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Exploring Organizational Context and Structure as Predictors of Medication Errors and Patient Falls. J Patient Saf 2008. [DOI: 10.1097/pts.0b013e3181695671] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW Anaesthetists are members of the operating team. Although the surgeons usually consider themselves to be the leaders of the team, all members, including the anaesthetist, have their own legal, ethical and professional responsibilities. RECENT FINDINGS Good communication and sharing responsibility are characteristics of teamwork. Many factors can affect team functioning: training differences, social status, differences in responsibility, gender, age and culture, among others. An increasing number of individuals are involved in modern treatment due to limited working hours and increasing subspecialization, which complicates collaboration. Not all participants have the same perception of the team structure and its operation. Multidisciplinary, well designed training programmes are needed. SUMMARY Anaesthetists have to be more aware of their position in the care team and pay more attention to their legal, ethical and professional responsibilities.
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Adler PS, Kwon SW, Heckscher C. Perspective—Professional Work: The Emergence of Collaborative Community. ORGANIZATION SCIENCE 2008. [DOI: 10.1287/orsc.1070.0293] [Citation(s) in RCA: 317] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Organizations in the health care industry and beyond face pressures to lower their costs while maintaining quality, resulting in high levels of stress for their workers. In a nine-hospital study, this article explores the role that relationships play in enabling resilient responses to external pressures and the organizational practices that enable workers to respond in a resilient way when organizational change is required. The article argues that relational coordination—communicating and relating for the purpose of task integration—is a resilient response to external threats that require a coordinated collective response across multiple functions or roles. Findings suggest that workers engage in higher levels of relational coordination when they perceive this type of threat but that the presence of a particular type of high performance work system—a relational work system—greatly strengthens this resilient response.
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Polomano RC, Rathmell JP, Krenzischek DA, Dunwoody CJ. Emerging Trends and New Approaches to Acute Pain Management. Pain Manag Nurs 2008; 9:S33-41. [DOI: 10.1016/j.pmn.2007.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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356
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358
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Using 'soft solutions' to meet today's hard challenges in critical care. Aust Crit Care 2008; 18:4-5. [PMID: 18038527 DOI: 10.1016/s1036-7314(05)80018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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359
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Mills P, Neily J, Dunn E. Teamwork and Communication in Surgical Teams: Implications for Patient Safety. J Am Coll Surg 2008; 206:107-12. [DOI: 10.1016/j.jamcollsurg.2007.06.281] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 05/31/2007] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
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Cebul RD, Rebitzer JB, Taylor LJ, Votruba ME. Organizational fragmentation and care quality in the U.S healthcare system. THE JOURNAL OF ECONOMIC PERSPECTIVES : A JOURNAL OF THE AMERICAN ECONOMIC ASSOCIATION 2008; 22:93-113. [PMID: 19791306 DOI: 10.1257/jep.22.4.93] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Many goods and services can be readily provided through a series of unconnected transactions, but in health care, close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the U.S. healthcare system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations, and capabilities. These fragmented organizational structures lead to disrupted relationships, poor information flows, and misaligned incentives that combine to degrade care quality and increase costs. We illustrate our argument with examples taken from the insurance and hospital industries, and discuss possible responses to the problems resulting from organizational fragmentation.
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Affiliation(s)
- Randall D Cebul
- Center for Health Care Research & Policy, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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361
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Ramarajan L, Barsade SG, Burack OR. The influence of organizational respect on emotional exhaustion in the human services. JOURNAL OF POSITIVE PSYCHOLOGY 2008. [DOI: 10.1080/17439760701750980] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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362
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Whitehead C. The doctor dilemma in interprofessional education and care: how and why will physicians collaborate? MEDICAL EDUCATION 2007; 41:1010-6. [PMID: 17908118 DOI: 10.1111/j.1365-2923.2007.02893.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
CONTEXT Interprofessional educational (IPE) initiatives are seen as a means to engage health care professionals in collaborative patient-centred care. Given the hierarchical nature of many clinical settings, it is important to examine how the aims of formal IPE courses intersect with the socialisation of medical students into roles of responsibility and authority. OBJECTIVES This article aims to provide an overview of doctor barriers to collaboration and describe aspects of medical education and socialisation that may limit doctor engagement in the goals of interprofessional education. Additionally, the paper examines the nature of team function in the health care system, reviewing different conceptual models to propose a spectrum of collaborative possibilities. Finally, specific suggestions are offered to increase the impact of interprofessional education programmes in medical education. DISCUSSION An acknowledgement of power differentials between health care providers is necessary in the development of models for shared responsibility between professions. Conceptual models of teamwork and collaboration must articulate the desired nature of interaction between professionals with different degrees of responsibility and authority. Educational programmes in areas such as professionalism and ethics have shown limited success when formal and informal curricula significantly diverge. The socialisation of medical students into the role of a responsible doctor must be balanced with training to share responsibility appropriately. Doctor collaborative capacity may be enhanced by programmes designed to develop particular skills for which there is evidence of improved patient outcomes.
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Affiliation(s)
- Cynthia Whitehead
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.
