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Burner A, Wahl C, Struwe L. Factors to Improve Reverse Integration: A Mixed Method Embedded Design Study. Community Ment Health J 2024; 60:525-535. [PMID: 37985631 DOI: 10.1007/s10597-023-01203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
Individuals with serious mental illness face inequity in receiving primary care services. The Substance Abuse and Mental Health Services Administration (SAMHSA) granted funds to Certified Community Behavioral Health Clinics (CCBHC) to integrate primary care and behavioral health specialties to increase access to care. This mixed method study aimed to measure the SAMHSA-defined levels of reverse integration at a CCBHC at one point in time. Providers and patients provided feedback through semi-structured interviews. Qualitative data was investigated for themes, while the quantitative data was run through inferential analysis with the Kruskal Wallis H test. Clinically meaningful results showed people using primary care at the integrated clinic were more satisfied and were more apt to continue seeing their current providers than those receiving non-integrated care. The CCBHC achieved level 4 integration; factors investigated confirmed proximity alone does not necessitate integration without effective communication and implementation of practice changes.
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Affiliation(s)
- Aundrea Burner
- University of Nebraska Medical Center, 550 N 19th Street, Lincoln, NE, 68588-0620, USA.
| | - Carol Wahl
- University of Nebraska Medical Center, 550 N 19th Street, Lincoln, NE, 68588-0620, USA
| | - Leeza Struwe
- University of Nebraska Medical Center, 550 N 19th Street, Lincoln, NE, 68588-0620, USA
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Rock LK, Morse KJ, Eppich W, Rudolph JW. Transforming Team Culture: A Case Study From Critical Care. Chest 2023; 163:1448-1457. [PMID: 36642367 DOI: 10.1016/j.chest.2022.12.046] [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: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
Interprofessional team conflict amplifies division and impedes patient care. Normal differences of opinion escalate to frank conflicts when members respond with indignation or resentment. These behaviors engender a workplace culture that degrades collaborative clinical management and patient safety. We describe the impacts of dysfunctional team culture along with interventions that can lead to more productive teams. In our case study, an interprofessional group of critical care clinicians recognized that their interactions impaired collaborative care and requested support. Two experts, a nurse and a physician, facilitated two 2-h workshops with 18 critical care physicians, nurses, and fellows to begin transforming their dysfunctional unit culture. After establishing psychological safety, facilitators introduced the learning pathways grid to explore (1) how faulty assumptions lead to dysfunctional interactions and suboptimal results and (2) how new assumptions informed by new insights enable teams to redesign their interactions. Through reflection and analysis, clinicians concluded that understanding other clinicians' goals and perspectives benefits patients and families, helps clinicians feel valued, and fosters mutual trust. This exercise supports interprofessional teams to transform dysfunctional interactions by helping team members to develop a mindset of humility and inquiry and to remind themselves about the good intentions in others. To address conflict, we offer a conversational approach grounded in curiosity, respect, and transparency. Ultimately, the most important communication strategy for effective critical care is caring about the perspectives and experiences of other members of the interprofessional team.
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Affiliation(s)
- Laura K Rock
- Beth Israel Deaconess Medical Center, Harvard Medical School, Center for Medical Simulation, Boston, MA.
| | - Kate J Morse
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jenny W Rudolph
- Center for Medical Simulation, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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3
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Sigmon LB, Woodard EK. What Patients Think: A Study Examining Perceptions of Teamwork, Self-Management, and Quality of Life of Patients Diagnosed With Diabetic Foot Ulceration. Clin Diabetes 2023; 41:518-525. [PMID: 37849512 PMCID: PMC10577505 DOI: 10.2337/cd22-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Identifying strategies to support patients diagnosed with diabetic foot ulceration (DFU) is essential to affect not only wound outcomes but also mortality and quality of life. This article reports on a cross-sectional, descriptive, correlational study of patients receiving treatment for DFU at a specialty clinic. Most participants were <60 years of age and had been diagnosed with diabetes for >5 years. Results indicated that patients with higher self-management scores reported improved general health, physical functioning, and quality of life. These findings, in a younger patient population with normal work and family obligations, suggest that interventions supporting self-management behaviors can improve physical, emotional, and general health and, ultimately, quality of life. The involvement of an interprofessional care team enhances these self-management behaviors.
