For the past two years, I have been deeply involved in interprofessional education and collaboration efforts at Cleveland Clinic. As an instructional designer by training, I strive to engage all stakeholders any time I am designing educational programming. This is particularly important when your audiences are from a number of professions, with a wide range of expertise level and diverse views on the need for learning.

Earlier this year, our Office of Interprofessional Learning, which I co-direct, implemented a very successful interprofessional educational experience in one of our intensive care units. Our SMiLE program (Strengthening Minds by Leveraging Education) aims to build shared mental models and consists of a one-time, online module and weekly half-hour, in-person sessions. The online module exposes participants to the basics of interprofessional collaboration, which includes but is not limited to:  (a) the importance of interprofessional collaboration; (b) how the use of team tools and strategies such as Situation, Background, Assessment, Recommendation (SBAR), Concern, Uncomfortable, Safety, and

and Debrief contribute to the development of shared mental  models; and (c) full descriptions of each of the roles in the unit, drafted by professionals from each of those roles. The in-person, faculty-led sessions are attended by a minimum of four professions in groups of 15-20. These sessions focus on bringing awareness about each other’s roles and discussing TeamSTEPPS communication strategies. We sought the literature, conducted focus groups with our target audiences, and engaged members from a number of professions including medicine, nursing, and pharmacy. The program was so well received that we  thought we had reached the sweet spot of interprofessional education; just the right balance of preparation, information, and discussion. When another intensive care unit asked us to implement the program in their department, we were over confident; we thought we would put out the honey and the bees would come. After all, residents and fellows from the requesting unit had been part of our focus groups.

We formed a curriculum planning team and asked them to review our existing educational materials with the goal of making the experience meaningful to their unit. However, when these materials came back with minor changes, it should have raised a red flag. It is work nothing that the planning team included members from various professions form the requesting unit; yet the voices and perspectives of those who were most intimately familiar with interprofessional initiatives (i.e., front line nurses) were not reflected in this process—thus, we moved to implementation ill prepared.

We spent a lot of time modifying the online materials to make them user friendly and appealing. We spent even more time recruiting faculty and participants. The logistics of implementing the program alone was a full-time job.  In the end, before we stopped to rethink our approach, we held  5 sessions with a total of 50 participants from professions including: Attending Physicians, APPs, Dietitians, Case Mangers, Child Life Specialists, Clinical Technicians, Fellows, Nurses, Pharmacy, Residents, Respiratory Therapists, and Social Workers. The feedback we received could be summed up as something was not needed in their unit—in other words, they perceived this session as a waste of time! 

While it was tempting to blame those who reviewed the curriculum as the reason why the implementation failed, I took ownership of the problem. I did not do my due diligence to ensure the curriculum (online and in-person) met the needs of our new audience. This is a basic instructional design principle and a reminder that no matter how busy we get, we must bring all stakeholders to the table. Thus, I hosted a number of meetings and engaged in trouble shooting dialogues attempting to identify the cause of the problem.

All that to say that we did what we should have started with, we observed the unit in action and took an inventory of the interprofessional-related efforts already in place. We found this unit was leaps and bounds ahead of other units in the organization. We observed that caregivers knew each other fairly well and engaged in collaborative practices on a daily basis.  They conducted group sign outs, interdisciplinary rounds on every patient and family, held weekly case conferences, and interprofessional M&Ms. Hence, our program focusing on roles/responsibilities and communication strategies seemed “like going to kindergarten,” as one nurse put it. 

Our failed implementation was a lost opportunity; the perceptions of our educational program plummeted and we lost stakeholder buy-in. We had been presented with a captive audience able and willing to enhance their collaborative practices and we blew it! As it turns out, there is a need for interprofessional education in the unit, but it would have been ideal to focus on residents and fellows only, as these are the constant new members that need to understand the interprofessional philosophy of the unit and how to best work with this group. Now we have to work even harder to ensure sustainability, so that what when we do implement the program it is welcomed and supported.  We will ensure that we plant the right flowers to promote pollination of enduring interprofessional practices.

What did I learn? I learned that Gemba walks are not just for lean initiatives and honey is not the best way to attract bees. (Gemba is a Japanese word meaning the actual place; in quality improvement it is used as a primary step, where one visits the workplace to gain an understanding of actual work processes). I learned that as convenient as it is to simply rely on the leadership’s view of the interprofessional team’s learning needs, it is better to observe the frontline caregivers in their environment doing their daily work. I learned that as director on interprofessional learning, it is my duty to amplify the voices of the frontline caregivers across professions. I was reminded that it is imperative to seek a first-hand understanding the workplace environment, as this is the best way to unpack perspectives and identify the true need of the interprofessional team. Most importantly, I was reminded that if I am to develop and implement meaningful educational experiences, I must seek to be truly inclusive and bring not just the leadership but also frontline representatives to the planning table.  



Did you know that the Harvard Macy Institute Community Blog has had more than 185 posts? Previous blog posts have explored topics including the flipped classroom,  instructional design, and collaborative learning methods.

Cecile Foshee, PhD, MEd

Cecile M. Foshee, PhD, is a medical educator who currently serves as Director of GME Learning Innovation, Director of the Master of Education in Health Professions Education, and co-director of the Office of Interprofessional Learning at Cleveland Clinic. She also holds faculty appointments at Case Western Reserve University and Cleveland State University. Cecile has taught in the Harvard Macy Institute Health Care Education 2.0 course since 2017. Her areas of professional interest include interprofessional education, the clinical learning environment, and informal learning. Cecile can be followed on Twitter and/or LinkedIn, and/or email.