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363
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Kautz CM, Gittell JH, Weinberg DB, Lusenhop RW, Wright J. Patient benefits from participating in an integrated delivery system: impact on coordination of care. Health Care Manage Rev 2007; 32:284-94. [PMID: 17666999 DOI: 10.1097/01.hmr.0000281629.30149.b1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the presumption in health services literature has been that integrated delivery systems (IDSs) should improve the coordination of care, the benefits have not yet been well established through empirical research. PURPOSES This study assesses whether receiving care from providers who belong to the same IDS improves patient-perceived coordination of care; concurrently, we develop a new approach for assessing the performance of IDS. METHODOLOGY/APPROACH A study was conducted of 222 patients who received primary unilateral total knee arthroplasty at a large IDS' acute care hospital. To isolate the effects of provider membership, we enrolled patients who received surgery from the same surgical department in the same acute care hospital in the IDS. We used baseline and 6-week postoperation patient surveys to assess the impact of the participation of the patients' providers in the IDS on patient-perceived coordination of care. FINDINGS We found no consistent effects of IDS membership on patient-perceived coordination of care. Patients with in-network rehabilitation care experienced fewer problems than patients with out-of-network rehabilitation care did, while patients with in-network home care experienced more problems than patients with out-of-network home care did. Membership of a patient's primary care physician had no observed effects. PRACTICE IMPLICATIONS Health care managers and administrators need to undertake a realistic examination of the care-coordinating mechanisms that exist in their IDS. This study has shown that the integration of financial, contractual, and administrative processes is not enough to improve care from the patient's perspective; to improve care, it is advised that an IDS take a patient-centered approach in its design and implementation. We discuss potential reasons for uneven integration of IDS, particularly with respect to the lack of coordinating mechanisms, and argue for the usefulness of the approach developed here for assessing IDS performance over time.
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Affiliation(s)
- Cori M Kautz
- Health Policy and Clinical Research Division, Abt Associates, Cambridge, MA, USA.
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364
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Mark BA, Hughes LC, Belyea M, Chang Y, Hofmann D, Jones CB, Bacon CT. Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries? JOURNAL OF SAFETY RESEARCH 2007; 38:431-46. [PMID: 17884430 PMCID: PMC2062533 DOI: 10.1016/j.jsr.2007.04.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 12/19/2006] [Accepted: 04/25/2007] [Indexed: 05/17/2023]
Abstract
PROBLEM Hospital nurses have one of the highest work-related injury rates in the United States. Yet, approaches to improving employee safety have generally focused on attempts to modify individual behavior through enforced compliance with safety rules and mandatory participation in safety training. We examined a theoretical model that investigated the impact on nurse injuries (back injuries and needlesticks) of critical structural variables (staffing adequacy, work engagement, and work conditions) and further tested whether safety climate moderated these effects. METHOD A longitudinal, non-experimental, organizational study, conducted in 281 medical-surgical units in 143 general acute care hospitals in the United States. RESULTS Work engagement and work conditions were positively related to safety climate, but not directly to nurse back injuries or needlesticks. Safety climate moderated the relationship between work engagement and needlesticks, while safety climate moderated the effect of work conditions on both needlesticks and back injuries, although in unexpected ways. DISCUSSION AND IMPACT ON INDUSTRY: Our findings suggest that positive work engagement and work conditions contribute to enhanced safety climate and can reduce nurse injuries.
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365
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Weinberg DB, Lusenhop RW, Gittell JH, Kautz CM. Coordination between formal providers and informal caregivers. Health Care Manage Rev 2007; 32:140-9. [PMID: 17438397 DOI: 10.1097/01.hmr.0000267790.24933.4c] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The increased "outsourcing" of care-related tasks to patients and their informal caregivers is part of a broader trend in service industries toward engaging customers as "coproducers" of service outcomes. As both quasi-patients and quasi-providers, caregivers may play a critical role in successful coproduction, but they require coordination with care providers to play this role effectively. When tasks are highly interdependent, uncertain, and time constrained, as they often are in health care, relational forms of coordination are expected to be most effective. PURPOSES This study explores the effects of coordination between formal providers and informal caregivers on caregiver preparation to provide care at home and the effect of caregiver preparation on patient outcomes. Gittell's theory of relational coordination posits that effective coordination occurs through frequent, high-quality communication that is supported by relationships of shared goals, shared knowledge, and mutual respect. We extend the relational coordination model, previously used to examine coordination between formal providers, to encompass coordination of care between formal providers and informal caregivers. METHODOLOGY We surveyed patients before and 12 weeks after knee replacement surgery to assess outcomes. At 6 weeks postsurgery, we surveyed their caregivers regarding coordination with providers and preparation to provide care. FINDINGS We found that relational coordination between formal providers and caregivers improves caregiver preparation to provide care, which, in turn, is positively associated with patients' freedom from pain, functional status, and mental health. IMPLICATIONS Providers should be encouraged to attend to the interpersonal aspects of their interactions with caregivers to promote relational coordination, which may ultimately benefit the patient's health. It is not enough, however, to urge providers to build shared goals, shared knowledge, and mutual respect with patients and caregivers. Dedicated resources and support are needed, given the context of constrained resources and brief encounters in which providers deliver care.