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Breton M, Gaboury I, Martin E, Green ME, Kiran T, Laberge M, Kaczorowski J, Ivers N, Deville-Stoetzel N, Bordeleau F, Beaulieu C, Descoteaux S. Impact of externally facilitated continuous quality improvement cohorts on Advanced Access to support primary healthcare teams: protocol for a quasi-randomized cluster trial. BMC PRIMARY CARE 2023; 24:97. [PMID: 37038126 PMCID: PMC10088119 DOI: 10.1186/s12875-023-02048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Improving access to primary health care is among top priorities for many countries. Advanced Access (AA) is one of the most recommended models to improve timely access to care. Over the past 15 years, the AA model has been implemented in Canada, but the implementation of AA varies substantially among providers and clinics. Continuous quality improvement (CQI) approaches can be used to promote organizational change like AA implementation. While CQI fosters the adoption of evidence-based practices, knowledge gaps remain, about the mechanisms by which QI happens and the sustainability of the results. The general aim of the study is to analyse the implementation and effects of CQI cohorts on AA for primary care clinics. Specific objectives are: 1) Analyse the process of implementing CQI cohorts to support PHC clinics in their improvement of AA. 2) Document and compare structural organisational changes and processes of care with respect to AA within study groups (intervention and control). 3) Assess the effectiveness of CQI cohorts on AA outcomes. 4) Appreciate the sustainability of the intervention for AA processes, organisational changes and outcomes. METHODS Cluster-controlled trial allowing for a comprehensive and rigorous evaluation of the proposed intervention 48 multidisciplinary primary care clinics will be recruited to participate. 24 Clinics from the intervention regions will receive the CQI intervention for 18 months including three activities carried out iteratively until the clinic's improvement objectives are achieved: 1) reflective sessions and problem priorisation; 2) plan-do-study-act cycles; and 3) group mentoring. Clinics located in the control regions will receive an audit-feedback report on access. Complementary qualitative and quantitative data reflecting the quintuple aim will be collected over a period of 36 months. RESULTS This research will contribute to filling the gap in the generalizability of CQI interventions and accelerate the spread of effective AA improvement strategies while strengthening local QI culture within clinics. This research will have a direct impact on patients' experiences of care. CONCLUSION This mixed-method approach offers a unique opportunity to contribute to the scientific literature on large-scale CQI cohorts to improve AA in primary care teams and to better understand the processes of CQI. TRIAL REGISTRATION Clinical Trials: NCT05715151.
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Affiliation(s)
- Mylaine Breton
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada.
