2015 and Beyond The Process of Charting a Future for the Respiratory Therapy Profession
Questions to Be Addressed How will patients receive healthcare services in the future? How will respiratory therapy be provided? What skills, knowledge and attributes (KSAs) will respiratory therapists need to provide care safely, efficiently and cost-effectively? What educational and credentialing systems are needed to provide and validate these KSAs? How do we get from the present to the future without having an adverse impact on the respiratory therapy workforce?
Strategies to Find Answers Two components of the process: Information gathering Decision making (BOD) Minimize influence of organizational politics
Examined how healthcare will be delivered in the future Explored RT services identified in1st conference The Conferences 1 st Conference (March 2008) 2 nd Conference (April 2009) Examined the educational and credentialing systems Identified the respiratory services needed Defined competencies required to provide future respiratory services 3 rd Conference (July 2010) Recommend educational and credentialing options for the workforce to acquire identified competencies and a transition plan
Strategies to Find Answers Blue Ribbon Planning Committee Blue Ribbon Planning Committee Respiratory therapy director Respiratory therapy educator Administrator (acute care hospital) Administrator (healthcare system) Healthcare workforce expert Patient/consumer Physician (critical care) Physician (chronic care) 2 year college representative 4 year college representative Federal government representative Military representative Planning Committee Members Bob Kacmarek (Mass General) Tom Barnes (Northeastern University) Karen Stewart (CAMC) John Walton (Resurrection Health Care) Ed O Neal (Cntr for Health Profess) John Walsh (Alpha One) Charles Durbin (SCCM Past Pres) Woody Kageler (Disease Mgt) Janell Lang (NN2) David Gayle (ASAHP) Judy Blumenthal (HHS) COL Michael Morris (Brooke Army Med Center) *Writing Committee
Strategies to Find Answers Responsibilities Planning Committee Conference chairs selects conference chairs appoints writing committee approves conference agenda, topics, presenters identifies stakeholder groups propose conference agenda, topics, presenters ; conduct conferences Executive staff provides administrative support and manages the conferences
Strategies to Find Answers Involve Stakeholder Organizations Organizations within the following stakeholder groups were invited to participate in conferences: Employers Insurers Professional Organizations Foundations State and Government Agencies Educators Patients and Consumers Credentialing and Accrediting Agencies State and Federal Government Agencies
Strategies to Find Answers Conference Structure During each conference: Conference is moderated by the co-chairs. Speakers present topics to faculty, planning group and stakeholder representatives. Each presentation is followed by discussion in which all attendees have the opportunity to participate. All presentations and discussions are recorded for later transcription and distribution to the writing committee. After all presentations, co-chairs summarize proceedings which are distributed to all attendees. Attendees provide feedback to co-chairs.
Strategies to Find Answers Conference Structure Following each conference: Writing committee chair assigns conference topics to each member of the writing committee. Transcript of each presentation and discussion along with copies of presenter s slides are provided to the writing committee. Writing committee members draft summaries of assigned individual presentations and discussions and submit them to the writing committee chair. Using these summaries, the writing committee chair incorporates them into a draft paper describing the findings of the conference and presents it to the planning committee. Planning committee provides review and comment to the writing committee chair who then submits paper for publication in a peer-reviewed journal.
Creating a Vision for Respiratory Care in 2015 and Beyond First conference was held March 3-5, 2008 Conference goals: examine the characteristics of the current healthcare delivery system and how it is likely to evolve as we move into the future project what and how respiratory therapy services will be delivered in the future
20 Stakeholder Organizations Represented by 37 Participants Alpha 1 Foundation American Association for Cardiovascular and Pulmonary Rehabilitation (AACPR) American Association for Respiratory Care (AARC) American College of Chest Physicians (ACCP) American Thoracic Society (ATS) California Board for Respiratory Care Center for Health Professions Commission on Accreditation of Allied Health Education Programs (CAAHEP) Committee on Accreditation of Respiratory Care (CoARC) COPD Foundation National Association for Medical Direction of Respiratory Care (NAMDRC) National Board for Respiratory Care National Heart Lung and Blood Institute National Home Oxygen Patients Association National Network of Health Career Programs in Two Year Colleges (NN2) North Carolina Board for Respiratory Care Society of Critical Care Medicine (SCCM) The Association of Schools of Allied Health Professions (ASAHP) The Joint Commission United States Public Health Service
Conference Findings Predicted changes in healthcare delivery: Increased % of patients 55 or older. Increase incidence of chronic disease due to advanced age and effectiveness of diagnosis. Treatment more focused on patient management and avoiding hospital admission. Preserving health rather than illness treatment will become the goal of care.
