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Drake C, Wang V, Stechuchak KM, Sperber N, Bruening R, Coffman CJ, Choate A, Van Houtven CH, Allen KD, Colon-Emeric C, Jackson GL, Tucker M, Meyer C, Kappler CB, Hastings SN. Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans: Evidence from a multi-site trial in the Veterans Health Administration. PM R 2024. [PMID: 38967454 DOI: 10.1002/pmrj.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed to promote quality improvement efforts and implementation of new clinical programs. OBJECTIVE This study examines the role of CONNECT, a complexity science-based implementation intervention to promote team readiness, for enhancing implementation of the 'Assisted Early Mobility for Hospitalized Older Veterans' program (STRIDE), an inpatient, supervised walking program. DESIGN We conducted a stepped-wedge cluster randomized trial using a convergent mixed-methods design. Within each randomly assigned stepped-wedge sequence, Veterans Affairs Medical Centers (VAMCs) were randomized to receive standardized implementation support only or additional training via the CONNECT intervention. Data for the study were obtained from hospital administrative and electronic health records, surveys, and semi-structured interviews with clinicians before and after implementation of STRIDE. SETTING Eight U.S. VAMCs. PARTICIPANTS Three hundred fifty-three survey participants before STRIDE implementation and 294 surveys after STRIDE implementation. Ninety-two interview participants. INTERVENTION CONNECT, a complexity-science-based intervention to improve team function. MAIN OUTCOME MEASURES The implementation outcomes included STRIDE reach and fidelity. Secondary outcomes included validated measures of team function (i.e., team communication, coordination, role clarity). RESULTS At four VAMCs randomized to CONNECT, reach was higher (mean 12.4% vs. 3.8%), and fidelity was similar to four non-CONNECT VAMCs. VAMC STRIDE delivery teams receiving CONNECT reported improvements in team function domains, similar to non-CONNECT VAMCs. Qualitative findings highlight CONNECT's impact and the influence of team characteristics and contextual factors, including team cohesion, leadership support, and role clarity, on reach and fidelity. CONCLUSION CONNECT may promote greater reach of STRIDE, but improvement in team function among CONNECT VAMCs was similar to improvement among non-CONNECT VAMCs. Qualitative findings suggest that CONNECT may improve team function and implementation outcomes but may not be sufficient to overcome structural barriers related to implementation capacity.
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Affiliation(s)
- Connor Drake
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Virginia Wang
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M Stechuchak
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Nina Sperber
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca Bruening
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Cynthia J Coffman
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashley Choate
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Courtney Harold Van Houtven
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelli D Allen
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cathleen Colon-Emeric
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - George L Jackson
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matthew Tucker
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Cassie Meyer
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Caitlin B Kappler
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Susan N Hastings
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
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Attieh S, Kilpatrick K, Chênevert D, Pomey MP, Loiselle CG. Measuring Team Functioning During the COVID-19 Pandemic: Perspectives of Cancer Care Team Members. J Multidiscip Healthc 2024; 17:2623-2633. [PMID: 38828266 PMCID: PMC11141571 DOI: 10.2147/jmdh.s448985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
Background In a public health crisis such as COVID-19, cancer teams face significant challenges including acute work disruptions, rapid shifts in clinical practice, and burnout. Within this context, it is crucial to explore team functioning from the perspectives of multiple stakeholders. Objective This quantitative pilot study aimed to 1) measure perceptions of multi-stakeholders on key indicators of team functioning (Team Effectiveness, TE, and Team Relational Coordination, TRC) during COVID-19 and its transition, and 2) document whether patient perceptions of TE/TRC are significantly associated with their cancer care experiences. Methods A descriptive design with repeated measures was used. Through convenience sampling, participants were recruited from two outpatient cancer clinics at a large university-affiliated hospital, in Montréal, Qc, Canada. Sixty-six participants (ie, 13 healthcare professionals, 40 patients, 6 informal caregivers, and 7 volunteers) completed e-measures at T1 (years 2021-2022) and n = 44 at T2 (year 2023). Results At T1, participants reported high perceptions of Team Effectiveness (scale 1 to 6) M = 4.47; SD = 0.7 (Mdn = 4.54; IQR: 4.06-5) and Relational Coordination (scale 1 to 5) M = 3.77; SD = 0.77 (Mdn = 3.81; IQR: 3.12-4.38) with no significant differences in perceptions across the four groups. At T2, no significant changes in TE/TRC perceptions were found. At both time points, patient perceptions of TE/TRC were significantly correlated with positive cancer care experiences (Spearman rank correlation rs ranging from 0.69 and 0.83; p < 0.01). Conclusion To our knowledge, this is the first study documenting perceptions of cancer team functioning amidst the pandemic as reported by multiple stakeholders. Significant relationships between patient perceptions of TE/TRC and their cancer care experiences underscore the importance of including patients' views in team functioning processes. Future work should rely on larger sample sizes to further explore key elements of optimal team functioning.
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Affiliation(s)
- Samar Attieh
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - 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, QC, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montréal, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montréal, QC, Canada
- Centre d’excellence sur le partenariat avec les patients et le public, Montréal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Carmen G Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
- Segal Cancer Center, Jewish General Hospital, Montréal, Canada
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Schroeck H, Whitty MA, Hatton B, Martinez-Camblor P, Wen L, Taenzer AH. Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration. Jt Comm J Qual Patient Saf 2024; 50:308-317. [PMID: 38360445 DOI: 10.1016/j.jcjq.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams. METHODS This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups. RESULTS A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel. CONCLUSION Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.
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Olive MV, Gastaldi L, Corso M. Digitally-mediated coordination in healthcare: the effects of teleconsultation on doctor-to-doctor relational coordination. BMC Health Serv Res 2024; 24:258. [PMID: 38419009 PMCID: PMC10900703 DOI: 10.1186/s12913-024-10726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Digitalization transforms the way in which interdependent work is coordinated, especially in healthcare settings. This work deepens the effect of teleconsultation use on health professionals' coordination. For this aim, we rely on Relational Coordination Theory (RCT), which explores coordination as an interactive process among group participants within the context of task interdependency. METHODS We collected data through an online survey administered to Italian specialist doctors between March and April 2023. 489 complete answers were gathered. Hypotheses have been tested through Structural Equation Modelling. RESULTS We found that teleconsultation frequency of use has a positive and significant effect on both components of relational coordination, confirming our hypotheses. CONCLUSIONS Theoretically, this research contributes to our understanding of the effect of digitally mediated coordination mechanisms on relational coordination. In practice, we shed light on the organizational implications of telemedicine under a novel perspective, focusing on the role of professional interactions in digitally mediated work and providing useful elements for the organizational design of telemedicine.
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Affiliation(s)
- Mattia Vincenzo Olive
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy.
| | - Luca Gastaldi
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Mariano Corso
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
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Edwards ST, Johnson A, Park B, Eiff P, Guzman CEV, Gordon L, Taylor C, Tuepker A. "What We're Doing Now…Is More Than Water Cooler": Perspectives of Primary Care Leaders on Leading Through (and Beyond) COVID-19. J Gen Intern Med 2024; 39:239-246. [PMID: 37582949 PMCID: PMC10853095 DOI: 10.1007/s11606-023-08373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/04/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND COVID-19 presented numerous challenges to primary care, but little formal research has explored the experience of practice leaders and their strategies for managing teams as the crisis unfolded. OBJECTIVE Describe the experience of leaders in US primary care delivery organizations, and their strategies for leading teams during COVID-19 and beyond. DESIGN Qualitative study using semi-structured interviews performed between 9/15/2020 and 8/31/2021. PARTICIPANTS Purposive sample of 17 clinical leaders in a range of US primary care organizations. APPROACH An iterative grounded review of interview transcripts was performed, followed by immersion/crystallization analysis. KEY RESULTS Early in the pandemic, practice leaders reported facing rapid change and the need for constant decision-making, amidst an environment of stress, fear, and uncertainty, but this was buffered by a strong sense of purpose. Later, leaders noted the emergence of layered crises, and evolving challenges including fatigue, burnout, and strained relationships within their organizations and with the communities they serve. Leaders described four interrelated strategies for supporting their teams: (1) Being intentionally present, physically and emotionally; (2) Frequent and transparent communication; (3) Deepening and broadening relationships; (4) Increasing adaptive decision-making, alternating between formal hierarchical and flexible participatory processes. These strategies were influenced by individual leaders' perceived autonomy, which was impacted by the leader's specific role, and organizational size, complexity, and funding model. CONCLUSIONS As the burnout and workforce crises have accelerated, the identified strategies can be useful to leaders to support teams and build organizational resilience in primary care moving forward.
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Affiliation(s)
- Samuel T Edwards
- Relationships in Equity, Leadership and Team Effectiveness (RELATE) Lab, Department of Family Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA.
- Section of General Internal Medicine, Veterans Affairs (VA) Portland Health Care System, Portland, OR, USA.
- Division of General Internal Medicine and Geriatrics, OHSU, Portland, OR, USA.
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
| | - Amanda Johnson
- University of Minnesota M Health Fairview Masonic Children's, Minneapolis, MN, USA
| | - Brian Park
- Relationships in Equity, Leadership and Team Effectiveness (RELATE) Lab, Department of Family Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Patrice Eiff
- Relationships in Equity, Leadership and Team Effectiveness (RELATE) Lab, Department of Family Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Cirila Estela Vasquez Guzman
- Relationships in Equity, Leadership and Team Effectiveness (RELATE) Lab, Department of Family Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Leah Gordon
- Relationships in Equity, Leadership and Team Effectiveness (RELATE) Lab, Department of Family Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Cynthia Taylor
- Relationships in Equity, Leadership and Team Effectiveness (RELATE) Lab, Department of Family Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Anaïs Tuepker
- Relationships in Equity, Leadership and Team Effectiveness (RELATE) Lab, Department of Family Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA
- Division of General Internal Medicine and Geriatrics, OHSU, Portland, OR, USA
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
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McGuier EA, Rothenberger SD, Campbell KA, Keeshin B, Weingart LR, Kolko DJ. Team Functioning and Performance in Child Advocacy Center Multidisciplinary Teams. CHILD MALTREATMENT 2024; 29:106-116. [PMID: 35943489 PMCID: PMC9908768 DOI: 10.1177/10775595221118933] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The quality of teamwork in Child Advocacy Center (CAC) multidisciplinary teams is likely to affect the extent to which the CAC model improves outcomes for children and families. This study examines associations between team functioning and performance in a statewide sample of CAC teams. Multidisciplinary team members (N = 433) from 21 CACs completed measures of affective, behavioral, and cognitive team functioning. Team performance was assessed with three measures: team member ratings of overall performance, ratings of mental health screening/referral frequency, and caregiver satisfaction surveys. Linear mixed models and regression analyses tested associations between team functioning and performance. Affective team functioning (i.e., liking, trust, and respect; psychological safety) and cognitive team functioning (i.e., clear direction) were significantly associated with team members' ratings of overall performance. Behavioral team functioning (i.e., coordination) and cognitive team functioning were significantly associated with mental health screening/referral frequency. Team functioning was not associated with caregiver satisfaction with CAC services. Aspects of team functioning were associated with team members' perceptions of overall performance and mental health screening/referral frequency, but not caregiver satisfaction. Understanding associations between team functioning and performance in multidisciplinary teams can inform efforts to improve service quality in CACs and other team-based service settings.