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366
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Dayton E, Henriksen K. Communication failure: basic components, contributing factors, and the call for structure. Jt Comm J Qual Patient Saf 2007; 33:34-47. [PMID: 17283940 DOI: 10.1016/s1553-7250(07)33005-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication is a taken-for-granted human activity that is recognized as important once it has failed. Communication failures are a major contributor to adverse events in health care. BASIC COMMUNICATION COMPONENTS AND PROCESSES The components and processes of communication converge in an intricate manner, creating opportunities for misunderstanding along the way. When a patient's safety is at risk, providers should speak up (that is, initiate a message) to draw attention to the situation before harm is caused. They should also clearly explain (encode) and understand (decode) each other's diagnosis and recommendations to ensure well coordinated delivery of care. INDIVIDUAL, GROUP, AND ORGANIZATIONAL FACTORS Beyond basic dyadic communication exchanges, an intricate web of individual, group, and organizational factors--more specifically, cognitive workload, implicit assumptions, authority gradients, diffusion of responsibility, and transitions of care--complicate communication. THE CALL FOR STRUCTURE More structured and explicitly designed forms of communication have been recommended to reduce ambiguity, enhance clarity, and send an unequivocal signal, when needed, that a different action is required. Read-backs, Situation-Background-Assessment-Recommendation, critical assertions, briefings, and debriefings are seeing increasing use in health care. CODA: Although structured forms of communication have good potential to enhance clarity, they are not fail-safe. Providers need to be sensitive to unexpected consequences regarding their use.
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Affiliation(s)
- Elizabeth Dayton
- Department of Sociology, Johns Hopkins University, Baltimore, USA.
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367
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368
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Williams A, Dunning T, Manias E. Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement. J Adv Nurs 2007; 57:244-56. [PMID: 17233645 DOI: 10.1111/j.1365-2648.2006.04093.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement. BACKGROUND Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis. METHOD A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005. FINDINGS Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study. CONCLUSION Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.
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Affiliation(s)
- Allison Williams
- School of Nursing, The University of Melbourne, Carlton, Victoria, Australia.
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369
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Weinberg DB, Gittell JH, Lusenhop RW, Kautz CM, Wright J. Beyond our walls: impact of patient and provider coordination across the continuum on outcomes for surgical patients. Health Serv Res 2007; 42:7-24. [PMID: 17355579 PMCID: PMC1955241 DOI: 10.1111/j.1475-6773.2006.00653.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate patients' experience with coordination of their postsurgical care across multiple settings and the effects on key outcomes. DATA SOURCES Primary data collected over 18 months from 222 unilateral knee-replacement patients at Brigham and Women's Hospital in Boston, MA. STUDY DESIGN Patients were surveyed about the coordination of their postdischarge care during the 6-week period postdischarge when they received care from rehabilitation facilities and/or home care agencies and follow-up care from the surgeon. DATA COLLECTION Patients were surveyed before surgery and at 6 and 12 weeks postsurgery. PRINCIPAL FINDINGS Patient reports highlight problems with coordination across settings and between providers and themselves. These problems, measured at 6 weeks, were associated with greater joint pain, lower functioning, and lower patient satisfaction at 6 weeks after surgery. At 12 weeks after surgery, coordination problems were associated with greater joint pain, but were not associated with functional status. CONCLUSION Coordination across settings affects patients' clinical outcomes and satisfaction with their care. Although accountable for transfer to the next care setting, providers are neither accountable for nor supported to coordinate across the continuum. Addressing this system problem requires both introducing coordinating mechanisms and also supporting their use through changes in providers' incentives, resources, and time.
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Affiliation(s)
- Dana Beth Weinberg
- Department of Sociology, Queens College-CUNY, 65-30 Kissena Blvd., Flushing, NY 11367, USA
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370
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Pfefferle SG, Gittell JH, Hodgkin D, Ritter G. Pediatrician Coordination of Care for Children with Mental Illnesses. Med Care 2006; 44:1085-91. [PMID: 17122712 DOI: 10.1097/01.mlr.0000237177.11301.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with mental illnesses are seen across various service sectors, including pediatric primary care. As such, care coordination, which has been shown to improve outcomes, is especially important. Little is known about organizational and state level factors that might affect pediatricians' efforts to coordinate care for children with mental illnesses. OBJECTIVES This study used data from a survey of primary care pediatricians to examine organizational and state level variables associated with increased care coordination for children with mental illnesses. METHODS We undertook a cross-sectional study using data from a survey of pediatricians. A total of 1337 pediatricians in 6 states were surveyed about their care coordination and about organizational characteristics. State level data were gathered from various sources. A 5-item scale was developed for the dependent variable of past month coordination contacts (Cronbach's alpha = 0.82). RESULTS No state level variables were associated with pediatrician coordination behaviors. Having a regular case conferencing mechanism, staff assigned to coordinate care, and a mental health specialist in the practice were associated with increased past month coordination contacts. Pediatricians in rural practices coordinated care more frequently than those in other locations. Pediatricians who screened more and those with more experience had higher rates of care coordination. CONCLUSIONS Having a regular case conferencing mechanism, staff assigned to coordinate care, and a mental health specialist in the practice were associated with increased mental health care coordination. This information should be useful in planning ways to increase care coordination for children with mental illnesses seen in pediatric primary care.