Conference Findings Predicted changes in healthcare delivery(cont.): Better communication among all providers of care as well as the patient and his/her family members to improve outcomes New models of healthcare delivery (such as the Hospital at Home and Medical Home ) will emerge with increasing emphasis on coordination of care through the healthcare system including the home Increasing scrutiny for quality and this will be linked to reimbursement with initiatives Reimbursement changes will be the most important drivers of changes in health and disease management
Conference Findings Changes likely to occur in the healthcare workforce 24/7 staffing in inpatient and other settings will dissuade individuals from pursuing health care careers Continued shortage of healthcare providers Care demand will increase at a faster pace than the healthcare workforce will be able to expand There will be a long-term competition for all healthcare professionals throughout the US economy Will be aggravated by the retirement of current providers
Conference Findings Changes likely to occur in the healthcare workforce Shortage of teaching faculty and the limited number of programs will limit the number of entrants admitted into and graduating from allied health professional schools Clinical sites are limited in number and variety and will need to be expanded to include venues such as office practices and patients homes New technological resources for educational delivery and knowledge access will challenge traditional education Employers will find attractive ways to secure and retain workers by investing in education to reduce the time between initial employment and full productivity, and provide career ladders for existing employees
Conference Findings Changes expected in respiratory care: The science of respiratory care will continue to evolve and increase in complexity, clinical decisions will become more data driven Respiratory care delivery will be an increasingly important part of care delivered in all venues. Scientifically supported algorithms (protocols) will be the most common way to deliver respiratory care. Increased complexity of care and use of protocols will stimulate an even greater need for more practitioners to be involved in research and require the average respiratory provider to be adept at understanding the practical ramifications of published research.
Conference Findings Changes expected in respiratory care: Information management will become an important tool in selecting a therapy and evaluating the effects of treatment decisions. New respiratory life support technologies will be developed and deployed. Research on their clinical and cost effectiveness by the respiratory community will be necessary Public health issues, military and disaster response concerns will continue and require new skill sets for respiratory care providers.
Creating a Vision for Respiratory Care in 2015 and Beyond Robert M Kacmarek PhD RRT FAARC, Charles G Durbin MD FAARC, Thomas A Barnes EdD RRT FAARC, Woody V Kageler MD MBA, John R Walton MBA RRT FAARC, and Edward H O Neil PhD The respiratory care profession is over 60 years old. Throughout its short history, change and innovation have been the terms that best describe the development of the profession. The respiratory therapist (RT) of today barely resembles the clinicians of 60 years ago, and the future role of the RT is clearly open to debate. Medicine is continually changing, with new approaches to disease management emerging almost daily. Third-party payers are challenging payment for iatrogenic injury, manpower issues are affecting all disciplines in medicine, and the nonphysician and physician work force is aging. These factors make us question what the respiratory care profession will look like in the year 2015. To address this issue the American Association for Respiratory Care established a task force to envision the RT of the future. The goal is to identify potential new roles and responsibilities of RTs in 2015 and beyond, and to suggest the elements of education, training, and competency-documentation needed to assure safe and effective execution of those roles and responsibilities. We present the initial findings of that task force. Respir Care 2009;54(3):375 389. 2009 Daedalus Enterprises
Conference 2- Educating the Future Respiratory Therapist Workforce: Identifying the Options April 6 8, 2009 Dallas/Fort Worth Airport Marriott
Educating the Future Respiratory Therapist Workforce- Conference Goal Identify the specific competencies required to fulfill the roles described in the first conference
14 Stakeholder Organizations Represented by 42 Participants Alpha-1 Foundation American Association for Respiratory Care (AARC) American College of Chest Physicians (ACCP) American Society of Health System Pharmacists (ASHP) American Thoracic Society (ATS) Association of Asthma Educators California Board for Respiratory Care Commission on Accreditation of Allied Health Education Programs (CAAHEP) Committee on Accreditation of Respiratory Care (CoARC) COPD Foundation Emphysema Foundation for Our Right to Survive (EFFORTS) National Board for Respiratory Care (NBRC) National Network of Health Career Programs in Two Year Colleges (NN2) North Carolina Board for Respiratory Care Ohio Board for Respiratory Care Society of Critical Care Medicine (SCCM) The Association of Schools of Allied Health Professions (ASAHP)
Educating the Future Respiratory Therapist Workforce - Day 1 and Day 2 (morning) Strategy-Plenary Sessions Review of outcomes from the first conference. Presentations on patient care delivery in acute and chronic venues. CEO perspective Presentations from accrediting, credentialing and state licensing organizations.
