Extending the Population Health Workforce through Service Learning Internships during COVID

Abstract

This report arises from the intersection of service learning and population health at an academic medical center. At UCSF, the Office of Population Health and Accountable Care (OPHAC) employs health care navigators to help patients access and benefit from high-value care. In early 2020, facing COVID-19, UCSF leaders asked OPHAC to help patients and employees navigate testing, treatment, tracing, and returning to work protocols. OPHAC established a COVID hotline to route callers to the appropriate resources, but needed to increase the capacity of the navigator workforce. To address this need, OPHAC turned to UCSF’s service learning program for undergraduates, the Patient Support Corps (PSC). In this program, UC Berkeley undergraduates earn academic credit in exchange for serving as unpaid patient navigators. In July 2020, OPHAC provided administrative funding for the PSC to recruit and deploy students as COVID hotline navigators. In September 2020, the PSC deployed 20 students collectively representing 2.0 full-time equivalent navigators. After training and observation, and with supervision and escalation pathways, students were able to fill half-day shifts and perform near the level of staff navigators. Key facilitators relevant to success reflected both PSC and OPHAC strengths. The PSC onboards student interns as institutional affiliates, giving them access to key information technology systems, and trains them in privacy and other regulatory requirements so they can work directly with patients. OPHAC strengths included a learning health systems culture that fosters peer mentoring and collaboration. A key challenge was that, even after training, students required around 10 hours of supervised practice before being able to take calls independently. As a result, students rolled on to the hotline in waves rather than all at once. Post-COVID, OPHAC is planning to use student navigators for outreach. Meanwhile, the PSC is collaborating with pipeline programs in hopes of offering this internship experience to more students from backgrounds that are under-represented in healthcare. Other campuses in the University of California system are interested in replicating this program. Adopters see the opportunity to increase capacity and diversity while developing the next generation of health and allied health professionals. 1 Introduction: Description of the nature of the problem being addressed and rationale for the proposed innovation This case study reports on a collaboration that represents the intersection of two major trends: service learning in education (1–4) and population health in health care (5, 6). Service learning programs involve students in experiential learning outside of classroom settings. Population health programs target an entire population or panel of patients and attempt to address their health and wellness in an integrated and holistic fashion. The past decade has seen a steady increase in the proportion of patients cared for under accountable care or other risk sharing programs. Such programs create alignment for all parties for the provision of high quality and affordable health care, and create opportunity for health systems to innovate with new models of care delivery. In early 2020, population health programs faced an influx of demand from patients who were potentially exposed to coronavirus infection and who needed help with testing, treatment, and tracing services related to COVID-19 (7). Population health programs needed to expand their capacity to address this demand. At the same time, health care delivery systems were dealing with a reduction in revenue, and many had instituted hiring freezes. Meanwhile, undergraduate institutions have launched service learning programs to ensure that students are exposed to high impact practices such as internships (8–11). Students benefit from internships and other experiential learning opportunities because they allow students to apply knowledge, gain skills, interact with role models and mentors, and work on interprofessional teams (2, 12–14). Internships also present challenges, as well as opportunities, in terms of equity and access (15). In principle, service learning programs can extend the workforce capacity of population health programs, including during a surge in demand due to a pandemic. This case study describes one such innovative collaboration at an academic medical center where students helped increase the capacity of a COVID hotline.