environment, and context. And again, role models are important.
As far as training needs, there was need for formal programs, but much more important is the need for role models and, specifically, for a structured mentorship program.
FIGURE C-1 Stellenbosch University leadership strategies.
SOURCE: Stellenbosch University.
Rose Chalo Nabirye, Ph.D., M.P.H.
Nelson Sewankambo, M.B.Ch.B., M.Sc., M.D., F.R.C.P., L.L.D. (HC)
Defining competencies, developing and implementing an interprofessional training model to develop competencies and skills in the realm of health professions ethics and professionalism
Innovation and Motivation for Selection of Innovation
This project is a major innovation aimed at contributing to improvement in the quality of health service. Although there is a lot of discussion about the need to improve professional ethics and professionalism in low- and middle-income countries, there has been very little attempt to develop competency-based interprofessional education programs to address the challenges. Professionalism is defined in several different ways (Wilkinson et al., 2009). The Royal College of Physicians (2005) has defined professionalism as “a set of values, behaviors, and relationships that underpin the trust the public has in doctors.” This definition can be extended to embrace all types of health workers.
Overall aim: To prepare a future workforce committed to practicing to a high degree of ethics and professionalism and performing effectively as part of an interprofessional health team with leadership skills.
- To define competencies and develop a curriculum for interprofessional education of health professional students (nursing, medicine, public health, dentistry, pharmacy, and radiography) in order to develop their skills in the realm of ethics and professionalism.
- To pilot a curriculum for interprofessional education of health professional students (nursing, medicine, public health, dentistry, pharmacy, and radiography) to develop their skills in the realm of ethics and professionalism.
- To develop curriculum for interprofessional education for health workers and tutors in ethics and professionalism and pilot its implementation in partnership with the regulatory professional councils.
Approach to Implementation of the Project
A critical element of this project will be the engagement of major stakeholders, including the Ministry of Health, patients, hospitals and health centers, private practitioners, professional councils, educators, students, alumni, and consumer rights groups nationally. This engagement will ensure the participation of stakeholders in the implementation and the commitment of local resources to support this effort. Through this engagement, the collaborative will define the extent of the problem (unethical and unprofessional practices among nurses, doctors, public health workers, and other health professionals) and identify the necessary interventions, including the required competencies and interprofessional training approaches that will address the gaps as well as the necessary post-training support to ensure the institutionalization of ethics and professionalism among health professionals in Uganda. Stakeholders will participate in the implementation of training and mentoring trainees at their respective places of work. Of particular importance are the students who have initiated the formation of a student ethics and professionalism club. They are advanced in the planning process and will be supported through this project and contribute to the whole process of this project. Right from the beginning, the collaborative plans to align this educational project with the needs of Uganda’s population. Concerns have been raised about ethics and professionalism among health professionals in Uganda, largely by the media. There are, however, only limited, brief reports in publications in the recent past in peer-reviewed literature on the issue of ethics and professionalism among health workers in Uganda (Hagopian et al., 2009; Kiguli et al., 2011; Kizza et al., 2011).
Some national reports highlight the challenges in this area, but few formal studies have been conducted to document the extent of the problem, the contextual factors, and possible interventions (UNHCO, 2003, 2010). Because of the lack of comprehensive evaluations and evidence, the collaborative plans to initiate this project with a systematic needs assessment. The needs assessment will involve the participation of representatives from several key partners mentioned previously. Data will be collected through an analysis of key documents from the professional councils, which are statutory units charged with the responsibility of investigating reports and cases of professional indiscipline among doctors, dentists, nurses, pharmacists, and others. The collaborative will undertake limited surveys and key informant interviews among the above-named groups.
Development and Implementation of the Curriculum
Results from the needs assessments will be used to inform the curriculum development process, which will employ a six-step approach (Kern et al., 2009). Prior to curriculum development, interprofessional competencies will be defined through stakeholder engagement and suggestions, building on the five competencies defined by the 2003 IOM report A Bridge to Quality. Trainees will learn not only competencies related to ethical practices and professionalism but also competencies of interprofessional collaboration and leadership (IPEC Expert Panel, 2011). Stakeholder discussions will be held to get a clearer understanding of society’s needs and the challenges of ensuring high standards of ethics and professionalism. This will be followed by a consensus process to arrive at an agreed-on set of competencies to be acquired during an interdisciplinary course for the students who are the next generation of leaders.
A curriculum will be developed for students and for teachers based on the needs assessment results and the defined competencies.
A number of institutional reforms will be needed as the instructional reforms are implemented. These include a careful review of the linkages and collaboration between the university and the aforementioned stakeholders, and the recognition and the reward system for excellence in demonstrating the desired high standards of ethics and professionalism among both students and staff.
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