At a meeting called by the Institute of Medicine to discuss its recent report, Retooling the Healthcare Workforce for an Aging America, we focused on the particular issue of using team care to meet those needs. Reflecting on the IOM process, I observed that in addition to considering workforce issues from the traditional viewpoint of counting heads, the group think about "weighing" heads as well-that is, considering what knowledge, skills, and attitudes need to be in the minds of the workforce.
Many health professionals feel a terrible ambivalence about caring for older adults, especially in cases that seem futile and hopeless. They ask themselves, why even bother to give medical attention if a cure isn't likely? Even more commonly, professionals feel overwhelmed by the complex requirements of geriatric care, particularly when facing them alone. Most of us have probably heard a provider say, "I didn't ask about that because I didn't want to open Pandora's box."
Fortunately, many stakeholders have begun to recognize that with appropriate training and support, a team approach can bring together the skills and time needed to deliver high quality care. We now recognize that a team approach offers a way to open that box in a safe and effective way. Additionally, because health care remains a cottage industry, supporting many thousands of businesses, the team approach not only improves quality of care but actually widens the supply chain, and in human terms, helps put food on the table for many more families.
The Foundation's response to these issues, The Geriatric Interdisciplinary Team Training (GITT) initiative, funded 14 planning projects followed by nine implementation grants of $750K over three years between 1996-2001. We also funded a national resource center and evaluation. And what happened? Professional schools relentlessly resisted change. All but two abandoned the idea of team training and returned to supporting a traditional, mono-disciplinary approach, with all of its financial incentives, professional prestige, and well-protected professional silos.
Yet we and the Institute of Medicine are not the only ones calling for change in how our nation trains health professionals. The AAMC recently issued a call for interdisciplinary training between physicians, nurses and other health care professionals. At a recent Mayo Clinic symposium on health care education reform--discussed in depth on the Health Beat blog--participants also came to the same conclusions.
The question is, how do we get there from here? An Institute of Medicine report, Health Professions Education: A Bridge to Quality, published after a summit of health professionals in 2002, made a series of recommendations but also observed, "Once in practice, health professionals are asked to work in interdisciplinary teams, often to support those with chronic conditions, yet they are not educated together or trained in team-based skills."
So it's time to try something new. Here, I believe, is the next step: Get deans at health education centers to sit down together and plan educational priorities that include not only the appropriate skill sets for each profession but also training in team-based skills. Health care professionals should also speak out to create informed consumer demand, letting the public know which professions deliver which service best and how much to spend for those services. If nurses won't advocate for physicians and vice versa, who will?