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Costa DK, Boltey E, Mosley EA, Manojlovich M, Wright NC. Knowing your team in the intensive care unit: an ethnographic study on familiarity. J Interprof Care 2024; 38:593-601. [PMID: 38517041 PMCID: PMC11141211 DOI: 10.1080/13561820.2024.2329968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
Effective interprofessional team function is integral to high-quality care in the intensive care unit (ICU). However, little is known about how familiarity develops among teams, which may be an important antecedent to effective team function and quality care. To examine team familiarity and how it impacts ICU team function and care, we conducted an ethnographic study in four ICUs (two medical ICUs, one mixed medical-surgical ICU, and one surgical ICU) in two community hospitals and one academic medical center. We conducted 57.5 h of observation, 26 shadowing experiences, and 26 interviews across the four ICUs sequentially. We used thematic analysis to examine familiarity among the team. We found that ICU team members become familiar with their team through interpersonal, relational interactions, which involved communication, time working together, social interactions, trust, and respect. Our findings underscore the relational aspect of effective teams and demonstrate that time working together, social interactions, communication, developing trust, and respect are pathways to familiarity and optimal team function. Leveraging unique and creative ways to enhance the relational aspects of ICU teams could be an area for future research and lead to improved ICU outcomes.
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Affiliation(s)
- Deena Kelly Costa
- Yale School of Nursing, Orange CT
- Yale School of Medicine, Section on Pulmonary, Critical Care & Sleep Medicine, New Haven CT
| | | | - Elizabeth A. Mosley
- University of Pittsburgh School of Medicine, Division of General Internal Medicine, Pittsburgh, PA
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2
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Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024; 116:800-811. [PMID: 38419574 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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Neubauer FB, Wagner FL, Lörwald A, Huwendiek S. Sharpening the lens to evaluate interprofessional education and interprofessional collaboration by improving the conceptual framework: a critical discussion. BMC MEDICAL EDUCATION 2024; 24:615. [PMID: 38835006 DOI: 10.1186/s12909-024-05590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
It has been difficult to demonstrate that interprofessional education (IPE) and interprofessional collaboration (IPC) have positive effects on patient care quality, cost effectiveness of patient care, and healthcare provider satisfaction. Here we propose a detailed explanation for this difficulty based on an adjusted theory about cause and effect in the field of IPE and IPC by asking: 1) What are the critical weaknesses of the causal models predominantly used which link IPE with IPC, and IPE and IPC with final outcomes? 2) What would a more precise causal model look like? 3) Can the proposed novel model help us better understand the challenges of IPE and IPC outcome evaluations? In the format of a critical theoretical discussion, based on a critical appraisal of the literature, we first reason that a monocausal, IPE-biased view on IPC and IPC outcomes does not form a sufficient foundation for proper IPE and IPC outcome evaluations; rather, interprofessional organization (IPO) has to be considered an additional necessary cause for IPC; and factors outside of IPC additional causes for final outcomes. Second, we present an adjusted model representing the "multi-stage multi-causality" of patient, healthcare provider, and system outcomes. Third, we demonstrate the model's explanatory power by employing it to deduce why misuse of the modified Kirkpatrick classification as a causal model in IPE and IPC outcome evaluations might have led to inconclusive results in the past. We conclude by applying the derived theoretical clarification to formulate recommendations for enhancing future evaluations of IPE, IPO, and IPC. Our main recommendations: 1) Focus should be placed on a comprehensive evaluation of factual IPC as the fundamental metric and 2) A step-by-step approach should be used that separates the outcome evaluation of IPE from that of IPC in the overarching quest for proving the benefits of IPE, IPO and IPC for patients, healthcare providers, and health systems. With this critical discussion we hope to enable more effective evaluations of IPE, IPO and IPC in the future.
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Affiliation(s)
- Florian B Neubauer
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland.
| | - Felicitas L Wagner
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Andrea Lörwald
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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House S, Naim Ali HA, Stucky C. Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center. Qual Manag Health Care 2024:00019514-990000000-00074. [PMID: 38654420 DOI: 10.1097/qmh.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
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.
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Affiliation(s)
- Sherita House
- Author Affiliations:University of North Carolina at Greensboro School of Nursing (Dr House); The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Dr Naim Ali); and Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl, AE, Germany (Dr Stucky)
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Kim JG, Gonzalo JD, Chen I, Vo A, Lupi C, Hyderi A, Haidet P, DeWaters A, Blatt B, Holmboe E, Thompson LR, Jimenez J, Madigosky W, Chung PJ. How a Team Effectiveness Approach to Health Systems Science Can Illuminate Undergraduate Medical Education Outcomes. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:374-380. [PMID: 38166319 DOI: 10.1097/acm.0000000000005619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
ABSTRACT Health care delivery requires physicians to operate in teams to successfully navigate complexity in caring for patients and communities. The importance of training physicians early in core concepts of working in teams (i.e., "teaming") has long been established. Over the past decade, however, little evidence of team effectiveness training for medical students has been available. The recent introduction of health systems science as a third pillar of medical education provides an opportunity to teach and prepare students to work in teams and achieve related core competencies across the medical education continuum and health care delivery settings. Although educators and health care system leaders have emphasized the teaching and learning of team-based care, conceptual models and evidence that inform effective teaming within all aspects of undergraduate medical education (including classroom, clinical, and community settings) are needed to advance the science regarding learning and working in teams. Anchoring teaming through the core foundational theory of team effectiveness and its operational components could catalyze the empirical study of medical student teams, uncover modifiable factors that lead to the evidence for improved student learning, and improve the link among competency-based assessments between undergraduate medical education and graduate medical education. In this article, authors articulate several implications for medical schools through 5 conceptual areas: admissions, the design and teaching of team effectiveness in health systems science curricula, the related competency-based assessments, and course and program evaluations. The authors then discuss the relevance of the measurable components and intended outcomes to team effectiveness in undergraduate medical education as critical to successfully prepare students for teaming in clerkships and eventually residency and clinical practice.
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Tandan M, Dunlea S, Cullen W, Bury G. Teamwork and its impact on chronic disease clinical outcomes in primary care: a systematic review and meta-analysis. Public Health 2024; 229:88-115. [PMID: 38412699 DOI: 10.1016/j.puhe.2024.01.019] [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: 07/14/2023] [Revised: 12/31/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Teamwork positively affects staff performance and patient outcomes in chronic disease management. However, there is limited research on the impact of specific team components on clinical outcomes. This review aims to explore the impact of teamwork components on key clinical outcomes of chronic diseases in primary care. STUDY DESIGN Systematic review and meta-analysis. METHODS This systematic review and meta-analysis conducted searching EMBASE, PubMed, Cochrane Central Register of Controlled Trials. Studies included must have at least one teamwork component, conducted in primary care for selected chronic diseases, and report an impact of teamwork on clinical outcomes. Mean differences and 95% confidence intervals were used to determine pooled effects of intervention. RESULTS A total of 54 studies from 1988 to 2021 were reviewed. Shared decision-making, roles sharing, and leadership were missing in most studies. Team-based intervention showed a reduction in mean systolic blood pressure (MD = 5.88, 95% CI 3.29-8.46, P= <0.001, I2 = 95%), diastolic blood pressure (MD = 3.23, 95% CI 1.53 to 4.92, P = <0.001, I2 = 94%), and HbA1C (MD = 0.38, 95% CI 0.21 to 0.54, P = <0.001, I2 = 58%). More team components led to better SBP and DBP outcomes, while individual team components have no impact on HbA1C. Fewer studies limit analysis of cholesterol levels, hospitalizations, emergency visits and chronic obstructive pulmonary disease-related outcomes. CONCLUSION Team-based interventions improve outcomes for chronic diseases, but more research is needed on managing cholesterol, hospitalizations, and chronic obstructive pulmonary disease. Studies with 4-5 team components were more effective in reducing systolic blood pressure and diastolic blood pressure. Heterogeneity should be considered, and additional research is needed to optimize interventions for specific patient populations.
