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Failure is not fatal, but failure to change might be

Dr. Brian Cross, Guest Commentary • Jul 1, 2018 at 8:00 AM

Forty-one years ago, a collision of two planes on a runway in the Canary Islands caused the deaths of 583 people — the largest disaster in aviation history. Communication problems related to the cockpit hierarchy were mostly to blame for the catastrophe. Aviation team members who had information that could have prevented the horrible accident remained silent out of fear of retribution from officers of higher rank.

The introspection that resulted after the disaster led to a complete cultural change across the aviation industry that put in place a team-based approach in which anyone can stop the process if safety is in question.

Unlike the mass tragedy in the Canary Islands, harm occurs one case at a time in medicine, and identifying common root causes is more difficult. Recent evidence suggests medical errors are the third-leading cause of mortality in the U.S. Healthcare System, with 250,000 deaths per year resulting from medical errors. That equates to four 747 airplanes falling from the sky each day, of each week, of each month, of each year.

In 2001, a groundbreaking report by the Institute of Medicine determined that similar team communication flaws to those associated with in the Canary Islands collision are to blame for many of these medical errors.

The IOM identified a need to adopt a team-based approach to health care delivery. To catalyze this change, the IOM recommended students from different health care professions be intentionally trained together, anticipating that when fully trained graduates enter the workforce equipped with positive interprofessional teamwork skills, health care delivery would become more effective, efficient, patient-centered and, above all, safer.

Still, teamwork principles have struggled to get traction within the two important arms of our health care system: training — the education of health professions students before they enter the health system as practitioners — and implementation — the provision of care within the system by graduates of training programs.

Within East Tennessee State University’s Academic Health Sciences Center, the tradition of engagement in interprofessional education and practice actually predates the 2001 IOM report. Beginning in 1991, ETSU was one of only three institutions in the nation to receive a 10-year, $9 million grant from the W.K. Kellogg Foundation to establish an interprofessional, community-focused approach to health professions education and health care delivery.

That funding enabled the creation of educational, research and practice structures focused primarily on rural community partnerships. As a result, health professions students from medicine, nursing and public health began to learn intensively from, with and about one another. This created a supportive environment for increased IPE engagement across the health sciences at ETSU.

A leadership retreat in 2010 initiated planning for the incorporation of IPE principles throughout all health profession educational programs at ETSU and forged a new approach to IPE. For the last four years, interprofessional teams of about six-to-eight students have been exposed to a two-year IPE experience that includes informative, formative and transformative learning opportunities.

The success of this pilot program has resulted in national and international recognition for the IPE program at ETSU and IPE faculty from ETSU have been invited to share their knowledge at national and international educational meetings. In addition, ETSU was recently recognized as an incubator site with The National Center for Interprofessional Practice and Education.

ETSU is uniquely positioned to serve as a regional, national and international voice advocating for widespread implementation of interprofessional health care training, and for dissemination of the best teaching practices to prepare health professions students to enter the workplace as highly effective members of collaborative practice teams.

Soon, ETSU’s efforts in IPE will have a new home through the creation of the Interprofessional Education and Research Center at Building 60 on the Quillen Veterans Affairs Medical Center campus at Mountain Home. An agreement between all five colleges within ETSU’s AHSC resulted in the building renovation project that has transformed an historic quartermaster’s building into a state-of-the-art home for interprofessional health care training at ETSU.

The renovation will create an environment where interprofessional teams can practice delivering care in simulated medical office, hospital and patient home settings. The new educational facility, expected to be in use by the fall, will significantly enhance the interprofessional opportunities provided at ETSU to our students, who are the health care professionals of the future.

John Wooden, former UCLA men’s basketball head coach who led his team to an impressive 10 national championships in 12 years, once noted “teamwork is not a preference, it is a requirement.” He also said “failure is not fatal, but failure to change might be.”

When it comes to the training of future health care professionals, truer words could not be spoken. At ETSU, we are helping transform health care education to launch health care professionals who can keep their teams, and most importantly, their patients, flying.

Dr. Brian Cross is an associate professor and vice chairman in the ETSU Bill Gatton College of Pharmacy's Department of Pharmacy Practice. He was recently named a Fulbright Scholar for his work in interprofessional education and teaching others how to best provide team-based care.

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