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Natarajan A, Venegas MG, Mai D, Dowling E, Simon W, Pessegueiro AM, Vangala S, Dermenchyan A. Perceptions and Behaviors of Nurses and Physicians During Bedside Rounds in Medical-Surgical Units. Am J Crit Care 2024; 33:364-372. [PMID: 39217111 DOI: 10.4037/ajcc2024308] [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: 09/04/2024]
Abstract
BACKGROUND Communication and collaboration among health care professionals during bedside rounds improve patient outcomes and nurses' and physicians' satisfaction. OBJECTIVES To determine barriers to nurse-physician communication during bedside rounds and identify opportunities to improve nurse-physician collaboration at an academic medical center. METHODS A survey with Likert-scale and open-ended questions regarding professional attitudes toward nurse-physician communication was administered to 220 nurses and physicians in medical-surgical units to assess perceptions of participation in bedside rounds. After the survey was given, observational data from 1007 bedside rounds were collected via a standardized data collection tool. RESULTS Nurses and physicians perceived different barriers to including nurses in bedside rounds. Nurses most often cited being unaware that bedside rounds were occurring (38 of 46 nurses [83%]); physicians most often cited nurse unavailability (43 of 52 physicians [83%]). Of 1007 observed rounds, 602 (60%) involved in-person contact of nurses and physicians; 418 (69%) of the 602 included a conversation between the nurse and physician about the nurse's concerns. Of 355 rounds with no in-person or telephone contact between nurses and physicians, the medicine team did not contact the nurse in 284 (80%). Conversations about nurses' concerns occurred more often after physician-initiated contacts (73% of 369 contacts) and nurse-initiated contacts (74% of 93 contacts) than after chance encounters (57% of 140 contacts). CONCLUSION Initiating discussions of care between nurses and physicians and discussing nurses' concerns during bedside rounds have multiple benefits.
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Affiliation(s)
- Aishwarya Natarajan
- Aishwarya Natarajan is a medical student at the University of California, San Francisco School of Medicine. She was the executive director of The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative, Department of Medicine, University of California, Los Angeles (UCLA) Health from 2020 to 2021
| | - Manuel G Venegas
- Manuel G. Venegas III is a medical student at the University of Southern California, Keck School of Medicine, Los Angeles. He was a fellow of the THINQ Collaborative in the Department of Medicine at UCLA Health from 2020 to 2022
| | - Dylan Mai
- Dylan Mai is a medical student at the University of California, Irvine School of Medicine. He was director of finance for the THINQ Collaborative in the Department of Medicine at UCLA Health from 2021 to 2022
| | - Erin Dowling
- Erin Dowling is a hospitalist and medical co-director for inpatient quality at the Department of Medicine at UCLA Health
| | - Wendy Simon
- Wendy Simon is a hospitalist and medical co-director for Inpatient quality at the Department of Medicine at UCLA Health
| | - Antonio M Pessegueiro
- Antonio M. Pessegueiro is a hospitalist and director of the medical education pathway for the Department of Medicine at UCLA Health
| | - Sitaram Vangala
- Sitaram (Ram) Vangala is a principal statistician and associate director of the Department of Medicine Biostatistics at UCLA Health
| | - Anna Dermenchyan
- Anna Dermenchyan is interim chief quality officer, Department of Medicine at UCLA Health
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Mullen JE, Reynolds MR. Implementation of Nurse Integrated Rounds Improves Interdisciplinary Communication in the Pediatric Intensive Care Unit. AACN Adv Crit Care 2024; 35:180-186. [PMID: 38848560 DOI: 10.4037/aacnacc2024707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Affiliation(s)
- Jodi E Mullen
- Jodi E. Mullen is Senior Quality Improvement Specialist, Department of Clinical Quality and Patient Safety, UF Health Shands Hospital, 3300 SW Williston Rd, Gainesville, FL 32608
| | - Melissa R Reynolds
- Melissa R. Reynolds is Registered Nurse, Department of Nursing and Patient Services, UF Health Shands Hospital, Gainesville, Florida
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Gunnels MS, Thompson SL, Jenifer Y. Use of Rounding Checklists to Improve Communication and Collaboration in the Adult Intensive Care Unit: An Integrative Review. Crit Care Nurse 2024; 44:31-40. [PMID: 38555969 DOI: 10.4037/ccn2024942] [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: 04/02/2024]
Abstract
BACKGROUND Intensive care units are complex settings that require effective communication and collaboration among professionals in many disciplines. Rounding checklists are frequently used during interprofessional rounds and have been shown to positively affect patient outcomes. OBJECTIVE To identify and summarize the evidence related to the following practice question: In an adult intensive care unit, does the use of a rounding checklist during interprofessional rounds affect the perceived level of staff collaboration or communication? METHODS An integrative review was performed to address the practice question. No parameters were set for publication year or specific study design. Studies were included if they were set in adult intensive care units, involved the use of a structured rounding checklist, and had measured outcomes that included staff collaboration, communication, or both. RESULTS Seven studies with various designs were included in the review. Of the 7 studies, 6 showed that use of rounding checklists improved staff collaboration, communication, or both. These results have a variety of practice implications, including the potential for better patient outcomes and staff retention. CONCLUSIONS Given the complexity of the critical care setting, optimizing teamwork is essential. The evidence from this review indicates that the use of a relatively simple rounding checklist tool during interprofessional rounds can improve perceived collaboration and communication in adult intensive care units.
