Practicing at full potential, improving team-based care

Fewer primary care physicians, more people with health insurance and flat or declining reimbursements – those realities create the perfect storm that results in crunch time like never before for patients’ face-to-face interaction with their providers.

A 2017 report by Medscape, surveying more than 19,200 physicians in 27 specialties, concluded the median time spent with each person is 13 to 16 minutes. But what if every member of the health care team – physicians, family nurse practitioners, physician assistants, medical assistants, registered nurses, pharmacists and mental health specialists – worked to their fullest potential? And what if health students learned that full-team approach while still in school?

That is the goal of SPLICE, a System-transforming, Patient-centered Longitudinal Interprofessional Community-based Education initiative driven by a collaboration between the Betty Irene Moore School of Nursing and UC Davis School of Medicine. Much like a rope is joined together by the interweaving of strands, health care outcomes are strengthened when teams work together with a shared goal.

“Primary care clinics must evolve to meet today’s realities, but there’s a knowledge gap among the different experts in the mix,” explains Debra Bakerjian, an associate adjunct professor at the School of Nursing and principal investigator on the five-year project. “They haven’t learned how to be a team. Each is siloed within their individual profession, often speaking different languages. Our goal is to provide a clinical experience where learners work across professional boundaries and function as a team, so that they can take this to their work environment after they graduate.”

As the only academic health center in California’s vast Central Valley, UC Davis Health is committed to health education that results in delivery of community-based and person-centered care throughout the region. SPLICE enables medical residents, pharmacy residents, nurse practitioner and physician assistant graduate students to engage in a team-based approach from their very first clinical experiences.

“As learners, if they can learn each professional’s unique role in contributing to care and experience how an interdisciplinary approach improves quality, safety and patient satisfaction, they will enter the real world better prepared for 21st-century practice,” says Tonya Fancher, associate dean for Workforce Innovation and Community Engagement at the School of Medicine.

Before entering the clinical setting, teamlettes of students take the SPLICE curriculum, an intense regimen of videos that focus on health coaching, quality improvement, interprofessional competencies and clinical focus areas, including hypertension, diabetes, depression screening and smoking cessation. Once in clinical rotations at the Sacramento County Health Center, they practice what they’ve learned with preceptors who have also been trained in how to engage learners with a team mindset.

“We believe that primary care is the backbone of the health care system,” says Marcia Jo, program manager for Sacramento County Primary Health Services. “Training programs like this are crucial to exposing future clinicians to the primary care environment in hopes they will choose a career to serve as the first contact and principal point of continuing care for people.”

The paradigm of health care is shifting. No longer is the goal to provide care only during episodes of illness. Providers must look at ways to keep a person healthy outside of clinics and keeping entire populations healthy by looking beyond just the physical ailment at one moment in time.

“We want to see improvement in the knowledge, skills and abilities in team-based practice. Then we will track students after graduation to learn if they are still working in teams,” Bakerjian says. “It’s no good just to educate students, if they don’t go out into the world and change how care is provided.”

While SPLICE is focused on student and resident learners, researchers will also educate staff, faculty physicians, physician assistants, family nurse practitioners and pharmacists in quality improvement, patient safety and interprofessional team training to ensure enduring system change.