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Affiliation(s)
- Susan G Pfefferle
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA.
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371
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Abstract
The objective of this study is to test the transtheoretical integration model, which proposes relationships among team-based phenomena and patient safety and resource-use outcome variables. The sample consisted of 411 nursing staff (n = 372) and multidisciplinary team members (n = 39) from 16 medical surgical units. Staff were surveyed to evaluate their perceptions of hospital culture, work group design, and positive and negative team processes. Managers provided data concerning outcome variables of patient falls with injury, average length of stay (LOS), and labor and supply expenses for their patient care units. A group-type hospital culture predicted fewer patient falls with injury; a developmental-type hospital culture predicted higher patient care unit costs. Team design and processes were predictive of longer LOS for patients on medical-surgical units. Conclusions of the study were that hospital contexts external to the patient care unit may be important contributors to patient safety and resource use on nursing units.
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372
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Pearson A, Porritt KA, Doran D, Vincent L, Craig D, Tucker D, Long L, Henstridge V. A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment. INT J EVID-BASED HEA 2006; 4:118-59. [DOI: 10.1111/j.1479-6988.2006.00039.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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373
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A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment. INT J EVID-BASED HEA 2006. [DOI: 10.1097/01258363-200606000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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374
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Matlow AG, Wright JG, Zimmerman B, Thomson K, Valente M. How can the principles of complexity science be applied to improve the coordination of care for complex pediatric patients? Qual Saf Health Care 2006; 15:85-8. [PMID: 16585105 PMCID: PMC2464825 DOI: 10.1136/qshc.2005.014605] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Clinical and technological advances in medicine have resulted in more patients requiring multidisciplinary care and coordination of services. This is particularly challenging in pediatrics, given the dependency of children. Coordination of care is a key ingredient of quality care; when suboptimal, clinical outcomes and satisfaction can suffer. In this article we view coordination of care through the lens of complexity science in an effort to find new solutions to this healthcare challenge.
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Affiliation(s)
- A G Matlow
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.
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375
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Horvitz-Lennon M, Kilbourne AM, Pincus HA. From Silos To Bridges: Meeting The General Health Care Needs Of Adults With Severe Mental Illnesses. Health Aff (Millwood) 2006; 25:659-69. [PMID: 16684729 DOI: 10.1377/hlthaff.25.3.659] [Citation(s) in RCA: 187] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite their higher burden of chronic general medical disorders, adults with severe mental illnesses have poorer access to and quality of general health care compared to people without mental illnesses. Because a key contributor to this situation is the separation between the mental health care sector (patients' health care home) and the general health care sector, bridges to connect these systems are needed. We discuss obstacles to clinical integration and propose strategies to address them.
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Affiliation(s)
- Marcela Horvitz-Lennon
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, USA
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376
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Nadolski GJ, Bell MA, Brewer BB, Frankel RM, Cushing HE, Brokaw JJ. Evaluating the quality of interaction between medical students and nurses in a large teaching hospital. BMC MEDICAL EDUCATION 2006; 6:23. [PMID: 16638142 PMCID: PMC1459856 DOI: 10.1186/1472-6920-6-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 04/25/2006] [Indexed: 05/04/2023]
Abstract
BACKGROUND Effective health care depends on multidisciplinary collaboration and teamwork, yet little is known about how well medical students and nurses interact in the hospital environment, where physicians-in-training acquire their first experiences as members of the health care team. The objective of this study was to evaluate the quality of interaction between third-year medical students and nurses during clinical rotations. METHODS We surveyed 268 Indiana University medical students and 175 nurses who worked at Indiana University Hospital, the School's chief clinical training site. The students had just completed their third year of training. The survey instrument consisted of 7 items that measured "relational coordination" among members of the health care team, and 9 items that measured psychological distress. RESULTS Sixty-eight medical students (25.4%) and 99 nurses (56.6%) completed the survey. The relational coordination score (ranked 1 to 5, low to high), which provides an overall measure of interaction quality, showed that medical students interacted with residents the best (4.16) and with nurses the worst (2.98; p < 0.01). Conversely, nurses interacted with other nurses the best (4.36) and with medical students the worst (2.68; p < 0.01). Regarding measures of psychological distress (ranked 0 to 4, low to high), the interpersonal sensitivity score of medical students (1.56) was significantly greater than that of nurses (1.03; p < 0.01), whereas the hostility score of nurses (0.59) was significantly greater than that of medical students (0.39; p < 0.01). CONCLUSION The quality of interaction between medical students and nurses during third-year clinical rotations is poor, which suggests that medical students are not receiving the sorts of educational experiences that promote optimal physician-nurse collaboration. Medical students and nurses experience different levels of psychological distress, which may adversely impact the quality of their interaction.