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Affiliation(s)
- Marshall S Gunnels
- Marshall S. Gunnels is a nurse in the neuroscience intensive care unit at Mayo Clinic, Rochester, Minnesota
| | - Susan L Thompson
- Susan L. Thompson is a clinical nurse specialist in the multispecialty intensive care unit at Mayo Clinic
| | - Yvette Jenifer
- Yvette Jenifer is a clinical nurse specialist at Johns Hopkins Bayview Medical Center and the Doctor of Nursing Practice Advanced Practice project coordinator at Johns Hopkins School of Nursing, Baltimore, Maryland
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Wang J, Kidd VD, Giafaglione B, Strong B, Ohri A, White J, Amin A. Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center. Cureus 2024; 16:e55976. [PMID: 38469366 PMCID: PMC10927320 DOI: 10.7759/cureus.55976] [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] [Accepted: 03/10/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Patient experience is a crucial aspect of healthcare delivery, and it encompasses various elements that contribute to a patient's perception of the care they receive. Patient satisfaction and patient experience are related but distinct concepts. Patient experience focuses on whether specific aspects of care occurred, while patient satisfaction gauges whether patient expectations were met. It goes beyond mere satisfaction and delves into the broader aspects of how patients interact with the healthcare system and the quality of those interactions, with health plans, doctors, nurses, and staff in various healthcare facilities. Other aspects highly valued by patients include elements such as timely access to care and information, good communication with the healthcare team, and friendly staff. Patient experience can influence both the healthcare and financial outcomes of healthcare facilities. It is well understood that positive patient experiences may lead to better care adherence, improved clinical outcomes, enhanced patient safety, and better care coordination. Payers, both public and private, have recognized the importance of patient experience. Improving patient experience benefits healthcare facilities financially by strengthening customer loyalty, building a positive reputation, increasing referrals, and reducing medical malpractice risk and staff turnover. Methodology A multidisciplinary retrospective quality improvement initiative was initiated to effectively improve nurse-physician communication and organizational outcomes in several hospital units. Results Using an innovative staff-developed and driven acronym, IMOMW (I'm on my way), the study demonstrated significant positive outcomes such as increased Epic documentation (Epic Systems Corporation, Verona, Wisconsin, United States) of physician and nursing rounding by 13%, a 10.5% rise in recommend facility net promoter score (NPS) patient experience survey scores, 13.4% increase in physician and nurse team communication, 5.4% increase in nursing communication, and a 5.3% increase in physician communication. Moreover, pilot units outperformed the control group consisting of medical-surgical units located in newer portions of the hospital. Conclusion This quality improvement study demonstrates improved interdisciplinary nurse-physician communication, Epic documentation, and patient experience scores. Further investigation is necessary to better understand the specific factors and/or processes that influence the sustainability of interventions that improve nurse-physician communication and patient experience.
