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Kilpatrick K, Tchouaket E, Fernandez N, Jabbour M, Dubois CA, Paquette L, Landry V, Gauthier N, Beaulieu MD. Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes. BMC FAMILY PRACTICE 2021; 22:76. [PMID: 33866963 PMCID: PMC8054435 DOI: 10.1186/s12875-021-01406-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs. METHODS A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes. RESULTS Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes. CONCLUSIONS This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada.
| | - Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
| | - Nicolas Fernandez
- Centre for Pedagogy Applied to the Health Sciences, Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Carl-Ardy Dubois
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Lysane Paquette
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Véronique Landry
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Gauthier
- Nursing and Physical Health Directorate, Centre intégré universitaire de santé et de services sociaux de La Capitale-Nationale, Québec, Québec, Canada
| | - Marie-Dominique Beaulieu
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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Kushner DS, Strasser DC. Stroke Inpatient Rehabilitation Team Conferences: Leadership and Structure Improve Patient Outcomes. J Stroke Cerebrovasc Dis 2020; 29:104622. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/27/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022] Open
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Kilpatrick K, Tchouaket É, Jabbour M, Hains S. A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities. BMC Nurs 2020; 19:6. [PMID: 32015689 PMCID: PMC6990528 DOI: 10.1186/s12912-019-0395-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/26/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To better meet long-term care (LTC) residents' (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Québec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Québec. This paper reports on resident outcomes and field notes. METHODS Research Design: This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Québec. Participants: Data were collected from September 2015-August 2016. The cohort consisted of all residents (n = 538) followed by the nurse practitioners. Nurse practitioner interventions (n = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Analysis: Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data. RESULTS Nurse practitioners (n = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, n = 331). The number of interventions/resident (range: 2.2-16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified. CONCLUSIONS The implementation of NPs in LTC in Québec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Québec.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL-HMR), Montréal, Canada
| | - Éric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Canada
| | | | - Sylvie Hains
- Retired, Ministère de la Santé et des services sociaux du Québec, Québec, Canada
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Perreira TA, Perrier L, Prokopy M, Neves-Mera L, Persaud DD. Physician engagement: a concept analysis. J Healthc Leadersh 2019; 11:101-113. [PMID: 31440112 PMCID: PMC6666374 DOI: 10.2147/jhl.s214765] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
The term "physician engagement" is used quite frequently, yet it remains poorly defined and measured. The aim of this study is to clarify the term "physician engagement." This study used an eight step-method for conducting concept analyses created by Walker and Avant. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched on February 14, 2019. No limitations were put on the searches with regard to year or language. Results identify that the term "physician engagement" is regular participation of physicians in (1) deciding how their work is done, (2) making suggestions for improvement, (3) goal setting, (4) planning, and (5) monitoring of their performance in activities targeted at the micro (patient), meso (organization), and/or macro (health system) levels. The antecedents of "physician engagement" include accountability, communication, incentives, interpersonal relations, and opportunity. The results include improved outcomes such as data quality, efficiency, innovation, job satisfaction, patient satisfaction, and performance. Defining physician engagement enables physicians and health care administrators to better appreciate and more accurately measure engagement and understand how to better engage physicians.