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Affiliation(s)
- Gregory J Nadolski
- Office of Medical Student Affairs, Indiana University School of Medicine, 635 Barnhill Drive, MS-164, Indianapolis, Indiana 46202-5120, USA
| | - Mary A Bell
- Office of Medical Student Affairs, Indiana University School of Medicine, 635 Barnhill Drive, MS-164, Indianapolis, Indiana 46202-5120, USA
| | - Barbara B Brewer
- Office of Professional Practice, John C Lincoln North Mountain Hospital, 250 East Dunlap Avenue, Phoenix, Arizona 85020, USA
| | - Richard M Frankel
- The Regenstrief Institute, Indiana University School of Medicine, 1050 Wishard Boulevard, RG-6, Indianapolis, Indiana 46202-2872, USA
| | - Herbert E Cushing
- Office of Medical Student Affairs, Indiana University School of Medicine, 635 Barnhill Drive, MS-164, Indianapolis, Indiana 46202-5120, USA
| | - James J Brokaw
- Office of Medical Student Affairs, Indiana University School of Medicine, 635 Barnhill Drive, MS-164, Indianapolis, Indiana 46202-5120, USA
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377
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Lingard L, Espin S, Rubin B, Whyte S, Colmenares M, Baker GR, Doran D, Grober E, Orser B, Bohnen J, Reznick R. Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR. Qual Saf Health Care 2006; 14:340-6. [PMID: 16195567 PMCID: PMC1744073 DOI: 10.1136/qshc.2004.012377] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pilot studies of complex interventions such as a team checklist are an essential precursor to evaluating how these interventions affect quality and safety of care. We conducted a pilot implementation of a preoperative team communication checklist. The objectives of the study were to assess the feasibility of the checklist (that is, team members' willingness and ability to incorporate it into their work processes); to describe how the checklist tool was used by operating room (OR) teams; and to describe perceived functions of the checklist discussions. METHODS A checklist prototype was developed and OR team members were asked to implement it before 18 surgical procedures. A research assistant was present to prompt the participants, if necessary, to initiate each checklist discussion. Trained observers recorded ethnographic field notes and 11 brief feedback interviews were conducted. Observation and interview data were analyzed for trends. RESULTS The checklist was implemented by the OR team in all 18 study cases. The rate of team participation was 100% (33 vascular surgery team members). The checklist discussions lasted 1-6 minutes (mean 3.5) and most commonly took place in the OR before the patient's arrival. Perceived functions of the checklist discussions included provision of detailed case related information, confirmation of details, articulation of concerns or ambiguities, team building, education, and decision making. Participants consistently valued the checklist discussions. The most significant barrier to undertaking the team checklist was variability in team members' preoperative workflow patterns, which sometimes presented a challenge to bringing the entire team together. CONCLUSIONS The preoperative team checklist shows promise as a feasible and efficient tool that promotes information exchange and team cohesion. Further research is needed to determine the sustainability and generalizability of the checklist intervention, to fully integrate the checklist routine into workflow patterns, and to measure its impact on patient safety.
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Affiliation(s)
- L Lingard
- University of Toronto, Wilson Centre for Research in Education, Toronto, Ontario, Canada M5G 2C4.
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Gurses AP, Xiao Y. A systematic review of the literature on multidisciplinary rounds to design information technology. J Am Med Inform Assoc 2006; 13:267-76. [PMID: 16501176 PMCID: PMC1513658 DOI: 10.1197/jamia.m1992] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Multidisciplinary rounds (MDR) have become important mechanisms for communication and coordination of care. To guide design of tools supporting MDR, we reviewed the literature published from 1990 to 2005 about MDR on information tools used, information needs, impact of information tools, and evaluation measures. Fifty-one papers met inclusion criteria and were included. In addition to patient-centric information tools (e.g., medical chart) and decision-support tools (e.g., clinical pathway), process-oriented tools (e.g., rounding list) were reported to help with information organization and communication. Information tools were shown to improve situation awareness of multidisciplinary care providers, efficiency of MDR, and length of stay. Communication through MDR may be improved by process-oriented information tools that help information organization, communication, and work management, which could be achieved through automatic extraction from clinical information systems, displays and printouts in condensed forms, at-a-glance representations of the care unit, and storing work-process information temporarily.
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Affiliation(s)
- Ayse P Gurses
- Department of Anesthesiology and Program in Trauma, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF 5-34, Baltimore, MD 21201, USA.
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379
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Pearson A, Porritt KA, Doran D, Vincent L, Craig D, Tucker D, Long L, Henstridge V. A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment. JBI LIBRARY OF SYSTEMATIC REVIEWS 2006; 4:1-69. [PMID: 27819880 DOI: 10.11124/01938924-200604020-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The overall aim of this comprehensive systematic review was to identify the best available evidence on the effect of team characteristics, processes, structure and composition within the context of collaborative practice among nursing teams that create a healthy work environment. SEARCH STRATEGY The search strategy sought to find both published and unpublished studies and papers written in the English language. An initial limited search of Medline and CINAHL databases was undertaken to identify optimal search terms. A second extensive search using all identified keywords and index terms was then undertaken. METHODOLOGICAL QUALITY Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package. RESULTS The papers included in the review included nine experimental or quasi-experimental studies, 11 descriptive studies and four qualitative studies. A variety of different team structures such as interdisciplinary teams, primary nursing, team nursing, multidisciplinary models of care delivery and the use of a Partner in Patient Care model were investigated. Team characteristics should include accountability, commitment, enthusiasm and motivation. Social support within a team from a supervisor or colleague increased satisfaction levels of staff. CONCLUSION The results of the review lead to the development of a number of recommendations for practice that could assist with creating a health work environment.