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Affiliation(s)
- Justin Wang
- Clinical Operations, University of California Irvine Medical Center, Orange, USA
| | - Vasco Deon Kidd
- Orthopaedic Surgery, University of California Irvine School of Medicine, Irvine, USA
| | - Brad Giafaglione
- Clinical Operations, University of California Irvine Medical Center, Orange, USA
| | - Brian Strong
- Nursing, University of California Irvine Medical Center, Orange, USA
| | - Anuj Ohri
- Hospital Medicine, University of California Irvine School of Medicine, Irvine, USA
| | - Janice White
- Nursing - Medical Surgical/Telemetry, University of California Irvine Medical Center, Orange, USA
| | - Alpesh Amin
- Medicine, University of California Irvine School of Medicine, Irvine, USA
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Huang KX, Chen CK, Pessegueiro AM, Dowling E, Dermenchyan A, Natarajan A, Krishnan D, Vangala SS, Simon WM. Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds. J Hosp Med 2023; 18:888-895. [PMID: 37584618 DOI: 10.1002/jhm.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Effective team communication during interdisciplinary rounds (IDRs) is a hallmark of safe, efficient, patient-centered care. However, there is limited understanding of optimal IDR structures and procedures. OBJECTIVE This study aimed to analyze direct observations of physician and nurse interactions during bedside IDR to identify behaviors associated with increased interprofessional communication. DESIGNS, SETTINGS AND PARTICIPANTS Trained observers audited general medicine ward rounds at an academic medical center using a standardized tool to record physician and nurse behavior and communication in 1007 patient encounters in October 2019 to March 2020. RESULTS There were significant differences in physician and nurse interaction time among physicians with different levels of training, with attendings demonstrating higher interaction time than residents (5.4 ± 4.6 vs. 4.3 ± 3.7 min, p = .02) and interns or medical students (3.0 ± 3.2 min, p = .002). Attendings were more likely to initiate a conversation about nurse concerns (76.9%) compared to residents (67.9%) and interns or medical students (59.3%, p = .03). Early nurse participation in bedside visits was associated with increased physician and nurse interaction time (5.0 ± 4.6 vs. 1.9 ± 1.7 min, p < .001) and physician initiative to ask about nurse concerns (74.8% vs. 64.3%, p = .04). In addition, physician initiative to ask the nurse for concerns rather than waiting for the nurse to offer concerns without being prompted was associated with a subsequent conversation about those concerns (74.5% vs. 61.8%, p < .001) and the physician asking about patient or family concerns (94.2% vs. 88.4%, p = .01). CONCLUSIONS Implementing IDR structures and procedures that promote attending physician involvement, physician initiative, and early nurse participation could optimize interdisciplinary communication and quality of care.
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Affiliation(s)
- Kelly X Huang
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Caitlin K Chen
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | | | - Erin Dowling
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Anna Dermenchyan
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | | | - Dhwani Krishnan
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Sitaram S Vangala
- Department of Medicine Statistics Core, UCLA Health, Los Angeles, California, USA
| | - Wendy M Simon
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
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Lainidi O, Jendeby MK, Montgomery A, Mouratidis C, Paitaridou K, Cook C, Johnson J, Karakasidou E. An integrative systematic review of employee silence and voice in healthcare: what are we really measuring? Front Psychiatry 2023; 14:1111579. [PMID: 37304444 PMCID: PMC10248453 DOI: 10.3389/fpsyt.2023.1111579] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.
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Affiliation(s)
- Olga Lainidi
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | | | - Anthony Montgomery
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | | | | | - Clare Cook
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, United Kingdom
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Ageel M, Shbeer A. Assessment of the Critical Care Work Environment of Intensive Care Unit Nurses in Saudi Arabia. Risk Manag Healthc Policy 2022; 15:2413-2420. [PMID: 36582743 PMCID: PMC9793786 DOI: 10.2147/rmhp.s391698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background Nurses play a major role in the delivery of complex and challenging critical care in intensive care units (ICUs). Assessment of work environment is essential indicators of hospital management and can be applied to workforce planning and identifying nursing profession needs. The American Association of Critical-Care Nurses (AACN) recognized six standards for a healthy work environment and developed the Healthy Work Environment Assessment Tool (HWEAT). The aim of this study was to assess the work environment of ICU nurses in Jazan, Saudi Arabia. Methods This cross-sectional study was conducted at public and private hospitals. Data were collected using a self-administered questionnaire that included the sociodemographic characteristics and the AACN HWEAT. Data were analyzed to obtain descriptive and inferential statistics. The Mann-Whitney U and Kruskal-Wallis tests were employed to compare demographic data, on the basis of the overall mean HWEAT score. Results The study participants were 238 ICU nurses, who were predominantly female (83%). The mean overall HWEAT score was 3.55±1.03, which is within the "good" range, and was higher for male nurses (3.66), nurses aged ≥41 years (3.76), and nurses with postgraduate education (4.04), work experiences of >10 years (3.63), and alternate work shifts (3.6). Nurses in private hospitals had significantly higher overall scores than nurses in public hospitals (3.83 vs 3.19, P<0.001). All HWEAT standards ("effective decision-making", "authentic leadership", "appropriate staffing", "true collaboration", "skilled communication", and "meaningful recognition") were rated as good (mean range, 3.43-3.63). Conclusion The study results could assist hospitals in prioritizing the adoption of AACN HWE standards. A target benchmark of "good" was established for both the overall score and each standard, which indicates a good work environment as perceived by ICU nurses. In Addition, interpersonal differences should be considered when developing improvement initiatives.