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Affiliation(s)
- Elizabeth A. McGuier
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Kristine A. Campbell
- Center for Safe and Healthy Families, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Brooks Keeshin
- Center for Safe and Healthy Families, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - David J. Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Attieh S, Loiselle CG. Cancer Care Team Functioning during COVID-19: A Narrative Literature Review and Synthesis. Curr Oncol 2024; 31:335-349. [PMID: 38248107 PMCID: PMC10814830 DOI: 10.3390/curroncol31010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Amid pandemics, health care teams face unprecedented challenges, requiring significant efforts to sustain optimal functioning and navigate rapid practice changes. It is therefore crucial to identify factors affecting team functioning in these contexts. The present narrative review more specifically summarizes the literature on key elements of cancer teams' functioning during COVID-19. The search strategy involved four main databases (i.e., Medline OVID, EMBASE, PsycINFO, and CINAHL), as well as Google Scholar, from January 2000 to September 2022. Twenty-three publications were found to be relevant. Each was read thoroughly, and its content summarized. Across publications, three key themes emerged: (1) swiftly adopting virtual technology for communication and interprofessional collaboration, (2) promoting team resilience, and (3) encouraging self-care and optimizing team support. Our findings underscore key team functioning elements to address in future pandemics. More research is needed to document the perspectives of broader-based team members (such as patients and lay carers) to inform more comprehensive evidence-based team functioning guidelines.
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Affiliation(s)
- Samar Attieh
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
| | - Carmen G. Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada;
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3T2, Canada
- Segal Cancer Center, CIUSSS Centre-Ouest, Montreal, QC H3T 1E2, Canada
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Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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Satterstrom P, Vogus TJ, Jung OS, Kerrissey M. Voice is not enough: A multilevel model of how frontline voice can reach implementation. Health Care Manage Rev 2024; 49:35-45. [PMID: 38019462 DOI: 10.1097/hmr.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
ISSUE When frontline employees' voice is not heard and their ideas are not implemented, patient care is negatively impacted, and frontline employees are more likely to experience burnout and less likely to engage in subsequent change efforts. CRITICAL THEORETICAL ANALYSIS Theory about what happens to voiced ideas during the critical stage after employees voice and before performance outcomes are measured is nascent. We draw on research from organizational behavior, human resource management, and health care management to develop a multilevel model encompassing practices and processes at the individual, team, managerial, and organizational levels that, together, provide a nuanced picture of how voiced ideas reach implementation. INSIGHT/ADVANCE We offer a multilevel understanding of the practices and processes through which voice leads to implementation; illuminate the importance of thinking temporally about voice to better understand the complex dynamics required for voiced ideas to reach implementation; and highlight factors that help ideas reach implementation, including voicers' personal and interpersonal tactics with colleagues and managers, as well as senior leaders modeling and explaining norms and making voice-related processes and practices transparent. PRACTICE IMPLICATIONS Our model provides evidence-based strategies for bolstering rejected or ignored ideas, including how voicers (re)articulate ideas, whom they enlist to advance ideas, how they engage peers and managers to improve conditions for intentional experimentation, and how they take advantage of listening structures and other formal mechanisms for voice. Our model also highlights how senior leaders can make change processes and priorities explicit and transparent.
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Wang YJ, Chen IH. Effect of School Bullying on Students' Peer Cooperation: A Moderated Mediation Model. CHILDREN (BASEL, SWITZERLAND) 2023; 11:11. [PMID: 38275432 PMCID: PMC10814818 DOI: 10.3390/children11010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Studies show that cooperative environments enhance student performance. However, school bullying can significantly undermine peer cooperation. There is limited research on how school bullying impacts peer cooperation and the mechanisms involved. METHODS Using data from 15-year-old middle school students in four Chinese provinces and cities, as part of the 2018 Program for International Student Assessment (PISA), this study employs a moderated mediation model. It examines the negative effects of school bullying on peer cooperation, the mediating role of school belonging, and the moderating effects of teacher support and parents' support. RESULTS School bullying negatively impacts peer cooperation. School belonging partially mediates this relationship. Teacher support moderates the effect of school bullying on school belonging, which in turn affects peer cooperation. Parents' support moderates the direct impact of school bullying on peer cooperation. CONCLUSION School bullying reduces peer cooperation by diminishing students' sense of belonging in school. This effect is lessened with increased support from teachers and parents. The findings suggest that while social support is beneficial, it must be balanced and not excessive.
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Affiliation(s)
- Yu-Jiao Wang
- School of Education Science, Liupanshui Normal University, Liupanshui 553004, China
| | - I-Hua Chen
- Chinese Academy of Education Big Data, Qufu Normal University, Qufu 273100, China;
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Sinskey JL, Chang JM, Lu AC, Pian-Smith MC. Patient Safety and Clinician Well-Being. Anesthesiol Clin 2023; 41:739-753. [PMID: 37838381 DOI: 10.1016/j.anclin.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Clinician well-being and patient safety are intricately linked. We propose that organizational factors (ie, elements of the perioperative work environment and culture) affect both, as opposed to a bidirectional causal relationship. Threats to patient safety and clinician well-being include clinician mental health issues, negative work environments, poor teamwork and communication, and staffing shortages. Opportunities to mitigate these threats include the normalization of mental health care, peer support, psychological safety, just culture, teamwork and communication training, and creative staffing approaches.
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Affiliation(s)
- Jina L Sinskey
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, 4th Floor, San Francisco, CA, USA.
| | - Joyce M Chang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, 4th Floor, San Francisco, CA, USA
| | - Amy C Lu
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - May C Pian-Smith
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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Graves JA, Lee D, Leszinsky L, Nshuti L, Nikpay S, Richards M, Buntin MB, Polsky D. Physician patient sharing relationships within insurance plan networks. Health Serv Res 2023; 58:1056-1065. [PMID: 36734605 PMCID: PMC10480085 DOI: 10.1111/1475-6773.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To quantify shared patient relationships between primary care physicians (PCPs) and cardiologists and oncologists and the degree to which those relationships were captured within insurance networks. DATA SOURCES Secondary analysis of Vericred data on physician networks, CareSet data on physicians' shared Medicare patients, and insurance plan attributes from Health Insurance Compare. Data validation exercises used data from Physician Compare and IQVIA. STUDY DESIGN Cross-sectional study of the PCP-to-specialist in-network shared patient percentage (primary outcome). We also categorized networks by insurance market segment (Medicare Advantage [MA], Medicaid managed care, small-group or individually purchased), insurance plan type, and network breadth. DATA EXTRACTION We analyzed data on 219,982 PCPs, 29,400 cardiologists, and 22,745 oncologists who, in 2021, accepted MA (n = 941 networks), Medicaid managed care (n = 293), and individually-purchased (n = 332) and small-group (n = 501) plans. PRINCIPAL FINDINGS Networks captured, on average, 64.6% of PCP-cardiology shared patient ties, and 61.8% of PCP-oncologist ties. Less than half of in-network ties (44.5% and 38.9%, respectively) were among physicians with a common organizational affiliation. After adjustment for network breadth, we found no evidence of differences in the shared patient percentage across insurance market segments or networks of different types (p-value >0.05 for all comparisons). An exception was among national versus local and regional networks, where we found that national plans captured fewer shared patient ties, particularly among the narrowest networks (58.4% for national networksvs. 64.7% for local and regional networks for PCP-cardiology). CONCLUSIONS Given recent trends toward narrower networks, our findings underscore the importance of incorporating additional and nuanced measures of network composition to aid plan selection (for patients) and to guide regulatory oversight.
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Affiliation(s)
- John A. Graves
- Department of Health Policy, Department of MedicineVanderbilt University School of Medicine, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Dennis Lee
- Department of Health PolicyVanderbilt UniversityNashvilleTennesseeUSA
| | - Lena Leszinsky
- Department of Health PolicyVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Leonce Nshuti
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sayeh Nikpay
- Division of Health Policy and ManagementUniversity of Minnesota, School of Public HealthMinneapolisMinnesotaUSA
| | - Michael Richards
- Department of EconomicsBaylor University Hankamer Business SchoolWacoTexasUSA
| | - Melinda B. Buntin
- Department of Health PolicyVanderbilt University School of Medicine, Peabody School of Education, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Daniel Polsky
- Bloomberg School of Public, Carey Business School, Department of Health Policy and ManagementJohns Hopkins UniversityBaltimoreMarylandUSA
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House S, Ali HN, Newhouse R, Stucky C. A relational coordination training intervention to improve job satisfaction and intent to stay in the intensive care unit: A pilot study. Nurs Outlook 2023; 71:102001. [PMID: 37421939 DOI: 10.1016/j.outlook.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Relational coordination (RC) explores the coordination of work between and among professionals in a workgroup. RC is associated with higher job satisfaction and retention; however, researchers have not tested RC training interventions to improve job satisfaction and retention. PURPOSE To explore changes in job satisfaction and intent to stay among health care professionals following a virtual RC training intervention. METHODS We conducted a pilot, parallel group randomized controlled trial in four intensive care units. Data collection occurred via survey. Difference-in-difference regression models were used to analyze the job satisfaction and intent to stay outcomes. DISCUSSION The RC training intervention did not influence job satisfaction or intent to stay. Participants with baccalaureate degrees and African American/Black participants reported lower intent to stay. CONCLUSION The results from this pilot study are a critical first step in testing the efficacy of an RC training intervention to improve staff outcomes in a larger powered study.
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Affiliation(s)
- Sherita House
- The University of North Carolina at Greensboro School of Nursing, Greensboro, NC.
| | - Hebatallah Naim Ali
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA.
| | | | - Christopher Stucky
- Department of Nursing, Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl, Germany.