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Affiliation(s)
- Alan Pearson
- 1The Joanna Briggs Institute, Royal Adelaide Hospital, 2School of Population Health and Clinical Practice, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia; 3Faculty of Nursing, University of Toronto, 4RNAO, Toronto, Ontario, Canada; and 5Nursing and Patient Care Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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380
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Safran DG, Miller W, Beckman H. Organizational dimensions of relationship-centered care. Theory, evidence, and practice. J Gen Intern Med 2006; 21 Suppl 1:S9-15. [PMID: 16405711 PMCID: PMC1484831 DOI: 10.1111/j.1525-1497.2006.00303.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Four domains of relationship have been highlighted as the cornerstones of relationship-centered health care. Of these, clinician-patient relationships have been most thoroughly studied, with a rich empirical literature illuminating significant linkages between clinician-patient relationship quality and a wide range of outcomes. This paper explores the realm of clinician-colleague relationships, which we define to include the full array of relationships among clinicians, staff, and administrators in health care organizations. Building on a stream of relevant theories and empirical literature that have emerged over the past decade, we synthesize available evidence on the role of organizational culture and relationships in shaping outcomes, and posit a model of relationship-centered organizations. We conclude that turning attention to relationship-centered theory and practice in health care holds promise for advancing care to a new level, with breakthroughs in quality of care, quality of life for those who provide it, and organizational performance.
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Affiliation(s)
- Dana Gelb Safran
- The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA 02111, USA.
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381
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Wiecha J, Pollard T. The interdisciplinary eHealth team: chronic care for the future. J Med Internet Res 2004; 6:e22. [PMID: 15471748 PMCID: PMC1550606 DOI: 10.2196/jmir.6.3.e22] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Accepted: 01/10/2004] [Indexed: 11/13/2022] Open
Abstract
An interdisciplinary clinical team is a consistent grouping of people from relevant clinical disciplines, ideally inclusive of the patient, whose interactions are guided by specific team functions and processes to achieve team-defined favorable patient outcomes. Teamwork supported by properly designed eHealth applications could help create more effective systems of care for chronic disease. Given its synchronous and asynchronous communication capacity and information-gathering and -sharing capabilities, the Internet is a logical platform for supporting interdisciplinary clinical teamwork. Research is needed to better understand how interdisciplinary eHealth team members can work together in everyday practice and to guide the development of effective and efficient eHealth software applications to support greater clinical teamwork.
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Affiliation(s)
- John Wiecha
- Distance Education for Health, Department of Family Medicine, Dowling 5 South, 1 Boston Medical Center Place, Boston University Medical Campus, Boston, MA 02118, USA.
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382
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Swarztrauber K, Vickrey BG. Do neurologists and primary care physicians agree on the extent of specialty involvement of patients referred to neurologists? J Gen Intern Med 2004; 19:654-61. [PMID: 15209604 PMCID: PMC1492387 DOI: 10.1111/j.1525-1497.2004.30535.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Understanding the roles and responsibilities of physicians who manage mutual patients is important for assuring good patient care. Among physicians expressing a preference to involve a neurologist in the care of a patient, we evaluated agreement between neurologists and primary care physicians for the extent of specialty involvement in the evaluation and management of the patient, and the factors influencing those preferences. DESIGN AND SETTING A self-administered survey containing 3 clinical scenarios was developed with the assistance of a multispecialty advisory board and mailed to a stratified probability sample of physicians. PARTICIPANTS Six hundred and eight family physicians, 624 general internists, and 492 neurologists in 9 U.S. states. INTERVENTIONS For each scenario, those respondents who preferred involvement of a specialist were asked about the preferred extent of that involvement: one-time consultation with and without test/medication ordering, consultation and limited follow-up, or taking over ongoing care of the specialty problem as long as it persists. MAIN RESULTS Survey response rate was 60%. For all 3 scenarios, neurologists preferred a greater extent of specialty involvement compared to primary care physicians (all P <.05). Other physician and practice characteristic factors, including financial incentives, had lesser or no influence on the extent of specialty involvement preferred. CONCLUSIONS The disagreement between primary care physicians and specialists regarding the preferred extent of specialist involvement in the care of patients with neurological conditions should raise serious concerns among health care providers, policy makers, and educators about whether mutual patient care is coordinated and appropriate.
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Affiliation(s)
- Kari Swarztrauber
- Department of Neurology, Portland VA Medical Center and Oregon Health Sciences University, Portland, Oregon 97207, USA.