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Affiliation(s)
- Tyrone A Perreira
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Prokopy
- Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - Lina Neves-Mera
- Legal, Policy and Professional Issues, Ontario Hospital Association, Toronto, Ontario, Canada
| | - D David Persaud
- School of Health Administration at Dalhousie University, Dalhousie University, Halifax, Nova Scotia, Canada
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Kilpatrick K, Tchouaket É, Paquette L, Guillemette C, Jabbour M, Desmeules F, Landry V, Fernandez N. Measuring patient and family perceptions of team processes and outcomes in healthcare teams: questionnaire development and psychometric evaluation. BMC Health Serv Res 2019; 19:9. [PMID: 30612571 PMCID: PMC6322340 DOI: 10.1186/s12913-018-3808-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/11/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a lack of validated instruments examining dimensions of team functioning from the perspective of patients and families consistent with a conceptual framework. The study aimed to develop and assess the psychometric properties of the Patient-Perceptions of Team Effectiveness (PTE) questionnaire. METHODS A cross-sectional survey was undertaken in three studies. Data were collected from May-October 2016 for Study 1, April 2018-ongoing for Study 2, and October 2016 to June 2017 for Study 3. Online and paper versions of the self-administered questionnaire were available in English and in French. The initial questionnaire included 41 items. Study 1 included 320 respondents. Reliability was assessed using Cronbach alpha. Face validity (n = 250) was assessed using a structured questionnaire. Content validity was examined using subject matter experts and Spearman's item-total correlations. Construct validity was examined using known group comparisons (i.e., clinical specialty, education, length of follow-up, reason of consultation). Content analysis was used for open-ended questions. RESULTS The questionnaire took 10 to 15 min to complete. Positive assessments were noted for instructions, formatting, font size and logical ordering of questions. In Study 1, reliability indices for the PTE-Overall, Team Processes and Outcomes subscales ranged from 0.72 to 0.84. Item-total correlations ranged from 0.551 to 0.794 (p < 0.001). Differences were noted between clinical specialties, education, length of follow-up, reason of consultation, low and high functioning teams. No differences were noted between English and French language respondents. Psychometric properties were re-assessed in Study 2 and 3 after unclear questions were reworked. Reliability indices for the subscales ranged from 0.76 to 0.94 and differences remained significant between low and high functioning teams. CONCLUSION The final 43-item instrument is easy to administer to patients and families. The studies provide evidence of validity to support the propositions in the conceptual framework. The patient-level measures can be aggregated to the team, organizational or system level. The information can be used to assess healthcare team functioning in acute and primary care and determine the role patients and families are playing in teams. Further testing is needed with patients and families who are hospitalized or receiving care from teams in rural areas.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, Canada
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | | | - Lysane Paquette
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Claudel Guillemette
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | - Mira Jabbour
- Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal-Hôpital Maisonneuve-Rosemont (CIUSSS-EMTL), Montréal, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Deutsch A, Heinemann AW, Cook KF, Foster L, Miskovic A, Goldsmith A, Cella D. Inpatient Rehabilitation Quality of Care From the Patient's Perspective: Effect of Data Collection Timing and Patient Characteristics. Arch Phys Med Rehabil 2018; 100:1032-1041. [PMID: 30476488 DOI: 10.1016/j.apmr.2018.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare, by collection time and patient characteristics, inpatient rehabilitation quality measure scores calculated using patient-reported data. DESIGN Cohort study of rehabilitation inpatients with neurologic conditions who reported their experience of care and pain status at discharge and 1month after discharge. SETTING Two inpatient rehabilitation facilities (IRFs). PARTICIPANTS Patients with neurologic conditions (N=391). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We calculated 18 quality measure scores using participants' responses to 55 experience of care and health status questions addressing communication, support and encouragement, care coordination, discharge information, goals, new medications, responsiveness of staff, cleanliness, quietness, pain management, care transitions, overall hospital rating, willingness to recommend, and pain. RESULTS Of the 391 participants reporting at discharge, 277 (71%) also reported postdischarge after multiple attempts by e-mail, mail, and telephone. Discharge experience of care quality scores ranged from 25% (responsiveness of hospital staff) to 75% (willingness to recommend hospital); corresponding postdischarge scores were 32% to 87%, respectively. Five of the 16 experience of care quality scores increased significantly between discharge and postdischarge. The percentage of participants reporting high pain levels at discharge did not change across time periods. Patients with less education, older age, higher motor and cognitive function, and those who were not Hispanic or black had more favorable quality measure scores. CONCLUSION Patients' experience of care responses tended to be more favorable after discharge compared to discharge, suggesting that survey timing is important. Responses were more favorable for patients with selected characteristics, suggesting the possible need for risk adjustment if patient-reported quality measure scores are compared across IRFs.