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14
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Saucke MC, Alagoz E, Arroyo N, Gutierrez-Meza DE, Fernandes-Taylor S, Ingraham AM. The invisible work of transfer centre nurses: A qualitative study of strategies to overcome communication challenges. J Adv Nurs 2023; 79:2539-2552. [PMID: 36843245 PMCID: PMC10293039 DOI: 10.1111/jan.15603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/12/2023] [Accepted: 02/05/2023] [Indexed: 02/28/2023]
Abstract
AIMS To explore the role of transfer centre nurses and how they facilitate communication between referring and accepting providers during calls about interhospital transfers, including their strategies to overcome communication challenges. DESIGN A qualitative interview study. METHODS We conducted semi-structured interviews with 17 transfer centre nurses at one tertiary medical centre from March to August 2019, asking participants to describe their work. We performed content analysis, applying codes based on the Relational Coordination Framework and generating emergent codes, then organized codes in higher-order concepts. We followed the COREQ checklist. RESULTS Transfer centre nurses employed multiple strategies to mitigate communication challenges. When referring providers had misconceptions about the transfer centre nurse's role and the accepting hospital's processes, the nurses informed referring providers why sharing information with them was necessary. If providers expressed frustrations or lacked understanding about their counterpart's caseload, the nurses managed providers' emotions by letting them "vent," explaining the other provider's situational context and describing the hospital's capabilities. Some nurses also mediated conflict and sought to break the tension if providers debated about the best course of action. When providers struggled to share complete and accurate information, the nurses hunted down details and 'filled in the blanks'. CONCLUSION Transfer centre nurses perform invisible work throughout the lifespan of interhospital transfers. Nurses' expert knowledge of the transfer process and hospitals' capabilities can enhance provider communication. Meanwhile, providers' lack of knowledge of the nurse's role can impede respectful and efficient transfer conversations. Interventions to support and optimize the transfer centre nurses' critical work are needed. IMPACT This study describes how transfer centre nurses facilitate communication and overcome challenges during calls about interhospital transfers. An intervention that supports this critical work has the potential to benefit nurses, providers and patients by ensuring accurate and complete information exchange in an effective, efficient manner that respects all parties. PATIENT OR PUBLIC CONTRIBUTION This study was designed to capture the perspectives and experiences of transfer centre nurses themselves through interviews. Therefore, it was not conducted using input or suggestions from the public or the patient population served by the organization.
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Affiliation(s)
- Megan C Saucke
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Esra Alagoz
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Natalia Arroyo
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | | | | | - Angela M Ingraham
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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15
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Mellinger JL, Fernandez AC, Winder GS. Management of alcohol use disorder in patients with chronic liver disease. Hepatol Commun 2023; 7:e00145. [PMID: 37314739 DOI: 10.1097/hc9.0000000000000145] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/15/2023] [Indexed: 06/15/2023] Open
Abstract
Alcohol use disorder (AUD) rates have risen dramatically in the United States, resulting in increasing rates of alcohol-associated liver disease (ALD), but many patients struggle to access alcohol use treatment. AUD treatment improves outcomes, including mortality, and represents the most urgent means by which care can be improved for those with liver disease (including ALD and others) and AUD. AUD care for those with liver disease involves 3 steps: detecting alcohol use, diagnosing AUD, and directing patients to alcohol treatment. Detecting alcohol use can involve questioning during the clinical interview, the use of standardized alcohol use surveys, and alcohol biomarkers. Identifying and diagnosing AUD are interview-based processes that should ideally be performed by a trained addiction professional, but nonaddiction clinicians can use surveys to determine the severity of hazardous drinking. Referral to formal AUD treatment should be made, especially where more severe AUD is suspected or identified. Therapeutic modalities are numerous and include different forms of one-on-one psychotherapy, such as motivational enhancement therapy or cognitive behavior therapy, group therapy, community mutual aid societies (such as Alcoholics Anonymous), inpatient addiction treatment, and relapse prevention medications. Finally, integrated care approaches that build strong relationships between addiction professionals and hepatologists or medical providers caring for those with liver disease are crucial to improving care for this population.
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Affiliation(s)
- Jessica L Mellinger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Anne C Fernandez
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - G Scott Winder
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Neurology, Michigan Medicine, Ann Arbor, Michigan, USA
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16
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Shortell SM, Toussaint JS, Halvorson GC, Kingsdale JM, Scheffler RM, Schwartz AY, Wadsworth PA, Wilensky G. The Better Care Plan: a blueprint for improving America's healthcare system. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad007. [PMID: 38756832 PMCID: PMC10986211 DOI: 10.1093/haschl/qxad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/30/2023] [Indexed: 05/18/2024]
Abstract
The United States falls far short of its potential for delivering care that is effective, efficient, safe, timely, patient-centered, and equitable. We put forward the Better Care Plan, an overarching blueprint to address the flaws in our current system. The plan calls for continuously improving care, moving all payers to risk-adjusted prospective payment, and creating national entities for collecting, analyzing, and reporting patient safety and quality-of-care outcomes data. A number of recommendations are made to achieve these goals.
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Affiliation(s)
| | - John S Toussaint
- Catalysis, Inc. 3825 East Calumet Street, Suite 400-114, Appleton, WI 54915, United States
| | - George C Halvorson
- The Institute for Intergroup Understanding, 1300 Bracketts Point Road, Wayzata, MN 55391, United States
| | | | | | | | - Peter A Wadsworth
- Amory Associates, 1310 Norwest Drive, Norwood, MA 02062, United States
| | - Gail Wilensky
- Project Hope, 1220 19th Street, Washington, DC 20036, United States
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17
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McGuier EA, Aarons GA, Wright JD, Fortney JC, Powell BJ, Rothenberger SD, Weingart LR, Miller E, Kolko DJ. Team-focused implementation strategies to improve implementation of mental health screening and referral in rural Children's Advocacy Centers: study protocol for a pilot cluster randomized hybrid type 2 trial. Implement Sci Commun 2023; 4:58. [PMID: 37237302 PMCID: PMC10214641 DOI: 10.1186/s43058-023-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Children's Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs' capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings. METHODS We will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers' understanding of their child's mental health needs and caregivers' intentions to initiate mental health services (effectiveness aim). CONCLUSIONS Targeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT05679154 . Registered on January 10, 2023.
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Affiliation(s)
- Elizabeth A McGuier
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Jaely D Wright
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - John C Fortney
- Division of Population Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Scott D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laurie R Weingart
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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Hagum CN, Tønnessen E, Nesse MA, Shalfawi SAI. A Holistic Analysis of Team Dynamics Using Relational Coordination as the Measure regarding Student Athlete Total Load: A Cross-Sectional Study. Sports (Basel) 2023; 11:sports11050104. [PMID: 37234060 DOI: 10.3390/sports11050104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Despite its small population, Norway wins a disproportionately large number of medals in international competitions. Therefore, it has been thought that the Norwegian sports model and sports school programs are influential in developing young Norwegian athletes to achieve such results. Today, more than 110 Norwegian private and public schools offer the elite sports program in Norway. Most student athletes attending those schools combine their high school education with elite sports, where they attend training sessions at both school and clubs. The number of people involved with the student athlete on a daily basis (i.e., other student athletes, club coaches, school coaches, schoolteachers, parents, and health personnel) indicate the importance of optimal communication and coordination. However, to the authors' knowledge, no previous studies have explored communication and coordination among this population group. Therefore, the primary objective of this study was to use a holistic analysis of team dynamics using the Relational Coordination Survey as a measure to explore the relational coordination within and between student athletes, club coaches, and school coaches. A secondary objective of this study was to explore student athletes', club coaches', and school coaches' relational coordination with schoolteachers, parents, and health personnel. In addition, the study aimed to explore differences in student athletes' relational coordination with their significant others according to sport, school, performance level, sex, and school year. METHODS The quality of relational coordination was measured by a cross-sectional questionnaire of student athletes (n = 345), club coaches (n = 42), and school coaches (n = 25) concerning training load and life load. Multiple one-way analyses of variance were used to assess differences between groups. RESULTS The results show that student athletes, club coaches, and school coaches perceived moderate to weak relational coordination with parents, schoolteachers, and health personnel. Student athletes' relational coordination score with parents was the only strong score observed. Furthermore, the results reveal notable differences in student athletes' relational coordination with the roles according to their characteristics. CONCLUSIONS The findings suggest a potential for enhancing relationships and communication within and between the significant roles involved with student athletes. The results further indicate that those involved with the student athlete should consider a holistic approach to enhance communication and coordination, including physical, psychological, and other life factors, for optimal student athlete management and development. More resources are necessary to facilitate effective communication and coordination regarding the student athlete's total load.
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Affiliation(s)
- Cathrine Nyhus Hagum
- Department of Education and Sports Science, University of Stavanger, 4036 Stavanger, Norway
| | - Espen Tønnessen
- Faculty of Health Sciences, Kristiania University College, 0107 Oslo, Norway
| | - Marie Aarrestad Nesse
- Department of Education and Sports Science, University of Stavanger, 4036 Stavanger, Norway
| | - Shaher A I Shalfawi
- Department of Education and Sports Science, University of Stavanger, 4036 Stavanger, Norway
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Park B, Tuepker A, Vasquez Guzman CE, Edwards S, Waller Uchison E, Taylor C, Eiff MP. An antidote to what's ailing healthcare workers: a new (old) way of relational leadership. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 36971656 DOI: 10.1108/lhs-08-2022-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE The purpose of the study's mixed-methods evaluation was to examine the ways in which a relational leadership development intervention enhanced participants' abilities to apply relationship-oriented skills on their teams. DESIGN/METHODOLOGY/APPROACH The authors evaluated five program cohorts from 2018-2021, involving 127 interprofessional participants. The study's convergent mixed-method approach analyzed post-course surveys for descriptive statistics and interpreted six-month post-course interviews using qualitative conventional content analysis. FINDINGS All intervention features were rated as at least moderately impactful by at least 83% of participants. The sense of community, as well as psychological safety and trust created, were rated as impactful features of the course by at least 94% of participants. At six months post-intervention, participants identified benefits of greater self-awareness, deeper understanding of others and increased confidence in supporting others, building relationships and making positive changes on their teams. ORIGINALITY/VALUE Relational leadership interventions may support participant skills for building connections, supporting others and optimizing teamwork. The high rate of skill application at six months post-course suggests that relational leadership development can be effective and sustainable in healthcare. As the COVID-19 pandemic and systemic crises continue to impact the psychological well-being of healthcare colleagues, relational leadership holds promise to address employee burnout, turnover and isolation on interprofessional care teams.