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Affiliation(s)
- Mohammed Ageel
- College of Medicine, Jazan University, Jazan, Saudi Arabia,Correspondence: Mohammed Ageel, College of Medicine, Jazan University, Jazan, Saudi Arabia, Tel +966505769570, Email
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Ageel M, Shbeer A. Exploring Occupational Stress Among Intensive Care Units Nurses in Saudi Arabia Using the Health and Safety Executive Management Standards Indicator Tool. NURSING: RESEARCH AND REVIEWS 2022. [DOI: 10.2147/nrr.s386670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Arora VM, Klein A, Coe A, Patel A, Albert D, Blanchard A. Implementation and evaluation of IGNITE (Improving GME Nursing Interprofessional Team Experiences) to improve care in an academic health system. Healthcare (Basel) 2022; 10:100642. [DOI: 10.1016/j.hjdsi.2022.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/22/2022] [Accepted: 07/02/2022] [Indexed: 11/04/2022] Open
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Merriman C, Freeth D. Conducting a good ward round: How do leaders do it? J Eval Clin Pract 2022; 28:411-420. [PMID: 35220643 PMCID: PMC9305892 DOI: 10.1111/jep.13670] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Ward rounds (WRs) are complex social processes. Done well, WR discussions and decisions contribute to timely, safe, effective progression of care. However, literature highlights medical dominance; marginalisation or absence of other perspectives, safety risks and suboptimal resource use. This study examined leadership behaviours and what supported good interprofessional WRs, defined as enabling interprofessional collaboration and decision making which progresses patient care in a safe and timely manner. Deepening appreciation of this art should support learning and improvements. METHOD Mixed-method appreciative inquiry (AI) into how WRs go well and could go well more often. CONTEXT daily interprofessional consultant-led WRs in a large adult critical care unit. DATA ethnographic and structured observations (73 h, 348 patient reviews); AI conversations and interviews (71 participants). Inductive iterative analysis shaped by Activity Theory. PARTICIPANTS 256 qualified healthcare professionals working in the unit. RESULTS Leadership of good WRs supported (and minimized contradictions to): making good use of expertise and time, and effective communication. These three key activities required careful and skilled orchestration of contributions to each patient review, which was achieved through four distinct phases (a broadly predictable script), ensuring opportunity to contribute while maintaining focus and a productive pace. This expertise is largely tacit knowledge, learnt informally, which is difficult to analyse and articulate oneself, or explain to others. To make this easier, and thus support learning, we developed the metaphor of a conductor leading musicians. CONCLUSIONS Whilst everyone contributes to the joint effort of delivering a good WR, WR leadership is key. It ensures effective use of time and diverse expertise, and coordinates contributions rather like a conductor working with musicians. Although WR needs and approaches vary across contexts, the key leadership activities we identified are likely to transfer to other settings.
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Affiliation(s)
- Clair Merriman
- Insitute of Health Sciences Education, Queen Mary University of London, London, UK.,Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Della Freeth
- Insitute of Health Sciences Education, Queen Mary University of London, London, UK.,Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Education Directorate, Royal College of Physicians, London, UK
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Moyse T, Yates E, Fajardo V, Glorioso-Wible J, Schaffer JL, Nystrom LM, Siedlecki SL. From the Patient's Perspective: Orthopedic Virtual Rounds. J Patient Exp 2021; 8:23743735211065269. [PMID: 34901412 PMCID: PMC8655446 DOI: 10.1177/23743735211065269] [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: 11/15/2022] Open
Abstract
Interdisciplinary rounding on hospital inpatients is an integral part of providing high-quality, safe patient care. As orthopedic groups have grown and geographic coverage increased, surgeons are challenged to make in-person rounds on their patients every day given time constraints and physical distances. Virtual technology is being used in multiple healthcare settings to provide patients with the opportunity to connect with health care professionals when in-person options are not available. The purpose of this study was to explore the patient experience of virtual inpatient rounding. Using digital communication technology, virtual rounds were conducted by having the surgeon connect via their mobile device or laptop to the nursing unit's communication tablet. Twenty-seven patient interviews were digitally recorded and qualitatively analyzed. Results demonstrated that virtual rounds provided a positive patient experience for many. Most patients felt that virtual rounds were a good alternative when in-person rounds are not possible. Dissatisfaction was related to feeling “rushed” by the surgeon. This feedback can be used to better prepare patients and providers for virtual rounds and to enhance virtual technologies.