| | - Isabelle Gaboury
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Elisabeth Martin
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | | | - Tara Kiran
- University of Toronto, Toronto, ON, Canada
| | | | | | - Noah Ivers
- University of Toronto, Toronto, ON, Canada
| | - Nadia Deville-Stoetzel
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Francois Bordeleau
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Christine Beaulieu
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
| | - Sarah Descoteaux
- Université de Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Office 200, Longueuil, QC, J4K 0A8, Canada
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Sigmon LB, Reis PJ, Woodard EK, Hinkle JF. Patient and family perceptions of interprofessional collaborative teamwork: An integrative review. J Clin Nurs 2022; 32:2102-2113. [PMID: 35322493 DOI: 10.1111/jocn.16295] [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: 09/12/2021] [Revised: 01/07/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
AIMS To understand the patient and family perceptions of teamwork by synthesising existing evidence using the Interprofessional Education Collaborative Core Competencies for Interprofessional Collaborative Practice as a guiding framework. BACKGROUND Advances in healthcare have resulted in more people living longer with health conditions, and patients and families have become the primary caregivers. The role of the interprofessional collaborative team supports a paradigm shift to a care model with the patient and family at the centre of healthcare decisions. However, patient and family views of interprofessional collaborative team care have rarely been studied. METHODS The authors applied Whittmore and Knafl's methodology to conduct an integrative review of the literature. Databases searched included Cumulative Index to Nursing and Allied Health Literature, PubMed and PsycINFO along with reference searches. The studies included were those related to patient and family perceptions of teamwork published from 2000 to 2020. The IPEC Core Competencies for Interprofessional Collaborative Practice served as the guiding framework for analysis. A PRISMA flow chart documented the search, inclusion and exclusion criteria for the review. RESULTS Seventeen articles met the inclusion criteria. The findings identified differing perspectives by patients of the impact of the interprofessional collaborative team in their care which suggests that interventions to increase knowledge about interprofessional collaborative team care from the patient and family perspective may be beneficial. CONCLUSIONS There is limited research on understanding IPC teams from the patient and family viewpoint. This review reveals incongruencies in patient and provider perspectives of IPC teams and suggests the need for additional research about patient and family perspectives of teamwork. To fully implement the IPC team vision, perceptions of teamwork must be fully understood.
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Affiliation(s)
- Lorie B Sigmon
- School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Pamela J Reis
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Elizabeth K Woodard
- School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Julie F Hinkle
- School of Nursing, University of North Carolina Wilmington, Wilmington, North Carolina, USA
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Gaboury I, Breton M, Perreault K, Bordeleau F, Descôteaux S, Maillet L, Hudon C, Couturier Y, Duhoux A, Vachon B, Cossette B, Rodrigues I, Poitras ME, Loignon C, Vasiliadis HM. Interprofessional advanced access - a quality improvement protocol for expanding access to primary care services. BMC Health Serv Res 2021; 21:812. [PMID: 34388996 PMCID: PMC8361639 DOI: 10.1186/s12913-021-06839-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Advanced Access (AA) Model has shown considerable success in improving timely access for patients in primary care settings. As a result, a majority of family physicians have implemented AA in their organizations over the last decade. However, despite its widespread use, few professionals other than physicians and nurse practitioners have implemented the model. Among those who have integrated it to their practice, a wide variation in the level of implementation is observed, suggesting a need to support primary care teams in continuous improvement with AA implementation. This quality improvement research project aims to document and measure the processes and effects of practice facilitation, to implement and improve AA within interprofessional teams. METHODS Five primary care teams at various levels of organizational AA implementation will take part in a quality improvement process. These teams will be followed independently over PDSA (Plan-Do-Study-Act) cycles for 18 months. Each team is responsible for setting their own objectives for improvement with respect to AA. The evaluation process consists of a mixed-methods plan, including semi-structured interviews with key members of the clinical and management teams, patient experience survey and AA-related metrics monitored from Electronic Medical Records over time. DISCUSSION Most theories on organizational change indicate that practice facilitation should enable involvement of stakeholders in the process of change and enable improved interprofessional collaboration through a team-based approach. Improving access to primary care services is one of the top priorities of the Quebec's ministry of health and social services. This study will identify key barriers to quality improvement initiatives within primary care and help to develop successful strategies to help teams improve and broaden implementation of AA to other primary care professionals.
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Affiliation(s)
- Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.