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383
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Horak BJ, Pauig J, Keidan B, Kerns J. Patient Safety: A Case Study in Team Building and Interdisciplinary Collaboration. J Healthc Qual 2004; 26:6-12; quiz 12-3. [PMID: 15060954 DOI: 10.1111/j.1945-1474.2004.tb00478.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This case report presents specific steps taken to address potential patient safety problems, particularly those regarding collaboration between nurses and house staff at The George Washington University Hospital. Issues affecting patient care (e.g., lack of communication and teamwork) were identified through interviews, focus groups, and observations. The actions taken were team-building meetings that included a sensitivity session; coaching with nursing managers; and ground rules for nurse and physician collaboration. This report also describes the agenda for the team-building meetings, results, and lessons learned for implementation at other sites.
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Affiliation(s)
- Bernard J Horak
- Health Systems Administration Programs, Georgetown University, School of Nursing and Health Studies, Washington, DC, USA.
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384
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Vahey DC, Swan BA, Lang NM, Mitchell PH. Measuring and improving health care quality: nursing's contribution to the state of science. Nurs Outlook 2004; 52:6-10. [PMID: 15014374 DOI: 10.1016/j.outlook.2003.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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385
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Abstract
BACKGROUND In 1998, the Committee on Health Care Quality in America was created and given the charge of devising a strategy to achieve substantial improvement in the quality of health care for all Americans. One strategy to move the quality agenda forward is the use of evidence by both providers of health care and consumers of health care. One feature of this agenda, evidence-based practice, refers to a hierarchy of evidence ranging from individual randomized, controlled trials to expert opinion. OBJECTIVES The purposes of this article are to describe the evidence base in nursing, discuss the quality and strength of nursing's evidence, illustrate the application of the Quality Health Outcomes Model, and present recommendations for practice, research, and policy to increase nursing's contribution to quality health care. RESULTS AND RECOMMENDATIONS Nurses everywhere must use innovative solutions to operationalize the "evidence" in evidence-based nursing. The Quality Health Outcomes Model (QHOM) provides a useful way of advancing research and evidence about the quality of health care in America. In concert with the conceptual framework for the National Health Care Quality Report, the QHOM provides a map for identifying evidence gaps and research questions arising from the model and conceptual framework, as well as evidence synthesis (integrating methodologic quality) driven by theoretical understanding.
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Affiliation(s)
- Beth Ann Swan
- Office of International Programs & PAHO/WHO Collaborating Center for Nursing and Midwifery Leadership, and the Family and Community Health Division, University of Pennsylvania School of Nursing, Philadelphia, USA.
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386
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Edwards N. Doctors and managers: poor relationships may be damaging patients-what can be done? Qual Saf Health Care 2004; 12 Suppl 1:i21-4. [PMID: 14645744 PMCID: PMC1765767 DOI: 10.1136/qhc.12.suppl_1.i21] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The problem of poor relationships between doctors and managers is a common feature of many healthcare systems. This problem needs to be explicitly addressed and there are a number of positive steps that could be taken. Firstly, there would be value in working to improve the quality of relationships and better mutual understanding of the necessarily different positions of doctors and managers. Finding a common approach to managing resources, accountability, autonomy, and the creation of more systematic ways of working seems to be important. The use of costed clinical pathways may be one approach. Rather than seeing guidelines and accountability systems as a threat to autonomy there is an argument that they are an essential adjunct to it. Redefining autonomy in order to preserve it and to ensure that it encompasses accountability and responsibility will be an important step. A key step is the development of clinical leadership.
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Affiliation(s)
- N Edwards
- NHS Confederation, 1 Warwick Row, London, SW1E 5ER, UK.
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387
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Abstract
Little research has been conducted examining the linkages between nurse staffing and care delivery models in relation to patient care quality. Nurses in this study perceive that an all-RN staffing model is associated with better quality outcomes for patients, and that staffing models that include professional and unregulated staff may pose a challenge for unit-based communication and the coordination of care. Patient care delivery models were also important predictors of the quality outcomes studied.
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388
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Wrobel JS, Charns MP, Diehr P, Robbins JM, Reiber GE, Bonacker KM, Haas LB, Pogach L. The relationship between provider coordination and diabetes-related foot outcomes. Diabetes Care 2003; 26:3042-7. [PMID: 14578237 DOI: 10.2337/diacare.26.11.3042] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between provider coordination and amputations in patients with diabetes. RESEARCH DESIGN AND METHODS The study design was a cross-sectional, descriptive study of process and outcomes for diabetes-related foot care at 10 Department of Veterans Affairs (VA) medical centers representing different geographic regions, population densities, patient populations, and amputation rates. The subjects included all providers of diabetes foot care and a random sample of primary care providers at each medical center. The main outcome measures were the Foot Systems Assessment Tool (FootSAT), nontraumatic lower extremity amputation rates, and investigators' ordinal ranking of site effectiveness based on site visits. RESULTS The survey response rate was 48%. Scale reliability, as measured by Cronbach's alpha, ranged from 0.73 to 0.93. The scale scores for programming coordination (i.e., electronic medical record, policies, reminders, protocols, and educational seminars) and feedback coordination (i.e., discharge planning, quality of care meetings, and curbside consultations) were negatively associated with amputation rates, suggesting centers with higher levels of coordination had lower amputation rates. Statistically significant associations were found for programming coordination with minor amputations (P = 0.02) and total amputations (P = 0.04). CONCLUSIONS The FootSAT demonstrated a stronger association with amputation rates than site visit rankings. Among these 10 VA facilities, those with higher levels of programming and feedback coordination had significantly lower amputation rates.
