schools, a step that could be cost-effective. The partners might include community colleges and various nontraditional partners that could influence IPE with their unique perspectives, leading to breakthrough innovations. Feeley said that such innovative ideas are appearing already with social media, gaming, and engineering. One other possible pedagogic innovation would be for interprofessional grand rounds to receive a greater focus than the traditional siloed grand rounds.

In the area of culture, Feeley said there appears to be a disconnect between what educators view as needed in the health care workforce and what providers feel they need. Feeley identified learning opportunities to build the workforce from such things as task sharing and by applying experiences from the military, which has always focused on cost-effective, high-quality care. Feeley was quick to point out that task sharing is distinct from task shifting, which is very important in the cost discussion. Almost every time there is a cost discussion in the United States, it involves who can do the best job at the lowest cost, he said, but the responsibility for high quality is not shifted from one to another. Quality is a responsibility that needs to be “shared” among all health workers, regardless of the remuneration provided for accomplishing the task. Adding to the human resources comments, Feeley asked how people other than health professionals, such as patients, caregivers, volunteers, aides, and clerks, can be included in the conversations about what is needed to provide high-quality, lower-cost health and health care.

Parenthetically, Feeley said, patients in the United States are not engaged in the cost of their care, and that is a huge problem. It is equally important to find better definitions of cost and of whose cost is being described—the provider, the payer, government, or the patient. This leads to the notion of metrics. According to Feeley, measurements are often described in terms of money or dollars, but metrics could also include human values that are important to patients. Also, he said that data systems, which are critical for measurement, are incredibly deficient.

There is much energy and optimism, Feeley said, but not much proof that IPE improves values or that it is the right starting point in health care. Obtaining such proof may require rethinking who is on the team (i.e., patients, caretakers, etc.) and how health care is structured. Given that prevention and early detection will lower costs, Feeley said, how might a system transition from health care to one that ensures better health?

In closing, Feeley acknowledged that many provider organizations and many governments are looking at controlling costs. He also encouraged providers and educators to better educate the public about health costs. “It is safe to talk about costs,” said Feeley, “and we need to all address how we do more with less.”



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement