Sherril B. Gelmon

Collaborating for improvement in health professions education.

Continual improvement efforts have been slower in health professions education than in health care delivery. This article identifies the lessons learned by teams working in an Interdisciplinary Professional Education Collaborative in overcoming barriers to carrying out continual improvement efforts in these educational organizations.

Making organizational change to achieve improvement and interprofessional learning: perspectives from health professions educators

Health professionals must learn to work in the context of an interdisciplinary team in order to meet the needs of the evolving health care delivery system. These teams must work successfully with community systems to achieve common goals, while understanding and respecting diverse perspectives, experiences and skills. Strategies for changing health professions education to prepare new health professionals for such work have been tested by the Interdisciplinary Professional Education Collaborative. Illustrations of making educational change, and creating situations to sustain the change, are offered from the Collaboratives experience. Teams participating in the Collaborative engaged in interprofessional education, working on community-based health improvement issues. The illustrations are offered in the context of higher education, and the many barriers to making change that must be overcome. The work of the Collaborative provides valuable illustrations of successful activities to promote and create change, and ultimately to achieve improvement and interprofessional learning, better preparing new health professionals for the health systems in which they will work.

Community-Based Education and Service: The Hpsisn Experience

Health services delivery is increasingly shifting to community-based settings. The competencies required of future health professionals require a shift in their educational preparation. Service learning is suggested as an educational method with the potential to reform health professions education in tandem with the changes occurring in the health services delivery. The Health Professions Schools in Service to the Nation Program (HPSISN), a US demonstration project of service learning in the health professions, examines the impact of service learning on students, faculty, communities and institutions across a wide array of universities and community settings. This paper describes the evaluation of the HPSISN program, including the evaluation model, key study questions, findings and lessons learned. The HPSISN evaluation was designed to assess the effectiveness of service learning as a pedagogy in health professions education and describe the impact of service learning activities through university-communi...

Community-Engaged Scholarship in the Academy: An Action Agenda

Change • July/August 2013 O ver the past decade or more, national commissions, professional associations, and accrediting and funding agencies have identified community engagement as a core mission of higher education. Students, faculty, and community partners all benefit from moving the classroom to the community (and back again). Community-engaged research has also gained recognition as a legitimate approach to producing and mobilizing knowledge. Yet as changes to curricula and research within programs or institutions (and in some cases across disciplines By Sherril B. Gelmon, Catherine Jordan and Sarena D. Seifer Community-Engaged Scholarship in the Academy

Building the foundation for health system transformation: Oregon's Patient-Centered Primary Care Home program.

OBJECTIVE Health system reform is largely dependent upon the transformation of primary care in addition to the alignment of incentives that mediate the allocation of resources. The Patient-Centered Medical Home (PCMH) is a model of enhanced primary care that encourages coordination, patient-centered care, integration of public health services, and innovative methods for improving population health-all critical elements of health system reform. Because it changes the way primary care is organized and delivered, the PCMH model has been adopted as a foundational component of Oregons health system transformation. This article presents insights drawn from an evaluation of the implementation of Oregons Patient-Centered Primary Care Home (PCPCH) program and the adoption of the model by primary care providers. DESIGN We used a mixed-methods approach consisting of 2 surveys of recognized PCPCH practices, qualitative document analysis, and key informant interviews. Evaluation research findings were triangulated with findings from PCPCH clinic site visits conducted as part of a regulatory verification process. RESULTS Survey results describe a broad range of strategies and practices adopted by recognized PCPCH clinics within 6 defined core attributes: (1) access to care; (2) accountability; (3) comprehensive whole-person care; (4) continuity; (5) coordination and integration; and (6) person- and family-centered care. We also identify 4 key factors that influenced the conceptualization, development, and implementation of the PCPCH program: (1) support and motivations; (2) administrative barriers and resource constraints; (3) alignment of short- and long-term financial incentives; and (4) leadership and interpersonal relationships. CONCLUSIONS This evaluation provides insights into the factors that influence implementation of a primary care home program as public policy; the strategies and challenges associated with implementation of the model; and the implications of both for other states that are engaged in-or considering-similar system reform efforts.

