Partnerships: Successes, Challenges and Strategies The Power of Local Communities to Impact Health...
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Transcript of Partnerships: Successes, Challenges and Strategies The Power of Local Communities to Impact Health...
Partnerships: Successes, Challenges and Strategies The Power of Local Communities to Impact Health Care Workforce
Hilda R. Heady, Executive DirectorWest Virginia Rural Health Education Partnerships
Presented to “Our Communities In Crisis”November 2, 2001
Bend, Oregon
Why Partnerships and How do they succeed?
Our experience in partnership teach us about the whole, about synergy
Partnerships create a forum that honors the diversity of needs and resources
Partnerships can define and create power as an infinite and shared commodity
Partnerships can provide the foundation for social change
Why and How Partnerships succeedPartnerships can define and create power as an infinite and shared commodity
Partnerships can provide the foundation for social change
West Virginia Rural Health Education Partnerships
Created by 1991 Rural Health Initiative Act and first students placed in 1992 (Kellogg and RHI)
Covers 47 counties with rural underserved areas
Significant changes in all schools in response to the needs of the state
WVRHEP Infrastructure 10 state health professions schools 13 consortia with local boards 17 site coordinators and secretaries 17 Learning Resources Centers, 11 have MDTV 130 student rotations on average per month 318Training sites 594 Field faculty 670 community level partners
Service to the people of West Virginia Over 35,000 weeks of
student training since 1992
Average 150,000 community service contacts per year (740,000 since 1997)
Service to the People of West Virginia
Over $4 million in uncompensated dental care
288 Health Professionals recruited to rural underserved areas of the state
WV Graduates Recruited to Rural Underserved Areas in the State
1991-2002Total No. No. w/rural
rotations
MD & DO’s
(91-98 grads) 124 124
Nurse Practitioners 59 59
Nurse-midwives 2 2
Physician Assistants 60 60
Dentists 48 48
Dental Hygienists 14 14
Pharmacists 69 69
Physical Therapists 26 26
TOTAL 402 402 (100%)
Discovering Partner EquanimityDiscovering Partner Equanimity
Partner Equanimity Role of community members
as the stewards of the partnership
Role of defining power and expertise
Decision making authority of State Panel in legislation
Funding tied to functioning of the partnership i.e.school and community money in same allocation
Partnerships Respond to Community Needs
•Higher Education mission is one of social responsibility•A social contract with the people of the state•Decision making is not just shared it is synergistic•Releasing power creates more power•The pie gets larger and is seen as a whole instead of various sized slices
Why Does it work?
Schools had an “intensely reflective experience No one partner group is solely responsible for
outcomes Successes and challenges are shared Communities know best what they need and
what kind of practitioners they want Synergy of partnership is meeting in the middle
How Does it Work? Students and residents see a true picture of
rural health care Curriculum engages students in ways to learn
community values Students are invited to see their educations as a
way back in instead of a way out Community shows respect for students and
involves them in all areas of community life
What influences graduates to go into rural practice?
Acceptance by community and practitioners
As students getting real “hands on” training
Experiencing confidence and skill building early
Learning and seeing the rewards as well as the challenges in the real setting, not just academically
What influences graduates to go into rural practice?
Having the option Seeing their own
communities differently Bonding as a group Learning interdependent
skills
Build on the strengths of community commitment
Engage community expertise in teaching and mentoring students
Honoring and Sustaining Tradition…
While Innovating
Consortia prioritized service-learning activities
Tracked by State’s Healthy People 2010 Flagship objectives
The Rural Health Curriculum All health professional
students complete rural rotations as a degree requirement (since 1996)
Complete clinical objectives 20% of their time in
community service-learning, research, and/or Interdisciplinary Case Management sessions.
Rural Practitioners as Field Faculty
Recruited by site coordinators and schools Approved by schools and consortia board To pay or not to pay a consortia decision Adjunct appointment at only one school Reciprocity of appointment among schools Faculty Development is interdisciplinary and
discipline specific
Distance Teaching Tools Tele-health system in 10 of 13 consortia Routine schedule (grand rounds) AND broadcasts
from the field Satellite in all learning resource centers Web CT courses off web site (example:
interdisciplinary health informatics course) Weekly interdisciplinary case management sessions
(IDS) required, disciplines rotate and student lead
Retention of Other Health Sciences Graduates
1995 2000WVU
Dental 15 (50%) 21 (58%)Pharmacy 59 (74%) 41 (89%)Nurse Practitioner 12 (48%) 25 (93%)
MarshallNurse Practitioner 5 (56%) 14 (82%)
Total MD PhysiciansActive in practice, 1998
Percent in-state MD graduatesWest Virginia33%
Region III 32%US 32%
WV Rank 24/45
Source: HRSA State Health Workforce Profiles, Dec. 2000
Percent MD & DO graduates in WV
WV Medical Grads 1987-92 1990-95
In WV, all specialties 317 (36%) 357 (38%)In WV, primary care 168 (19%) 219 (23%)In WV, rural areas 89 (10%) 98 (10%)
Number MD & DO graduates in WV
WV Med.Grads 1987-92 1990-95 Increase
In WV, all specialties 317 357 + 40 (13%)In WV, primary care 168 219 +51 (30%)In WV, rural areas 89 98 +9 (10%)
Medical Students’ Choice of Primary Care Residencies
WVU graduates, 2000 51 (63%)Marshall graduates, 2000 32 (74%)WVSOM graduates, 1999 40 (65%)
US average for MD 2000* (58%)grads
*Data for DO grads not available
1995 WV Med Grads completing PC residency training by 2000
Completing PC residencies No. WV Practice
In West Virginia 54 31 (57%)In other states 70 13 (19%)
Physician Specialties of 92 recruits 1991-2000
Primary Care*
61 Family Practice
12 Internal Medicine 4 Pediatrics4 OB/GYN
4 General Practice
1 Emergency Medicine
* West Virginia practical definition
Subspecialties
2 Orthopedic Surgery
1 Psychiatry
1 Anesthesiology
1 Radiology
1 Ophthalmology
West Virginia Rural Health Education Partnerships
www.wvrhep.org