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Affiliation(s)
- Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Quality Measurement and Health Policy Program, RTI International, Chicago, IL.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Linda Foster
- Alexian Brothers Rehabilitation Hospital, Elk Grove Village, IL
| | - Ana Miskovic
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
| | - Arielle Goldsmith
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Kash BA, Cheon O, Halzack NM, Miller TR. Measuring Team Effectiveness in the Health Care Setting: An Inventory of Survey Tools. Health Serv Insights 2018; 11:1178632918796230. [PMID: 30158825 PMCID: PMC6109848 DOI: 10.1177/1178632918796230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Guidance for measuring team effectiveness in dynamic clinical settings is necessary; however, there are no consensus strategies to help health care organizations achieve optimal teamwork. This systematic review aims to identify validated survey instruments of team effectiveness by clinical settings. Methods: PubMed, MEDLINE, and ISI Web of Knowledge were searched for team effectiveness surveys deployed from 1990 to 2016. Validity and reliability were evaluated using 4 psychometric properties: interrater agreement, internal consistency, content validity, and structural integrity. Two conceptual frameworks, the Donabedian model and the Command Team Effectiveness model, assess conceptual dimensions most measured in each health care setting. Results: The 22 articles focused on surgical, primary care, and other health care settings. Few instruments report the required psychometric properties or feature non-self-reported outcomes. The major conceptual dimensions measured in the survey instruments differed across settings. Team cohesion and overall perceived team effectiveness can be found in all the team effectiveness measurement tools regardless of the health care setting. We found that surgical settings have distinctive conditions for measuring team effectiveness relative to primary or ambulatory care. Discussion: Further development of setting-specific team effectiveness measurement tools can help further enhance continuous quality improvements and clinical outcomes in the future.
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Affiliation(s)
- Bita A Kash
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
| | - Ohbet Cheon
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
| | - Nicholas M Halzack
- Health Policy & Reimbursement, Roche Diagnostics Corporation, Washington, DC, USA
| | - Thomas R Miller
- Health Policy Research, American Society of Anesthesiologists, Schaumburg, IL, USA
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Jesus TS, Hoenig H. Postacute rehabilitation quality of care: toward a shared conceptual framework. Arch Phys Med Rehabil 2014; 96:960-9. [PMID: 25542676 DOI: 10.1016/j.apmr.2014.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/29/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum.
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Affiliation(s)
- Tiago Silva Jesus
- Health Psychology Department, Medical School, University Miguel Hernández, Elche, Spain.
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC; Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC
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Smits SJ, Bowden D, Falconer JA, Strasser DC. Improving medical leadership and teamwork: an iterative process. Leadersh Health Serv (Bradf Engl) 2014. [DOI: 10.1108/lhs-02-2014-0010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– This paper aims to present a two-decade effort to improve team functioning and patient outcomes in inpatient stroke rehabilitation settings.
Design/methodology/approach
– The principal improvement effort was conducted over a nine-year period in 50 Veterans Administration Hospitals in the USA. A comprehensive team-based model was developed and tested in a series of empirical studies. A leadership development intervention was used to improve team functioning, and a follow-up cluster-randomized trial documented patient outcome improvements associated with the leadership training.
Findings
– Iterative team and leadership improvements are presented in summary form, and a set of practice-proven development observations are derived from the results. Details are also provided on the leadership training intervention that improved teamwork processes and resulted in improvements in patient outcomes that could be linked to the intervention itself.
Research limitations/implications
– The practice-proven development observations are connected to leadership development theory and applied in the form of suggestions to improve leadership development and teamwork in a broad array of medical treatment settings.
Practical implications
– This paper includes suggestions for leadership improvement in medical treatment settings using interdisciplinary teams to meet the customized needs of the patient populations they serve.
Originality/value
– The success of the team effectiveness model and the team-functioning domains provides a framework and best practice for other health care organizations seeking to improve teamwork effectiveness.
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