Addressing needs of diverse stakeholders: Twelve tips for leaders of health professions education programs

Figures & data

Figure 1. Fishbone diagram steps and example.

Table 1. Examples of considerations that can arise when launching an interprofessional education program.

12 Tips	Interprofessional Education (IPE) Program Team Reflections
Tip 1: Identify overlapping and diverging interests of various stakeholders.	Numerous stakeholders within each of these entities had expressed interest: School of Medicine, School of Nursing, School of Pharmacy, School of Public Health, School of Veterinary Medicine. How to ensure adequate communication within these schools as well as among them? While there was common desire for improving patient outcomes and overall quality of care, willingness to make changes varied widely as healthcare is addressed differently by the educators in different departments within these professional schools. How could we find a good starting place for IPE that supports change by all? Expectations regarding scope of collaboration seemed to vary based on individual desires – we heard concerns about it being worth it for “me” at the margin given my various other demands? Others were concerned about dominance of one particular school’
Tip 2: Prioritize stakeholder interests, establish expectations, and timelines.	Our program, like many IPE programs, underestimated the institutional resistance to moving away from traditional departmental structures into a team-based approach. Also, we can expect to struggle to find a steady stream of funds for ongoing support of the IPE program given budget and other entrenched processes.
Tip 3: Assess organizational climate for a continuous quality improvement (CQI) mind-set.	Some of us already had a CQI mind-set focused on only improving what can be measured but others were less comfortable with some of these concepts applied to IPE. We needed to achieve consensus related to:  • Measurement of the right parameters  • Performance on these parameters  • Tasks Implemented for Improvement  • Aspects that were not being measured but still mattered  • Striking the right measurement balance given resource constraints
Tip 4: Explore implicit organizational assumptions, choices, and make them explicit.	We created self-awareness about implicit assumptions by posing and addressing critical questions about a new IPE program:  • Was there a historical context that should be considered? Was IPE attempted previously? Was it successful? If not, why not? • Did the institution currently foster an individual or competitive approach to patient care? Was self-sufficiency valued over collaborative work? • How well was the concept of interprofessional education understood within the institution? • Did the silo-based approach to teaching inherently create barriers to IPE because of the way classes were structured and faculty compensated?
Tip 5: Identify “need-to-have” vs. “nice-to-have” tasks.	We used a prioritization method for classifying tasks into various categories so our team members were accustomed to thinking in terms of:  • Must have, Should have, Could have, Won’t have but would like to (MoSCoW method) (Clegg and Barker 1994) Could we find common “must haves”? How could we address which stakeholders’ preferences should be prioritized first?
Tip 6: Use academic cycles to access resources and create deliverable outcomes.	We had different academic calendars for different professional schools that posed challenges; how could we reconcile this situation? We had different budget processes across professional schools and we had to consider the implications of these differences for our program outputs  • We had to evaluate the IPE program outcomes in terms of their alignment with the fiscal budget cycle for the University Our IPE programs faced logistical issues in bringing together learners from various schools to work together on a team. • Classroom space for one set of students was very inconvenient for others. In many cases, neither faculty nor students were co-located. The logistical challenges had to be taken into account.
Tip 7: Anticipate future needs for accreditation, reporting, etc.	We needed to identify and reconcile the various accreditation-related factors: Anaesthesiology Assistant – CAAHEP, Dentistry – CODA, Medicine – LCME, Nursing – AACN/CCNE, Pharmacy – ACPE, Physical Therapy – CAPTE, Physician Assistant – ARC-PA, Public Health – CEPH^a How could we get someone involved who already knows about these factors from each of the schools?
Tip 8: Assemble team and consider their competing demands up front.	Faculty delivering IPE curricula must allocate time and energy to learn about the other disciplines and we already knew we had some shortfalls.  • We knew we needed to generate some new funding before proceeding.  • Questions about why a faculty member was spending so much on IPE and time away from traditional departmental activities did arise.
Tip 9: Work with the team to build a spectrum of skills for a variety of program activities.	Many Interprofessional education programs struggle to enlist faculty to teach and model IPE skills to students and this was true for our program.  • Faculty development was a critical component in facilitating the mind-set shift towards a new mode of pedagogy. • We needed to find ways to reward participating faculty to invest in skill development.
Tip 10: Establish processes to support appropriate conflict management.	We had to consider how our IPE curriculum could leverage existing case-based teaching on conflict prone situations and high-tension scenarios that frequently occur in the hospital setting (e.g. two cardiologists disagree on the course of action in front of the patient who had a recent stent placement, a senior intensive care unit nurse disagrees with the medication plan suggested by a junior attending physician.)
Tip 11: Check-in with stakeholders, manage their expectations, and anticipate changing interests.	Support from senior management at our hospital system was more than symbolic. Presidents of University systems, chief executives of hospitals, high ranking academic administrators or organizations, senior academic administrators of various schools/divisions – all of them were key players in allocation of resources, both human and financial. They had the access and the authority to examine progress as well as pending issues from all relevant perspectives. We considered which were on board and which had unrealistic expectations? Did we have good processes in place to ensure two-way feedback loops?
Tip 12: Review progress on tasks, revise plans as needed based on implementation, and garner team support.	We had to find regular meeting times and identify who was critical for implementing which tasks and who was important for periodic reviews. How could we sustain momentum? Did we have budget for team building and time-intensive development or review efforts?

^a CAAHEP: Commission on Accreditation of Allied Health Education Programs; CODA: Commission on Dental Accreditation; LCME: Liaison Committee of Medical Education; AACN: American Association of Critical-Care Nurses; CCNE: Commission on Collegiate Nursing Education; ACPE: Accreditation Council for Pharmacy Education; CAPTE: Commission on Accreditation in Physical Therapy Education; ARC-PA: Accreditation Review Commission on Education for the Physician Assistant; CEPH: Council on Education for Public Health.

Clegg D, Barker R. 1994. CASE method fast-track. Reading: Addison-Wesley.

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