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Hughes AM, Arredondo K, Lester HF, Oswald FL, Pham TND, Jiang C, Hysong SJ. What can we learn from COVID-19?: examining the resilience of primary care teams. Front Psychol 2023; 14:1265529. [PMID: 38078279 PMCID: PMC10703302 DOI: 10.3389/fpsyg.2023.1265529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/06/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction The COVID-19 pandemic continues to place an unprecedented strain on the US healthcare system, and primary care is no exception. Primary care services have shifted toward a team-based approach for delivering care in the last decade. COVID-19 placed extraordinary stress on primary care teams at the forefront of the pandemic response efforts. The current work applies the science of effective teams to examine the impact of COVID-19-a crisis or adverse event-on primary care team resilience. Methods Little empirical research has been done testing the theory of team resilience during an extremely adverse crisis event in an applied team setting. Therefore, we conducted an archival study by using large-scale national data from the Veterans Health Administration to understand the characteristics and performance of 7,023 Patient Aligned Care Teams (PACTs) during COVID-19. Results Our study found that primary care teams maintained performance in the presence of adversity, indicating possible team resilience. Further, team coordination positively predicted team performance (B = 0.53) regardless of the level of adversity a team was experiencing. Discussion These findings in turn attest to the need to preserve team coordination in the presence of adversity. Results carry implications for creating opportunities for teams to learn and adjust to an adverse event to maintain performance and optimize team-member well-being. Teamwork can act as a protective factor against high levels of workload, burnout, and turnover, and should be studied further for its role in promoting team resilience.
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Affiliation(s)
- Ashley M. Hughes
- Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL, United States
- Center of VHA Innovation for Complex, Chronic Healthcare, Edward Hines JR VA Hospital, Hines, IL, United States
| | - Kelley Arredondo
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Veterans’ Health Administration Office of Rural Health’s Veterans Center, White River Junction, VT, United States
- VA South Central Mental Illness Research, Education and Clinical Center (SC MIRECC), a Virtual Center, Houston, TX, United States
| | - Houston F. Lester
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Department of Management, University of Mississippi, Oxford, MS, United States
| | - Frederick L. Oswald
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Trang N. D. Pham
- Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL, United States
| | - Cheng Jiang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Sylvia J. Hysong
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
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Hysong SJ, McGuire AL. Increasing physician participation as subjects in scientific and quality improvement research. BMC Med Ethics 2022; 23:81. [PMID: 35964081 PMCID: PMC9375069 DOI: 10.1186/s12910-022-00817-5] [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: 12/31/2020] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background The twenty-first century has witnessed an exponential increase in healthcare quality research. As such activities become more prevalent, physicians are increasingly needed to participate as subjects in research and quality improvement (QI) projects. This raises an important ethical question: how should physicians be remunerated for participating as research and/or QI subjects? Financial versus non-monetary incentives for participation Research suggests participation in research and QI is often driven by conditional altruism, the idea that although initial interest in enrolling in research is altruistic or prosocial, decisions to actually perform study tasks are cost–benefit driven. Thus, the three models commonly employed to appropriately compensate participants (in-kind compensation such as travel reimbursement, paying market rates for the subject’s time, and paying market rates for the activity asked of the participant) are a poor fit when the participant is a clinician, largely due to the asymmetry between cost and benefit or value to the participant. Non-monetary alternatives such as protected time for participation, continuing education or maintenance of certification credit, or professional development materials, can provide viable avenues for reducing this asymmetry. Conclusion Research and QI are integral to the betterment of medicine and healthcare. To increase physician participation in these activities as the subject of study, new models are needed that clarify the physician’s role in research and QI as a subject. Non-monetary approaches are recommended to successfully and ethically encourage research and QI participation, and thus incorporate these activities as a normal part of the ethical clinician’s and successful learning healthcare system’s world view.
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Affiliation(s)
- Sylvia J Hysong
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. .,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd. (152), Houston, TX, USA.
| | - Amy L McGuire
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
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Hysong SJ, Arredondo K, Hughes AM, Lester HF, Oswald FL, Petersen LA, Woodard L, Post E, DePeralta S, Murphy DR, McKnight J, Nelson K, Haidet P. An evidence-based, structured, expert approach to selecting essential indicators of primary care quality. PLoS One 2022; 17:e0261263. [PMID: 35041671 PMCID: PMC8765671 DOI: 10.1371/journal.pone.0261263] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The purpose of this article is to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and (when appropriate) generate new measures of health care quality, using primary care as a case example. Primary health care is central to the health care system and health of the American public; thus, ensuring high quality is essential. Due to its complexity, ensuring high-quality primary care requires measurement frameworks that can assess the quality of the infrastructure, workforce configurations, and processes available. This paper describes the use of the Productivity Measurement and Enhancement System (ProMES) to compile a targeted set of such measures, prioritized according to their contribution and value to primary care. METHODS We adapted ProMES to select and rank existing primary care measures according to value to the primary care clinic. Nine subject matter experts (SMEs) consisting of clinicians, hospital leaders and national policymakers participated in facilitated expert elicitation sessions to identify objectives of performance, corresponding measures, and priority rankings. RESULTS The SMEs identified three fundamental objectives: access, patient-health care team partnerships, and technical quality. The SMEs also selected sixteen performance indicators from the 44 pre-vetted, currently existing measures from three different data sources for primary care. One indicator, Team 2-Day Post Discharge Contact Ratio, was selected as an indicator of both team partnerships and technical quality. Indicators were prioritized according to value using the contingency functions developed by the SMEs. CONCLUSION Our article provides an actionable guide to applying ProMES, which can be adapted to the needs of various industries, including measure selection and modification from existing data sources, and proposing new measures. Future work should address both logistical considerations (e.g., data capture, common data/programming language) and lingering measurement challenges, such as operationalizating measures to be meaningful and interpretable across health care settings.
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Affiliation(s)
- Sylvia J. Hysong
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Kelley Arredondo
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Ashley M. Hughes
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Center of Innovations in Chronic Complex Healthcare, Edward Hines Jr VA Medical Center Hines, Hines, Illinois, United States of America
| | - Houston F. Lester
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Frederick L. Oswald
- Department of Psychology, Rice University, Houston, Texas, United States of America
| | - Laura A. Petersen
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - LeChauncy Woodard
- Department of Health Systems and Population Health Science, University of Houston College of Medicine, Houston, Texas, United States of America
| | - Edward Post
- VA HSR&D Center for Clinical Management Research, Ann Arbor, Michigan, United States of America
| | - Shelly DePeralta
- VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Daniel R. Murphy
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jason McKnight
- Department of Primary Care and Population Health, Texas A&M Health Science Center, Bryan, Texas, United States of America
| | - Karin Nelson
- VHA Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, Washington, United States of America
| | - Paul Haidet
- Penn State Health West Campus Health and Wellness Center, Hershey, Pennsylvania, United States of America
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