Leveraging a funding collaborative to develop more PhD prepared nurse scientists and leaders.

BACKGROUND: Over its almost 50 year history, The Robert Wood Johnson Foundation (RWJF) has provided about $500M to nursing initiatives focused on education, practice, policy and leadership development. While RWJF was most often the sole funder of many of these initiatives, it has also joined with others to create a larger and more sustained impact on particularly challenging nursing, health, and health care issues. PURPOSE: The purpose of this article was to describe the challenges and opportunities of a unique funding collaborative developed to engage new partners, increase the visibility of doctoral nursing education and increase funding of the RWJF Future of Nursing Scholars program to develop more PhD prepared nurses and nurse faculty. METHODS: Interviews were conducted with several members of the FNS Funders Collaborative as well as the scholars they supported. The perspectives of three funders, a regional philanthropy (IBC Foundation) and two health systems (Cedars Sinai and Sharp HealthCare) are presented here. Together they supported 13 nurses to complete their PhD through the RWJF Future of Nursing Scholars program. FINDINGS: RWJF contributed $20 M and 13 other funders contributed an additional $3Mto the initiative. The additional funds supported 42 nurses to earn their PhD degree through the program. Six of the 13 funders are health systems, four are regional or health related philanthropies, and others include United Health Care, Johnson & Johnson, and the Care Institute. DISCUSSION: There were many lessons learned for RWJF and the other funders. Given the size of RWJF, some other philanthropies were concerned about how contributions would be represented, others wanted their funding to go directly to care improvement. Some health systems were not prepared for their nurses to decrease work time while pursuing further education. The nurse faculty and nurse PhD shortages have persisted now for over a decade. Although FNS made a significant contribution by developing over 200 new nurse PhDs (faculty and leaders), more funding collaborations that engage new and different partners must be developed so that nursing education does not have to focus on the same problems in the next decade.

Developing Emerging Leaders to Support Team-Based Primary Care.

Teams are increasingly used to deliver high-quality, accessible primary care, yet few leadership programs support the development of team-based care leadership capabilities. The 12-month Emerging Leaders program presents a prototype for how interdisciplinary training targeting frontline staff might be implemented. Emerging Leaders training included didactic content, mentorship, applied peer-to-peer learning, and personal leadership development components delivered in person and virtually. Attendance at training events was high. Nominators and Emerging Leaders noted improvements in knowledge, skills, and attitudes of program participants. Forty percent of participants went on to promotions or new jobs.

Overview of the Robert Wood Johnson Foundation Nurse Faculty Scholars program.

BACKGROUND: The Robert Wood Johnson Foundation Nurse Faculty Scholars program was created to address the nursing faculty shortage and thereby decrease the nursing shortage. PURPOSE: The purpose of the study was to describe the program development, implementation, and ongoing outcome evaluation. METHODS: Data on scholarly productivity, impact of research, research funding, and leadership positions were compiled, including an h-index (impact of publications) comparison with a comparison group of other interdisciplinary faculty at the same institutions of the 90 current and alumni scholars. DISCUSSION: There is evidence of the achievements of the individual scholars; however, the effect of the synergy of the multiple components of the program is difficult to capture in traditional evaluation strategies. CONCLUSIONS: The sense of possibility and responsibility (to the profession, to improving the health of all Americans, and to one's school of nursing and university) was a significant outcome of the program. Lessons learned from the program are important for the leadership development and retention of nursing faculty.

Registered Nurses in Primary Care: Emerging New Roles and Contributions to Team-Based Care in High-Performing Practices.

The years since the passage of the Affordable Care Act have seen substantial changes in the organization and delivery of primary care. These changes have emphasized greater team involvement in care and expansion of the roles of each team member including registered nurses (RNs). This study examined the roles of RNs in 30 exemplary primary care practices. We identified the emergence of new roles and activities for RNs characterized by greater involvement in face-to-face patient care and care management, their own daily schedule of patient visits and contacts, and considerable autonomy in the care of their patients.

