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Dr. Kathleen Gallo, Senior Vice President and Chief Learning Officer, North Shore-Long Island Jewish Health System
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Dr. Kathleen Gallo, Senior Vice President and Chief Learning Officer, North Shore-Long Island Jewish Health System

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Disrupting Healthcare Education: Calling all Innovators

Disrupting Healthcare Education: Calling all Innovators

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  • 1. Disrupting Healthcare Education: Calling All Innovators Kathleen Gallo, PhD, MBA, RN, FAAN Senior Vice President & Chief Learning Officer 1
  • 2. 2 4 North Shore - LIJ Health System
  • 3. The Changing Landscape 3
  • 4. 4
  • 5. Problems Identified in Graduate Medical Education and Nursing Education Medical • Too diffuse, uncoordinated • Too long, redundant • Too much encouragement of specialization • Too linked to hospital reimbursement Nursing • Lockstep, inflexible curriculum and authoritarian, passive teaching methods • Focus on specialized, fragmented acute care • Inadequate attention to lifelong learning process (e.g. critical thinking, decision- making collaboration) • Segregation of nursing practice and education Source: Larson, Elaine L., (1995). New Rules for the Game: Interdisciplinary Education for Healthcare Professionals, Nursing Outlook, 43, 181 5
  • 6. 6 Healthcare’s Response... •Align with the rapidly changing environment •Paradigm shift in organizational models needed to occur
  • 7. Traditional Healthcare Models • Hierarchal • Slow • Inwardly Focused • Reactive 7
  • 8. Emerging Organizational Model • Flat • Nimble/Flexible • Customer-centered • Pro-active 8
  • 9. How do we prepare healthcare professionals to work in value- based collaborative work environments? 9
  • 10. North Shore-LIJ Health System’s Answer: Creating a world class “Learning Organization” 10
  • 11. 11 The Center for Learning and Innovation • Health System’s corporate university • A vehicle for Strategic Organizational Learning • Led by the Chief Learning Officer
  • 12. 12 The Center’s Objectives • Build a first class organization of continuous learning • Develop Human Capital necessary to support the strategic business goals and objectives of the North Shore-LIJ Health System • Invest in and develop a cadre of leaders at all levels throughout the organization • Create and promote a system culture dedicated to excellence, innovation, teamwork, and continuous change
  • 13. 13 A Learning Organization Emphasizes increased adaptability to the accelerating pace of change that is occurring
  • 14. 14 Building Blocks of a Learning Organization • Personal Mastery • Mental Modeling •Systems Thinking •Team Learning •Building a Shared Vision
  • 15. 15
  • 16. 16
  • 17. Source: Mazur, Eric (2012) The Scientific Approach to Teaching: Research as a Basis for Course Design 17
  • 18. 18 • Lecture/discussion activities are the least effective ways to enhance learning • Teaching methods should match more closely with how learners learn • Rather than bringing learners to classrooms, faculty can work directly with learners in simulated work environments What the Brain Has Told Us About Learning
  • 19. It is only in the “does” triangle that the clinician truly performs 19
  • 20. KOLB 2011 20
  • 21. • Activities that are specifically designed to improve the current level of performance • Repeated application with use of knowledge over extended periods of time leads to remarkably good retention However………. • The lack of adequate feedback make efficient learning impossible. Mere repetition does not automatically improve performance Deliberate Practice 21
  • 22. 22
  • 23. 23
  • 24. 24 Core Principles • Learning – active pedagogy • Knowledge in action creating effective results • Value learning over teaching • Trust the learners to learn much of the factual knowledge outside of class • Learners must be prepared and active learners everyday • Knowledge in Action-not factual memorization (Science that sticks) • Assessment that reflects Core Principles • Critical thinking