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Affiliation(s)
- Meera Tandan
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Shane Dunlea
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Walter Cullen
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Gerard Bury
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
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Chandra Shaw S, Datta K, Lall M, Jaipurkar R, Shakya A, Kanitkar M. Development of a hybrid undergraduate portfolio for the AETCOM module. Med J Armed Forces India 2024; 80:192-198. [PMID: 38525458 PMCID: PMC10954497 DOI: 10.1016/j.mjafi.2022.04.001] [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: 08/02/2021] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background A structured Attitude Ethics and Communication (AETCOM) module for undergraduates exists. For ensuring that the module achieves what it is intended to achieve, there was a felt need to develop a learning portfolio with an emphasis on reflections and with a scope for assessment. Methods The AETCOM module by NMC has laid out objectives, lesson plans, and case-based scenarios. Hybrid portfolio development was necessary to align the sessions to the objectives and lesson plans and to help students capture their learning process with self-reflection, and at the same time, ensure the scope of assessment of these activities. Hence, writing reflections was considered the most important step. Measures were taken to train students in writing reflections, and faculty development workshops were also conducted. An evaluation was done using Kirkpatrick model level I-III using student's feedback form, scores of rubric matrix for assessment of reflections and one-on-one interaction with students by trained faculty. Faculty perspectives on portfolio development were collected. Results A significant improvement in students' self-assessment scores on AETCOM module was seen (p <0.05). An assessment of reflections using a rubric matrix showed that all the students reached at least grade B by the end of three months. More than 90% of faculty members felt that the faculty is vital for assessing AETCOM. Conclusion The development of a hybrid portfolio for AETCOM requires faculty development and special sessions for students on writing reflections. The hybrid portfolio provides the learner to self reflect, and a rubric matrix can be used to assess reflections.
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Affiliation(s)
- Subhash Chandra Shaw
- Senior Advisor (Pediatrics & Neonatologist), Army Hospital (R&R), New Delhi, India
| | - Karuna Datta
- Professor & Head, Department of Sports Medicine, Armed Forces Medical College, Pune, India
| | - Mahima Lall
- Professor, Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Raksha Jaipurkar
- Professor & Head, Department of Physiology, Armed Forces Medical College, Pune, India
| | - A.K. Shakya
- Training Officer (UG), Armed Forces Medical College, Pune, India
| | - Madhuri Kanitkar
- Vice Chancellor, Maharashtra University of Health Sciences, Nashik, Maharashtra, India
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Nash P, Clark V, McConnell E, Mills W, Morgan R, Pimentel C, Ritchey K, Levy C, Snow AL, Hartmann C. Improving safety and preventing falls using an evidence-based, front-line staff huddling practice: protocol for a pragmatic trial to increase quality of care in State Veterans Homes. BMJ Open 2024; 14:e084011. [PMID: 38413157 PMCID: PMC10900326 DOI: 10.1136/bmjopen-2024-084011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Falls in nursing homes are a major cause for decreases in residents' quality of life and overall health. This study aims to reduce resident falls by implementing the LOCK Falls Programme, an evidence-based quality improvement intervention. The LOCK Falls Programme involves the entire front-line care team in (1) focusing on evidence of positive change, (2) collecting data through systematic observation and (3) facilitating communication and coordination of care through the practice of front-line staff huddles. METHODS AND ANALYSIS The study protocol describes a mixed-methods, 4-year hybrid (type 2) effectiveness-implementation study in State Veterans Homes in the USA. The study uses a pragmatic stepped-wedge randomised trial design and employs relational coordination theory and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework to guide implementation and evaluation. A total of eight State Veterans Homes will participate and data will be collected over an 18-month period. Administrative data inclusive of all clinical assessments and Minimum Data Set assessments for Veterans with a State Veterans Home admission or stay during the study period will be collected (8480 residents total). The primary outcome is a resident having any fall. The primary analysis will be a partial intention-to-treat analysis using the rate of participants experiencing any fall. A staff survey (n=1200) and qualitative interviews with residents (n=80) and staff (n=400) will also be conducted. This research seeks to systematically address known barriers to nursing home quality improvement efforts associated with reducing falls. ETHICS AND DISSEMINATION This study is approved by the Central Institutional Review Board (#167059-11). All participants will be recruited voluntarily and will sign informed consent as required. Collection, assessment and managing of solicited and spontaneously reported adverse events, including required protocol alterations, will be communicated and approved directly with the Central Institutional Review Board, the data safety monitoring board and the Office of Research and Development. Study results will be disseminated through peer-reviewed publications and conference presentations at the Academy Health Annual Research Meeting, the Gerontological Society of America Annual Scientific Meeting and the American Geriatrics Society Annual Meeting. Key stakeholders will also help disseminate lessons learnt. TRIAL REGISTRATION NUMBER NCT05906095.
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Affiliation(s)
- Princess Nash
- Research and Development, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA
| | - Valerie Clark
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Eleanor McConnell
- Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Whitney Mills
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services Policy and Practice, Brown University, Providence, Rhode Island, USA
| | - Robert Morgan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- School of Public Health, The University of Texas Health Science Center, Houston, Texas, USA
| | - Camilla Pimentel
- New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Katherine Ritchey
- US Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Cari Levy
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - A Lynn Snow
- Research and Development, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Christine Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Levoy E, Sperber A, Poon D, Casazza M, Vargas J, Yang S, Grant G, Singer S, Srinivas N. A Multifaceted Intervention to Improve Teamwork on an Inpatient Pediatric Neurosurgery Service. Jt Comm J Qual Patient Saf 2024; 50:104-115. [PMID: 37806797 DOI: 10.1016/j.jcjq.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Increased safety reports related to interprofessional teamwork on an acute care unit at a quaternary children's hospital prompted a teamwork-focused improvement effort on the pediatric neurosurgery service. METHODS An interprofessional workgroup was formed and met twice monthly throughout the project. A survey using modified validated items was disseminated to pediatric neurosurgery nurses, advanced practice providers (APPs), and physicians in March 2021 to identify opportunities for improvement. Structured debriefs on survey results promoted discourse on teamwork. The researchers implemented two interventions: (1) nursing-centered interprofessional education and (2) a rounding checklist before redistributing the survey in December 2021. RESULTS Baseline and follow-up survey response rates were 84.1% (58/69) and 71.4% (50/70), respectively. Nurses at baseline perceived lower teamwork scores for 12 items compared to physicians and APPs (p < 0.05). Nurse perceptions improved after interventions in: "using 'we' rather than 'they'" (21.3% vs. 51.2% agree, p = 0.003), "I am confident that this team works effectively" (46.8% vs. 80.5%, p = 0.001), "shared understanding of each other's role on the team" (48.9% vs. 73.2% agree, p = 0.02), and "getting others on the team to listen" (46.8% vs. 75.6%, p = 0.004). Mean teamwork effectiveness improved from 4.12 to 5.25 (out of 7; p < 0.0001). Nurses ranked three interventions as most effective: interprofessional training (35/41, 85.4%), educational clinical pearls (14/41, 34.1%), and structured opportunities to discuss teamwork (10/41, 24.4%). CONCLUSION Interprofessional training, a teamwork survey, and structured debriefing improved nurse perceptions of teamwork. Interventions targeting social components of change can improve teamwork even without process changes.