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Affiliation(s)
- Brian Park
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; School of Public Health, Oregon Health and Science University, Portland, Oregon, USA and Portland State University, Portland, Oregon, USA
| | - Anaïs Tuepker
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA and Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | | | - Samuel Edwards
- Division of Medicine, Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA and Section of General Internal Medicine, Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA, and
| | - Elaine Waller Uchison
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; School of Public Health, Oregon Health and Science University, Portland, Oregon, USA and Portland State University, Portland, Oregon, USA
| | - Cynthia Taylor
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; School of Public Health, Oregon Health and Science University, Portland, Oregon, USA and Portland State University, Portland, Oregon, USA
| | - M Patrice Eiff
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; School of Public Health, Oregon Health and Science University, Portland, Oregon, USA and Portland State University, Portland, Oregon, USA
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20
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Anderson SR, Gianola M, Medina NA, Perry JM, Wager TD, Losin EAR. Doctor trustworthiness influences pain and its neural correlates in virtual medical interactions. Cereb Cortex 2023; 33:3421-3436. [PMID: 36001114 PMCID: PMC10068271 DOI: 10.1093/cercor/bhac281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/13/2022] Open
Abstract
Trust is an important component of the doctor-patient relationship and is associated with improved patient satisfaction and health outcomes. Previously, we reported that patient feelings of trust and similarity toward their clinician predicted reductions in evoked pain in response to painful heat stimulations. In the present study, we investigated the brain mechanisms underlying this effect. We used face stimuli previously developed using a data-driven computational modeling approach that differ in perceived trustworthiness and superimposed them on bodies dressed in doctors' attire. During functional magnetic resonance imaging, participants (n = 42) underwent a series of virtual medical interactions with these doctors during which they received painful heat stimulation as an analogue of a painful diagnostic procedure. Participants reported increased pain when receiving painful heat stimulations from low-trust doctors, which was accompanied by increased activity in pain-related brain regions and a multivariate pain-predictive neuromarker. Findings suggest that patient trust in their doctor may have tangible impacts on pain and point to a potential brain basis for trust-related reductions in pain through the modulation of brain circuitry associated with the sensory-discriminative and affective-motivational dimensions of pain.
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Affiliation(s)
- Steven R Anderson
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Morgan Gianola
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Natalia A Medina
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Jenna M Perry
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, 3 Maynard St, Hanover, NH 03755-3565, USA
| | - Elizabeth A Reynolds Losin
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146-0751, USA
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Spitzer EG, Kaitz J, Fix GM, Harvey KLL, Stadnick NA, Sullivan JL, Williamson AK, Miller CJ. Developing Relational Coordination: A Qualitative Study of Outpatient Mental Health Teams. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01261-2. [PMID: 36892721 PMCID: PMC9996570 DOI: 10.1007/s10488-023-01261-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
Previous studies have shown Relational Coordination improves team functioning in healthcare settings. The aim of this study was to examine the relational factors needed to support team functioning in outpatient mental health care teams with low staffing ratios. We interviewed interdisciplinary mental health teams that had achieved high team functioning despite low staffing ratios in U.S. Department of Veterans Affairs medical centers. We conducted qualitative interviews with 21 interdisciplinary team members across three teams within two medical centers. We used directed content analysis to code the transcripts with a priori codes based on the Relational Coordination dimensions, while also being attentive to emergent themes. We found that all seven dimensions of Relational Coordination were relevant to improved team functioning: frequent communication, timely communication, accurate communication, problem-solving communication, shared goals, shared knowledge, and mutual respect. Participants also described these dimensions as reciprocal processes that influenced each other. In conclusion, relational Coordination dimensions can play pivotal roles in improving team functioning both individually and in combination. Communication dimensions were a catalyst for developing relationship dimensions; once relationships were developed, there was a mutually reinforcing cycle between communication and relationship dimensions. Our results suggest that establishing high-functioning mental health care teams, even in low-staffed settings, requires encouraging frequent communication within teams. Moreover, attention should be given to ensuring appropriate representation of disciplines among leadership and defining roles of team members when teams are formed.
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Affiliation(s)
- Elizabeth G Spitzer
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research, Boston, Massachusetts and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States.
| | - Jenesse Kaitz
- VA Bedford Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, United States
| | - Gemmae M Fix
- VA Bedford Healthcare System Center for Healthcare Organization and Implementation Research and Boston University School of Public Health Boston, Bedford, Massachusetts, United States
| | - Kimberly L L Harvey
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research, Boston, Massachusetts and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego; UC San Diego, Altman Clinical and Translational Research, Institute, Dissemination and Implementation Science Center, La Jolla, California; and Child and Adolescent Services Research Center, San Diego, California, United States
| | - Jennifer L Sullivan
- A Medical Center, Center of Innovation in Long Term Services and Supports and Brown University School of Public Health, Providence, Providence, Rhode Island, United States
| | | | - Christopher J Miller
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Department of Psychiatry, Harvard Medical School, Bedford, Massachusetts, United States
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Ellsworth BL, Settecerri DJ, Mott NM, Vastardis A, Hider AM, Thompson J, Dossett LA, Hughes TM. Surgeon Perspectives on Determinants of Same-Day Mastectomy: A Roadmap for Implementing Change. Ann Surg Oncol 2023; 30:1712-1720. [PMID: 36536198 PMCID: PMC9762864 DOI: 10.1245/s10434-022-12934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Same-day discharge after mastectomy without immediate reconstruction (MwoR) has been shown to be safe, with improved patient satisfaction when compared with patients discharged 1 or more days after surgery. Nevertheless, only 16% of patients undergoing MwoR in Michigan are discharged on the day of surgery, with significant variation between facilities (3-88%). Our objective was to explore determinants of same-day discharge and offer strategies for broader implementation of this practice. METHODS We conducted semi-structured interviews with surgeons performing MwoR across the state of Michigan. Recruitment utilized purposeful and snowball sampling methods. The Tailored Implementation in Chronic Disease (TICD) framework was used to inform the creation of the interview guide. Interviews were transcribed and then analyzed using directed content analysis guided by the TICD framework. Salient determinants were organized into patient, provider, and system-level factors. RESULTS Participants (n = 26) included general surgeons, breast surgeons, and surgical oncologists. Most surgeons (n = 18, 69%) reported that they discharged fewer than 60% of patients the same day after MwoR. The most common barriers included patient knowledge at the patient level; awareness of evidence, surgeon dogma, and peer influence at the provider level; and team processes and operating room logistics at the system level. CONCLUSION We identified surgeon-defined determinants of same-day discharge after MwoR. For the identified barriers, potential implementation strategies could include incorporation of preoperative drain teachings for patients, utilizing consensus statements and opinion leaders to disseminate evidence supporting same-day mastectomies, and conducting workshops with relevant stakeholders to establish consistent facility practice patterns among surgical teams.
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Affiliation(s)
| | - Daniel J Settecerri
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Nicole M Mott
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Andrew Vastardis
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Ahmad M Hider
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jessica Thompson
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lesly A Dossett
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Tasha M Hughes
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA.
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Kerrissey M, Novikov Z, Tietschert M, Phillips R, Singer SJ. The ambiguity of "we": Perceptions of teaming in dynamic environments and their implications. Soc Sci Med 2023; 320:115678. [PMID: 36682086 DOI: 10.1016/j.socscimed.2023.115678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/04/2023] [Accepted: 01/13/2023] [Indexed: 01/16/2023]
Abstract
In healthcare, organizations increasingly call on clinicians and staff to team up fluidly to deliver integrated services across disciplines and settings. Yet little is known about how clinicians and staff perceive of team membership in healthcare environments where team boundaries are often ambiguous and continually shifting. We draw on the context of primary care in the United States, where fluid multi-disciplinary teamwork is commonly exhorted, to investigate the extent to which clinicians and staff perceive of various roles (e.g., physician, front desk) as members in their teams, and to identify potential implications. Using a survey fielded within 59 clinics (n = 828), we find substantial variation in individuals' perceptions of the roles they consider as team members during an episode of care (e.g., mean team size = 10.60 roles; standard deviation = 5.09). Perceiving more expansive sets of roles as team members exhibits a positive association with performance as measured by care quality (b = 0.02; p < .01) but a curvilinear association with job satisfaction. Separating an individual's perceived core (roles always perceived as part of the team) and periphery (roles sometimes perceived as part of the team), perceiving a larger core is positively associated with performance (b = 0.03 p < .01). In contrast, perceiving a larger periphery is marginally negatively associated with performance (b = -0.02, p < .10). This appears to be driven by divergence from the norm perception of the core, i.e., when individuals attribute to the periphery the roles that are considered by most others to be core. Our findings suggest that individuals viewing the roles they must team with more expansively may generate higher quality output but experience a personal toll. Delivering on the ideal of team-based care in dynamic environments may require helping team members gain clarity about their teammates and implementing policies that attend to job satisfaction as team boundaries shift and expand.
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Affiliation(s)
- Michaela Kerrissey
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02116, USA.
| | - Zhanna Novikov
- UTHealth Houston School of Public Health, USA; Stanford University, USA.
| | | | | | - Sara J Singer
- Stanford University School of Medicine, Stanford Graduate School of Business (by Courtesy), USA.
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Relationships and resilience at work and at home: Impact of relational coordination on clinician work-life balance and well-being in times of crisis. Health Care Manage Rev 2023; 48:80-91. [PMID: 36279316 PMCID: PMC9704816 DOI: 10.1097/hmr.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been an unusually comprehensive crisis that has taken a toll on people in their roles both at work and at home, giving rise to a new normal. PURPOSE Relational coordination theory shows how communicating and relating for the purpose of task integration drives positive outcomes for workers, their clients, and their employers. The ecological theory of work-family spillover shows how relational dynamics from work spillover into family life, and vice versa. We build upon these two theories to understand how relationships at work impact work-life balance and worker well-being, especially in times of crisis. METHODOLOGY This study was based on surveys of clinicians affiliated with a large California health system during the COVID-19 pandemic. Mediation and multilevel logistic regression models were used to assess how relational coordination among colleagues impacts well-being (job satisfaction and lack of burnout) through its effects on work-life balance (schedule control and personal time). RESULTS A 1-point increase in relational coordination tripled clinician odds of having schedule control ( OR = 3.33, p < .001) and nearly doubled the odds of having adequate personal time ( OR = 1.83, p < .001). A 1-point increase in relational coordination nearly quadrupled odds of being satisfied with their job ( OR = 3.92, p < .001) and decreased odds of burnout by 64% ( OR = 0.36, p < .001). The impact of relational coordination on worker well-being was mediated by greater schedule control and personal time. CONCLUSION Relational coordination among colleagues impacts worker well-being by enabling greater control over one's schedule and more personal time, thus creating a positive spillover from work to home in times of crisis. PRACTICE IMPLICATIONS In times of crisis, leaders should prioritize relational coordination among colleagues in order to support their resilience both at work and at home.
