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