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Judd BK, Whelehan DF, Baysari MT, Baillie AJ. The Impact of Personal Protective Equipment on Cognitive and Emotional Aspects of Health Care Work. J Occup Environ Med 2024; 66:174-178. [PMID: 38013405 DOI: 10.1097/jom.0000000000003021] [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: 11/29/2023]
Abstract
OBJECTIVE Personal protective equipment (PPE) is critical to the safety of health professionals and vital to clinical practice. However, there is little known about the cognitive and emotional impact of PPE on health professionals' performance, comfort, and well-being. METHODS A mixed-method, cross-sectional, observational study was adopted. An online survey consisting of 5-point Likert scale questions and free-text comments canvassed the opinions of patient-facing health professionals. RESULTS An overall negative impact of PPE on health professionals' ability to carry out work was found from 185 responses from medicine, nursing, and allied health disciplines, including increased fatigue, poor communication, and feeling uncomfortable. CONCLUSIONS There are significant negative impacts of PPE on health professionals' ability to carry out work, impairing communication, task efficiency, and comfort. Personal protective equipment is an essential infection control practice requiring further research, design, and testing to overcome challenges.
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Affiliation(s)
- Belinda K Judd
- From the Faculty of Medicine and Health, University of Sydney, Sydney, Australia (B.K.J., M.T.B., A.J.B.); and School of Medicine Trinity College Dublin, University of Dublin, Dublin, Ireland (D.F.W.)
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Karuga R, Khan S, Kok M, Moraa M, Mbindyo P, Broerse J, Dieleman M. Teamwork in community health committees: a case study in two urban informal settlements. BMC Health Serv Res 2023; 23:1373. [PMID: 38062432 PMCID: PMC10702094 DOI: 10.1186/s12913-023-10370-5] [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: 04/25/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Community health committees (CHCs) are mechanisms for community participation in decision-making and overseeing health services in several low-and middle-income countries (LMICs). There is little research that examines teamwork and internal team relationships between members of these committees in LMICs. We aimed to assess teamwork and factors that affected teamwork of CHCs in an urban slum setting in Nairobi, Kenya. METHODS Using a qualitative case-study design, we explored teamwork of two CHCs based in two urban informal settlements in Nairobi. We used semi-structured interviews (n = 16) to explore the factors that influenced teamwork and triangulated responses using three group discussions (n = 14). We assessed the interpersonal and contextual factors that influenced teamwork using a framework for assessing teamwork of teams involved in delivering community health services. RESULTS Committee members perceived the relationships with each other as trusting and respectful. They had regular interaction with each other as friends, neighbors and lay health workers. CHC members looked to the Community Health Assistants (CHAs) as their supervisor and "boss", despite CHAs being CHC members themselves. The lay-community members in both CHCs expressed different goals for the committee. Some viewed the committee as informal savings group and community-based organization, while others viewed the committee as a structure for supervising Community Health Promoters (CHPs). Some members doubled up as both CHPs and CHC members. Complaints of favoritism arose from CHC members who were not CHPs whenever CHC members who were CHPs received stipends after being assigned health promotion tasks in the community. Underlying factors such as influence by elites, power imbalances and capacity strengthening had an influence on teamwork in CHCs. CONCLUSION In the absence of direction and support from the health system, CHCs morph into groups that prioritize the interests of the members. This redirects the teamwork that would have benefited community health services to other common interests of the team. Teamwork can be harnessed by strengthening the capacity of CHC members, CHAs, and health managers in team building and incorporating content on teamwork in the curriculum for training CHCs.
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Affiliation(s)
- Robinson Karuga
- LVCT Health, P.O. Box 19835, Nairobi, 00202, Kenya.
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands.
| | - Sitara Khan
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - Maryse Kok
- KIT Royal Tropical Institute, Mauritskade 64, 1092 AD, Amsterdam, Netherlands
| | - Malkia Moraa
- Directorate of Preventive and Promotive Health, Nairobi City County, City Hall Way, P.O Box 30075-00100, Nairobi, Kenya
| | - Patrick Mbindyo
- Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62 000, Nairobi, 00200, Kenya
| | - Jacqueline Broerse
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - Marjolein Dieleman
- KIT Royal Tropical Institute, Mauritskade 64, 1092 AD, Amsterdam, Netherlands
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Kornelsen J, Ho H, Williams K, Skinner T. Optimizing rural healthcare through improved team function: a case study of the Rural Surgical Obstetrical Networks programme. J Interprof Care 2023:1-9. [PMID: 38038596 DOI: 10.1080/13561820.2023.2280586] [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: 11/28/2022] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
We explored enablers and mechanisms of optimal team function within rural hospital teams, and the impact of these factors on health service sustainability in British Columbia. The data were drawn from interviews and focus groups with healthcare providers and administrators (n = 169) who participated in the Rural Surgical Obstetrical Networks (RSON) initiative to support low-volume rural surgical and obstetrical services in British Columbia, Canada. The 5-year programme (2018-2022) provided evidence-based system interventions across eight rural sites with the objective of providing sustainable, quality health services to meet population needs. To explore the impact of RSON interventions on local team function, we performed a scoping review, to assess the current literature surrounding enablers of effective rural hospital teamwork. Through inductive thematic analysis of interview data, we identified five enablers of good team function at RSON sites, including emphasis on local leadership, shared direction, commitment to sustainability, respect and solidarity among colleagues, and meaningful communication. The RSON project led to a shift in team culture in participating sites, improved team function, and contributed to improved clinical processes and patient outcomes. The findings have implications for rural health policy and practice in British Columbia and other jurisdictions with similar health service delivery models and geographic contexts.
