Building and Sustaining a Culture of Clinical Education: Discovering Value and Promoting Excellence
In the United States, healthcare spending continues to escalate. In 2014, $3.0 trillion, or 17.5% of the gross domestic product was spent on healthcare.1 This upward trend is expected to continue with projections showing a 5.8% annual average growth in expenditures from 2014 to 2024.2 Currently, households contribute a 28% share of the total health spending.2 Reducing spending for healthcare will be required to achieve a sustainable financial future,3 but reductions in federal health spending will likely increase the financial burden of households and decrease access to healthcare. Maintaining or increasing spending does not guarantee higher quality healthcare or greater patient satisfaction.4 These concerns are some of the driving forces behind the changes in healthcare delivery.
Central to many of the drivers of healthcare reform, including the Affordable Care Act (PL 111-148) and the Triple Aim initiative, is the commitment to value-based healthcare.5,6 Value-based healthcare delivery can be defined as value that is equivalent to patient health outcomes per dollar spent.7 Value-based healthcare emphasizes patient choice and “positive-sum competition”, or continuous improvement in value, amongst competitors.8 As part of the healthcare delivery system, physical therapy (PT) is subject to this value demand.4,9 Therefore, physical therapists must become more cognizant of articulating their value proposition or marketing statement which clearly explains the value of their services.10 Evidence of best practice, provider performance and cost-effectiveness are elements that can be used to define the PT value proposition.4 Academic and clinical educators need to embody this value proposition through innovation in clinical education and practice to prepare students to deliver the value promised in the future.4
Healthcare reform is pushing PT practitioners to achieve better outcomes more efficiently, which undeniably adds stress to their roles as clinicians and clinical educators.11 Payment to healthcare facilities for providing clinical education experiences has been suggested as a means to partially offset the perceived financial burden of mentoring students in today’s healthcare environment.12 However, it is unlikely that cost shifting from one strained system to another will contribute to achieving the value-based services desired. Rather than being viewed as a burden, clinical education should be seen as a resource that one can leverage to not only facilitate the implementation of value-based healthcare, but to educate students who will be ready to execute the value-based healthcare model. This joint venture of education and provision of services, when executed in accordance with best practices, can feed into the sustainability of healthcare while providing value-based PT services. This vision is the PT clinical education value proposition: a call to action, a call to excellence.
Methods and/or Description of Project
The session will begin with a brief review of the Triple Aim for healthcare improvement and the basic tenets of value-based healthcare. The concept of cost-effectiveness will be included, but this session will focus on the qualitative value added to healthcare services when delivered in conjunction with a quality clinical education program. The audience will be introduced to the concept of a value proposition and the framework proposed by Jewell et al.4 to demonstrate PT’s value proposition. Parallels will be drawn to demonstrate how this framework, which includes identifying and adopting best practices, measuring provider performance and evaluating cost effectiveness, may be used to build, promote, and sustain a quality clinical education culture that supports value-based healthcare. Participants will be given a framework-based worksheet to document ideas about their specific value proposition for clinical education. The inter-relationship between excellence in clinical education and value in healthcare services will be emphasized.
The structures, processes and outcomes of one hospital system will be shared to exemplify how this framework can be utilized to integrate education and provision of healthcare services to substantiate a sound clinical education value proposition. The clinic site’s history will be discussed relative to the growth of their clinical education program and evolution of their culture as they identified and adopted best practices through the grassroots efforts of their clinical instructors (CIs). Educational strategies utilized to add value to service delivery, such as purposely designing student research projects to inform policy development and in-services to promote evidence-based practice, will be discussed and qualitative measurements of provider performance will be shown. Practical suggestions for organizing and scheduling clinical education experiences to maintain productivity and quantitative data to assess cost-effectiveness will be included. Finally, policies for CI development and recognition as well as clinical placement processes and document templates, including revisions made to maintain a continual flow of students, will be provided to demonstrate how to sustain an active clinical education culture.
The presentation will end with time for participants to share ideas for developing and articulating their clinical education value proposition followed by a question and answer session. A call to action will be made to encourage CCCEs, CIs and DCEs to be the change agents needed to discover value as the driver for success in achieving excellence in clinical education and practice.
