Restructuring academic health centers to advance interdisciplinary collaborations: opportunities for psychiatry departments.

Healthcare reform initiatives have highlighted the importance of interdisciplinary teams, especially within psychiatry departments, where multiple disciplines already work together (1). The goal of these collaborations is to optimize patient outcomes. A succession of Institute of Medicine (IOM) reports has reaffirmed that optimal clinical services require health professionals (not just physicians) to collaborate in order to foster wellness, manage acute and chronic illness, and provide compassionate care across the life continuum. The IOM report titled, “Health Professions Education: A Bridge to Quality” (2), observed that the training of healthcare professionals must change because, once in practice, they are asked to work in interdisciplinary teams, yet they are not educated together or trained in team-based skills. To achieve this educational goal, the IOM report titled, “Crossing the Quality Chasm” (3) observed that, across professional schools, there are shared competencies that should be identified and integrated into the educational programs. The report went on to recommend that accreditation, credentialing, and licensing organizations provide competency-based oversight across disciplines. These recommendations were reaffirmed more recently by a Josiah Macy Jr. Foundation report (4). When the IOM evaluated rural health care (5), one of its recommendations for schools of medicine, dentistry, nursing, allied health, public health, and behavioral health was to develop curricula in order to improve health care in rural communities. These curricula would include a core competency for all disciplines to be able to provide interdisciplinary care. The report also advocated for cross-training in key shortage areas for rural communities. For example, the report expressed particular concern over the lack of mental health and substance abuse programs, and recommended that all physicians, nurses, and allied health professionals who work in rural settings, regardless of specialty, receive training in the recognition and treatment of psychiatric disorders, including alcoholism and substance abuse. Finally, the IOM expressed concern over the quality of care in long-term care facilities (6) and the shortage of clinical services being provided to an aging population (7). Among their many recommendations in both reports was the need to improve the training and competencies of all healthcare professionals in the field of geriatric medicine, including paid caregivers, informal caregivers, and traditional specialties, such as nursing and medicine. The reports also discussed the need for educating and training multidisciplinary teams to provide clinical care (6, 7). Articles that support the need for multidisciplinary and team approaches to clinical problems have also been published in the psychiatric literature (8–11). Since psychiatrists have extensive experience in collaborating with social workers, psychologists, psychiatric nurses, and other mental health professionals, they are well-positioned to assist other healthcare professionals in such team approaches. As the five IOM reports emphasized (1–3, 5–7), there is a compelling need to have care delivered through collaboration and integration. This goal has been articulated by the leadership at UC Davis (12) and has led to the changes described in this article. To create more multidisciplinary and team approaches to education and clinical care, the University of California, Davis Health System made structural reforms to better achieve these goals. This article discusses the reforms made at UC Davis.