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Affiliation(s)
- Jude Kornelsen
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Hilary Ho
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kim Williams
- Rural Coordination Centre of British Columbia, Vancouver, Canada
| | - Tom Skinner
- Rural Coordination Centre of British Columbia, Vancouver, Canada
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13
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Marc-Aurele K, Branche T, Adams A, Feister J, Boyle K, Scala M. Recommendations for creating a collaborative NICU environment to support teamwork and trainee education. J Perinatol 2023; 43:1520-1525. [PMID: 37620402 DOI: 10.1038/s41372-023-01756-8] [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: 03/28/2023] [Revised: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
In a 2022 survey, a majority of neonatology program directors reported regular conflict between neonatal-perinatal fellows and frontline providers (FLPs) (i.e., neonatal nurse practitioners (NNPs), neonatal physician assistants (PAs), and neonatal hospitalists). This paper reviews recommendations of a multidisciplinary workgroup for creating a more collaborative unit environment that supports teamwork and education. The self-study framework is a helpful tool to identify specific pressure points at individual institutions. Implementing clear guidelines for procedural distribution and role clarification are often critical interventions. FLPs and Pediatric Physician Trainees may benefit from conflict management coaching and communication training. At the same time, we recommend that respective leaders support a psychologically safe environment for team members to feel safe to solve problems on their own. Going forward, more work is important to optimize teamwork in the setting of anticipated staffing shortages, limitations to resident neonatology exposure, changes in training requirements, and ongoing development of the FLP role.
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Affiliation(s)
| | - Tonia Branche
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aaron Adams
- Duke University School of Medicine, Durham, NC, USA
| | - John Feister
- Stanford University School of Medicine, Stanford, CA, USA
| | - Kristine Boyle
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Melissa Scala
- Stanford University School of Medicine, Stanford, CA, USA.
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Brown JC, Ding L, Querubin JA, Peden CJ, Barr J, Cobb JP. Lessons Learned From a Systematic, Hospital-Wide Implementation of the ABCDEF Bundle: A Survey Evaluation. Crit Care Explor 2023; 5:e1007. [PMID: 37954897 PMCID: PMC10637401 DOI: 10.1097/cce.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Objective We recently reported the first part of a study testing the impact of data literacy training on "assessing pain, spontaneous awakening and breathing trials, choice of analgesia and sedation, delirium monitoring/management, early exercise/mobility, and family and patient empowerment" [ABCDEF [A-F]) compliance. The purpose of the current study, part 2, was to evaluate the effectiveness of the implementation approach by surveying clinical staff to examine staff knowledge, skill, motivation, and organizational resources. DESIGN The Clark and Estes Gap Analysis framework was used to study knowledge, motivation, and organization (KMO) influences. Assumed influences identified in the literature were used to design the A-F bundle implementation strategies. The influences were validated against a survey distributed to the ICU interprofessional team. SETTING Single-center study was conducted in eight adult ICUs in a quaternary academic medical center. SUBJECTS Interprofessional ICU clinical team. INTERVENTIONS A quantitative survey was sent to 386 participants to evaluate the implementation design postimplementation. An exploratory factor analysis was performed to understand the relationship between the KMO influences and the questions posed to validate the influence. Descriptive statistics were used to identify strengths needed to sustain performance and weaknesses that required improvement to increase A-F bundle adherence. MEASUREMENT AND RESULTS The survey received an 83% response rate. The exploratory factor analysis confirmed that 38 of 42 questions had a strong relationship to the KMO influences, validating the survey's utility in evaluating the effectiveness of implementation design. A total of 12 KMO influences were identified, 8 were categorized as a strength and 4 as a weakness of the implementation. CONCLUSIONS Our study used an evidence-based gap analysis framework to demonstrate key implementation approaches needed to increase A-F bundle compliance. The following drivers were recommended as essential methods required for successful protocol implementation: data literacy training and performance monitoring, organizational support, value proposition, multidisciplinary collaboration, and interprofessional teamwork activities. We believe the learning generated in this two-part study is applicable to implementation design beyond the A-F bundle.
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Affiliation(s)
- Joan C Brown
- Office of Performance and Transformation, Keck Medicine of USC, University of Southern California, Los Angeles, CA
- Departments of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Li Ding
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jynette A Querubin
- Office of Performance and Transformation, Keck Medicine of USC, University of Southern California, Los Angeles, CA
| | - Carol J Peden
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Juliana Barr
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
- VA Palo Alto Health Care System, Palo Alto, CA
| | - Joseph Perren Cobb
- Departments of Surgery and Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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15
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Sebok-Syer SS, Lingard L, Panza M, Van Hooren TA, Rassbach CE. Supportive and collaborative interdependence: Distinguishing residents' contributions within health care teams. MEDICAL EDUCATION 2023; 57:921-931. [PMID: 36822577 DOI: 10.1111/medu.15064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Individual assessments disregard team contributions, while team assessments disregard an individual's contributions. Interdependence has been put forth as a conceptual bridge between our educational traditions of assessing individual performance and our imminent challenge of assessing team-based performance without losing sight of the individual. The purpose of this study was to develop a more refined conceptualisation of interdependence to inform the creation of measures that can assess the interdependence of residents within health care teams. METHODS Following a constructivist grounded theory approach, we conducted 49 semi-structured interviews with various members of health care teams (e.g. physicians, nurses, pharmacists, social workers and patients) across two different clinical specialties-Emergency Medicine and Paediatrics-at two separate sites. Data collection and analysis occurred iteratively. Constant comparative inductive analysis was used, and coding consisted of three stages: initial, focused and theoretical. RESULTS We asked participants to reflect upon interdependence and describe how it exists in their clinical setting. All participants acknowledged the existence of interdependence, but they did not view it as part of a linear spectrum where interdependence becomes independence. Our analysis refined the conceptualisation of interdependence to include two types: supportive and collaborative. Supportive interdependence occurs within health care teams when one member demonstrates insufficient expertise to perform within their scope of practice. Collaborative interdependence, on the other hand, was not triggered by lack of experience/expertise within an individual's scope of practice, but rather recognition that patient care requires contributions from other team members. CONCLUSION In order to assess a team's collective performance without losing sight of the individual, we need to capture interdependent performances and characterise the nature of such interdependence. Moving away from a linear trajectory where independence is seen as the end goal can also help support efforts to measure an individual's competence as an interdependent member of a health care team.
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Affiliation(s)
| | - Lorelei Lingard
- Department of Medicine and Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Michael Panza
- Centre for Education Research and Innovation, Western University, London, Ontario, Canada
| | - Tamara A Van Hooren
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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16
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Sick B, Radosevich DM, Pittenger AL, Brandt B. Development and validation of a tool to assess the readiness of a clinical teaching site for interprofessional education (InSITE). J Interprof Care 2023; 37:S105-S115. [PMID: 30739518 DOI: 10.1080/13561820.2019.1569600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 12/02/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
Interprofessional education within clinical teaching sites is a key part of training for pre-professional students. However, the necessary characteristics of these interprofessional clinical teaching sites is unclear. We developed a tool, the Interprofessional Education Site Readiness, or InSITE, tool, for individuals at a site to use as a self-assessment of the site's current readiness for providing interprofessional education. The tool progressed through six stages of development, collecting evidence for validity and reliability, resulting in a final tool with 23 questions distributed across five domains. Data from 94 respondents from a variety of national sites were used for the item analysis showing acceptable item-to-total correlations. Internal reliability testing gave a Cronbach's coefficient alpha of more than 0.70 for each group level comparison. Known groups validity testing provides strong evidence for its responsiveness in detecting differences in sites where IPE is implemented. The results of the testing lead us to conclude that the InSITE tool has acceptable psychometric properties. Additionally, we discovered that the process in which the InSITE tool was used demonstrated that it can facilitate learning in practice for the health professionals and can help make implicit, informal workplace learning and the hidden curriculum explicit.
