The Jefferson Teamwork Observation Guide JTOG Using a

The Jefferson Teamwork Observation Guide (JTOG): Using a Mobile Application Platform to Assess the Behavior of Interprofessional Teams Lauren Collins, MD Shoshana Sicks, Ed. M Elizabeth Speakman, Ed. D, RN, ANEF, FNAP Carolyn Giordano, Ph. D Kevin Lyons, Ph. D, FASAHP Sarah Dallas, BA

Disclosures • The authors have no relevant financial or non-financial relationships to disclose.

Learning Objectives • Explain the value of assessing students’, preceptors’ and patients’/caregivers’ understanding of team approaches to patient care • Describe the JTOG tool as a method to measure interprofessional education competencies in educational, simulation, or practice settings • Prepare to implement the JTOG mobile application prototype at the home institution with students, preceptors, and/or patients and caregivers

JTOG Project Objectives • Develop short, easy-to-use observational tool assessing team function and measuring behaviors (not attitudes) linked to core interprofessional education competencies • Conduct 360 degree assessment of team functioning that will help us to improve patient safety and satisfaction and enhance patient outcomes • Use technology to advance assessment • Collect data nationally to create a set of new benchmarks for team function in various settings

Jefferson Center for Interprofessional Education (JCIPE) • Established 2007 • Mission: To promote excellence in healthcare through interprofessional education and scholarship • Vision: JCIPE will define the future of interprofessional care by creating a culture of collaborative educational practice, setting the standards for patient-centered care and team-based training, and becoming a national/international leader in developing an evidence base to support interprofessional education • Scope: Dedicated to implementing and evaluating interprofessional education and collaborative practice initiatives throughout the Thomas Jefferson University curriculum

Background and Rationale • Interprofessional Education: “When students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. ” • Collaborative Practice: “When multiple health workers from different backgrounds work together with patients, families, careers, and communities to deliver the highest quality of care. ” World Health Organization, 2010

Background and Rationale • Early IOM and WHO reports call for team-based training to save patient lives – “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. ” (IOM, 2001) • IPE shown to enhance collaborative practice, which in turn addresses the Triple Aim – Improve patient outcomes, enhance patient satisfaction, decrease costs • IPE Core Competencies developed in 2011 (IPEC) – – Roles/Responsibilities Teamwork Values/Ethics Communication

Background and Rationale • IPE is now a part of most accreditation standards • Numerous studies, Cochrane reviews, and expert reports have documented the lack of reliable evaluation tools for assessing teamwork and documenting IPE core competencies, most recently the April 2015 IOM report • Gap in IPE literature regarding effect of IPE on patient outcomes

Jefferson Teamwork Observation Guide (JTOG) • Important for students/providers to learn about, and practice effective teamwork • Existing tools – measure attitudes, not behaviors or skills – are too cumbersome for use in clinical settings, not adaptable for 360° evaluation (learner, preceptor, patient, caregiver), – too lengthy, or – only in small pilot/validation phases

Jefferson Teamwork Observation Guide (JTOG) • An educational tool to allow students to easily observe/learn from teams in action • Developed over two years using student, clinician, and expert feedback • Provides a set of guidelines to help students focus their observations on behaviors consistent with high functioning teams • 14 quantitative, three qualitative items

Competency-Based Evaluation

Guidelines • There appeared to be a team leader who coordinated discussion – In some situations there will be a designated team leader. If so, that person should purposely seek out and encourage input from all appropriate members of the team, and keep them on task – If there is no designated leader, does an informal leader emerge to coordinate the discussion? • Team members appeared to have respect, confidence, and trust in one another – Members of the team seem to accept the suggestions of other team members. There are cordial interactions among the members and positive body language – There is no rolling of the eyes or other negative non-verbal behavior

Benefits of an App • Portable – Asynchronous or synchronous – Multiple settings • Easy to use – Prepopulated forms – More robust data entry • Enhanced data collection – Mixed-methods study – Multi-institutional study • Tracking – Accreditation requirement fulfillment

Results “Being able to interact and work as a team requires each team member to have a deep understanding of what all the other team members do. I learned that in order to work successfully with other professions, I must be more proficient in their lingo and better understand exactly what their jobs entail. ” “I saw that teamwork is clearly the best way to provide comprehensive, holistic care for a patient. Each member of the team had something unique to say about each patient that really added to the picture of that patient's health. Without even one of those disciplines, the picture would be incomplete. They all appeared to take each other's comments seriously and hopefully allowed others' comments to help them know and care for the patient that much better. ” -Medical students after observing the Rehab Team Conference

Family Medicine Partnerships • Students – Third year clerkship (2 x/rotation) – Fourth year sub-internship (2 x/rotation) • Patients – Outpatient clinic (100 samples) – Inpatient sit/walk rounds (20 samples) • Coming soon…Residents – Evaluators – Peers

Future Directions • Streamlining all IPE, teamwork, and collaborative practice evaluation using four versions of JTOG: 1. 2. 3. 4. Team assessment Individual assessment Patient assessment Caregiver assessment • Gathering data from a variety of teams and settings • Creating comprehensive database • Developing longitudinal quantitative/qualitative feedback reports for individuals/teams

Future Directions • Develop set of national benchmarks for users from multiple institutions • Provide educational and practice teams with opportunities to identify specific areas for faculty/staff/curricular development • Allow for studies within Jefferson and across multiple institutions

References • World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice. Geneva, Switzerland: WHO Department of Human Resources for Health; 2010. Retrieved from http: //whqlibdoc. who. int/hq/2010/WHO_HRH_HPN_10. 3_eng. pdf. • Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21 st Century. Washington, DC: National Academies Press; 2001. • Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative; 2011. Retrieved from: http: //www. aacn. nche. edu/education-resources/ ipecreport. pdf.

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