Effective team-based primary care: observations from innovative practices.

BACKGROUND: Team-based care is now recognized as an essential feature of high quality primary care, but there is limited empiric evidence to guide practice transformation. The purpose of this paper is to describe advances in the configuration and deployment of practice teams based on in-depth study of 30 primary care practices viewed as innovators in team-based care. METHODS: As part of LEAP, a national program of the Robert Wood Johnson Foundation, primary care experts nominated 227 innovative primary care practices. We selected 30 practices for intensive study through review of practice descriptive and performance data. Each practice hosted a 3-day site visit between August, 2012 and September, 2013, where specific advances in team configuration and roles were noted. Advances were identified by site visitors and confirmed at a meeting involving representatives from each of the 30 practices. RESULTS: LEAP practices have expanded the roles of existing staff and added new personnel to provide the person power and skills needed to perform the tasks and functions expected of a patient-centered medical home (PCMH). LEAP practice teams generally include a rich array of staff, especially registered nurses (RNs), behavioral health specialists, and lay health workers. Most LEAP practices organize their staff into core teams, which are built around partnerships between providers and specific Medical Assistants (MAs), and often include registered nurses (RNs) and others such as health coaches or receptionists. MAs, RNs, and other staff are heavily involved in the planning and delivery of preventive and chronic illness care. The care of more complex patients is supported by behavioral health specialists, RN care managers, and pharmacists. Standing orders and protocols enable staff to act independently. CONCLUSIONS: The 30 LEAP practices engage health professional and lay staff in patient care to the maximum extent, which enables the practices to meet the expectations of a PCMH and helps free up providers to focus on tasks that only they can perform.

Round Six Of Partners Investing In Nursing's Future: Implications For The Health Sector, Policy Makers, And Foundations.

In its 2011 report on the future of nursing, the Institute of Medicine issued recommendations to position nursing to meet the challenges of twenty-first-century health care. Following release of the report, the Robert Wood Johnson Foundation funded eleven local and regional partnerships of nurses, foundations, and other stakeholders to begin implementing some of the recommendations in their regions. A qualitative evaluation of these partnerships found that although not all goals were met, most of the partnerships achieved meaningful gains. Partnership participants emphasized the value of engaging foundations and other stakeholders from outside nursing in the implementation process, the necessity of funding for implementation, the need for policy makers to address constraints that local and regional partnerships by themselves cannot address, and the unique leadership and convening role that local and regional foundations can play to help their regions respond to complex challenges for the nursing profession.

The emerging primary care workforce: preliminary observations from the primary care team: learning from effective ambulatory practices project.

Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team.

A self-instructional model to teach systems-based practice and practice-based learning and improvement.

BACKGROUND: When mandated as resident competencies in 1999, systems-based practice (SBP) and practice-based learning and improvement (PBLI) were new concepts to many. OBJECTIVE: To describe and evaluate a 4-week clinical elective (Achieving Competence Today-ACT) to teach residents SBP and PBLI. DESIGN: ACT consisted of a four-week active learning course and follow-up teaching experience, guided and supported by web-based materials. The curriculum included readings, scheduled activities, work products including an improvement project, and weekly meetings with a non-expert preceptor. The evaluation used a before-after cross-comparison of ACT residents and their peers. PARTICIPANTS: Seventy-eight residents and 42 faculty in 18 US Internal Medicine residency programs participated between 2003 and 2005. RESULTS AND MAIN MEASUREMENTS: All residents and faculty preceptors responded to a knowledge test, survey of attitudes, and self-assessment of competency to do 15 tasks related to SBP/PBLI. All measures were normalized to a 100-point scale. Each program's principal investigator (PI) identified aspects of ACT that were most and least effective in enhancing resident learning. ACT residents' gains in knowledge (4.4 on a 100-point scale) and self-assessed competency (11.3) were greater than controls' (-1.9, -8.0), but changes in attitudes were not significantly different. Faculty preceptors' knowledge scores did not change, but their attitudes became more positive (15.8). PIs found a ready-to-use curriculum effective (rated 8.5 on a 10-point scale). CONCLUSIONS: ACT increased residents' knowledge and self-assessment of their own competency and raised faculty's assessment of the importance of residents' learning SBP/PBLI. Faculty content expertise is not required for residents to learn SBP/PBLI.