Development, Implementation, and Assessment of a Competency Model for a Graduate Public Affairs Program in Health Administration

Abstract Competency-based education has become the norm for professional graduate degree programs. This paper describes the development, implementation, and ongoing validation of a competency model designed for a multifaceted public administration program. The model is based on accreditation standards and competencies promulgated by NASPAA and CAHME, and reflects a unique focus on community-engaged pedagogies. A framework consisting of 10 competencies was implemented in 2011–12 and validated through feedback from stakeholders, alumni, field preceptors, and graduates. A two-dimensional matrix of content coverage and expected levels of competency attainment delineates the articulation of competencies, curriculum, and course content, and provides a framework for program evaluation. Multiple methods for evaluating the competency-based graduate health administration program are described. Ongoing efforts to refine courses, the curriculum, and the competency model are discussed in the context of the program’s mission, multiple accreditation standards, assessment of student learning outcomes, and engagement of community stakeholders.

CES4Health.info: An Online Tool for Peer Reviewed Publication and Dissemination of Diverse Products of Community-Engaged Scholarship

Community-engaged scholarship (CES)—research, teaching, programmatic and other scholarly activities conducted through partnerships between academic and community partners—may result in innovative applied products such as manuals, policy briefs, curricula, videos, toolkits, and websites. Without accepted mechanisms for peer-reviewed publication and dissemination, these products often do not “count” toward faculty promotion and tenure (P&T) and have limited opportunities for broad impact. This paper reports on CES4Health.info, a unique online tool for peerreviewed publication and dissemination of products of CES in forms other than journal articles. In its first year, CES4Health.info has published 24 products and documented the satisfaction of users, authors, and reviewers.

Accreditation of emerging oral health professions: options for dental therapy education programs

Objectives: The study explored the options for accreditation of educational programs to prepare a new oral health provider, the dental therapist. Methods: A literature review and interviews of 10 content experts were conducted. The content experts represented a wide array of interests, including individuals associated with the various dental stakeholder organizations in education, accreditation, practice, and licensure, as well as representatives of non-dental accrediting organizations whose experience could inform the study. Results: Development of an educational accreditation program for an emerging profession requires collaboration among key stakeholders representing education, practice, licensure, and other interests. Options for accreditation of dental therapy education programs include establishment of a new independent accrediting agency; seeking recognition as a committee within the Commission on Accreditation of Allied Health Education Programs; or working with the Commission on Dental Accreditation (CODA) to create a new accreditation program within CODA. These options are not mutually exclusive, and more than one accreditation program could potentially exist. Conclusions: An educational accreditation program is built upon a well-defined field, where there is a demonstrated need for the occupation and for accreditation of educational programs that prepare individuals to enter that occupation. The fundamental value of accreditation is as one player in the overall scheme of improving the quality of higher education delivered to students and, ultimately, the delivery of health services. Leaders concerned with the oral health workforce will need to consider future directions and the potential roles of new oral health providers as they determine appropriate directions for educational accreditation for dental therapy.

Formulating the mess: lessons from "Building Knowledge of Health Care as a System".

This article describes the experiences of a group of health adminstration educators, a group of medical educators, and a group of nursing educators in applying the lessons of the exercise “Building Knowledge of Health Care as a System” to the organization of health professions education.

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon

Background: Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). Methods: Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics. Between 2015 and 2016, semistructured interviews and focus groups were completed with 85 key informants. Results: Clinics reported similar challenges implementing the PCPCH model, including shifting patterns of care use, fidelity to the PCPCH model, and refining care processes. The following ten implementation strategies emerged: expanding access through care teams, preventing unnecessary emergency department visits through patient outreach, improved communication and referral tracking with outside providers, prioritization of selected program metrics, implementing patient-centered practices, developing continuous improvement capacity through committees and “champions,” incorporating preventive services and chronic disease management, standardization of workflows, customizing electronic health records, and integration of mental health. Conclusion: Clinic leaders benefited from understanding the local context in which they were operating. Despite differences in size, ownership, geography, and population, all clinic leaders were observed to be proponents of strategies commonly associated with a “learning organization”: systems thinking, personal mastery, mental models, shared vision, and team. Clinics can draw on their own characteristics, use state resources, and look to established PCMHs to build the evidence base for implementation in primary care.