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Affiliation(s)
- James S Wrobel
- VA Medical and Regional Office Center, Department of Veterans Affairs, White River Junction, Vermont 05009, USA.
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389
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Abstract
Physicians and patients find it hard to communicate when treatment fails to cure or control cancer. Communication barriers include fear of "giving up," losing the medical team, and discussing death. The quality of physician-patient communication affects important outcomes including patient distress, coping, and quality of life, and physician burnout. Communication skills that can be taught, learned, and maintained for physicians at all levels of training, and effective educational programs have been described. Research on communication skills training should focus on the best method of delivery, the "dose-response" effect, and how to measure success of training in complex health care environments.
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Affiliation(s)
- Geoffrey H Gordon
- Division of General Medicine and Geriatrics, Oregon Health and Science University, L475, Portland, OR 97201, USA.
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390
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Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc 2003; 51:549-55. [PMID: 12657078 DOI: 10.1046/j.1532-5415.2003.51185.x] [Citation(s) in RCA: 750] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care fragmentation. Despite how common these transitions have become, the challenges of improving care transitions have received little attention from policy makers, clinicians, and quality improvement entities. This article begins with a definition of transitional care and then discusses the nature of the problem, its prevalence, manifestations of poorly executed transitions, and potentially remediable barriers. Necessary elements for effective transitions are then presented, followed by promising new directions for quality improvement at the level of the delivery system, information technology, and national health policy. The article concludes with a proposed research agenda designed to advance the science of high-quality transitional care.
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Affiliation(s)
- Eric A Coleman
- Division of Geriatric Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80206, USA.
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391
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Katz JN, Phillips CB, Baron JA, Fossel AH, Mahomed NN, Barrett J, Lingard EA, Harris WH, Poss R, Lew RA, Guadagnoli E, Wright EA, Losina E. Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. ARTHRITIS AND RHEUMATISM 2003; 48:560-8. [PMID: 12571867 DOI: 10.1002/art.10754] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate whether hospital volume and surgeon volume of total hip replacements (THRs) are associated with patient-reported functional status and satisfaction with surgery 3 years postoperatively. METHODS We performed a population-based cohort study of a stratified random sample of Medicare beneficiaries who underwent elective primary or revision THR in Ohio, Pennsylvania, or Colorado in 1995. The primary outcomes were the self-reported Harris hip score and a validated scale measuring satisfaction with the results of surgery. Both outcomes were assessed 3 years postoperatively. Hospital volume was defined as the aggregate number of elective primary and revision THRs performed on Medicare beneficiaries in the hospital in 1995. High-volume hospitals were defined as those in which >100 such procedures are performed annually, and low-volume centers were defined as those in which </=12 procedures (primary THR cohort) or </=30 procedures (revision cohort) are performed annually. RESULTS In unadjusted analyses, patients who underwent surgery in low-volume centers had worse functional status 3 years following primary and revision THR compared with patients whose surgery was performed in higher-volume centers. Patients whose revision THR was performed by a low-volume surgeon also had worse function. After adjustment for sociodemographic and clinical variables, however, the association between higher hospital volume and better functional status following primary THR was weak and statistically nonsignificant, and no statistically significant or clinically important associations between hospital or surgeon volume and functional status following revision THR was observed. Patients who underwent elective primary THR in low-volume centers were more likely to be dissatisfied with the results of surgery compared with patients whose surgeries were performed in high-volume centers. Similarly, patients whose surgeons performed </=12 procedures per year were more likely to be dissatisfied with the results of revision THR than were patients whose surgeons performed >12 procedures per year. CONCLUSION Hospital volume and surgeon volume have little effect on 3-year functional outcome following THR, after adjusting for patient sociodemographic and select clinical characteristics. However, satisfaction with primary THR is greater among patients who underwent surgery in high-volume centers, and satisfaction with revisions is greater among patients whose operations were performed by higher-volume surgeons. Referring clinicians should incorporate these findings into their discussion of referral choices with patients considering THR. Conclusions regarding the effect of volume on longevity of the implants must await longer-term followup studies. Finally, further research is warranted to better understand the association between hospital and surgeon procedure volume and patient satisfaction with surgery.
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Affiliation(s)
- Jeffrey N Katz
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, B-3, Boston, MA 02115, USA.
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392
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Ruiz Arranz J, González de la Flor P, Godino Izquierdo M, Sanz López A. Análisis de las estancias generadas por la artroplastia de rodilla. Rev Esp Cir Ortop Traumatol (Engl Ed) 2003. [DOI: 10.1016/s1888-4415(03)76082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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393
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394
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Gittell JH. Supervisory Span, Relational Coordination and Flight Departure Performance: A Reassessment of Postbureaucracy Theory. ORGANIZATION SCIENCE 2001. [DOI: 10.1287/orsc.12.4.468.10636] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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395
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Gittell JH. Organizing work to support relational co-ordination. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2000. [DOI: 10.1080/095851900339747] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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