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Prætorius T, Baymler Lundberg AS, Søndergaard E, Tang Knudsen S, Sandbæk A. The effect of virtual specialist conferences between endocrinologists and general practitioners about type 2 diabetes: study protocol for a pragmatic randomized superiority trial. Trials 2022; 23:1059. [PMID: 36578024 PMCID: PMC9795951 DOI: 10.1186/s13063-022-06961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To support the primary care sector in delivering high-quality type 2 diabetes (T2D), literature reviews emphasize the need for implementing models of collaboration that in a simple and effective way facilitate clinical dialogue between general practitioners (GPs) and endocrinologists. The overall aim of the project is to evaluate if virtual specialist conferences between GPs and endocrinologists about patients living with T2D is clinically effective and improves diabetes competences and organization in general practice in comparison to usual practice. METHODS A prospective, pragmatic, and superiority RCT with two parallel arms of general practices in the Municipality of Aarhus, Denmark. All general practices are invited (n = 100). The intervention runs for 12 months and consists of four virtual conferences between endocrinologists and an individual general practice. Before the first conference, an introductory webinar teaches GPs about how to use an IT-platform to identify and manage T2D patients. The main analysis (month 12) concerns the difference between the intervention and control arm. It is expected that the virtual conferences at the patient level will improve adherence to international recommendations on diabetes medication for T2D patients and improve the risk profile with a reduction in glycated haemoglobin, blood pressure, and cholesterol. The study design allows for identifying a significant difference between the intervention (n = 15) and control group (n = 15) regarding the three primary clinical outcomes with a power of 0.8870-0.9941. At the general practice level, it is expected that general practitioners and practice staff in the intervention group will improve self-reported diabetes competence and organization. The control arm will get the intervention when the primary intervention ends (months 12-24), and the intervention arm transitions to a maintenance phase. DISCUSSION The potential of virtual conferences is yet to be fully tapped because of methodological limitations. Studies have also not yet systematically evaluated virtual conferences in the context of chronic care using a high-quality research design. Given the nature of this real-life intervention, general practitioners and endocrinologists cannot be blinded to their allocation to either the intervention or comparison arm. TRIAL REGISTRATION ClinicalTrials.gov, United States National Institutes of Health trial ID: NCT05268081. Registered on 4 March 2022.
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Affiliation(s)
- Thim Prætorius
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Anne Sofie Baymler Lundberg
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722 Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Esben Søndergaard
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Søren Tang Knudsen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Annelli Sandbæk
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722 Department of Public Health, Aarhus University, Aarhus, Denmark
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Impact of dedicated neuro-anesthesia management on clinical outcomes in glioblastoma patients: A single-institution cohort study. PLoS One 2022; 17:e0278864. [PMID: 36512593 PMCID: PMC9746943 DOI: 10.1371/journal.pone.0278864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Glioblastomas are mostly resected under general anesthesia under the supervision of a general anesthesiologist. Currently, it is largely unkown if clinical outcomes of GBM patients can be improved by appointing a neuro-anesthesiologist for their cases. We aimed to evaluate whether the assignment of dedicated neuro-anesthesiologists improves the outcomes of these patients. We also investigated the value of dedicated neuro-oncological surgical teams as an independent variable in both groups. METHODS A cohort consisting of 401 GBM patients who had undergone resection was retrospectively investigated. Primary outcomes were postoperative neurological complications, fluid balance, length-of-stay and overall survival. Secondary outcomes were blood loss, anesthesia modality, extent of resection, total admission costs, and duration of surgery. RESULTS 320 versus 81 patients were operated under the anesthesiological supervision of a general anesthesiologist and a dedicated neuro-anesthesiologist, respectively. Dedicated neuro-anesthesiologists yielded significant superior outcomes in 1) postoperative neurological complications (early: p = 0.002, OR = 2.54; late: p = 0.003, OR = 2.24); 2) fluid balance (p<0.0001); 3) length-of-stay (p = 0.0006) and 4) total admission costs (p = 0.0006). In a subanalysis of the GBM resections performed by an oncological neurosurgeon (n = 231), the assignment of a dedicated neuro-anesthesiologist independently improved postoperative neurological complications (early minor: p = 0.0162; early major: p = 0.00780; late minor: p = 0.00250; late major: p = 0.0364). The assignment of a dedicated neuro-oncological team improved extent of resection additionally (p = 0.0416). CONCLUSION GBM resections with anesthesiological supervision of a dedicated neuro-anesthesiologists are associated with improved patient outcomes. Prospective evidence is needed to further investigate the usefulness of the dedicated neuro-anesthesiologist in different settings.
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Pittalis C, Brugha R, Bijlmakers L, Cunningham F, Mwapasa G, Clarke M, Broekhuizen H, Ifeanyichi M, Borgstein E, Gajewski J. Using Network and Complexity Theories to Understand the Functionality of Referral Systems for Surgical Patients in Resource-Limited Settings, the Case of Malawi. Int J Health Policy Manag 2022; 11:2502-2513. [PMID: 35065544 PMCID: PMC9818113 DOI: 10.34172/ijhpm.2021.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A functionally effective referral system that links district level hospitals (DLHs) with referral hospitals (RHs) facilitates surgical patients getting timely access to specialist surgical expertise not available locally. Most published studies from low- and middle-income countries (LMICs) have examined only selected aspects of such referral systems, which are often fragmented. Inadequate understanding of their functionality leads to missed opportunities for improvements. This research aimed to investigate the functionality of the referral system for surgical patients in Malawi, a low-income country. METHODS This study, conducted in 2017-2019, integrated principles from two theories. We used network theory to explore interprofessional relationships between DLHs and RHs at referral network, member (hospital) and community levels; and used principles from complex adaptive systems (CAS) theory to unpack the mechanisms of network dynamics. The study employed mixed-methods, specifically surveys (n=22 DLHs), interviews with clinicians (n=20), and a database of incoming referrals at two sentinel RHs over a six-month period. RESULTS Obstacles to referral system functionality in Malawi included weaknesses in formal coordination structures, notably: unclear scope of practice of district surgical teams; lack of referral protocols; lack of referral communication standards; and misaligned organisational practices. Deficiencies in informal relationships included mistrust and uncollaborative operating environments, undermining coordination between DLHs and RHs. Poor system functionality adversely impacted the quality, efficiency and safety of patient referral-related care. Respondents identified aspects of the district-RH relationships, which could be leveraged to build more collaborative and productive inter-professional relationships in the future. CONCLUSION Multi-level interventions are needed to address failures at both ends of the referral pathway. This study captured new insights into longstanding problems in referral systems in resource-limited settings, contributing to a better understanding of how to build more functional systems to optimise the continuum and quality of surgical care for rural populations in similar settings.
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Affiliation(s)
- Chiara Pittalis
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruairí Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frances Cunningham
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Brisbane, QLD, Australia
| | - Gerald Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Morgane Clarke
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Henk Broekhuizen
- Department of Health and Society, Wageningen University and Research, Wageningen, The Netherlands
| | - Martilord Ifeanyichi
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Mende-Siedlecki P, Rivet EB, Grover AC, Hagiwara N. Making Meaningful Impacts: Centering Breakdowns in Dyadic Communication Processes in Racial Disparities in Surgical Pain Care. Ann Surg 2022; 276:e646-e648. [PMID: 35762595 PMCID: PMC9749421 DOI: 10.1097/sla.0000000000005516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although pain care decisions unfold as a negotiation between patients and surgeons, previous research has examined patient-level and provider-level factors contributing to racial disparities in surgical pain care in isolation. We call for changes in the investigations of such racial disparities at the levels of conceptualization, research design, analysis, and research team composition.
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Affiliation(s)
| | - Emily B. Rivet
- Department of Surgery, School of Medicine, Virginia Commonwealth University
| | - Amelia C. Grover
- Department of Surgery, School of Medicine, Virginia Commonwealth University
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University
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Draganović Š, Offermanns G. Patient safety culture in Austria and recommendations of evidence-based instruments for improving patient safety. PLoS One 2022; 17:e0274805. [PMID: 36251643 PMCID: PMC9576070 DOI: 10.1371/journal.pone.0274805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/03/2022] [Indexed: 11/05/2022] Open
Abstract
This study aimed to investigate the patient safety culture in Austria. We identified factors that contributed to a higher degree of patient safety and subsequently developed evidence-based suggestions on how to improve patient safety culture in hospitals. Moreover, we examined differences in the perception of patient safety culture among different professional groups. This study used a cross-sectional design in ten Austrian hospitals (N = 1,525). We analyzed the correlation between ten patient safety culture factors, three background characteristics (descriptive variables), and three outcome variables (patient safety grade, number of adverse events reported, and influence on patient safety). We also conducted an analysis of variance to determine the differences in patient safety culture factors among the various professional groups in hospitals. The findings revealed that all ten factors have considerable potential for improvement. The most highly rated patient safety culture factors were communication openness and supervisor/manager’s expectations and actions promoting safety; whereas, the lowest rated factor was non-punitive response to error. A comparison of the various professional groups showed significant differences in the perception of patient safety culture between nurses, doctors, and other groups. Patient safety culture in Austria seems to have considerable potential for improvement, and patient safety culture factors significantly contribute to patient safety. We determined evidence-based practices as recommendations for improving each of the patient safety factors.
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Affiliation(s)
- Šehad Draganović
- Department of Organization, Human Resources, and Service Management, Faculty of Management and Economics, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
- * E-mail:
| | - Guido Offermanns
- Department of Organization, Human Resources, and Service Management, Faculty of Management and Economics, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
- Karl Landsteiner Society, Institute for Hospital Organization, Vienna, Austria
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Falzarano F, Cimarolli VR, Minahan J, Horowitz A. Long-Distance Caregivers: What are Their Experiences with Formal Care Providers? Clin Gerontol 2022; 45:1273-1284. [PMID: 32589110 PMCID: PMC7762738 DOI: 10.1080/07317115.2020.1783043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Extensive literature has documented the experiences of informal caregivers and their interactions with formal care providers, yet this research is almost entirely limited to caregivers who live near their care-recipients. This study aims to describe long-distance caregivers' (LDC) experiences (e.g., satisfaction and challenges) with formal care providers. Subgroup differences were examined based on the care-recipient's (CR) dementia status and residential setting (community versus residential care). METHODS Data were collected from 296 LDCs (Mage = 56.64, SD = 12.40) categorized into four subgroups based on CR dementia status and residential setting. Participants rated their overall satisfaction, satisfaction with communication and information, and described challenges faced in their interactions with formal care providers. RESULTS Challenges related to formal care providers were significantly greater and satisfaction significantly lower among LDCs of CRs in residential care, irrespective of dementia status, when compared to LDCs of CRs in the community. CONCLUSIONS This study provides insights into the experiences of a growing segment of the caregiver population managing care from a distance, specifically in their interactions with formal care providers. CLINICAL IMPLICATIONS The results of this study point to the possible necessity for the development of novel interventions to improve and enhance communication and collaboration between FCPs and informal caregivers.