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Affiliation(s)
- Tonya Moyse
- Cleveland Clinic, Cleveland, OH, USA
- Tonya Moyse, Cleveland Clinic, 9500 Euclid Avenue, H70-46, Cleveland, OH, 44195, USA.
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Hower KI, Vennedey V, Hillen HA, Stock S, Kuntz L, Pfaff H, Pförtner TK, Scholl I, Ansmann L. Is Organizational Communication Climate a Precondition for Patient-Centered Care? Insights from a Key Informant Survey of Various Health and Social Care Organizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218074. [PMID: 33147837 PMCID: PMC7662290 DOI: 10.3390/ijerph17218074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
Abstract
Health and social care organizations are under pressure of organizing care around patients' needs and preferences while complying with regulatory frameworks and constraint resources. To implement patient-centered care in health and social care organizations successfully, particular organizational preconditions need to be considered. Findings on the implementation of patient-centered care and its preconditions are rare and insufficiently account for the organizational context to explain differences. This study examines the implementation status of patient-centered care in diverse health and social care organizations and analyzes the communication climate as a precondition of successful implementation. In a cross-sectional postal key informant survey, decision makers in the highest leading positions from six different types of health and social care organizations in Cologne, Germany, were surveyed using a paper-pencil questionnaire. Patient-centered care implementation was operationalized by three categories (principles, activities, and enablers) including 15 dimensions. Organizational communication climate was operationalized by aspects of open and constructive communication, cooperation, and inclusion. Out of 1790 contacted organizations, 237 participated. In the analyses, 215 complete datasets were included. Descriptive analyses, Kruskal-Wallis test, post hoc pair-wise test, and linear regression modeling were performed. Results show that the implementation status of patient-centered care was perceived as high but differed between the various types of organizations and in terms of patient-centered care categories. Organizational communication climate was significantly associated with the implementation of patient-centered care. Especially in organizations with a higher number of employees, strategies to create a positive communication climate are needed to create a precondition for patient-centered care.
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Affiliation(s)
- Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, 50933 Cologne, Germany; (H.P.); (T.-K.P.)
- Correspondence:
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), 50935 Cologne, Germany; (V.V.); (S.S.)
| | - Hendrik Ansgar Hillen
- Department of Business Administration and Health Care Management, University of Cologne, 50931 Cologne, Germany; (H.A.H.); (L.K.)
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), 50935 Cologne, Germany; (V.V.); (S.S.)
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, 50931 Cologne, Germany; (H.A.H.); (L.K.)
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, 50933 Cologne, Germany; (H.P.); (T.-K.P.)
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, 50933 Cologne, Germany; (H.P.); (T.-K.P.)
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Lena Ansmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany;
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Dinius J, Philipp R, Ernstmann N, Heier L, Göritz AS, Pfisterer-Heise S, Hammerschmidt J, Bergelt C, Hammer A, Körner M. Inter-professional teamwork and its association with patient safety in German hospitals-A cross sectional study. PLoS One 2020; 15:e0233766. [PMID: 32470083 PMCID: PMC7259596 DOI: 10.1371/journal.pone.0233766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 05/13/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Inter-professional teamwork is a prominent factor in quality of care and may lead to improved patient safety. Although team members' points of view are highly relevant when trying to improve inpatient procedures, there is a lack of systematic assessment of their perceptions. Therefore, study aims were to explore inter-professional teamwork, safety-related behavior, and patient safety in German hospitals from team members' point of view. Furthermore, we wanted to examine the association between inter-professional teamwork and safety-related behavior as well as the association between inter-professional teamwork and patient safety. METHODS We used cross-sectional pre-intervention data of a multicenter longitudinal study (German KOMPAS project). We gathered descriptive statistics for sample characteristics and to describe the current state of inter-professional teamwork, safety-related behavior, and patient safety. We used one-way variance analyses to assess differences between groups, and linear regression analyses to examine the association between inter-professional teamwork and the outcomes safety-related behavior, and patient safety. RESULTS 326 inpatient care team members participated in the study. Participants perceived a moderate to high level of inter-professional teamwork, and a moderate level of patient safety. Moreover, they reached rather high values in safety-related behavior. Professional group, work experience, and period of employment had an impact on the perceptions of inter-professional teamwork, and patient safety. Higher inter-professional teamwork was associated with better patient safety. We did not find an association between inter-professional teamwork and safety-related behavior. CONCLUSIONS Based on the association between inter-professional teamwork and patient safety, we recommend the implementation of team interventions. Because professional group, period of employment, and work experience had an impact on the perceptions of inter-professional teamwork and patient safety, we suggest future qualitative research to explore reasons for caregivers' critical evaluation. Moreover, we recommend longitudinal studies to reveal causal relationships, and subsequently to determine areas of improvement for a safer health care.
