Understanding patient-professional ‘co-production’ key to GME improvement

Forging a better understanding of the concept of co-production — patients and professionals interacting in health care service — will help providers improve graduate medical education (GME) nationally, according to a featured speaker at a two-day conference held on the University of Michigan campus.

On May 23, Paul B. Batalden, M.D., delivered the keynote address at the “Accountable Graduate Medical Education: Linking GME to High-value Health Care” conference, hosted by the Josiah Macy Jr. Foundation and the University of Michigan Medical School. GME is defined as formal medical education, usually hospital-sponsored or hospital-based training, pursued after receipt of the M.D. or D.O. degree.

“This is an invitation to discuss a new design, and to give new attention to people and the role they play, and the development of professionals getting ready for the next 20 to 30 years of their lives,” said Batalden, a senior fellow at the Institute for Healthcare Improvement, and active emeritus professor of pediatrics, community and family medicine, and the Dartmouth Institute for Health Policy and Clinical Practice in the Geisel School of Medicine at Dartmouth University.

In his talk, “GME and Better Value Healthcare Service,” Batalden reflected on what health care services might be possible in the next 20-30 years, and how the system currently prepares residents. He shared a visual model of coproduction, in which the interaction of the health care system, patients and professionals — through co-execution, co-planning and civil discourse — with community and society as the larger backdrop, will co-produce high-value health care services and, ultimately, good health for all.

Batalden also discussed a “sweet spot,” where patients, families and communities; health professions education and reform; and clinical practice reform intersect.  “We have been busy trying to improve activity, and not the relationship,” he said. “If we are serious about coproduction, and value creation, there are opportunities in education, system design, outside/edges, and measurement.”

The gathering, which concludes today in the Michigan League Ballroom, is the sixth Macy Regional Conference on Innovations in GME. The foundation’s president said he sees great excitement throughout the GME community, now that the discussion has shifted from problems to solutions.

“These conferences have exceeded our expectations,” said George E. Thibault, M.D., of stops in Nashville, Houston, San Francisco, Spokane and Boston. “The cumulative investment in training the next generation of physicians is one of the most important things we do as educators and as a health care system.”

Thibault said the momentum produced by the conferences has sparked a dialogue that was lacking. Several years ago, he said, a blue-ribbon panel convened and an Institute of Medicine report was produced that detailed compelling reasons to change GME. It also offered recommendations, to little effect.

“Nothing happened because there was a lot of opposition,” he recalled. “The focus was on winners and losers — who was going to be given money, or who was going to have it taken away.”

The conference includes breakout sessions on what interventions and experiments in GME programs are leading to improvements in patient-centered care; obtaining personalized outcomes-data for residents; and how Accreditation Council for Graduate Medical Education competencies and milestones can be linked to improvements in the value of care. Day two will feature a panel discussion on postgraduate models in the other health professions — current barriers and opportunities for collaboration.

Medical School leadership opened the conference, which is being attended by more than 200 health care professionals from seven states and more than 50 medical institutions.

Joseph C. Kolars, M.D., senior associate dean for education and global initiatives in the U-M Medical School, said conference attendees should view GME and its relationship to society with a different focus — what is GME doing to really improve care and health?

“The United States spends the most as a country on health care, but ranks 37th worldwide in overall care (or efficacy),” said Kolars, the Josiah Macy Jr., Professor of Health Professions Education. “We have to think of GME as an ecosystem. Our ability to work with the health care system, especially with other providers, has never been more important.”

Marschall S. Runge, M.D., Ph.D., executive vice president for medical affairs and dean of the U-M Medical School, said now is a pivotal time for how the health care system develops the next generation of physicians. He said the GME workforce has evolved, but more change is needed.

“We have to take advantage of the tremendous talent in the GME workforce,” Runge said. “We need to move from thinking of our residents as just a workforce to seeing them as a group that can really impact the future of health care.”