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Affiliation(s)
- Brian Sick
- Internal Medicine, University of Minnesota, Minneapolis, USA
| | - David M Radosevich
- Epidemiology and Biostatistics, University of Minnesota, Minneapolis, USA
| | - Amy L Pittenger
- Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, USA
| | - Barbara Brandt
- National Center for Interprofessional Practice and Education, University of Minnesota, Minneapolis, USA
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Williams VN, McManus B, Brooks-Russell A, Yost E, Olds DL, Tung GJ. Cross-sector Collaboration Between Public Health, Healthcare and Social Services Improves Retention: Findings from a Nurse Home Visiting Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1209-1224. [PMID: 37209315 DOI: 10.1007/s11121-023-01538-w] [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] [Accepted: 04/13/2023] [Indexed: 05/22/2023]
Abstract
The study aimed to examine the association between cross-sector collaboration in Nurse-Family Partnership (NFP), a model home visiting program, and participant retention. We used the 2018 NFP Collaboration Survey that measured agency-level collaboration, operationalized as relational coordination and structural integration, among nine community provider types (including obstetrics care, substance use treatment, child welfare). This dataset was linked to 2014-2018 NFP program implementation data (n = 36,900). We used random-intercept models with nurse-level random effects to examine the associations between provider-specific collaborations and participant retention adjusting for client, nurse, and agency characteristics. The adjusted models suggest that stronger relational coordination between nurses and substance use treatment providers (OR:1.177, 95% CI: 1.09-1.26) and greater structural integration with child welfare (OR: 1.062, CI: 1.04-1.09) were positively associated with participant retention at birth. Stronger structural integration between other home visiting programs and supplemental nutrition for women, infants, and children was negatively associated with participant retention at birth (OR: 0.985, CI: 0.97-0.99). Structural integration with child welfare remained significantly associated with participant retention at 12-month postpartum (OR: 1.032, CI: 1.01-1.05). In terms of client-level characteristics, clients who were unmarried, African-American, or visited by nurses who ceased NFP employment prior to their infant's birth were more likely to drop out of the NFP program. Older clients and high school graduates were more likely to remain in NFP. Visits by a nurse with a master's degree, agency rurality, and healthcare systems that implement the program were associated with participant retention. Cross-sector collaboration in a home visiting setting that bridges healthcare and addresses social determinants of health has potential to improve participant retention. This study sets the groundwork for future research to explore the implications of collaborative activities between preventive services and community providers.
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Affiliation(s)
- Venice Ng Williams
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, USA.
| | - Beth McManus
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, USA
| | - Ashley Brooks-Russell
- Department of Community Behavioral Health, Colorado School of Public Health, Aurora, USA
| | - Elly Yost
- National Service Office for Nurse-Family Partnership and Child First, Denver, USA
| | - David Lee Olds
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Gregory Jackson Tung
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, USA
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Liu L, Chien AT, Singer SJ. Enabling System Functionalities of Primary Care Practices for Team Dynamics in Transformation to Team-Based Care: A Qualitative Comparative Analysis (QCA). Healthcare (Basel) 2023; 11:2018. [PMID: 37510459 PMCID: PMC10379116 DOI: 10.3390/healthcare11142018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Team-based primary care has been shown to be an important initiative for transforming primary care to achieve whole-person care, enhance health equity, and reduce provider burnout. Organizational approaches have been explored to better implement team-based care but a thorough understanding of the role of system functions is lacking. We aimed to identify the combinations of system functionalities in primary care practices that most enable effective teamwork. We used a novel method, qualitative comparative analysis (QCA), to identify cross-case patterns in 19 primary care practices in the Harvard Academic Innovations Collaborative (AIC), an initiative for transforming primary care practices by establishing teams and implementing team-based care. QCA findings identified that primary care practices with strong team dynamics exhibited strengths in three operational care process functionalities, including management of abnormal test results, cancer screening and medication management for high-priority patients, care transitions, and in health information technology (HIT) functionality. HIT functionality alone was not sufficient to achieve the desired outcomes. System functionalities in a primary care practice that support physicians and their teams in identifying patients with urgent and complex acute illnesses requiring immediate response and care and overcoming barriers to collaboration within and across institutional settings, may be essential for sustaining strong team-based primary care.
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Affiliation(s)
- Lingrui Liu
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, Rockville, MD 20857, USA
| | - Alyna T. Chien
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA;
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Stanford Graduate School of Business, Stanford, CA 94305, USA
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Mand N, Stibane T, Sitter H, Maier RF, Leonhardt A. Successful implementation of a rater training program for medical students to evaluate simulated pediatric emergencies. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc47. [PMID: 37560048 PMCID: PMC10407587 DOI: 10.3205/zma001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 03/04/2023] [Accepted: 04/20/2023] [Indexed: 08/11/2023]
Abstract
Introduction Simulation-based training is increasingly used in pediatrics to teach technical skills, teamwork, and team communication, and to improve potential deficiencies in pediatric emergency care. Team performance must be observed, analyzed, and evaluated by trained raters. The structured training of medical students for the assessment of simulated pediatric emergencies has not yet been investigated. Methods We developed a rater training program for medical students to assess guideline adherence, teamwork, and team communication in simulated pediatric emergencies. Interrater reliability was measured at each training stage using Kendall tau coefficients. Results In 10 out of 15 pairs of raters interrater reliability was moderate to high (tau>0.4), whereas it was low in the remaining 5 pairs of raters. Discussion The interrater reliability showed good agreement between medical students and expert raters at the end of the rater training program. Medical students can be successfully involved in the assessment of guideline adherence as well as teamwork and team communication in simulated pediatric emergencies.
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Affiliation(s)
- Nadine Mand
- Philipps University of Marburg, University Hospital Marburg, Department of Pediatrics, Marburg, Germany
| | - Tina Stibane
- Philipps University of Marburg, Dr. Reinfried Pohl Center for Medical Education, Marburg, Germany
| | - Helmut Sitter
- Philipps University of Marburg, Dr. Reinfried Pohl Center for Medical Education, Marburg, Germany
| | - Rolf Felix Maier
- Philipps University of Marburg, University Hospital Marburg, Department of Pediatrics, Marburg, Germany
| | - Andreas Leonhardt
- Philipps University of Marburg, University Hospital Marburg, Department of Pediatrics, Marburg, Germany
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Hagum CN, Tønnessen E, Nesse MA, Shalfawi SAI. A Holistic Analysis of Team Dynamics Using Relational Coordination as the Measure regarding Student Athlete Total Load: A Cross-Sectional Study. Sports (Basel) 2023; 11:sports11050104. [PMID: 37234060 DOI: 10.3390/sports11050104] [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: 04/22/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Despite its small population, Norway wins a disproportionately large number of medals in international competitions. Therefore, it has been thought that the Norwegian sports model and sports school programs are influential in developing young Norwegian athletes to achieve such results. Today, more than 110 Norwegian private and public schools offer the elite sports program in Norway. Most student athletes attending those schools combine their high school education with elite sports, where they attend training sessions at both school and clubs. The number of people involved with the student athlete on a daily basis (i.e., other student athletes, club coaches, school coaches, schoolteachers, parents, and health personnel) indicate the importance of optimal communication and coordination. However, to the authors' knowledge, no previous studies have explored communication and coordination among this population group. Therefore, the primary objective of this study was to use a holistic analysis of team dynamics using the Relational Coordination Survey as a measure to explore the relational coordination within and between student athletes, club coaches, and school coaches. A secondary objective of this study was to explore student athletes', club coaches', and school coaches' relational coordination with schoolteachers, parents, and health personnel. In addition, the study aimed to explore differences in student athletes' relational coordination with their significant others according to sport, school, performance level, sex, and school year. METHODS The quality of relational coordination was measured by a cross-sectional questionnaire of student athletes (n = 345), club coaches (n = 42), and school coaches (n = 25) concerning training load and life load. Multiple one-way analyses of variance were used to assess differences between groups. RESULTS The results show that student athletes, club coaches, and school coaches perceived moderate to weak relational coordination with parents, schoolteachers, and health personnel. Student athletes' relational coordination score with parents was the only strong score observed. Furthermore, the results reveal notable differences in student athletes' relational coordination with the roles according to their characteristics. CONCLUSIONS The findings suggest a potential for enhancing relationships and communication within and between the significant roles involved with student athletes. The results further indicate that those involved with the student athlete should consider a holistic approach to enhance communication and coordination, including physical, psychological, and other life factors, for optimal student athlete management and development. More resources are necessary to facilitate effective communication and coordination regarding the student athlete's total load.
