At the Hartford Foundation we believe that the only way to deliver care that is comprehensive, efficient, and effective in meeting the complex needs of older adults is for health care professionals to work in high-functioning teams. Unfortunately, current training models do not prepare the workforce for that kind of collaborative practice. Recent evidence even shows an alarming and persistent lack of respect on the part of physicians for physicians in training, nurses, patients, and family members.

To try to lay the groundwork for improved team care, last week we and our private partners--the Josiah Macy Foundation, the Robert Wood Johnson Foundation, and the Gordon and Betty Moore Foundation—along with our public partner the Health Resources and Services Administration (HRSA), announced a plan to collaborate on a national center for interprofessional health education and practice. As a first step, HRSA has issued a funding opportunity announcement for its part in the project. Later this summer, we expect to jointly issue a request for proposals from the four private funders for the additional work of the center that we hope will be supported by philanthropy.

Many of our readers may remember that we tried to work on this issue once before, in our Geriatric Interdisciplinary Team Training initiative (GITT). GITT began in 1995 with $100,000 planning grants to 11 institutions to bring together a minimum of graduate-level medicine, nursing, and social work students in both didactic and practicum/clinical educational experiences. Nine sites were funded around the country as well as a initiative resource center at NYU nursing and a program evaluation at UCLA. While many of the sites designed high-quality educational experiences, we found that at the end of more than four years and $850,000 in foundation support plus required local matching funds, only a few sites could sustain the work (e.g., Rush in Chicago and to some extent Baylor). Our efforts to disseminate the training models to a general audience met with little interest, and by 2001 we had more or less concluded that the health care environment was not sufficiently hospitable to the ideas to continue to press the issue.

More than ten years later, however, the idea of teams is everywhere in health care. It is even widely said (if infrequently practiced) that patients should be "on the health care team." The logic of health reform, population demographics, and the health care workforce all push towards team work as a way to deliver higher quality care at lower costs. So the environment is much more conducive to team care, and we believe that another attempt to advance what is now called interprofessional education (IPE) is warranted.

What else will be different this time? In our last GITT effort, we misunderstood what a fundamental system change IPE was in the academic health professions. We treated it essentially as a new skill for which some faculty development and some nice curricular tools could create capacity within existing organizations to later inculcate into new trainees. But I think IPE is a much more fundamental change than we realized, and this time we will be looking to support more comprehensive change strategies.

Although faculty development and curricular tools are necessary, we now understand that successful IPE implies a change in how health professions education and training is funded, accredited, and regulated. One of the rude awakenings we got at the end of GITT was ho-hum responses among academic leaders who observed that without evidence of benefits to patient outcomes, they could not possibly be expected to sustain the new and "expensive" training models--an entirely unreasonable standard of evidence for training programs. Nonetheless, we understand now the need to keep practice stakeholders engaged not only for access to practicum sites but also to create demand for a team-trained workforce. We also will try to build public demand for IPE and public acceptance of interprofessional practice.

Finally, we won't be going it alone this time. We will have partners who are also highly respected leaders in health care education and improvement. In turn we will have to settle for a broader version of IPE (not just focused on geriatric patients), but we will be insisting on adequate representation of geriatric care issues, providers, and settings in the work of the IPE center to ensure that the benefits of team training can be readily transferred to the care of older Americans.

If there are other specifications we should try to build into the RFP and site selection process, we would be very interested in getting all the advice we can--either through comments here or directly. We need as many people on the team as possible to ensure that IPE succeeds this time.