Teamwork Essentials for Hospitalists

The Impact of the Excellence Program on Employee Performance at Aseer Central Hospital in Saudi Arabia: A Cross-Sectional Study

Introduction Motivation is a power that directs employees toward achieving their special goals and the organization's objectives in general. Recently, motivation has been considered one of the most important issues in the workplace since each organization wants to get the most out of its resources, including its manpower. In Saudi Arabia, the Aseer Health Directorate like the other regions, has a monthly reward containing certification and online announcements of employee excellence via email and website. The annual ministry program has three levels: 10% in salary for employees who have received excellence certification from the general director, 20% if they add research, and 30% if they register a patent. Methods A cross-sectional study was conducted in the Aseer Central Hospital among healthcare providers (HCP) of all categories using structured interviews with three parts: socio-demographic, knowledge about criteria for excellence in the program, and opinion toward the program and its effects. The sample size was calculated using the total number of employees in the hospital, with 77 being the bare minimum required. The sampling method used was systematic random sampling with a list of statistical analyses from the SPSS statistical package (IBM Corp., Armonk, NY, USA). The statistical analysis description for all variables was based on frequency and presence, followed by bivariate analysis. Results In the study, 103 participants who were physicians made up 28.2% of the sample, followed by nurses at 32%, and other health professionals at 39.8%. Males made up 64.1% and females 35.9%. While 55.3% of individuals claimed to be aware of the standards of excellence allowance, 44.7% of participants denied doing so. Around 7.8% of employees missed work or arrived late, compared to 92.2% who didn't, and 75% of those who had proof in their files received a pay cut or other penalty. The average employee's age was 33.5 years old, and 4.05% of them believed they performed better than their coworkers. An average of 4.43 employees believe that there will be more competition when the number of allowances increases. While the excellence allowance has a favorable effect as indicated by the 4.55 mean. With a mean of 2.47 and 2.45, the majority of employees, respectively, did not agree with the transparent and fair selection process. Conclusion  The purpose of the study was to demonstrate the significance of rewarding and encouraging employees, as well as the positive impact of this system on increasing their performance and productivity in order to implement the health organization's strategy and improve healthcare delivery and quality. There is a high percentage of employees who are dissatisfied with the transparency and fairness of the selection criteria, and some of them believe that team performance should be improved rather than individual performance. So the recommendation is to improve the selection criteria, make them more specific and transparent, and increase the number of teams and individuals who can be enrolled to improve the healthcare delivery system.

Reviewing High Reliability Team (HRT) Scholarship: A 21st Century Approach to Safety

High reliability team (HRT) theorizing emerged from high reliability organization (HRO) theory and now represents a distinct subset of HRO literature. Seeking to capture the development and range of HRT research, a comprehensive literature review was conducted. This systematic review of HRT scholarship, the first of its kind, provides a foundation from which small group and team scholars across disciplines may reflect on key lessons and chart future research. This review includes 71 articles across 21 disciplines and incorporates historical reflection on HRT theory foundations, existing empirical support, critiques and rivals, theory extensions, and ideas for future scholarship efforts.

"Friction by Definition": Conflict at Patient Handover Between Emergency and Internal Medicine Physicians at an Academic Medical Center

INTRODUCTION

Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context.

METHODS

We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method.

RESULTS

From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow).

CONCLUSIONS

Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.

Impact of a hospital unit-based leadership triad on key performance metrics

We piloted a triad leadership model consisting of a unit-based hospitalist medical director, nurse manager, and case manager on five medical inpatient units. The purpose of this explanatory case study was to determine what, if any, impact the triad team would have on commonly measured operational and quality metrics: observed to expected length of stay, likelihood to recommend the hospital, hand-washing compliance, all-cause 30-day readmission rates, percent of discharges by noon, and percent of discharge to skilled nursing facilities. Over the course of a year triad units demonstrated improvement in most metrics in comparison to the baseline period. While trends for the metrics were favorable, most striking was a statistically significant improvement in the observed to expected length of stay ratio (1.25 to 1.15, p < 0.001) which is the organization's most widely used marker for efficient hospital patient flow.As a result of these sustained operational, safety, quality, and financial performance metrics the model is being generalized to other medical as well as surgical units, including our observation unit. Intangible benefits include creating leadership development path for hospitalist, nursing, and case management colleagues.