Educating the Future Respiratory Therapist Workforce - Day 2 Strategy-Group Work Sessions Participants were divided into 6 small groups to (1) review and discuss competencies previously identified during the conference and (2) identify competencies for graduate and advanced clinical practice.
Educating the Future Respiratory Therapist Workforce - Day 2 Small Group Work Sessions Each individual wrote graduate competencies on index cards. Each person volunteered one competency which was listed on flip chart. Process repeated until all competencies are listed. Consensus reached through discussion. Process repeated for specialty practice competencies (beyond graduate level). Complete transcriptions of the competency statements generated in each small group were prepared overnight and distributed to the all participants.
Educating the Future Respiratory Therapist Workforce - Day 2 Strategy-Group Work Sessions Review of Small Group Work Sessions This plenary session allowed all participants to review common themes, issues, resources and barriers that arose in the small group discussions of the competencies.
Educating the Future Respiratory Therapist Workforce - Day 3 Plenary Sessions In plenary session all graduate and specialty practice competencies were placed on sticky board for consideration by participants. Note: Participants decide to focus on graduate competencies only. Participants reviewed, discussed and refined competencies. Participants grouped competencies into 7 distinct areas.
Educating the Future Respiratory Therapist Workforce - Day 3 Small Group and Final Plenary Sessions Participants in small groups reviewed, discussed, and refined competency group definitions. Group facilitator with assistance from writing committee drafted final competency group definition and competencies.
Competency Validation Post Conference Activities Final Definitions Competency list and definitions were refined and distributed to all participants post conference. Survey Participants indicated their agreement or disagreement with each competency via a webbased survey instrument. Results Reported Survey results analyzed and reported.
Educating the Future Respiratory Therapist Workforce Competency Survey Results Survey completed by 28/37 (75.7%) of eligible attendees (AARC staff excluded). Criterion: General agreement on competencies was determined by >80% of the survey respondents indicating approval or strong approval of the item. Median survey score of 4 or higher (rating scale of 1-5) = consensus for approval was achieved on 69 of the 73 competency definitions. Limited agreement was reached on four competency definitions that were approved by only 60.7% to 71.5% of the survey respondents.
Educating the Future Respiratory Therapist Workforce Competencies Required for Respiratory Therapists 7 Groups of Containing 73 Competencies: 1. Diagnostics 2. Disease Management 3. Evidence-Based Medicine and Protocols 4. Patient Assessment 5. Leadership 6. Emergency and Critical Care 7. Therapeutics
Consensus Statement Upon entry into practice, respiratory therapists should possess these identified competencies. Therapists already in the workforce but lacking these competencies should acquire them through postgraduate education and training.
Competencies Needed by Graduate Respiratory Therapists in 2015 and Beyond Published in Respiratory Care May 2012 Vol. 55 #10
Activities Conducted Prior to 3 rd Conference Analysis of anticipated RT workforce demand and supply. Assessment of educational community s willingness to initiate new programs and continue existing programs. Assessment the impact of incorporating defined competencies into current curricula. Assessment of the depth of education needed to assure competency of the elements in the 7 categories by the education community. Analysis of resources for providing new competencies to the current workforce.