  • 25. 25 Interprofessional Education (IPE) Interprofessional education occurs when learners from the health professions and related disciplines learn together about the concepts of health care and the provision of health care services toward improving the effectiveness and the quality of health care Essential Elements: - collaboration - respectful communication - reflection - application of knowledge and skills - experience in interprofessional teams Core Principles, Continued
  • 26. 26 Interprofessional Education (IPE) Why… • Increased incidence of preventable errors (IOM) • How care is delivered is as important as what care is delivered • Effective clinical teams are essential to the delivery of care that is patient-centered, safe and efficient Train in teams those that work in teams
  • 27. CENTER FOR LEARNING AND INNOVATION ORGANIZATIONAL DEVELOPMENT BEGINNINGS LEADERSHIP DEVELOPMENT COACHING WORKFORCE DEVELOPMENT CHANGE MANAGEMENT FACILITATION CUSTOMIZED SESSIONS PATIENT SAFETY INSTITUTE SIMULATION BASED EDUCATION INTER- PROFESSIONAL TEAM EDUCATION CLINICAL SKILLS EDUCATION EDUCATIONAL RESEARCH PHYSICIAN LEADERSHIP INSTITUTE PHYSICIAN BEGINNINGS LEADERSHIP DEVELOPMENT DEPARTMENT SPECIFIC EDUCATION DEPARTMENT TEAM BUILDING CLINICAL EDUCATION AT PATIENT SAFETY INSTITUTE SCHOLAR PIPELINE ADMINISTRATIVE FELLOWSHIPS MEDICAL SCHOLARS PIPELINE PROGRAM NEW YORKERS FOR CHILDREN PROGRAM INSTITUTE FOR HEALTH PROFESSIONS IS 59 PARTNERSHIP DOMESTIC AND INTERNATIONAL INTERNSHIPS EMERGENCY MEDICAL INSTITUTE PARAMEDIC EMERGENCY MEDICAL TECHNICIAN ADVANCED EMT AEMT & EMT RECERTIFICATION ACLS/BLS CONTINUING MEDICAL EDUCATION HOFSTRA NORTH SHORE LIJ SCHOOL OF MEDICINE EVALUATION AND ASSESSMENT CLINICAL SKILLS EDUCATION CLINICAL SIMULATION BIOSKILLS EDUCATION CENTER ATTENDING AND RESIDENT PHYSICIAN PROGRAMS CONTINUING MEDICAL EDUCATION HYBRID SIMULATION VENDOR SPONSORED PROGRAMS CLINICAL TRANSFORMATION LEAN / SIX SIGMA PROGRAM PROGRAM / PROJECT MANAGEMENT EHR CONTENT DEVELOPMENT CLINICAL COLLABORATIVES INDUSTRIAL ENGINEERING 27
  • 28. Text High Potential Participant Program Kick-Off Resume Submission To Program ALEAD Development Planning Executive Breakfast Forums Coaching CEO Breakfasts & System Tours Executive Forums External Development Opportunities Talent/ Resume Workshops Knowledge Exchange Commencement Required Elective Administrative/Clinical Components Mandatory Assessments • 360° • MBTI • EQ 28
  • 29. Physician High Potential Participant Program Kick -Off Individual Assessments • 360 • MBTI • EQ Individual Profile Submissions Internal Business Courses Level 1 Executive Breakfast Forums Executive Forums Coaching Internal Business Courses Level 2 Inter- professional Project Teams External Electives Mentorship/ Sponsorship Knowledge Exchange Sessions External Rotations Commencement Year One YearTwo Physician Components 29
  • 30. Interprofessional Leadership Capstone Project • Surgical Site Infections • Physician Communications • Flu Vaccination • Hand Washing • ICD-10 Adoption • Surgical Safety • Medication Reconciliation 30 • Chemotherapy Safety • Advanced Illness • Sepsis • Readmissions • Physician Engagement • Population Health Mgmt • OR Start Time • Antibiotic Stewardship
  • 31. 31 Patient Safety Institute 31
  • 32. 32
  • 33. PSI Mission The Patient Safety Institute, through education, collaboration, research and interprofessional simulation, assists members of the patient-care team in achieving excellence in the delivery of quality and safe patient care. The Patient Safety Institute promotes a culture dedicated to caring, excellence, innovation, integrity, teamwork and improving the health of the community. 33
  • 34. PSI Vision The Patient Safety Institute will be an internationally recognized leader in interprofessional simulation and a model provider of clinical education, promoting the practice of safe and effective patient care. 34
  • 35. Simulation: An Innovative Learning Strategy • Live simulation with high-fidelity simulators • Learner-centric environment • Experiential, emotionally engaging activity • Enhances self-discovery and learning through debriefing and reflection • Emphasizes learning outcomes • Stresses teamwork and communication 35
  • 36. 36 Advantages of Simulation • Deliberate practice of high risk, low incident events • Fosters the development of leadership, interpersonal skills and team behaviors • Minute by minute video and audio recording for reflective debriefing sessions and immediate feedback • Higher level of learning - Teamwork - Communication - Critical Thinking - Technical Skills
