Health Professions Education A Bridge to Quality (2003) / Chapter Skim
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3. The Core Competencies Needed for Health Care Professionals
3. The Core Competencies Needed for Health Care Professionals
Pages 45-74
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From page 45... ...
Preparing health care professionals to take on this task requires a common vision across the professions centered on a commitment to, first and foremost, meeting patients' needs as envisioned in the Quality Chasm report (Institute of Medicine, 20014. The committee recommends the following as an overarching vision for all programs and institutions engaged in the education of health professionals: Ad health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evid~ence-based~practice, quality improvement approaches, and informatics.
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From page 46... ...
Apply quality improvement identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; design and test interventions to change processes and systems of care, with the objective of improving quality. Utilize informatics communicate, manage knowledge, mitigate error, and support decision making using information technology.
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From page 47... ...
The summit committee used this list of skills and the vision set forth in the Quality Chasm report as the foundation for its work, combining the list of skills into common groupings. The committee supplemented these groupings with a review of other seminal reform efforts that have articulated core competencies across or within the health professions.
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From page 48... ...
and later expanded the list to 21 (Lenburg et al., 1999; O'Neil and the Pew Health Professions Commission, 19984. Debates centered on how to evaluate competency, focusing on the reliability, validity, and predictive ability of related measures.
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From page 49... ...
Unfortunately, this is not always the case, because health care professionals are often not supported by a system that aids them in providing optimum care. The scenario in Box 3-2, developed by the committee, is meant to illustrate some of the serious problems facing patients during an encounter with clinicians, and to show why the five core competencies outlined above are critical to improving health care.
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From page 51... ...
This form would have provided various graphs displaying a 6-month history of care while alerting health care providers to needed tests and services. In the paper-based system that characterizes the scenario in Box 3-2, patient input depends on each health care provider's remembering to update encounter forms and office staffs having time for data entry.
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From page 52... ...
Significant work done by researchers and experts in this competency area reveals specific skills needed by today's health professionals to be more responsive to patient needs (Gerteis et al., 1993; Halpern et al.,2001; Institute of Medicine, 2001; Lewin et al., 2001; Mead and Bower, 2000; O'Neil, 1992; Pew Health Professions Commission, 1995; Stewart, 20014: · Share power and responsibility with patients and caregivers. Engage in an ongoing dialogue with patients that brings about understanding, acceptance, cooperation, and identification of common goals and related care plans.
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From page 53... ...
In a randomized controlled trial of a self-management program for chronic disease patients, participants who received the intervention showed improvement as compared with the control group in health behaviors such as frequency of exercise and improved communication with health providers, as well as improved health status and reduced hospitalization (Lorig et al., 20014. Providing patient-centered care also has been shown to lead to greater clinician satisfaction, a reduction in malpractice claims, and patient loyalty to the clinician (Meryn, 19984.
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From page 54... ...
Another obstacle has been associated with the definition of terms related to this competency. Though a widely used phrase, patient-centered care has little shared meaning within and across the health professions.
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From page 55... ...
Still other studies have demonstrated some impact of effective team care on patient safety and reduction of medical errors (Silver and Antonow, 2000; Weeks et al., 2001~. However, more research is needed to fully explore the effect of teams on patient outcomes and cost, as well as the effectiveness of teams in ambulatory settings (Cooper and Fishman, 2003~.
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From page 56... ...
The notion of evidence-based practice refers to the integration of best research evidence, clinical expertise, and patient values in making decisions about the care of individual patients (Institute of Medicine, 2001; Straus and Sackett, 19984. Best research evidence includes evidence that can be quantified, such as that from randomized controlled trials, laboratory experiments, clinical trials, epidemiological research, and outcomes research; evidence based on qualitative research; and evidence derived from the practice knowledge of experts, including inductive reasoning (Guyatt et al., 2000; Higgs et al., 20014.
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From page 57... ...
Considerable progress has been made on identifying and disseminating best research findings about effective clinical practice. Such efforts include journals that summarize primary research, the Agency for Healthcare Research and Quality's development of a national clearinghouse for clinical guidelines and launch of evidence-based practice centers to produce and disseminate evidence reports and technology assessments, the National Institutes of Health's Consensus Development Program (National Institutes of Health, 2002)
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From page 58... ...
Another obstacle is that nursing and allied health interventions often are not evaluated using rigorous quantitative research designs, but are described in descriptive or qualitative studies (Department of Health and Human Services, 1998; Evers, 2001; Mazurek, 20024. Nursing and allied health leaders advocate standardizing evidence in their fields and combining it with other bodies of evidence to achieve the best possible outcomes for patients and strengthening the evidence base to include more randomized studies (Denehy, 1998; Department of Health and Human Services, 1998; Lang, 1999; Zielstorff, 1998~.
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From page 59... ...
A growing body of studies indicates that applying quality improvement methods and principles mitigates errors, waste, inefficiency, and delay (Holman et al., 2001; Kiefe et al., 2001; O'Connor et al., 19964. One study found that implementation of a quality improvement program was associated with a high level of adherence to quality-of-care indicators for acute mycordial infarction (Mehta et al., 20004.
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From page 60... ...
improvement techniques to reduce their inhospital mortality rate after coronary artery bypass graft surgery; after 2 years, a 24 percent reduction in the in-hospital mortality rate was achieved (O'Connor et al., 19964. Box 3-6 presents an example of how interdisciplinary teams can apply quality improvement strategies to reduce errors.
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From page 61... ...
Recl2vce Errors Information system applications have been shown to enhance patient safety by standardizing and automating certain decisions and by flagging errors, such as adverse drug interactions, before they are allowed to occur. Likewise, computerized medical records, with their elimination of handwritten data, are integral to error reduction.
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From page 62... ...
Many electronic medical records feature computer prompting that asks for missing information and therefore enables more complete documentation (Raymond and Dold, 20024. Make Decisions Computerized decision support systems serve as reminders to help primary care teams comply with evidence-based practice guidelines or as sources of feedback to providers to show how they are performing on various care 62
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There is ongoing debate among the health professions as to whether informatics is .
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From page 64... ...
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From page 65... ...
In addition, they discussed options that would allow her to meet her varied responsibilities. By the end of the interdisciplinary team meeting, Mrs.
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Third, the health care professionals emp1/toyed evidenced-basedpractice. Health professionals frequently expect newly diagnosed diabetics to change multiple behaviors to decrease their risk of complications.
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From page 67... ...
Conclusion In conclusion, the committee stresses that narrowing of the quality chasm can be realized, at least in part, by reforming health professions education: · For health professionals, there is a set of core competencies that can advance adherence to the rules of a redesigned health care system as envisioned in the Quality Chasm report: provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and utilize informatics. · The extent to which current health professionals are implementing these competency areas does not meet the health care needs of the American public.
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From page 68... ...
1998. A report card on continuous quality improvement.
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From page 69... ...
A randomized trial of community-based education. Effective ClinicalPractice 4~3~:95-104.
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2001. Improving quality improvement using achievable benchmarks for physician feedback: A randomized controlled trial.
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From page 71... ...
1999. Evidence suggesting that a chronic disease selfmanagement program can improve health status while reducing hospitalization: A randomized trial.
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From page 72... ...
Journal of the American Medical Informatics Association 4 (54:364-75. Pew Health Professions Commission.
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From page 73... ...
Joint Commission Journal on Quality Improvement 27 (54:243-54. Weingart, S.N.
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