Chapter 23

Introduction: practice change fellows initiatives

Eric A. Coleman and Nancy Whitelaw

Program overview

Our nation’s health delivery system frequently does not meet the unique needs of older adults. Wide gaps remain between evidence-based approaches, nationally recognized best practices, and how care is currently delivered for many conditions that disproportionately affect this population. Strong leadership is needed to ensure that promising evidence-based innovations are widely adopted to improve health and functional outcomes in older adults.

The Practice Change Fellows program is designed to expand the number of health care leaders who can effectively promote high-quality care to older adults in a wide range of health and health care organizations. These leaders are essential for overcoming barriers and building the business case for geriatric care in health plans, hospitals, nursing homes, home care agencies, outpatient physician practices, and community-based organizations. Building a cadre of health care champions who possess the essential leadership skills and understanding of promising innovations in care for older adults will ensure that this country will be prepared to meet the challenges of an expanding aged population.

Fellows receive $90,000 to support their projects over the two-year program. The Fellow’s home institution is expected to make a $45,000 monetary or in-kind contribution, recognizing that the Fellows’ career development and project add value to their respective organizations. The Practice Change Fellows program is made possible by the generous support of The Atlantic Philanthropies and The John A. Hartford Foundation.

Intended outcomes

The short-term goal of this program is to transform health care professionals working within the broadly defined delivery system into effective agents of change. These leaders will have strong management skills and content expertise to effectuate practice improvement for older adults within their organizations and communities and across the nation. The long-term goal is to establish a vigorous network of health care practice change specialists with the capacity to influence care for this population on a national scale.

Program eligibility

Nurses, physicians, and social workers are eligible to apply. Applicants must hold a leadership role in a health care delivery organization, health-related institution, or community-based organization with direct responsibility for geriatric services or aging-related programs. Within this context, the Practice Change Fellows program welcomes applications from professionals working in the broadly defined field of geriatric services and aging-related programs.

Program activities

Three primary program activities promote Practice Change Fellows’ leadership development. Over the two-year fellowship, these include: the completion of a project aimed at implementing a new geriatric program or service line; the execution of a customized leadership development learning contract; and active engagement at tri-annual national meetings.

Project

Through participation in this two-year program, Practice Change Fellows further refine their leadership skills through completion of a project aimed at integrating a new geriatric program or service line into their organization. Recognizing that leadership lessons are not learned in a vacuum, the project provides a vehicle for obtaining the requisite skills Fellows need to lead cultural and organizational change. In some cases, the project represents a new approach to improving care of older adults while in other cases the project focuses on how to translate established, or proven, evidence-based models into practice. The project is embedded in the daily workflow of the Fellow’s responsibilities and is therefore not an “add-on.” At the time the project is initiated, Fellows are expected to demonstrate insight into what would be required at their home institution to sustain the project after completion of their two-year participation in the Practice Change Fellows program. While the projects vary, many of them have focused on care coordination for the chronically ill elderly. For a list of projects see the organization’s website (www. practicechangefellows.org).

Learning Contract

With the support of their home-organization supervisor, assigned program Mentor, and the mentoring Pod, Fellows create and execute a customized formal learning contract that articulates specific goals for the two-year Practice Change Fellows program and describes immediate plans for effectuating programmatic change within the home organization to support older adults. The learning contract identifies particular leadership skills Fellows plan to develop during their participation in the program, and describes how the conduct and completion of their project will contribute to development of these skills. Finally, the learning contract details opportunities for how these newly developed skills will be applied toward improving care to older adults more broadly. By the end of the two years, Fellows will be expected to articulate a vision for what they hope to accomplish in the upcoming five years and the steps necessary to achieve this vision within their home organizations.

Tri-Annual Meetings

Practice Change Fellows attend three highly interactive national meetings each year (the tri-annual meetings). Attended by Fellows, the National Advisory Board, and select national experts in practice change in the areas of geriatric care delivery and aging-related programs, the meetings are founded on the premise that every attendee is both a teacher and a learner. Fellows have the opportunity to receive input on their projects through “hands-on,” case-based discussions complemented by group problem-solving activities. Fellows further gain exposure to evidence-based models of practice improvement and emerging changes in national health policy.

Fellows participate in skill-building seminars led by national experts who encourage active learning and peer-to-peer problem solving. The core six competencies addressed in these seminars include: selecting and measuring compelling outcomes for program sustainability; presenting a compelling business case; building high-performing teams; fostering cross-setting collaboration; leading cultural change; and negotiating conflict.

During each of the tri-annual meetings, Fellows receive mentoring from their assigned Mentor (a member of the National Advisory Board) and from participation in mentoring Pods. Composed of three to four Fellows and their assigned Mentors, as well as other leaders from the National Advisory Board, the Pod provides an interactive group approach to mentoring and shared learning that complements the more traditional one-to-one mentor-mentee relationship. The Pod concept offers a number of tangible benefits: it provides Fellows with a wider base of expertise and interdisciplinary perspectives, it insulates against Mentor attrition, and it allows more senior participants to model mentoring behavior to junior participants.

Between the tri-annual meetings, the Pods have regularly scheduled conference calls to further foster peer-to-peer learning and ensure that Fellows are receiving the support they need to successfully conduct their projects and develop their leadership skills.

Practice meets policy

The program recognizes that it plays a unique and important role at the interface between health care policy and health care practice. Whether through legislative or regulatory approaches, delivery system reform cannot be successful without the experience, expertise, and voice of practice leaders. Based upon successful leadership experiences, the Practice Change Fellows National Advisory Board, Fellows, and National Program Office understand how to implement a patient-centered medical home, an accountable care organization, a bundled-payment approach, and strategies to realize the potential of health information technology. For more additional information, application procedures, and timelines, and for a variety of web-related aging resources, see the Practice Change Fellows web site.

Suggested reading

The Atlantic Philanthropies web site is available at: http://www.atlanticphilanthropies.org.

The John A. Hartford Foundation web site is available at: http://www.jhartfound.org.

The Practice Change Fellows web site is available at: http://www.practicechangefellows.org.