Conference 3:Transitioning the Respiratory Therapy Workforce for 2015 and Beyond July 12-14, 2010 San Marcos Island, Florida Conference Goal To determine what changes in the profession are necessary to position respiratory therapists to fulfill the roles and responsibilities identified in conference one and to insure that respiratory therapists in 2015 and beyond acquire the competencies identified in conference two. It was postulated that changes would be needed in the education, accreditation and the credentialing process of the respiratory therapist to meet the needs identified from conferences one and two.
Conference 3 Methodology Day 1 Review of outcomes of 2 previous conferences. Presentation and review of pre-conference survey results. survey results (program directors, department directors, deans) included the competencies needed, education level, and credentials needed for entry into practice Overview of workforce information. Day 2 Group activities focused on generating, discussing, and accepting recommendations for change. Audience response system used to record participant responses and display voting results.
Conference 3 Methodology Day 2 (continued) Key decisions: conference goal, attributes to be applied to evaluate recommendations for transition plans and proposals for transition plans Day 3 Review of 11 conference recommendations Affirmation of attributes Group discussion of additional activities to gather input about recommendations from stakeholder groups including a post conference public hearing, visits to stakeholder groups and plans for publication of a peer-reviewed conference paper
Overview of 3 rd Conference Recommendations Major areas of recommendations: Education Professional credentials State licensing requirements Resources to develop and support: Consortia and cooperative models Continuing education for developing new competencies in the existing workforce
Transition Plan Attributes Maintain an adequate respiratory therapist workforce throughout the transition. Address unintended consequences such as respiratory therapist shortages. Require multiple options and flexibility in educating both students and the existing workforce. (e.g. affiliation agreements, internships, special skills workshops, continuing education, etc). Require competency documentation options for new graduates. Support a process of competency documentation for the existing workforce.
Transition Plan Attributes Continued: Assure that credentialing and licensure recommendations evolve with changes in practice. Address implications of changes in licensing, credentialing and accreditation. Establish practical timelines for recommended actions. Reflect the outcomes of the previous two 2015 and Beyond conferences. Identify the agencies most appropriate to implement identified elements.
December 2010 BOD Actions Approved the transition plan attributes. Required evaluation of recommendations from the 3 rd conference to assure that the transition attributes are not violated by their implementation. Required evaluation of the need for additional research, additional communication needs, and potential legal issues, including but not limited to legal credentialing. Required the AARC s leadership use the next year to conduct a briefing/listening tour to provide key stakeholder groups with an opportunity to better understand the project and allow AARC to gain additional input before final recommendations are made.
Implementation of BOD Actions Ad hoc committee established and charged to: Review the attributes and compare to the recommendations. Identify gaps and identify other information that will be necessary to act on the recommendations. Identify groups of organizations and interested parties that would be necessary to obtain feedback regarding the recommendations. Identify additional required information and methods to obtain it. Develop a time line for completing activities required to formulate recommendations for BOD action.
Stakeholder Groups Visited in 2011 NBRC -accrediting organization for credentialing CoARC- accrediting organization for schools National Network of Health Career Programs in Two- Year Colleges (NN2) The Association of Schools of Allied Health Professions (ASAHP) State society conferences
Current Ad Hoc Committee Activities Awaiting formal responses from NBRC and CoARC. Formulating final decisions about the need for additional information. Developing initial recommendations to present to the BOD in April 2012. Finalizing timelines that will lead to the final recommendations being presented to the BOD in November 2012.
Anticipated Outcomes Identify educational and credentialing options for the workforce to acquire identified competencies Develop a tactical road map to chart a thoughtful transition from the present to the future without negatively impacting on the workforce during the transition years and beyond.
Contact Information Bill Dubbs Director Education and Management Services American Association for Respiratory Care 9425 N. McArthur Blvd. Suite 100 Irving, Texas 75063-4706 (972) 243-2272 dubbs@aarc.org www.aarc.org