By Andrea Thrasher, MEd; Melissa Worrell, MA; Laura Belles, PharmD; Jill Guilfoile, MEd, BSN, NPD-BC; Anna Herbert, MSN, RN, CPHON; Sharon Herndon, BS; Odile Kennedy, MSN, APRN, CNP; Anne Lesko, PharmD; Laura Werts, MEd, MS, CMP
In December 2018, Cincinnati Children’s Hospital Medical Center accomplished a long-time goal by achieving Joint Accreditation status. While this achievement marked the end of one part of our Interprofessional Continuing Education (IPCE) journey, it was the beginning of another.
We are sharing our experience in a three-part article series in the Almanac. Our first installment focused on the essential role relationships play. This installment will focus on preparation for submitting the Joint Accreditation self-study and organizational infrastructure in anticipation of approval.
Assess Journey Readiness
The first step is to assess your journey readiness. During this phase, you will evaluate which route makes sense for your program, what resources you need and anticipate potential roadblocks.
We utilized the Guide to the Joint Accreditation Process (www.jointaccreditation.org) and the process of writing the self-study as our preparation checklist. A working group consisting of educators from nursing, CME and pharmacy met regularly. The first task was to use the self-study outline to identify areas for improvement. Each section was assigned to a team member for evaluation and documentation; however, the team provided input and sections were edited by the group. Through this process, we identified areas where our educational philosophy and/or policy were the same, but the execution, practice or documentation differed. Examples included:
- Similar but varied credit applications: A unified application was created.
- Evaluation improvement: While evaluations did include a team-based question, the wording of the question was not appropriate for all education. Using existing literature on team evaluation, we created a question bank to use in all activity evaluations.
- Mission statement improvement: We updated our mission statement to focus on team-based education.
- Competencies: We modified our program’s core competencies to better reflect IPCE goals.
These changes were documented and reflected in our self-study.
Pack (and Un-pack) for the Journey
A journey can be weighed down by packing too much. Through the assessment process, we discovered we had ‘over-packed’ by having four separate entry points and processes to apply for credit. We decided to let go of siloed process and create a single point of entry.
The Cincinnati Children's LEAN Collaborative provided a framework for key IPCE team stakeholders to engage in this work in a deliberate manner and start the "endless transformation of waste into value from the customer's perspective" (Lean Thinking, Womack and Jones).
First, intake practices were timed and mapped. Next, non-value added work was identified through an “Angry Cloud” exercise that identified four variations:
- Intake form
- Intake processor (staff)
- Acceptance criteria
- Accreditation criteria
Finally, five interventions were tested over 6 months: (a) web-based intake form, (b) discussion script, (c) complexity score, (d) yes/no/maybe scale and (e) weekly 30-minute review meetings.
The number of process steps per median number of days to onboard new education was reduced. Focus group qualitative data showed the web-based intake form improved ease of use, reduced completion time and eliminated data entry.
The discussion script minimized variation and reduced interview time. The complexity score and yes/no/maybe scale standardized acceptance criteria and increased staff capacity to initiate activity on-boarding discussions.
Finally, weekly 30-minute review meetings facilitated interprofessional education design opportunities. We did discover, however, that practice change was difficult, particularly for team members who had not been directly involved with the LEAN collaborative. It took time to develop a shared vocabulary, new communication methods and buy-in.
Maintain Flexibility to Navigate Roadblocks
Unanticipated roadblocks are part of any journey. Preparing as a team helps to adapt to and navigate barriers. We experienced turbulence with unanticipated staffing and leadership changes before full implementation. While the course we set was bumpier than expected, our strong relationships allowed us to navigate obstacles, ultimately strengthening and expanding our team.
When multiple education leaders left our institution in quick succession, we realized that team members not directly involved in preparation were not fully aware of the philosophy behind Joint Accreditation or the planned process changes. This highlighted knowledge and communication gaps. As a result, the remaining working group and LEAN collaborative members:
- Created a learning plan consisting of face-to-face and on-line education
- Paired experienced team members with inexperienced for mentoring
- Created bi-weekly leadership meetings to make high-level decisions
- Established a monthly meeting for all team members to communicate broad changes, solicit feedback and establish team improvement projects
In hindsight, these roadblocks could have been mitigated by developing a change management plan early in our process. Change management includes a detailed communication plan and multiple iterations of training and improvement. This can feel repetitive or tiring, particularly to those intimately involved with a project. It is integral, however, to successful team development.
When roadblocks do appear, established relationships, a positive attitude and a sense of humor help reframe them as opportunities. These unanticipated detours can make your trip richer than expected and reinforce the team experience. The team pulls together to get back on track or identify a new path, creating a stronger team identity in the process.
The right planning is crucial to the successful start of any Joint Accreditation and IPCE journey. This includes:
- Assess journey readiness: utilizing self-study to identify areas for improvement or increase collaborations
- Pack (and un-pack) for the journey: letting go of old to create new team processes
- Maintain flexibility to navigate roadblocks: use roadblocks to improve and strengthen your team
Our next installment will tackle the last leg of our journey — where we’re headed next!