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Affiliation(s)
- Cathrine Nyhus Hagum
- Department of Education and Sports Science, University of Stavanger, 4036 Stavanger, Norway
| | - Espen Tønnessen
- Faculty of Health Sciences, Kristiania University College, 0107 Oslo, Norway
| | - Marie Aarrestad Nesse
- Department of Education and Sports Science, University of Stavanger, 4036 Stavanger, Norway
| | - Shaher A I Shalfawi
- Department of Education and Sports Science, University of Stavanger, 4036 Stavanger, Norway
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Alegret N, Usart M, Valle A, De la Flor AR, Subirana L, Valero R. Improvement of Teamwork Nontechnical Skills Through Polytrauma Simulation Cases Using the Communication and Teamwork Skills (CATS) Assessment Tool. JOURNAL OF SURGICAL EDUCATION 2023; 80:706-713. [PMID: 36882339 DOI: 10.1016/j.jsurg.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess acquisition of nontechnical skills (NTS) through clinical simulation cases by healthcare personnel who participated in a Crisis Resource Management (CRM) training program for the initial care of polytraumatisms. DESIGN Pre-and postintervention study. SETTING Acute-care teaching hospital in Sabadell, Barcelona (Spain). PARTICIPANTS Healthcare personnel that composed teamworks providing initial care to polytraumatized patients attended 12-hour simulation training using a SimMan 3G manikin and performed exercises corresponding to 3 clinical scenarios. All simulations lasted 15 to 25 min and were video recorded. The CATS Assessment tool was used for analysis of teamwork NTS, which included 21 behaviors clustered into the categories of coordination, situational awareness, cooperation, communication, and crisis situation. RESULTS Three editions of the CRM training course were carried out with 12 trauma team groups composed by team leader, anesthesiologist, general surgeon, traumatologist, registered nurses, nursing assistant, and stretcher bearer. There were statistically significant (p <0.001) improvements in the speed of key times of total duration of case resolution, transfusion of hemoderivatives, Focused Assessment Sonography for Trauma, and chest and pelvic X-rays. The percentage of cases correctly resolved improved from 75% to 91.7% but differences were not statistically significant (p = 0.625). Precourse and postcourse results of CATS scores showed a statistically significant increase in the weighted total score as well as in all behavioral categories of coordination, situational awareness, cooperation, communication, and crisis situation. CONCLUSIONS Simulation-based training of NTS was associated with significant improvements in teamwork behaviors in the setting of the initial care of patients with polytraumatisms.
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Affiliation(s)
- Núria Alegret
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain.
| | - Mireia Usart
- Education and Information Technology, University Rovira i Virgili, Tarragona, Spain
| | - Anna Valle
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | | | - Laura Subirana
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Ricard Valero
- Service of Anesthesiology and Resuscitation, Hospital Clinic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Center for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain
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Raj M, Stephenson AL, DePuccio MJ, Sullivan EE, Tarver W, Fleuren B, Thomas SC, Scheck McAlearney A. Conceptual Framework for Integrating Family Caregivers Into the Health Care Team: A Scoping Review. Med Care Res Rev 2023; 80:131-144. [PMID: 36000495 DOI: 10.1177/10775587221118435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than 80% of family care partners of older adults are responsible for coordinating care between and among providers; yet, their inclusion in the health care delivery process lacks recognition, coordination, and standardization. Despite efforts to include care partners (e.g., through informal or formal proxy access to their care recipient's patient portal), policies and procedures around care partner inclusion are complex and inconsistently implemented. We conducted a scoping review of peer-reviewed articles published from 2015 to 2021 and reviewed a final sample of 45 U.S.-based studies. Few articles specifically examine the inclusion of care partners in health care teams; those that do, do not define or measure care partner inclusion in a standardized way. Efforts to consider care partners as "partners" rather than "visitors" require further consideration of how to build health care teams inclusive of care partners. Incentives for health care organizations and providers to practice inclusive team-building may be required.
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Affiliation(s)
| | | | | | | | | | | | - Samuel C Thomas
- Stanford School of Medicine and Intermountain Healthcare, USA
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Duffy CC, Bass GA, Yura C, Dymek M, Lorenzi C, Kaplan LJ, Clapp JT, Atkins JH. Thematic mapping of perioperative incident reporting data to relational coordination domains. J Interprof Care 2023; 37:245-253. [PMID: 36739556 DOI: 10.1080/13561820.2022.2057454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Communication failure is a common root cause of adverse clinical events. Problematic communication domains are difficult to decipher, and communication improvement strategies are scarce. This study compared perioperative incident reports (IR) identifying potential communication failures with the results of a contemporaneous peri-operative Relational Coordination (RC) survey. We hypothesised that IR-prevalent themes would map to areas-of-weakness identified in the RC survey. Perioperative IRs filed between 2018 and 2020 (n = 6,236) were manually reviewed to identify communication failures (n = 1049). The IRs were disaggregated into seven RC theory domains and compared with the RC survey. Report disaggregation ratings demonstrated a three-way inter-rater agreement of 91.2%. Of the 1,049 communication failure-related IRs, shared knowledge deficits (n = 479, 46%) or accurate communication (n = 465, 44%) were most frequently identified. Communication frequency failures (n = 3, 0.3%) were rarely coded. Comparatively, shared knowledge was the weakest domain in the RC survey, while communication frequency was the strongest, correlating well with our IR data. Linking IR with RC domains offers a novel approach to assessing the specific elements of communication failures with an acute care facility. This approach provides a deployable mechanism to trend intra- and inter-domain progress in communication success, and develop targeted interventions to mitigate against communication failure-related adverse events.