| | - Mylaine Breton
- Department of community health sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Kathy Perreault
- GMF-U Saint-Jean-sur-Richelieu, Saint-Jean-sur-Richelieu, Canada
| | - François Bordeleau
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Sarah Descôteaux
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Lara Maillet
- École Nationale d'Administration Publique, Montreal, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Yves Couturier
- School of social work, Faculty of letters and social sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Benoit Cossette
- Department of community health sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabel Rodrigues
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Christine Loignon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Helen-Maria Vasiliadis
- Department of community health sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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Lim L, Kanfer R, Stroebel RJ, Zimring CM. The Representational Function of Clinic Design: Staff and Patient Perceptions of Teamwork. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:254-270. [PMID: 32929991 DOI: 10.1177/1937586720957074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study empirically investigates the relationships between visibility attributes and both patients' and staff members' teamwork experiences. BACKGROUND Teamwork among healthcare professionals is critical for the safety and quality of patient care. While a patient-centered, team-based care approach is promoted in primary care clinics, little is known about how clinic layouts can support the teamwork experiences of staff and patients in team-based primary clinics. METHODS This article measured teamwork perceptions of staff members and patients at four primary care clinics providing team-based care. Visual access to staff workstations from both staff and patient perspectives was analyzed using VisualPower tool(version 21). The relationships between teamwork perception and visibility attributes were analyzed for each entity: staff members and patients. RESULTS The results showed that the visual relationships among staff members and those between staff members and patients have significant associations with overall perceptions of teamwork. While clinics providing more visual connections between staff workstations reported higher teamwork perception of staff members, patient perceptions of staff teamwork were inversely related to the number of visual connections between patients and staff workstations. CONCLUSIONS The findings of the study provide implications for designing team-based primary care clinics to enhance the teamwork experience of both staff members and patients, which is also applicable to teamwork perceptions in other settings where both inhabitants and visitors are main user groups of the spaces. This study illustrates the representational function of space: Organizations can emphasize their values via layout design by regulating what they show to inhabitants or visitors.
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Affiliation(s)
- Lisa Lim
- College of Architecture, 6177Texas Tech University, Lubbock, TX, USA
| | - Ruth Kanfer
- School of Psychology, College of Sciences, 1372Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Craig M Zimring
- School of Architecture, College of Design, 1372Georgia Institute of Technology, Atlanta, GA, USA
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8
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Dodge LE, Nippita S, Hacker MR, Intondi EM, Ozcelik G, Paul ME. Long-term effects of teamwork training on communication and teamwork climate in ambulatory reproductive health care. J Healthc Risk Manag 2020; 40:8-15. [PMID: 32761729 DOI: 10.1002/jhrm.21440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND We previously reported an association between team training in the ambulatory setting and improvements in team climate at 6 and 12 months, but it is unknown whether improvements persist at 2 years. STUDY DESIGN From 2014 to 2015, we enrolled 20 organizations, each operating a varying number of health centers, into a teamwork training initiative. We evaluated teamwork outcomes at baseline and 2 years using a communication behaviors assessment, the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ), and the Patients' Insights and Views of Teamwork (PIVOT) survey. RESULTS At 2 years, use of TeamSTEPPS® tools and strategies remained increased compared to baseline at many health centers; results ranged from 32% of centers reporting increased use of pauses to identify the patient to 91% reporting increased use of standardized language. Staff T-TPQ responses indicated that TeamSTEPPS® implementation was associated with improved perceptions of teamwork in approximately half (49%) of statements at 2 years. Significant improvements occurred in over half of PIVOT survey statements, and patient satisfaction was significantly greater at 2 years compared to baseline. CONCLUSIONS Patient and staff views of teamwork were significantly improved 2 years after TeamSTEPPS® implementation in ambulatory reproductive health care centers, demonstrating positive long-term effects of teamwork training.