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Affiliation(s)
- Francesca Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Verena R Cimarolli
- LeadingAge LTSS Center @UMass Boston, Washington, District of Columbia, USA
| | - Jillian Minahan
- Psychology Department, Fordham University, Bronx, New York, USA
| | - Amy Horowitz
- Graduate School of Social Services, Fordham University, New York, New York, USA
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Alagoz E, Saucke M, Arroyo N, Ingraham A. Communication During Interhospital Transfers of Emergency General Surgery Patients: A Qualitative Study of Challenges and Opportunities. J Patient Saf 2022; 18:711-716. [PMID: 36170588 PMCID: PMC9523144 DOI: 10.1097/pts.0000000000000979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Transferred emergency general surgery (EGS) patients experience worse outcomes than directly admitted patients. Improving communication during transfers may improve patient care. We sought to understand the nature of and challenges to communication between referring (RP) and accepting (AP) providers transferring EGS patients from the transfer center nurse's (TCN) perspective. METHODS Guided by the Relational Coordination Framework, we interviewed 17 TCNs at an academic medical center regarding (in)efficient and (in)effective communication between RPs and APs. In-person interviews were recorded, transcribed, and managed in NVivo. Four researchers developed a codebook, cocoded transcripts, and met regularly to build consensus and discuss emergent themes. We used data matrices to perform constant comparisons and arrive at higher-level concepts. RESULTS Challenges to ideal communication centered on the appropriateness and completeness of information, efficiency of the conversation, and degree of consensus. Transfer center nurses described that RPs provided incomplete information because of a lack of necessary infrastructure, personnel, or technical knowledge; competing clinical demands; or a fear of the transfer request being rejected. Inefficient communication resulted from RPs being unfamiliar with the information APs expected and the lack of a structured process to share information. Communication also failed when providers disagreed about the necessity of the transfer. Accepting providers diffused tension and facilitated communication by embracing the role of a "coach," negotiating "wait-and-see" agreements, and providing explanations of why transfers were unnecessary. CONCLUSIONS Transfer center nurses described numerous challenges to provider communication. Opportunities for improvement include sharing appropriate and complete information, ensuring efficient communication, and reaching consensus about the course of action.
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Affiliation(s)
- Esra Alagoz
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Wisconsin, USA
| | - Megan Saucke
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Wisconsin, USA
| | - Natalia Arroyo
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Wisconsin, USA
| | - Angela Ingraham
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Wisconsin, USA
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Charns MP, Bolton RE. Commentary on Burns, Nembhard and Shortell, "Integrating network theory into the study of integrated healthcare": Revisiting and extending research on structural and processual factors affecting coordination. Soc Sci Med 2022; 305:115037. [PMID: 35662513 DOI: 10.1016/j.socscimed.2022.115037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
Burns et al.'s innovative recommendation to use social network theory to study integration will contribute to our understanding of how healthcare systems can optimally deliver high quality, coordinated, person-centered care. We discuss three enhancements to this approach. (1) In increasing our attention to social network analysis and processual perspectives, we must not "throw out the baby with the bathwater" and abandon research that includes formal organizational structure. Structure remains an important focus for researchers and healthcare managers, who spend considerable resources on reorganizing. Since there is evidence that formal structure affects social processes and coordination, future research should build on that evidence and investigate how coordination is affected by the segmentation of organizations into units and the structures and processes designed to integrate interdependent work across those units. Conducting network analysis in the context of formal structure can help us better understand how formal structure affects both social networks and coordination. (2) Using multi-level, mixed methods, and qualitative research will be critically important to fully understand how and why formal organizational structure, social networks, and processual dynamics contribute to coordination or fragmentation of care. Because the relationships among these constructs occur not only within, but also across multiple levels, multi-level research is necessary to understand their effects on coordination. In considering the individual level, patients can be studied as a role embedded in networks. In addition, however, we must not lose a focus on patients as people at the center of multi-level networks, whose attitudes, values, preferences and goals may directly affect processual dynamics and coordination of care. (3) Finally, our field lacks precision in nomenclature, specification of levels, and the constructs within them, including ambiguity around even what is meant by "structure" and its variations. Furthermore, different authors use "macro", "meso", and "micro", differently, contributing to confusion in the discourse on organizational phenomena. Greater clarity and consistency in terminology is needed to facilitate research and improve communication across the field.
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Affiliation(s)
- Martin P Charns
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, 02130, USA; School of Public Health, Boston University, Boston, MA, 02118, USA.
| | - Rendelle E Bolton
- VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, MA, 01730, USA; The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, 02453, USA
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House S, Wilmoth M, Stucky C. Job satisfaction among nurses and physicians in an Army hospital: A content analysis. Nurs Outlook 2022; 70:601-615. [DOI: 10.1016/j.outlook.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 10/17/2022]
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Enam A, Dreyer HC, De Boer L. Impact of distance monitoring service in managing healthcare demand: a case study through the lens of cocreation. BMC Health Serv Res 2022; 22:802. [PMID: 35729627 PMCID: PMC9209829 DOI: 10.1186/s12913-022-08164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background There is a consensus among healthcare providers, academics, and policy-makers that spiraling demand and diminishing resources are threatening the sustainability of the current healthcare system. Different telemedicine services are seen as potential solutions to the current challenges in healthcare. This paper aims to identify how distance monitoring services rendered for patients with chronic conditions can affect the escalating demand for healthcare. First, we identify how distance monitoring service changes the care delivery process using the lens of service cocreation. Next, we analyze how these changes can impact healthcare demand using the literature on demand and capacity management. Method In this qualitative study, we explore a distance monitoring service in a primary healthcare setting in Norway. We collected primary data from nurses and general physicians using the semi-structured interview technique. We used secondary patient data collected from a study conducted to evaluate the distance monitoring project. The deductive content analysis method was used to analyze the data. Result This study shows that the application of distance monitoring services changes the care delivery process by creating new activities, new channels for interaction, and new roles for patients, general physicians, and nurses. We define patients’ roles as proactive providers of health information, general physicians’ roles as patient selectors, and nurses’ roles as technical coordinators, data workers, and empathetic listeners. Thus, the co-creation aspect of the service becomes more prominent demonstrating potential for better management of healthcare demand. However, these changes also render the management of demand and resources more complex. To reduce the complexities, we propose three mechanisms: foreseeing and managing new roles, developing capabilities, and adopting a system-wide perspective. Conclusion The main contribution of the paper is that it demonstrates that, although distance monitoring services have the potential to have a positive impact on healthcare demand management, in the absence of adequate managerial mechanisms, they can also adversely affect healthcare demand management. This study provides a means for practitioners to reflect upon and refine the decisions that they make regarding telemedicine deployment and resource planning for delivering care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08164-2.
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Affiliation(s)
- Amia Enam
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, 1365, Gløshaugen, Alfred Getz' vei 3, Trondheim, Norway.
| | - Heidi Carin Dreyer
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, Gløshaugen, Alfred Getz vei 3, Trondheim, Norway
| | - Luitzen De Boer
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, Gløshaugen, Alfred Getz vei 3, Trondheim, Norway
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Tracy TF. In the Footsteps of Mixter: Leadership and Management at the Point of Surgical Care. J Am Coll Surg 2022; 234:1119-1126. [PMID: 35703809 DOI: 10.1097/xcs.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Thomas F Tracy
- From Alpert Medical School, Brown University, Providence, RI
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Dziadzko M, Bouteleux A, Minjard R, Harich J, Joubert F, Pradat P, Pantel S, Aubrun F. Preoperative Education for Less Outpatient Pain after Surgery (PELOPS trial) in orthopedic patients-study protocol for a randomized controlled trial. Trials 2022; 23:422. [PMID: 35598000 PMCID: PMC9123724 DOI: 10.1186/s13063-022-06387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background Successful pain management after outpatient surgery requires proper education leading to correct decisions on the analgesics use at home. Despite different strategies adopted, up to ½ of patients receive little or no information about the treatment of postoperative pain, 1/3 of them are not able to follow postoperative analgesia instructions. This leads to higher rates of unmet needs in pain treatment, post-discharge emergency calls, and readmissions. Structured educational interventions using psychological empowering techniques may improve postoperative pain management. We hypothesize that preoperative education on use of an improved pain scale to make correct pain management decisions will improve the quality of post-operative pain management at home and reduce analgesics-related side effects. Methods A total of 414 patients scheduled for an outpatient orthopedic surgery (knee/shoulder arthroscopic interventions) are included in this randomized (1:1) controlled trial. Patients in the control arm receive standard information on post-discharge pain management. Patients in the experimental arm receive structured educational intervention based on the rational perception of postoperative pain and discomfort (anchoring and improved pain scale), and the proper use of analgesics. There is no difference in post-discharge analgesics regimen in both arms. Patients are followed for 30 days post-discharge, with the primary outcome expressed as total pain relief score at 5 days. Secondary outcomes include the incidence of severe pain during 30 days, changes in sleep quality (Pittsburg Sleep Quality Assessment), and patients’ perception of postoperative pain management assessed with the International Pain Outcomes questionnaire at day 30 post-discharge. Discussion The developed intervention, based on an improved pain scale, offers the advantages of being non-surgery-specific, is easily administered in a short amount of time, and can be delivered individually or in-group, by physicians or nurses. Trial registration ClinicalTrials.govNCT03754699. Registered on November 27, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06387-6.
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Affiliation(s)
- Mikhail Dziadzko
- Department of Anesthesiology and Intensive Care Medicine, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France. .,RESHAPE Lab, U1920, INSERM and Claude Bernard Lyon 1 University, Lyon, France. .,Department of Pain treatment, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Axelle Bouteleux
- Department of Anesthesiology and Intensive Care Medicine, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Raphael Minjard
- Department of Pain treatment, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,Center of Research in Clinical Psychopathology and Psychology (CRPPC) University Lumière Lyon 2, Lyon, France
| | - Jack Harich
- BS Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Fanny Joubert
- Center for Clinical Research, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Pradat
- Center for Clinical Research, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Solene Pantel
- Center for Clinical Research, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Frederic Aubrun
- Department of Anesthesiology and Intensive Care Medicine, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,RESHAPE Lab, U1920, INSERM and Claude Bernard Lyon 1 University, Lyon, France.,Department of Pain treatment, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
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Warfield ME, Lorenz L, Ali HN, Gittell JH. Strengthening Community Participation by People With Disabilities in Community-Based Group Homes Through Innovative Action Research. Front Public Health 2022; 10:747919. [PMID: 35570906 PMCID: PMC9099021 DOI: 10.3389/fpubh.2022.747919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
In the US and beyond, a paradigm shift is underway toward community-based care, motivated by changes in policies, payment models and social norms. A significant aspect of this shift for disability activists and policy makers is ensuring participation in community life for individuals with disabilities living in residential homes. Despite a U.S. government ruling that encourages community participation and provides federal and state funding to realize it, little progress has been made. This study builds on and integrates the expanded model of value creation with relational coordination theory by investigating how the resources and relationships between care providers, adults with disabilities, family members, and community members can be leveraged to create value for residents through meaningful community participation. The purpose of our community case study was to assess and improve the quality of relationships between stakeholder groups, including direct care staff and managers, residents, family members, and the community through an action research intervention. This study took place in a residential group home in a Northeastern US community serving adults with disabilities from acquired brain injury. A pre-test post-test design was used and quantitative assessments of relational coordination were collected through electronic surveys, administered at baseline, and post-intervention. Direct care staff, supervisors, the house manager, and nursing staff completed the survey. Qualitative data were collected through focus groups, change team meetings, and key informant interviews. Direct care staff formed a change team to reflect on their baseline relational coordination data and identified the weak ties between direct care staff, family members, and the community as an area of concern. Staff chose to hold a community-wide open house to provide an opportunity to foster greater understanding among staff, residents, family, and community members. The change team and other staff members coordinated with local schools, business owners, town officials, churches, and neighbors. The event was attended by 50 people, about two-thirds from the community. Following the intervention, there was an increase in staff relational coordination with the community. While statistical significance could not be assessed, the change in staff RC with the community was considered qualitatively significant in that real connections were made with members of the community both directly and afterwards. Despite a small sample size, a residential setting where management was favorable to initiating staff-led interventions, and no comparison or control group, our small pilot study provides tentative evidence that engaging direct care staff in efforts to improve relational coordination with community members may succeed in building relationships that are essential to realizing the goal of greater participation in community life.