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Affiliation(s)
- Caoimhe C Duffy
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary A Bass
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Yura
- Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Malwina Dymek
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cara Lorenzi
- Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Surgical Critical Care, Corporal Michael Crescencz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Justin T Clapp
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua H Atkins
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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House S, Crandell J, Stucky C, Kitzmiller R, Jones C, Gittell JH. Relational Coordination as a Predictor of Job Satisfaction and Intent to Stay Among Nurses and Physicians in the Military Health System. Mil Med 2023; 188:e316-e325. [PMID: 35050374 DOI: 10.1093/milmed/usab464] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Job satisfaction and retention of military and civilian nurses and physicians who work in military treatment facilities (MTFs) are critical to maintaining quality of care and operational readiness. Civilian nurses and physicians working in MTFs supplement staffing for active duty military nurses and physicians and support operational readiness when military nurses and physicians deploy in wartime crises or humanitarian efforts. Decreased retention of military and civilian nurses and physicians can negatively impact operational readiness and patient care outcomes. Although several factors (e.g., burnout, pay, and leadership) influence job satisfaction and retention among nurses and physicians in both military and civilian healthcare settings, high-quality communication and relationships between nurses and physicians are associated with better job satisfaction and retention. However, little is known about how high-quality communication and relationships affect job satisfaction and retention among nurses and physicians in MTFs. Relational coordination (RC) is a process of high-quality communication supported by relationships of shared knowledge, shared goals, and mutual respect among members of the healthcare team. By strengthening RC, hospital leaders can more effectively achieve desired outcomes. The purpose of this study was to explore how RC influences job satisfaction and intent to stay among nurses, residents, and physicians in an Army hospital, and whether job satisfaction mediated the relationship between RC and intent to stay. MATERIALS AND METHODS We conducted an exploratory, cross-sectional study in a 138-bed MTF in the southeastern USA and invited a convenience sample of military and civilian nurses, residents, and physicians to complete a 47-item survey on RC, job satisfaction, and intent to stay. We used Pearson's correlation to explore relationships between RC, job satisfaction, and intent to stay and then employed multiple regression to explore whether RC predicts job satisfaction and intent to stay, after controlling for professional role, demographic characteristics, and other covariates. Furthermore, we explored whether job satisfaction mediates the relationship between RC and intent to stay. RESULTS Two hundred and eighty-nine participants completed the survey. Seventy percentage of respondents were civilian, were Caucasian (61%), and had a mean age of 40 years old. The RCs within roles (β = 0.76, P < .001) and between roles (β = 0.46, P < .001) were both positively associated with job satisfaction. RCs within roles was associated with higher intent to stay (β = 0.38, P = .005). Civilian nurses and physicians reported higher intent to stay, followed by officers and enlisted service members. Job satisfaction mediated the relationship between RC within roles and intent to stay. CONCLUSION Our findings suggest that RC is a powerful workplace dynamic that influences job satisfaction and intent to stay, for nurses, residents, and physicians in MTFs. Specifically, we found that RC was positively associated with job satisfaction and intent to stay and that job satisfaction mediates the relationship between RC and intent to stay. We recommend that hospital leaders in MTFs explore interventions to strengthen RC among health professionals by including relational, work process and structural interventions as part of their strategy for retaining military healthcare professionals.
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Affiliation(s)
- Sherita House
- Indiana University School of Nursing, Indianapolis, IN 46202, USA
| | - Jamie Crandell
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | | - Cheryl Jones
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Morian H, Härgestam M, Hultin M, Jonsson H, Jonsson K, Nordahl Amorøe T, Creutzfeldt J. Reliability and validity testing of team emergency assessment measure in a distributed team context. Front Psychol 2023; 14:1110306. [PMID: 37151315 PMCID: PMC10157038 DOI: 10.3389/fpsyg.2023.1110306] [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] [Received: 11/28/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74-0.92 on the TEAM instrument's three domains of leadership, teamwork, and task management. Internal consistency (Cronbach's alpha) ranged between 0.89-0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams' overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.
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Affiliation(s)
- Hanna Morian
- Department of Nursing, Umeå University, Umeå, Sweden
- *Correspondence: Hanna Morian,
| | | | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesia and Critical Care Medicine, Umeå University, Umeå, Sweden
| | - Håkan Jonsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Karin Jonsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Torben Nordahl Amorøe
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Simulation Center West, Department of Research, Education, and Development, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
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McGuier EA, Kolko DJ, Stadnick NA, Brookman-Frazee L, Wolk CB, Yuan CT, Burke CS, Aarons GA. Advancing research on teams and team effectiveness in implementation science: An application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231190855. [PMID: 37790168 PMCID: PMC10387676 DOI: 10.1177/26334895231190855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Effective teams are essential to high-quality healthcare. However, teams, team-level constructs, and team effectiveness strategies are poorly delineated in implementation science theories, models, and frameworks (TMFs), hindering our understanding of how teams may influence implementation. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework is a flexible and accommodating framework that can facilitate the application of team effectiveness approaches in implementation science. Main Text We define teams and provide an overview of key constructs in team effectiveness research. We describe ways to conceptualize different types of teams and team constructs relevant to implementation within the EPIS framework. Three case examples illustrate the application of EPIS to implementation studies involving teams. Within each study, we describe the structure of the team and how team constructs influenced implementation processes and outcomes. Conclusions Integrating teams and team constructs into the EPIS framework demonstrates how TMFs can be applied to advance our understanding of teams and implementation. Implementation strategies that target team effectiveness may improve implementation outcomes in team-based settings. Incorporation of teams into implementation TMFs is necessary to facilitate application of team effectiveness research in implementation science.
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Affiliation(s)
- Elizabeth A. McGuier
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J. Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicole A. Stadnick
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina T. Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C. Shawn Burke
- Institute for Simulation and Training, School of Modeling, Simulation, and Training, University of Central Florida, Orlando, FL, USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
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Zunich R, Roberts MC, Blanchard C, Muluneh B, Carlson RB, Helms T. Scoping Review to Inform the Future Development of a Measure for Team-Based Care in Oncology. JCO Oncol Pract 2023; 19:e43-e52. [PMID: 36475754 DOI: 10.1200/op.22.00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Team-based care is the delivery of health services to an individual by at least two health care providers working collaboratively to achieve optimal care. Participants on the National Cancer Institute and the ASCO Teams in the Cancer Care Delivery Project have defined 13 key principles to serve as the foundation for a successful team; however, it is unclear whether there exist measures of these key principles. METHODS A scoping literature search was conducted for each key principle on PubMed and Embase to identify existing measures for key principles. Articles of interest were exported to a citation manager, Sciwheel, cataloged by the key principle. Existing measures were extracted via a two-stage screening process, with an abstract review followed by a full-text review. RESULTS Fifteen unique measures were identified, with items extrapolated for 12 of the 13 key principles. Measures were not exclusive and could represent more than one key principle. The number of measures varied per principle from zero to five, with Team Composition and Diversity yielding no existing measure. CONCLUSION The long-term goal is to compile and edit these measures, to create a comprehensive measure to be used in various team-based oncology care settings, and to address areas for improvement, ultimately optimizing patient care.
