Relational coordination as a merger and acquisition framework for healthcare organizations

A pilot study protocol of a relational coordination training intervention among healthcare professionals in an Army medical center

BACKGROUND

As patient care becomes more complex, high-quality communication and relationships among healthcare professionals are critical to coordinating care. Relational coordination (RC), a process of high-quality communication supported by shared goals, shared knowledge, and mutual respect, is positively associated with better patient (e.g., quality of care) and staff (e.g., job satisfaction, and retention) outcomes. A few researchers have found that communication skills training improves RC in civilian hospitals. However, researchers have not tested the feasibility of conducting communication skills training based on the RC framework among healthcare professionals in military hospitals. To address this gap, we propose conducting an RC training intervention in a military hospital. The primary aim of the proposed pilot study is to determine the feasibility (e.g., recruitment, retention, and completion rates) of conducting an RC training intervention in an Army medical center. The secondary aim is to explore the acceptability and usability of the RC training intervention. We will also explore changes in RC, quality of care, job satisfaction, and intent to stay among participants following the RC training intervention.

METHODS

A single-group feasibility study will be conducted among nurses and physicians from three units (intensive care unit, medical-surgical, and labor and delivery unit). A convenience sample of licensed practical nurses (LPNs), registered nurses (RNs), resident physicians, and physicians from the participating units will be invited to complete a 1-h RC training intervention once a month for 3 months. Participants will complete RC, quality of care, job satisfaction, and intent to stay measures at baseline and 2 weeks after each RC training intervention session. To assess the feasibility of conducting an RC training intervention, we will examine recruitment/retention rates, intervention session completion rates, and survey measure completion rates. Acceptability will be assessed qualitatively through focus group interviews, and results will be used to refine the intervention and determine if the selected measures align with participant experiences. For our secondary aim, we will explore the acceptability of the RC training intervention through focus group interviews. We will also explore changes in outcome measures using descriptive statistics with 95% confidence intervals.

DISCUSSION

Findings will establish the feasibility and acceptability of conducting an RC intervention in a military hospital and inform refinement of the intervention and study procedures prior to conducting a larger randomized controlled trial to establish efficacy.

Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center

BACKGROUND AND OBJECTIVES

High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center.

METHODS

We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other.

RESULTS

Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00).

CONCLUSIONS

We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.

The impact of professional role and demographic characteristics on job satisfaction and retention among healthcare professionals in a military hospital

BACKGROUND

Job satisfaction is significantly associated with retention. Although several factors are associated with job satisfaction and retention (pay, leadership, mentorship), the association of demographic characteristics has been understudied in the literature.

PURPOSE

To explore whether professional role and demographic characteristics are associated with job satisfaction and intent to stay among nurses and physicians in a military medical center.

METHODS

We conducted a descriptive, exploratory, cross-sectional study, and collected data via surveys. We used multiple regression to evaluate study variables.

RESULTS

Two hundred and eighty-nine participants completed the survey. Professional role and demographic characteristics were not associated with job satisfaction. Professional role, race, and education were associated with intent to stay for military respondents. Physicians (β = 0.53, p = .0259) and Caucasians (β = -0.55, p = .0172) reported lower intent to stay; respondents with graduate degrees reported higher intent to stay (β = 2.47, p = .0045). Professional role and demographic characteristics were not associated with intent to stay for civilians.

CONCLUSION

Job satisfaction and retention of nurses and physicians are critical to the quality of care. Civilian and military healthcare leaders should focus on interventions that enhance job satisfaction and retention as a strategy to improve patient and staff outcomes alike.