Managing intergroup silos to improve patient flow

Counseling lifestyle medicine in oncology: A qualitative analysis of interprofessional patient-nurse-physician interactions

OBJECTIVES

Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany.

METHODS

Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020.

RESULTS

Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation.

CONCLUSIONS

Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients.

PRACTICE IMPLICATIONS

Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care.

It's a jungle out there: Understanding physician payment and its role in group dynamics

Although collaboration between healthcare professionals is essential for the delivery of effective, efficient, and high-quality care, it remains an ongoing and critical challenge across health systems. As a result, many countries are experimenting with innovative payment and employment models. The literature tends to focus on improving collaboration across organizational and sectoral boundaries, and largely ignores potential barriers to collaborative work between members of the same profession within a single organization. Despite intergroup dynamics and professional boundaries having been shown to restrict patient flow and collaboration between specialties, studies have so far tended to overlook the potential effects of differentiated organizational and payment models on physicians' behaviors and intergroup dynamics. In the present study, we seek to unpack the influence of physicians' payment and employment models on their collaborative behaviors and on intergroup dynamics between specialties, adding to the current scholarship on physician payment and employment by considering how physicians' view and act in response to different structural arrangements. The findings suggest that adopting hybrid models, in which physicians are employed or paid differently within the same organization or practice, creates a bifurcation of the profession whereby physicians across different models are perceived to behave differently and have conflicting professional values. These models are perceived to inhibit collaboration between physicians and complicate hospital governance, restricting the ability to move towards new models of care delivery. These findings can be used as a basis for future work that aims to unpack the reality of physician payment and offer important insights for policies surrounding physician employment.

Clinical leaders crossing boundaries: A study on the role of clinical leadership in crossing boundaries between specialties

BACKGROUND

Due to the growing number of complex (multimorbid) patients, integrating and coordinating care across medical specialties around patient needs is an urgent theme in current health care. Clinical leadership plays an important role in stimulating coordination both within and between specialty groups, which results in better outcomes in terms of job satisfaction and quality of care.

PURPOSE

In this light, this study aims to understand the relation between physicians' clinical leadership and outcomes, focusing on the sequential mediation of relationships and coordination with physicians within their own medical specialty group and from other specialties.

METHODOLOGY

A cross-sectional self-administered survey among physicians in a Dutch hospital (n = 107) was conducted to measure clinical leadership, relational coordination at two levels (medical specialty group and between different specialties), quality of care, and job satisfaction.

RESULTS

Clinical leadership was related to better quality of care through more relational coordination within the medical specialty group. Clinical leadership was related to more job satisfaction through more relational coordination within the medical specialty group, through more relational coordination between specialties, and sequentially through both kinds of relational coordination.

CONCLUSION

Physicians who act as clinical leaders are important for crossing specialist boundaries and increasing care outcomes.

PRACTICAL IMPLICATIONS

To improve multidisciplinary collaboration, managers should encourage clinical leadership and pay attention to the strong relationships between physicians from the same specialty.

"Nurses are every bit of the flow:" Emergency department nurses' conceptualization of patient flow management

AIM

To validate and refine Benjamin and Jacelon's 2021 definition of patient flow management using the experience and knowledge of practicing emergency department nurses.

BACKGROUND

Patient flow requires complex, real-time decision-making to match patients to limited resources and facilitate their movement through care processes. A literature-based concept analysis of patient flow management was first performed in 2021, but the voice of nurses is largely absent from existing patient flow research.

DESIGN

This study employed an expanded concept analysis methodology, as articulated by Kathleen Cowles.

DATA SOURCE

Focus groups of nine emergency nurses were conducted.

RESULTS

Emergency nurses' conceptualization of patient flow management differs from the definition as it has emerged through patient flow literature. Patient flow management is a nurse-driven process that relies on nursing knowledge and the work of all emergency nurses, including bedside nurses. Emergency nurses perceive the ultimate goal of patient flow management to be the collective safety of patients, and they work to promote patient safety within their own scope of responsibility.

CONCLUSION

Understanding patient flow management as a nurse-driven process emphasizes the importance of nurse training and capacity to effective patient flow. Future research should explore the role of emergency nurses as active directors, rather than passive components, of patient flow. More work is needed to investigate this complex nursing task.

Despite Interventions, Emergency Flow Stagnates in Urban Western Canada

Purpose

This paper reports the quantitative component of a mixed-methods study of patient flow in the 10 urban health regions/zones of Western Canada. We assessed whether jurisdictions differed meaningfully in their emergency flow performance, defined as mean emergency department length of stay (ED LOS).

Methods

We used hierarchical linear modelling to compare ED LOS across jurisdictions, based on nationally reported data for 2017 to 2018. We also explored 36-month performance trends. Admitted and discharged patients were analyzed separately.

Results

With the exception of one high performer, no region's performance differed significantly from average for both admitted and discharged patients. The regions' levels of performance remained largely static throughout the study period.

Conclusions

Results precluded any mixed-methods comparison of high- and low-performing regions. However, they converged with our qualitative findings, which suggested that most regions were pursuing similar flow-improvement strategies with limited effectiveness. Deeper changes may be required to address persistent misalignment between capacity and demand.