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Affiliation(s)
- Marji Erickson Warfield
- Center for Youth and Communities, Lurie Institute on Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Laura Lorenz
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Hebatallah Naim Ali
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Jody Hoffer Gittell
- Institute for Health Systems, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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Agha L, Ericson KM, Geissler KH, Rebitzer JB. Team Relationships and Performance: Evidence from Healthcare Referral Networks. MANAGEMENT SCIENCE 2022; 68:3175-3973. [PMID: 35875601 PMCID: PMC9307056 DOI: 10.1287/mnsc.2021.4091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We examine the teams that emerge when a primary care physician (PCP) refers patients to specialists. When PCPs concentrate their specialist referrals-for instance, by sending their cardiology patients to fewer distinct cardiologists-repeat interactions between PCPs and specialists are encouraged. Repeated interactions provide more opportunities and incentives to develop productive team relationships. Using data from the Massachusetts All Payer Claims Database, we construct a new measure of PCP team referral concentration and document that it varies widely across PCPs, even among PCPs in the same organization. Chronically ill patients treated by PCPs with a one standard deviation higher team referral concentration have 4% lower health care utilization on average, with no discernible reduction in quality. We corroborate this finding using a national sample of Medicare claims and show that it holds under various identification strategies that account for observed and unobserved patient and physician characteristics. The results suggest that repeated PCP-specialist interactions improve team performance.
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Affiliation(s)
| | | | - Kimberley H Geissler
- University of Massachusetts at Amherst School of Public Health and Health Sciences
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House S, Crandell J, Stucky C, Wilmoth M. Relational Coordination Among Military and Civilian Nurses and Physicians in an Army Hospital: Do Demographic Characteristics and Professional Roles Matter? J Nurs Adm 2022; 52:293-300. [PMID: 35467595 DOI: 10.1097/nna.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to explore whether demographic characteristics and professional roles are associated with relational coordination (RC) among nurses and physicians. BACKGROUND The increased race, age, and gender diversity in the nursing and medical workforce raises questions regarding how well nurses and physicians communicate and interact. Relational coordination is a unique framework to enhance teamwork and care coordination among healthcare professionals. METHODS An exploratory cross-sectional study was conducted in a military hospital. The study variables were examined using multiple regression. RESULTS Two-hundred eighty-nine participants completed the survey. Professional role, race, age, gender, and experience were not associated with RC. Rank and education were significantly associated with RC. Enlisted service members reported higher RC between roles, and participants with graduate degrees reported lower RC within roles. CONCLUSION Hospital leaders can implement RC to foster inclusivity and teamwork among healthcare professionals despite demographic characteristics and professional roles.
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Affiliation(s)
- Sherita House
- Author Affiliations: Postdoctoral Fellow (Dr House), Indiana University School of Nursing, Indianapolis; Biostatistician (Dr Crandell) and Executive Vice Dean/Associate Dean, Academic Affairs (Dr Wilmoth), University of North Carolina at Chapel Hill School of Nursing; and Deputy Chief, Center for Nursing Science and Clinical Inquiry (Dr Stucky), Fort Bragg, North Carolina
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Malcolm EJ, Brandon Z, Wilson LE, Shoup JP, King HA, Lewinski A, Greiner MA, Malone S, Miller J, Keenan RT, Tarrant TK, Phinney D, Cho A, Bosworth HB, Shah K. eConsults' Impact on Care Access and Wait Times in Rheumatology. J Clin Rheumatol 2022; 28:147-154. [PMID: 35067514 DOI: 10.1097/rhu.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE A growing number of health systems have implemented eConsults to improve access to specialty advice, but few studies have described their use in rheumatology or impact on visit wait times. We evaluated the uptake of an eConsult program and its impact on wait times for in-person rheumatology visits. METHODS In this quality improvement project, we analyzed electronic health record data from 4 intervention clinics and 4 comparison clinics, 12 months before and after implementation of an eConsult program. We compared median wait time for rheumatology appointments using a pre-post difference-in-differences analysis and quantile regression, adjusting for patient age, race, sex, clinic pair, and primary insurance payer. We also interviewed 11 primary care providers from the intervention clinics and conducted a rheumatology provider focus group (n = 4) to elucidate experiences with the program. RESULTS Rheumatologists recommended management in primary care or referral to another specialty for 41% of eConsults, reducing initial demand for in-person visits. The median wait times dropped in the intervention and the comparison clinics (42 and 25 days, respectively). Intervention clinic median wait time dropped 17 days more than comparison clinics, and this was nonstatistically significant (p = 0.089). eConsults fit provider care tasks best for triage or initial workup for diagnosis, and less well when tests required interpretation, or when back and forth communication was needed to manage the patient's condition. CONCLUSIONS Implementation of eConsults for rheumatology was associated with reduced wait times for rheumatology appointments and supported primary care providers in the triage and workup for a substantial portion of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Julie Miller
- From the Duke University School of Medicine, Durham
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Mohammed ENA. Knowledge, causes, and experience of inter-professional conflict and rivalry among healthcare professionals in Nigeria. BMC Health Serv Res 2022; 22:320. [PMID: 35264179 PMCID: PMC8905746 DOI: 10.1186/s12913-022-07664-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/22/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction The healthcare workforce is regarded as an essential component of any functioning health system, and a lack of optimal collaboration among this group can result to poor quality healthcare services to the population. In Nigerian setting, the health sector is faced with challenges of inter-professional conflict and rivalry. This study aimed at understanding knowledge, causes, and experience of inter-professional conflict and rivalry among healthcare professionals in Nigeria. Methods A cross sectional study was undertaken to administer questionnaires to healthcare personnel in various healthcare facilities in Nigeria. Data were analysed using Statistical Package for Social Sciences. Results A total of 2207 valid responses were received, and male participants were in majority as indicated by 63.7% of the sample. Collectively, doctors and pharmacists represented two-thirds of the sample, and majority of the participants were in the public sector (82.5%). Disparity in salary structure was the highest source of conflict. Whilst almost all the participants indicated that inter-professional rivalry and conflict are prevalent in health sector, about three-quarters of them (73.2%) disagreed that this practice is productive. A considerable number of the respondents had experienced inter-professional conflict and rivalry. Conclusion Evidence from this study can help policymakers in developing framework that can be utilised in addressing rivalry and conflict in the healthcare sector.
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Affiliation(s)
- Elijah N A Mohammed
- Pharmacists Council of Nigeria, Plot 7/9 Industrial Layout, Idu, P.M.B 415 Garki, Abuja, Federal Capital Territory, Nigeria.
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Kazum E, Rath E, Shlaifer A, Sharfman ZT, Martin HD, Eizenberg G, Reider E, Amar E. Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade. Hip Int 2022; 32:265-270. [PMID: 32866047 DOI: 10.1177/1120700020950247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures. METHODS 52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively. RESULTS Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1: 1.1; Group 2: 3.00, p = 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period. CONCLUSIONS This study did not demonstrate significant clinical benefit for patients who receive postoperative intra-articular blockade in addition to preoperative peri-acetabular blockade with bupivacaine 0.5%. We recommend the use of preoperative peri-acetabular bupivacaine blockade without intra-articular blockade postoperatively for pain control in the setting of hip arthroscopy surgery.
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Affiliation(s)
- Efi Kazum
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Shlaifer
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zachary T Sharfman
- Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of MedicineBronx, NY, USA
| | - Hal D Martin
- Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA
| | - Gilad Eizenberg
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Evgeny Reider
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Physician Understanding of and Beliefs About Leadership. J Healthc Manag 2022; 67:120-136. [PMID: 35271522 DOI: 10.1097/jhm-d-21-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOAL Little is known about how physicians conceptualize leadership, what factors influence that conceptualization, and how their conceptualization may impact willingness to lead. We sought to explore how physicians conceptualize leadership. METHODS We conducted an exploratory study of data from a convenience sample of physicians across the United States using an anonymous, 54-item, online survey. We devised a novel leadership resonance score (LRS) to distinguish between leadership and management based on published definitions and prior pilot work. The activities fit on a spectrum from purely leadership actions to purely management actions, and we assigned a numeric value to each activity, allowing for quantification of a respondent's conceptualization of leadership as either more managing or more leading. PRINCIPAL FINDINGS There were 206 respondents (57% male; median age of 43 years [interquartile ranges, IQR: 32, 72]) who completed the survey. Respondents viewed leadership abilities to be highly important for physicians, with a median importance score of 80 (range 0-100, IQR: 50, 100). LRS indicated most physicians conflate leadership and management. Compared to other physicians, respondents assessed their own preparedness for leadership highly (median preparedness score: 70, IQR: 2, 100). Respondents' assessment of their preparedness for leadership was associated with age (Spearman's rho = 0.24, p < .001). LRS was not associated with preparedness for leadership (Spearman's rho = 0.12, p = .08). "Aversion to politics" was the most common barrier to interest in leadership (45%, 93/206), with "loss of personal time" being second (30%, 62/206). APPLICATIONS TO PRACTICE Our data demonstrate physicians misunderstand the differences between leadership and management. We surmise that if an accurate conceptualization of leadership by physicians is associated with increased willingness to lead, then educational activities designed to improve physicians' understanding of leadership could be beneficial in increasing physicians' willingness to take on leadership positions. An increased willingness by physicians to take on leadership roles would ultimately have a positive impact not only on individual patient care, but also on the healthcare system as a whole.