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Affiliation(s)
- Laura E Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, 02215.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, 02215.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, 02215
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, 02215.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, 02215
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, 02215.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, 02215.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, 02215
| | | | - Guzey Ozcelik
- Affiliates Risk Management Services, Inc., New York, NY, 10001
| | - Maureen E Paul
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, 02215.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, 02215.,Affiliates Risk Management Services, Inc., New York, NY, 10001
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Block L, LaVine NA, Martinez J, Strawser J, Lu C, Cacace F, Fornari A, Conigliaro J, Coletti DJ. A novel longitudinal interprofessional ambulatory training practice: the improving patient access care and cost through training (IMPACcT) clinic. J Interprof Care 2020; 35:472-475. [PMID: 32378439 DOI: 10.1080/13561820.2020.1751595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Few graduating health professionals choose primary care. Trainees satisfied with continuity ambulatory experiences are more likely to pursue primary care. The authors developed a longitudinal interprofessional ambulatory training program to improve team-based care and encourage primary care careers. The Improving Patient Access Care and cost through Training (IMPACcT) clinic, launched in 2016, includes physician, physician assistant, pharmacy, and psychology trainees. Residents, faculty, and interprofessional trainees complete "on-service" weeks together. Co-located administrative team members coordinate care and lead team "huddles." Interprofessional signout facilitates patient follow-up. The initial evaluation included process and quality indicators compared to the traditional resident practice. Learners reported increased perceived competence in interprofessional communication and teamwork after completing their training. Clinical quality outcomes suggested improved provider continuity and arrival rate compared to traditional resident practice (56.5% vs. 32.9%; 66.3% vs. 62.2%, p < .01). Patient satisfaction was higher in the IMPACcT clinic in the areas of coordinated care and team functioning. Ten of eighteen physician graduates in the program chose further training in primary care compared to 20 of 150 graduates not in the program (55.6% vs. 13.3%, p < .01). Implementing a longitudinal team-based ambulatory interprofessional training practice was associated with improved continuity of care and improved patient satisfaction indicators.
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Affiliation(s)
- Lauren Block
- Department of Medicine and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Nancy A LaVine
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Johanna Martinez
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Josiah Strawser
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Celia Lu
- Department of Clinical Health Professions, St. Johns College of Pharmacy and Health Sciences, Queens, NY, USA
| | - Frank Cacace
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Alice Fornari
- Department of Family Medicine and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Joseph Conigliaro
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Daniel J Coletti
- Department of Psychiatry and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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10
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Dodge LE, Nippita S, Hacker MR, Intondi EM, Ozcelik G, Paul ME. Impact of teamwork improvement training on communication and teamwork climate in ambulatory reproductive health care. J Healthc Risk Manag 2018; 38:44-54. [PMID: 30212606 DOI: 10.1002/jhrm.21353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND While team training is associated with improved hospital-based team climate, less is known about effects in the ambulatory setting. STUDY DESIGN In 2014 and 2015, we enrolled 20 organizations, each operating various health centers, into this ongoing study. Evaluation tools include a communication behaviors assessment (CBA) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS® ) Teamwork Perceptions Questionnaire (T-TPQ), which staff completes at baseline, 6 months, and 1 year, and the Patients' Insights and Views of Teamwork (PIVOT) survey, which patients complete at baseline and 1 year. We also assessed patient satisfaction. We analyzed T-TPQs paired at the individual level and CBAs and PIVOTs paired at the health center level. We also conducted key informant interviews with the first cohort. RESULTS CBAs showed that TeamSTEPPS tools and strategies were utilized, with 50% or more of centers reporting increases in all behaviors at 1 year; key informant interviews confirmed this. T-TPQ findings indicated that TeamSTEPPS implementation was associated with improved staff perceptions of teamwork at 6 months; lesser improvements were seen at 1 year. The PIVOT survey demonstrated significant improvements in select patient ratings of teamwork. Patient satisfaction improved at 1 year. CONCLUSIONS TeamSTEPPS has positive effects in the ambulatory reproductive health care environment. Improvements persisted at 1 year.