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Affiliation(s)
- Julia Dinius
- Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs-University, Freiburg, Germany
| | - Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Ernstmann
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Lina Heier
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Anja S. Göritz
- Occupational and Consumer Psychology, Institute of Psychology, Albert-Ludwigs-University, Freiburg, Germany
| | | | | | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antje Hammer
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs-University, Freiburg, Germany
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14
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Kang XL, Brom HM, Lasater KB, McHugh MD. The Association of Nurse-Physician Teamwork and Mortality in Surgical Patients. West J Nurs Res 2020; 42:245-253. [PMID: 31215348 PMCID: PMC6920603 DOI: 10.1177/0193945919856338] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study we describe nurse-physician teamwork, estimate its association with surgical patient outcomes (30-day mortality and failure-to-rescue), and determine whether these relationships depend upon other modifiable hospital nursing characteristics (nurse staffing and education levels) known to be associated with patient outcomes. This cross-sectional analysis included linked data from 29,391 nurses representing 665 acute care hospitals and 1,321,904 adult patients who underwent a general surgical, vascular, or orthopedic procedure. Surgical patients cared for in hospitals with better nurse-physician teamwork had significantly lower odds of 30-day mortality (odds ratio [OR] = 0.95) and failure-to-rescue (OR = 0.95). In addition, the odds of death and failure-to-rescue were lower for patients in hospitals with both higher nurse-physician teamwork and more favorable patient-to-nurse staffing ratios. Similar trends were observed related to nursing education levels. Improving interprofessional teamwork is one strategy to improve patient outcomes with the added importance of also considering additional features of their nursing workforce.
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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16
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Sang AX, Tisdale RL, Nielsen D, Loica-Mersa S, Miller T, Chong I, Shieh L. How Much Time are Physicians and Nurses Spending Together at the Patient Bedside? J Hosp Med 2019; 14:468-473. [PMID: 31112496 DOI: 10.12788/jhm.3204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bedside rounding involving both nurses and physicians has numerous benefits for patients and staff. However, precise quantitative data on the current extent of physician-nurse (MD-RN) overlap at the patient bedside are lacking. OBJECTIVE This study aimed to examine the frequency of nurse and physician overlap at the patient beside and what factors affect this frequency. DESIGN This is a prospective, observational study of time-motion data generated from wearable radio frequency identification (RFID)-based locator technology. SETTING Single-institution academic hospital. MEASUREMENTS The length of physician rounds, frequency of rounds that include nurses simultaneously at the bedside, and length of MD-RN overlap were measured and analyzed by ward, day of week, and distance between patient room and nursing station. RESULTS A total of 739 MD rounding events were captured over 90 consecutive days. Of these events, 267 took place in single-bed patient rooms. The frequency of MD-RN overlap was 30.0%, and there was no statistical difference between the three wards studied. Overall, the average length of all MD rounds was 7.31 ± 0.58 minutes, but rounding involving a bedside nurse lasted longer than rounds with MDs alone (9.56 vs 5.68 minutes, P < .05). There was no difference in either the length of rounds or the frequency of MD-RN overlap between weekdays and weekends. Finally, patient rooms located farther away from the nursing station had a lower likelihood of MD-RN overlap (Pearson's r = -0.67, P < .05). CONCLUSION RFID-based technology provides precise, automated, and high-throughput time-motion data to capture nurse and physician activity. At our institution, 30.0% of rounds involve a bedside nurse, highlighting a potential barrier to bedside interdisciplinary rounding.