Participants will begin to develop a value proposition to promote a value-based clinical education culture at their facility (CCCE/CIs) or the facilities of their clinical affiliates (DCEs) using the worksheet provided. Examples of processes and outcomes from one hospital system's experience will facilitate idea generation and discussion so that participants can identify actionable items by the end of the session. These examples will include:
- processes for encouraging and selecting CIs
- placement statistics showing expansion trends
- value-added quality improvements in provider performance (ie: clinic site outcomes from relevant student projects, educational activities and research)
- strategies for organizing and scheduling to maintain productivity
- productivity statistics showing cost-effectiveness with and without students and with 2:1 model of clinical instruction
- clinical placement processes including document templates for managing clinical placements when affiliating with multiple academic programs
- policies for CI development and recognition
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Value-based healthcare is the service delivery model of the future.9 Purposefully re-engineering clinical education programs can enhance the delivery of value-based healthcare now and in the future. Using one hospital system as a case example for building, promoting and sustaining a clinical education culture will provide guidance and inspiration for others to discover value through implementation of best practices in clinical education. Framing clinical education around the tenets of value-based healthcare will allow participants to formulate a clinical education value proposition that can be used to assist healthcare facilities in achieving affordable excellence in both education and practice.
1. Centers for Medicare and Medicaid Services. National Health Expenditures, 2014 Highlights. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf. Accessed April 4, 2016.
2. Centers for Medicare and Medicaid Services. National Health Expenditure, 2014 Fact Sheet. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html. Accessed April 4, 2016.
3. Congressional Budget Office. The Budget Outlook from 2016-2026 in 19 Slides. http://www.slideshare.net/cbo/the-2016-budget-outlook-in-19-slides. Accessed April 5, 2016.
4. Jewell DV, Moore JD, Goldstein MS. Delivering the physical therapy value proposition: a call to action. Phys Ther. 2013;93(1):104-114.
5. Patient Protection and Affordable Care Act (PL 111-148), (2010).
6. Coyne JS HP, Arbuckle BS, et al. Triple aim program: assessing its effectiveness as a hospital management. Hosp Top. 2014;92(4):88-95.
7. Porter ME. A strategy for health care reform - toward a value-based system. New Eng J Med. 2009;361(2):109-112.
8. President & Fellows of Harvard College. Value-Based Health Care Delivery. http://www.isc.hbs.edu/health-care/vbhcd/pages/default.aspx. Accessed April 15, 2016.
9. Fritz J. Physical therapy in a value-based health care world. J Orthop Sports Phys Ther. 2012;42(1):1-2.
10. Jewell D. 2014 Linda Crane Lecture More than 'White Hats'--Making the Case for Physical Therapy's Value Proposition. Cardiopulm Phys Ther J (American Physical Therapy Association, Cardiopulmonary Section). June 2014;25(2):55-64 10p.
11. Deusinger S, Crowner B, Burlis T, Stith J. Meeting Contemporary Expectations for Physical Therapists: Imperatives, Challenges, and Proposed Solutions for Professional Education. J Phys Ther Educ. January 2, 2014;28(Supp 1):56-61 6p.
12. Panel discussion: meeting the needs of the clinical-academic partnership Education Leadership Conference 2015.
1. Identify the basic tenets of value-based healthcare.
2. Apply a value-based framework to develop and sustain a clinical education culture that promotes excellence in education and practice.
3. Establish an evidence-based value proposition to promote excellence in clinical education.
4. Discuss one hospital system’s strategies and procedures to expand their clinical education culture and enhance their value-based healthcare delivery.
5. Describe the quantitative and qualitative outcomes of one hospital system’s clinical education program relative to their clinical education and service delivery.
Lecture, case examples, interactive discussion, and multimedia methods will be used.
Value-based framework for excellence in clinical education (0-10 minutes)
Building a culture of clinical education (10-30 minutes)
- Strategies: identify and adopt best practices
- Clinic site history and current practices
Promoting your clinical education cultural (30-50 minutes)
- Strategies for developing a value proposition: measure provider performance (qualitative) and evaluate cost-effectiveness (quantitative)
- Clinic site examples of qualitative and quantitative outcomes
Sustaining a clinical education culture (50-70 minutes)
- Strategies for maintaining student flow and CI motivation
- Clinic site policies and procedures: CI development, student placement procedures, and program evaluation
Sharing value propositions, question/answer and call to action (70-90 minutes)