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Itzchakov G, Weinstein N, Cheshin A. Learning to listen: Downstream effects of listening training on employees' relatedness, burnout, and turnover intentions. HUMAN RESOURCE MANAGEMENT 2022. [DOI: 10.1002/hrm.22103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Guy Itzchakov
- Department of Human Services University of Haifa Haifa Israel
| | | | - Arik Cheshin
- Department of Human Services University of Haifa Haifa Israel
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Handley SC, Passarella M, Martin AE, Lorch SA, Srinivas SK, Nembhard IM. Development and Testing of a Survey Measure of Organizational Perinatal
Patient‐Centered
Care Culture. Health Serv Res 2022; 57:806-819. [PMID: 35128641 PMCID: PMC9264452 DOI: 10.1111/1475-6773.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop and test a measure of patient-centered care (PCC) culture in hospital-based perinatal care. DATA SOURCES Data were obtained from US perinatal hospitals: one provided survey development data and 14 contributed data for survey testing. STUDY DESIGN We used qualitative and quantitative methods to develop the mother-infant centered care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach's α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated "MICC culture scores" at the individual, unit, and hospital level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity. DATA COLLECTION Survey development included 12 site-visit observations, one semi-structured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N = 316). PRINCIPAL FINDINGS Using responses from 10 hospitals with ≥4 responses from both units (n = 240), the 20-item MICC culture survey demonstrated reliability (Cronbach's α = 0.95) while capturing all PCC dimensions (subscale Cronbach's α = 0.72-0.87). CFA showed validity through goodness-of-fit (overall chi-square = 214 [p-value = 0.012], SRMR = 0.056, RMSEA = 0.041, CFI = 0.97, and TLI = 0.96). Aggregation statistics (ICCs < 0.05) justify unit- and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (p-values < 0.05), except for neonatal unit scores and RC (p-value = 0.11). CONCLUSIONS The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-reported outcomes. Future studies with patient outcomes will aid identification of improvement opportunities in perinatal care.
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Affiliation(s)
- Sara C. Handley
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Molly Passarella
- Department of Pediatrics Children’s Hospital of Philadelphia Philadelphia PA
| | - Ashley E. Martin
- Department of Pediatrics Children’s Hospital of Philadelphia Philadelphia PA
| | - Scott A. Lorch
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Sindhu K. Srinivas
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
- Department of Obstetrics and Gynecology Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
| | - Ingrid M. Nembhard
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
- The Wharton School University of Pennsylvania Philadelphia PA
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Everett CM, Docherty SL, Matheson E, Morgan PA, Price A, Christy J, Michener L, Smith VA, Anderson JB, Viera A, Jackson GL. Teaming up in primary care: Membership boundaries, interdependence, and coordination. JAAPA 2022; 35:1-10. [PMID: 34985006 PMCID: PMC9869344 DOI: 10.1097/01.jaa.0000805840.00477.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Increased demand for quality primary care and value-based payment has prompted interest in implementing primary care teams. Evidence-based recommendations for implementing teams will be critical to successful PA participation. This study sought to describe how primary care providers (PCPs) define team membership boundaries and coordinate tasks. METHODS This mixed-methods study included 28 PCPs from a primary care network. We analyzed survey data using descriptive statistics and interview data using content analysis. RESULTS Ninety-six percent of PCPs reported team membership. Team models fell into one of five categories. The predominant coordination mechanism differed by whether coordination was required in a visit or between visits. CONCLUSIONS Team-based primary care is a strategy for improving access to quality primary care. Most PCPs define team membership based on within-visit task interdependencies. Our findings suggest that team-based interventions can focus on clarifying team membership, increasing interaction between clinicians, and enhancing the electronic health record to facilitate between-visit coordination.
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Affiliation(s)
- Christine M Everett
- At Duke University in Durham, N.C., Christine M. Everett is an associate professor in the Division of PA Studies in the School of Medicine's Department of Family Medicine and Community Health and the Department of Population Health Sciences, and Sharron L. Docherty is a professor in the School of Nursing. Elaine Matheson is advanced practice provider medical director at Duke Primary Care in Durham. Perri A. Morgan is a professor in the Division of PA Studies in the Department of Family Medicine and Community Health and the Department of Population Health. In the Department of Family Medicine and Community Health, Ashley Price is a research program lead, Jacob Christy is a clinical research coordinator, and Lloyd Michener is a professor emeritus. Valerie A. Smith is an associate professor in the Department of Population Health and in the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Health Care System. John B. Anderson, Jr., is an associate professor in the Department of Family Medicine and Community Health and chief medical officer at Duke Primary Care. Anthony Viera is a professor and chair in the Department of Family Medicine and Community Health. George L. Jackson is a professor in the Department of Population Health, Department of Internal Medicine, Department of Family Medicine and Community Health and at ADAPT. The authors disclose that this research was supported by a grant from the National Institutes of Aging (K01AG53378). The grant funding source had no role in the design, conduct, collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors have disclosed no other potential conflicts of interest, financial or otherwise. The views expressed in this paper are those of the authors and do not reflect the position or policy of Duke University, Duke Health System, the Department of Veterans Affairs, or the US government
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House S, Wilmoth M, Stucky C. Relational coordination as a merger and acquisition framework for healthcare organizations. Nurs Manag (Harrow) 2022; 53:36-42. [PMID: 35105844 DOI: 10.1097/01.numa.0000816256.13974.1b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sherita House
- Sherita House is a postdoctoral fellow at Indiana University School of Nursing in Indianapolis, Ind. Margaret Wilmoth is the executive vice dean of academic affairs at the University of North Carolina at Chapel Hill School of Nursing in Chapel Hill, N.C. Christopher Stucky is the deputy chief of the Center for Nursing Science and Clinical Inquiry at Landstuhl Regional Medical Center in Landstuhl, Germany
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Hajjar L, Kragen B. Timely Communication Through Telehealth: Added Value for a Caregiver During COVID-19. Front Public Health 2021; 9:755391. [PMID: 34912769 PMCID: PMC8666719 DOI: 10.3389/fpubh.2021.755391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: This caregiver case study applies the lens of relational coordination theory (RC) to examine the value of telehealth as a medium of care coordination for a pediatric patient with hypermobile Ehlers-Danlos Syndrome (hEDS) during the COVID-19 pandemic. Background: The COVID-19 pandemic has placed an unprecedented burden on the delivery of healthcare around the globe and has increased the reliance on telehealth services. Delivering telehealth requires a high level of communication and coordination within and across providers as well as between providers, patients and their families. However, it is less clear how telehealth impacts the coordination of care. In this paper, we provide insight into the quality of care coordination between providers and an informal caregiver following policy changes to the provider payment structure in Massachusetts. Methods: This paper employs a single-case, autoethnographic study design where one of the authors uses their experiential insights, as mother of the patient, to inform a wider cultural and political understanding of the shift to remote caregiving for a pediatric patient with hEDS. Data was collected using reflective journaling, interactive interviews, and participant observation and analyzed using content analysis. Results: Findings revealed four interrelating roles of the caregiver including, logistics support, boundary spanner, home health aide, and cultural translator. The adoption of telehealth was associated with improved timeliness and frequency of communication between the caregiver and providers. Findings about the impact of telehealth adoption on accuracy of communication were mixed. Mutual respect between the caregiver and providers remained unchanged during the study period. Conclusions: This paper highlights areas where payer policy may be modified to incentivize timely communication and improve coordination of care through telehealth services. Additional insight from the perspective of an informal caregiver of a patient with a rare chronic disease provides an understudied vantage to the care coordination process. We contribute to relational coordination theory by observing the ways that caregivers function as boundary spanners, and how this process was facilitated by the adoption of telehealth. Insights from this research will inform the development of telehealth workflows to engage caregivers in a way that adds value and strengthens relational coordination in the management of chronic disease.
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Affiliation(s)
- Lauren Hajjar
- Institute for Public Service, Suffolk University, Boston, MA, United States
| | - Ben Kragen
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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Larsen BK, Hean S, Ødegård A. Exploring Norwegian prison frontline workers' perceptions of inter professional collaboration - a pilot study. Int J Prison Health 2021; 18:429-442. [PMID: 34898141 DOI: 10.1108/ijph-08-2021-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Interprofessional collaboration is necessary for handling the complex psychosocial needs of prisoners. This collaboration must be addressed to avoid high recidivism rates and the human and societal costs linked to them. Challenges are exacerbated by a linear approach to handling prisoners' problems, silo working between welfare agencies and professional boundaries between frontline workers. There are few adequate theoretical frameworks and tools to address these challenges in the prison context. The purpose of this study is to explore the perceptions that frontline staff working in Norwegian prison facilities have regarding interprofessional collaboration in providing mental health services for prisoners. DESIGN/METHODOLOGY/APPROACH This study had a non-experimental, cross-sectional design to explore perceptions of interprofessional collaboration in a prison context. Descriptive and multifactorial analyses (exploratory factor analysis and confirmatory factor analysis) were used to explore the data. FINDINGS The analysis showed that three factors, communication, organizational culture and domain, explained 95% of the variance. Results are discussed using relational coordination, as well as the conceptual PINCOM model, as a theoretical framework. ORIGINALITY/VALUE Few studies explicitly explore collaboration between professionals in mental health and prison services despite its being a prerequisite to achieving sufficient services for prisoners. To our knowledge, this current study is one of the first in Norway to explore collaboration in a prison context by analysing quantitative data and focusing on frontline workers perception of the phenomenon.
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Affiliation(s)
- Bjørn Kjetil Larsen
- Molde University College, Molde, Norway and Volda University College, Volda, Norway
| | - Sarah Hean
- University of Stavanger, Stavanger, Norway and Bournemouth University, Poole, UK
| | - Atle Ødegård
- Molde University College, Molde, Norway and Nordland Research Institute, Bodø, Norway
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Merry M, Riddle P, Warren J. A mental models approach for defining explainable artificial intelligence. BMC Med Inform Decis Mak 2021; 21:344. [PMID: 34886856 PMCID: PMC8656102 DOI: 10.1186/s12911-021-01703-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Wide-ranging concerns exist regarding the use of black-box modelling methods in sensitive contexts such as healthcare. Despite performance gains and hype, uptake of artificial intelligence (AI) is hindered by these concerns. Explainable AI is thought to help alleviate these concerns. However, existing definitions for explainable are not forming a solid foundation for this work. METHODS We critique recent reviews on the literature regarding: the agency of an AI within a team; mental models, especially as they apply to healthcare, and the practical aspects of their elicitation; and existing and current definitions of explainability, especially from the perspective of AI researchers. On the basis of this literature, we create a new definition of explainable, and supporting terms, providing definitions that can be objectively evaluated. Finally, we apply the new definition of explainable to three existing models, demonstrating how it can apply to previous research, and providing guidance for future research on the basis of this definition. RESULTS Existing definitions of explanation are premised on global applicability and don't address the question 'understandable by whom?'. Eliciting mental models can be likened to creating explainable AI if one considers the AI as a member of a team. On this basis, we define explainability in terms of the context of the model, comprising the purpose, audience, and language of the model and explanation. As examples, this definition is applied to regression models, neural nets, and human mental models in operating-room teams. CONCLUSIONS Existing definitions of explanation have limitations for ensuring that the concerns for practical applications are resolved. Defining explainability in terms of the context of their application forces evaluations to be aligned with the practical goals of the model. Further, it will allow researchers to explicitly distinguish between explanations for technical and lay audiences, allowing different evaluations to be applied to each.
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Affiliation(s)
- Michael Merry
- School of Computer Science, University of Auckland, Symonds St, Auckland, New Zealand
| | - Pat Riddle
- School of Computer Science, University of Auckland, Symonds St, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Symonds St, Auckland, New Zealand
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