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Affiliation(s)
- Adam X Sang
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Rebecca L Tisdale
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Derek Nielsen
- Clinical Technology, Stanford Hospital and Clinics, Stanford, California
| | - Silvia Loica-Mersa
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Travis Miller
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ian Chong
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Lisa Shieh
- Medical Director for Quality, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Govindarajan R. Moving on from CUSP to CUP: empowering multidisciplinary teams and integrating them in the management structure of hospital organization. J Multidiscip Healthc 2019; 12:257-268. [PMID: 31114217 PMCID: PMC6489672 DOI: 10.2147/jmdh.s198494] [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: 12/17/2018] [Accepted: 02/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The functional role of Comprehensive Unit-based Safety Program (CUSP) teams was extended to empower them and make them a part of the organizational management. Purpose: These improvements in the functional roles of CUSP were made with the objective of solving two structural issues, namely, departmentalization and compartmentalization present in health care organizations. Methods: The following were three improved functional roles: 1) instead of just being a reactive mechanism to implement improvements based on real safety issues, they also carried out risk analysis and implemented preventive actions proactively; 2) instead of focusing only on safety, they controlled all results such as safety, quality, treatment effectiveness and timeliness of their respective process units, using a series of Key Performance Indicators; and 3) instead of being a supplementary multidisciplinary team parallel to the organization´s departmentalized management structure, they were made to participate in the decision-making structure, representing their respective process units. These teams represented different process units and were named as Comprehensive Unit-based Process (CUP) teams. Results: The CUP structural design changed the dynamics of the organization: 1) it integrated members of different disciplines, especially physicians and nurses, and integrated them into a team with a shared goal, making internal communication and teamwork a "systemic" requirement; 2) it disabled the middle-level managers to represent the interests of specific knowledge-based groups such as physician departments or nursing areas while making decisions; and 3) it reassigned middle-level managers the task of representing different CUPs, making each manager responsible for a process unit, thus ensuring control over the results of multidisciplinary activities. Conclusion: The new organizational structure put burden on the system, not on its people, as it made multidisciplinary communication and teamwork to be the rule of the game, allowing patient-centered health care.
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Affiliation(s)
- Rajaram Govindarajan
- Operations Management, Innovation and Data Sciences, ESADE Business School, 08001Barcelona, Spain
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18
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Ratelle JT, Sawatsky AP, Kashiwagi DT, Schouten WM, Erwin PJ, Gonzalo JD, Beckman TJ, West CP. Implementing bedside rounds to improve patient-centred outcomes: a systematic review. BMJ Qual Saf 2018; 28:317-326. [PMID: 30224407 DOI: 10.1136/bmjqs-2017-007778] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Bedside rounds (BR) have been proposed as an ideal method to promote patient-centred hospital care, but there is substantial variation in their implementation and effects. Our objectives were to describe the implementation of BR in hospital settings and determine their effect on patient-centred outcomes. METHODS Data sources included Ovid MEDLINE, Ovid Embase, Scopus and Ovid Cochrane Central Registry of Clinical Trials from database inception through 28 July 2017. We included experimental studies comparing BR to another form of rounds in a hospital-based setting (ie, medical/surgical unit, intensive care unit (ICU)) and reporting a quantitative patient-reported or objectively measured clinical outcome. We used random effects models to calculate pooled Cohen's d effect size estimates for the patient knowledge and patient experience outcome domains. RESULTS Twenty-nine studies met inclusion criteria, including 20 from adult care (17 non-ICU, 3 ICU), and nine from paediatrics (5 non-ICU, 4 ICU), the majority of which (n=23) were conducted in the USA. Thirteen studies implemented BR with cointerventions as part of a 'bundle'. Studies most commonly reported outcomes in the domains of patient experience (n=24) and patient knowledge (n=10). We found a small, statistically significant improvement in patient experience with BR (summary Cohen's d=0.09, 95% CI 0.04 to 0.14, p<0.001, I2=56%), but no significant association between BR and patient knowledge (Cohen's d=0.21, 95% CI -0.004 to -0.43, p=0.054, I2=92%). Risk of bias was moderate to high, with methodological limitations most often relating to selective reporting, low adherence rates and missing data. CONCLUSIONS BR have been implemented in a variety of hospital settings, often 'bundled' with cointerventions. However, BR have demonstrated limited effect on patient-centred outcomes.