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Affiliation(s)
- Laura E Dodge
- Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical Center, Cambridge, MA.,Harvard School of Public Health, Cambridge, MA
| | - Siripanth Nippita
- Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Cambridge, MA
| | - Michele R Hacker
- Beth Israel Deaconess Medical Center, Boston, MA.,Harvard School of Public Health, Cambridge, MA.,Harvard Medical School, Cambridge, MA
| | | | - Guzey Ozcelik
- Affiliates Risk Management Services, Inc., New York, NY
| | - Maureen E Paul
- Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Cambridge, MA.,Affiliates Risk Management Services, Inc., New York, NY
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11
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Paul ME, Dodge LE, Intondi E, Ozcelik G, Plitt K, Hacker MR. Integrating TeamSTEPPS ® into ambulatory reproductive health care: Early successes and lessons learned. J Healthc Risk Manag 2018; 36:25-36. [PMID: 28415149 DOI: 10.1002/jhrm.21271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Most medical teamwork improvement interventions have occurred in hospitals, and more efforts are needed to integrate them into ambulatory care settings. In 2014, Affiliates Risk Management Services, Inc. (ARMS), the risk management services organization for a large network of reproductive health care organizations in the United States, launched a voluntary 5-year initiative to implement a medical teamwork system in this network using the TeamSTEPPS model. This article describes the ARMS initiative and progress made during the first 2 years, including lessons learned. METHODS The ARMS TeamSTEPPS program consists of the following components: preparation of participating organizations, TeamSTEPPS master training, implementation of teamwork improvement programs, and evaluation. We used self-administered questionnaires to assess satisfaction with the ARMS program and with the master training course. RESULTS In the first 2 years, 20 organizations enrolled. Participants found the preparation phase valuable and were highly satisfied with the master training course. Although most attendees felt that the course imparted the knowledge and tools critical for TeamSTEPPS implementation, they identified time restraints and competing initiatives as potential barriers. The project team has learned valuable lessons about obtaining buy-in, consolidating the change teams, making the curriculum relevant, and evaluation. CONCLUSION Ambulatory care settings require innovative approaches to integration of teamwork improvement systems. Evaluating and sharing lessons learned will help to hone best practices as we navigate this new frontier in the field of patient safety.
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Affiliation(s)
| | | | | | | | - Ken Plitt
- Affiliates Risk Management Services, Inc
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12
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Beaird G, Dent JM, Keim-Malpass J, Muller AGJ, Nelson N, Brashers V. Perceptions of Teamwork in the Interprofessional Bedside Rounding Process. J Healthc Qual 2017; 39:95-106. [DOI: 10.1097/jhq.0000000000000068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Grover E, Porter JE, Morphet J. An exploration of emergency nurses' perceptions, attitudes and experience of teamwork in the emergency department. ACTA ACUST UNITED AC 2017; 20:92-97. [PMID: 28196705 DOI: 10.1016/j.aenj.2017.01.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Teamwork may assist with increased levels of efficiency and safety of patient care in the emergency department (ED), with emergency nurses playing an indispensable role in this process. METHOD A descriptive, exploratory approach was used, drawing on principles from phenomenology and symbolic interactionism. Convenience, purposive sampling was used in a major metropolitan ED. Semi structured interviews were conducted, audio recorded, and transcribed verbatim. Transcripts were analysed using thematic analysis. RESULTS Three major themes emerged from the data. The first theme 'when teamwork works' supported the notion that emergency nurses perceived teamwork as a positive and effective construct in four key areas; resuscitation, simulation training, patient outcomes and staff satisfaction. The second theme 'team support' revealed that back up behaviour and leadership were critical elements of team effectiveness within the study setting. The third theme 'no time for teamwork' centred around periods when teamwork practices failed due to various contributing factors including inadequate resources and skill mix. DISCUSSION Outcomes of effective teamwork were valued by emergency nurses. Teamwork is about performance, and requires a certain skill set not necessarily naturally possessed among emergency nurses. Building a resilient team inclusive of strong leadership and communication skills is essential to being able to withstand the challenging demands of the ED.
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Affiliation(s)
- Elise Grover
- Peninsula Health, Frankston Hospital, Hastings Rd, Frankston, Victoria 3199, Australia; Monash University, Nursing and Midwifery, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia.
| | - Joanne E Porter
- Federation University Australia, Gippsland Campus, Northways Rd, Churchill, Victoria, 3841, Australia
| | - Julia Morphet
- Monash University, Nursing and Midwifery, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia
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