Educating interprofessional learners for quality, safety and systems improvement.

Most health professionals in training, as well as those in practice, lack the knowledge and skills they need to play an effective role in systems improvement. Until very recently, these competencies were not included in formal (or informal) educational curricula. Interprofessional collaboration - another core competency needed for successful systems improvement - is also inadequately taught and learned. Achieving Competence Today (ACT) was designed as a new model for interprofessional education for quality, safety and health systems improvement. The core of ACT is a four-module active learning course during which learners from different disciplines work together to develop a Quality Improvement Project to address a quality or safety problem in their own practice system. In this paper we describe the ACT program and curriculum model, discuss our strategies for maximizing ACT's interprofessional potential, and make recommendations for the future.

Preparing faculty to teach managing care competencies: lessons learned from a national faculty development program.

BACKGROUND: Although competencies for managing care are often described in the medical literature, educators have been slow to integrate these competencies into clinical curricula. Backlash against managed care has created a skeptical educational environment. Many faculty feel unprepared to teach the competencies in clinical settings. METHODS: From 1999 to 2001, we designed, implemented, and evaluated a faculty development program, funded by the Bureau of Health Professions, Division of Medicine. The goal of the program was to increase Undergraduate Medical Education for the 21st Century (UME-21) and Partnerships for Quality Education (PQE) faculty skills in teaching quality improvement and costeffectiveness in the clinical setting and to prepare them to teach these topics to other faculty. RESULTS: Thirty-nine faculty attended the 4-month faculty development program. The program, in a train-the-trainer model, consisted of two 2-day workshops as well as pre-, mid-, and end-program activities and teaching experiences. Readings, brief lectures followed by focused discussion, and active learning experiences were used to teach content, provide experience and feedback with teaching skills, and model a variety of teaching approaches. CONCLUSIONS: By the end of the program, participants believed that they had learned content (knowledge) and gained practical teaching skills. To be successful in effecting curriculum change around new topics, such as the managing care competencies, faculty need to not only master new content and methods but also learn how to be change agents in their schools. Because this work can be lonely, faculty need support within the school and connections with others, locally and nationally, who have similar ideas.

Evaluation of a faculty development program in managing care.

PURPOSE: To evaluate a faculty development program that teaches quality improvement and cost-effectiveness. METHOD: From October 2000 to February 2001, a two-part faculty development program was offered to 39 physicians from 19 U.S. medical schools supported by grants from the Partnerships for Quality Education (PQE) and Undergraduate Medical Education in the 21st Century (UME-21). Special features of the program included partnerships between academic and community physicians from each school, development of an educational innovation of interest to the participants, concurrent development of teaching skills and new medical knowledge, learning leadership skills (e.g., how to train colleagues to teach), and practice periods. The program focused on quality improvement and cost-effectiveness, but included other "managing care" topics. Prior to and after the course, participants assessed their knowledge of and competence to teach these topics, as well as other managing care topics. They also assessed their competence as medical educators and leaders. After the course, they indicated their progress in implementing their proposed educational innovations. RESULTS: Thirty-two of the 39 physicians completed evaluations both before and after the program. Self-assessed knowledge and competence to teach quality improvement and cost-effectiveness were significantly higher at the end of the course, as were all self-assessed teaching and leadership skills. The largest change scores occurred in assessments of competency to teach the new topics and to teach in new ways. Participants who implemented their innovations rated their competencies to teach quality improvement and cost-effectiveness higher than did non-implementers. CONCLUSION: Opportunities for faculty to learn how to teach a topic of stated importance to them, to practice what they have learned, and to work collaboratively with partners improved teaching skills.