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Affiliation(s)
- John T Ratelle
- Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam P Sawatsky
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Will M Schouten
- Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jed D Gonzalo
- General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Thomas J Beckman
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin P West
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
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Baik D, Abu-Rish Blakeney E, Willgerodt M, Woodard N, Vogel M, Zierler B. Examining interprofessional team interventions designed to improve nursing and team outcomes in practice: a descriptive and methodological review. J Interprof Care 2018; 32:719-727. [PMID: 30084723 DOI: 10.1080/13561820.2018.1505714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Effective interprofessional (IP) team-based care is critical to enhance the delivery of efficient care and improve nursing and IP team outcomes. This study aims to review the most recent IP team intervention studies that focused on outcomes related to nursing and IP teams. PubMed, CINAHL, PsycINFO, and Embase were searched for existing literature published between January 2011 and December 2016. The search strategy was developed through both literature review and consultation with a health sciences librarian. This review included IP team intervention studies published in peer-reviewed journals and written in English. Studies were included if they conducted an IP team intervention for healthcare teams that include nurses and examined outcomes related to nursing and the IP teams. Based on inclusion and exclusion criteria, 41 articles were included for the final review. Two authors extracted data on the characteristics of IP team interventions, assessment methods, and their outcomes related to nursing and IP teams using a data abstraction tool developed by the research team. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. We found that most of the included studies were conducted in the US and on inpatient units. A quasi-experimental study design was most commonly employed. Most studies conducted IP team training such as TeamSTEPPS® as a one-time activity. The most common outcomes measured were attitudes or perceptions about IP teamwork or communication, followed by patient-related outcomes, and knowledge or skills about IP competencies. The quality of the included studies was generally low. The findings from this review will contribute to understanding the characteristics of current IP intervention studies and call for IP scholars to design more rigorous yet realistic IP intervention studies.
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Affiliation(s)
- Dawon Baik
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Mayumi Willgerodt
- School of Nursing and Health Studies, University of Washington Bothell, WA, USA
| | - Nicole Woodard
- Center for Health Sciences Interprofessional Education, Research and Practice, University of Washington, Seattle, WA, USA
| | - Mia Vogel
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Brenda Zierler
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
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20
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Lingard L, Sue-Chue-Lam C, Tait GR, Bates J, Shadd J, Schulz V. Pulling together and pulling apart: influences of convergence and divergence on distributed healthcare teams. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1085-1099. [PMID: 28116565 PMCID: PMC5668127 DOI: 10.1007/s10459-016-9741-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/20/2016] [Indexed: 05/19/2023]
Abstract
Effective healthcare requires both competent individuals and competent teams. With this recognition, health professions education is grappling with how to factor team competence into training and assessment strategies. These efforts are impeded, however, by the absence of a sophisticated understanding of the the relationship between competent individuals and competent teams . Using data from a constructivist grounded theory study of team-based healthcare for patients with advanced heart failure, this paper explores the relationship between individual team members' perceived goals, understandings, values and routines and the collective competence of the team. Individual interviews with index patients and their healthcare team members formed Team Sampling Units (TSUs). Thirty-seven TSUs consisting of 183 interviews were iteratively analysed for patterns of convergence and divergence in an inductive process informed by complex adaptive systems theory. Convergence and divergence were identifiable on all teams, regularly co-occurred on the same team, and involved recurring themes. Convergence and divergence had nonlinear relationships to the team's collective functioning. Convergence could foster either shared action or collective paralysis; divergence could foster problematic incoherence or productive disruption. These findings advance our understanding of the complex relationship between the individual and the collective on a healthcare team, and they challenge conventional narratives of healthcare teamwork which derive largely from acute care settings and emphasize the importance of common goals and shared mental models. Complex adaptive systems theory helps us to understand the implications of these insights for healthcare teams' delivery of care for the complex, chronically ill.
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Affiliation(s)
- L Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Room 112, Health Sciences Addition, London, ON, N6A 5C1, Canada.
| | - C Sue-Chue-Lam
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - G R Tait
- Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, Canada
| | - J Bates
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - J Shadd
- Division of Palliative Care, Department of Family Medicine, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - V Schulz
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, London, ON, Canada
- Western University, London, ON, Canada
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Tuite DR, Healy D, MacKinnon TS. Implementing interprofessional bedside rounding at the prequalification stage. J Multidiscip Healthc 2016; 9:557-558. [PMID: 27822056 PMCID: PMC5087776 DOI: 10.2147/jmdh.s121999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Daniel R Tuite
- Faculty of Medicine, Brighton and Sussex Medical School, Brighton
| | - David Healy
- Faculty of Medicine, Brighton and Sussex Medical School, Brighton
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