  • 37. 37 It’s Not About the Simulator The power of individual or team training in a simulation environment lies in the integration of validated educational methods into the real simulation experience (Dunn, 2008) Pre-Work Simulation Debriefing Reflection
  • 38. 38 Debriefing • Feedback is the primary opportunity for learning • Most learners feel that inadequate feedback is provided during training • Without feedback, poor performance is not corrected, appropriate behavior is not reinforced, and learners develop their own system of self validation
  • 39. 39 Healthcare Simulation as a Platform for Interprofessional Education
  • 40. Course Development Process: A Team Approach Initial Contact Planning meeting Establish program objectives Share PSI’s approach, experience, capabilities Committing to the Partnership Faculty attends Simulation Instructor Course Confirm program timeline Developing the Program Design program according to established objectives Prepare scenario template for each scenario that is part of the program Finalize Program Design and Logistics Program agenda Distribute pre- work to participants Conduct practice session to ensure scenarios meet learning objectives Deliver Program Faculty and participants execute the learning experience Combine pre- and post-program learning, action learning, teaching methodologies, and delivery principles Post-Program Review and Follow Up Post-program surveys completed by participants Debrief with faculty and PSI staff Take key learning from the delivery process into the redesign process 40
  • 41. 41
  • 42. 42 Patient Safety Institute
  • 43. 43 Debrief Rooms
  • 44. 44 In-Situ Simulation
  • 45. 45 Interprofessional educational models are essential to develop and maintain interdisciplinary teams thereby advancing teamwork and improving patient safety Disruptive Innovation
  • 46. Source: Rogers, Everett M. (2003) Diffusion of Innovations, 5th Edition. New York, NY: Free Press 46
  • 47. 47
  • 48. 48 Change Management Strategy If you can’t change the people, change the people
  • 49. 49 What We Know For Sure • No matter how sophisticated the technology, if humans are involved, errors will occur – The brightest and best make errors • Culture is directly related to the safety record • The safety net is The Team not the individual • Teamwork allows larger and more complicated tasks to be accomplished safely and effectively Teamwork Trumps Autonomy and Is Essential to a Culture of Safety
  • 50. 50 Teams Rule • In complex problems, team performance will exceed the expected sum of all single actions • Mutual monitoring can help to notice individual errors • Shared workload can help to prevent the overstrain of an individual, and make sure that all tasks planned can be executed in a timely manner • Mutual support and encouragement can enable team members to master even the most difficult situations • Successful team performance results in low-error, high-quality patient care and high satisfaction of the healthcare provides
  • 51. 51 “Trying harder will not work. Changing systems will” -IOM in Crossing the Quality Chasm
  • 52. 52 Strategic Organizational Learning • Inseparable from work • Builds culture and morale • Transfer Best-Practices across boundaries • Develops Human Capital • Drives the organization into the future
  • 53. 53 Transformation Efforts • Until changes sink deeply into a company’s culture, new approaches are fragile and subject to regression • Anchoring change • A conscious attempt to show people how the new approaches, behaviors and attitudes have helped improve performance • To make sure that the next generation of top management really does personify the new approach
  • 54. 54 The Tipping Point “…that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire” Time Tipping Point From Malcolm Gladwell. The Tipping Point: How Little Things Can Make a Big Difference. Boston: Little Brown. 2000
  • 55. Innovation Ronald Harden The Light Bulb was not a Continuous Improvement of the Candle 55
  • 56. 56 Train in Teams Those That Work in Teams
  • 57. USS Montana 57
  • 58. 58