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Affiliation(s)
- Rada Zunich
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Carrie Blanchard
- Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Benyam Muluneh
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Rebecca Beth Carlson
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Taylor Helms
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Winder GS, Clifton EG, Perumalswami P, Mellinger JL. The art of interprofessional psychosocial communication: Optimizing patient interfaces with psychiatric specialists in liver transplantation. Transplant Rev (Orlando) 2022; 36:100728. [DOI: 10.1016/j.trre.2022.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
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Alfazari AS, Naim Ali HA, Alessa A, Magzoub ME. Assessing relational coordination and its impact on perceived mental health of students, teachers and staff in a clinical skills program during the COVID-19 pandemic. BMC MEDICAL EDUCATION 2022; 22:773. [PMID: 36357937 PMCID: PMC9647241 DOI: 10.1186/s12909-022-03828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The global spread of the COVID-19 virus caused unprecedented interruptions in medical education. This paper evaluates Relational Coordination (RC): communicating and relating for task integration; between the distinct stakeholders responsible for scheduling,delivering and receiving clinical teaching in the wake of the pandemic. METHODOLOGY Using a cross-sectional design, the level of Relational Coordination was assessed between twelve groups within a Clinical Skills Program at a Medical School in the United Arab Emirates. It also measures three relevant mental health factors: namely, Job satisfaction, Work Engagement, and Burnout. RESULTS Overall, RC scores were moderate (3.65 out of 5.00). Controlling for participants' position, RC was found to positively and significantly increase both job satisfaction (β = 1.10, p < 0.001) and work engagement (β = 0.78, p < 0.01)., Additionally, RC was significantly associated with lower burnout (β = -0.56, p = 0.05). Fifty percent of participants experienced high job satisfaction, with a mean score of 5.0 out of 7.0, while 73% reported being enthusiastic about their job, with a mean score of 6.0 out of 7.0. About a third of participants (27%) reported feeling burnout. CONCLUSIONS During times of disruption and crisis, medical education can benefit from higher levels of relational coordination. Our study shows the significant impact of relational coordination on mental health measures like job satisfaction and work engagement. To achieve the full potential and benefits of excellent levels of relational coordination in this program, we recommend six interventions focusing on improving communication, work processes, regular meetings, education innovations, capacity building, and the establishment of coaching and counseling programs for students and faculty.
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Affiliation(s)
- Ali S. Alfazari
- Medical Simulation Center, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hebatallah A. Naim Ali
- The Heller School for Social Policy and Management, Brandeis University, Waltham Massachusetts, USA
| | - Awad Alessa
- Department of Medical Education, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohi Eldin Magzoub
- Department of Medical Education, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Kerins J, Keay R, Smith SE, Tallentire VR. Assessing team behaviours and time to defibrillation during simulated cardiac arrest: a pilot study of internal medicine trainees. Simul Healthc 2022. [DOI: 10.54531/cope7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more.
Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an
Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3,
This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.
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Affiliation(s)
- Joanne Kerins
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Rona Keay
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Samantha E Smith
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Victoria R Tallentire
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
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Prentice D, Moore J, Fernandes B, Larabie E. Nursing Care Delivery Models and Intraprofessional Collaborative Care: Canadian Nurse Leaders' Perspectives. SAGE Open Nurs 2022; 8:23779608221133648. [PMID: 36277509 PMCID: PMC9583196 DOI: 10.1177/23779608221133648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction There are many different types of nursing care delivery models used to organize and provide care in hospitals. These models are comprised of different organizational structures and staffing skill mixes. Objective The aim of this study was to explore how nursing care delivery models promote intraprofessional collaborative care in acute care hospitals from the perspectives of nurse leaders. Methods A qualitative descriptive approach was used for this study. Telephone interviews were conducted between January 2021 and August 2021 using an interview guide comprised of semi-structured and structured questions. Using a purposeful sampling technique, ten leaders from nine hospital systems, representing both urban and rural hospitals in the province of Ontario, Canada, participated in the study. Content analysis was conducted resulting in two overarching themes. Results The first theme, Fluidity of the Model addresses the flexibility of the models and the impact of contextual factors such as changes in nurses' scope of practice, government funding changes, staffing mix, and organizational policies and rules. The second theme, Tools of the Trade describes the resources that hospitals implement to promote intraprofessional collaboration that indirectly impacts on patient safety. Conclusion Nursing care delivery models need to be flexible and adaptable. All nursing care delivery models in this study used various tools to promote intraprofessional collaborative care.
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Affiliation(s)
- Dawn Prentice
- Department of Nursing, Brock University, Canada,Dawn Prentice, Department of Nursing, Brock
University, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, Canada L2S 3A1.
| | - Jane Moore
- Department of Nursing, Brock University, Canada
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Braam A, Buljac-Samardzic M, Hilders CGJM, van Wijngaarden JDH. Collaboration Between Physicians from Different Medical Specialties in Hospital Settings: A Systematic Review. J Multidiscip Healthc 2022; 15:2277-2300. [PMID: 36237842 PMCID: PMC9552793 DOI: 10.2147/jmdh.s376927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022] Open
Abstract
Health care today is characterized by an increasing number of patients with comorbidities for whom interphysician collaboration seems very important. We reviewed the literature to understand what factors affect interphysician collaboration, determine how interphysician collaboration is measured, and determine its effects. We systematically searched six major databases. Based on 63 articles, we identified five categories that influence interphysician collaboration: personal factors, professional factors, preconditions and tools, organizational elements, and contextual characteristics. We identified a diverse set of mostly unvalidated tools for measuring interphysician collaboration that focus on information being transferred and understood, frequency of interaction and tone of the relationship, and value judgements about quality or satisfaction. We found that interphysician collaboration increased clinical outcomes as well as patient and staff satisfaction, while error rates and length of stay were reduced. The results should, however, be interpreted with caution, as most of the studies provide a low level of evidence.
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Affiliation(s)
- Anoek Braam
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands,Correspondence: Anoek Braam, Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle Building, P.O. Box 1738, Rotterdam, DR 3000, the Netherlands, Email
| | - Martina Buljac-Samardzic
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Carina G J M Hilders
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jeroen D H van Wijngaarden
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Doose M, Verhoeven D, Sanchez JI, Livinski AA, Mollica M, Chollette V, Weaver SJ. Team-Based Care for Cancer Survivors With Comorbidities: A Systematic Review. J Healthc Qual 2022; 44:255-268. [PMID: 36036776 PMCID: PMC9429049 DOI: 10.1097/jhq.0000000000000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coordination of quality care for the growing population of cancer survivors with comorbidities remains poorly understood, especially among health disparity populations who are more likely to have comorbidities at the time of cancer diagnosis. This systematic review synthesized the literature from 2000 to 2022 on team-based care for cancer survivors with comorbidities and assessed team-based care conceptualization, teamwork processes, and outcomes. Six databases were searched for original articles on adults with cancer and comorbidity, which defined care team composition and comparison group, and assessed clinical or teamwork processes or outcomes. We identified 1,821 articles of which 13 met the inclusion criteria. Most studies occurred during active cancer treatment and nine focused on depression management. Four studies focused on Hispanic or Black cancer survivors and one recruited rural residents. The conceptualization of team-based care varied across articles. Teamwork processes were not explicitly measured, but teamwork concepts such as communication and mental models were mentioned. Despite team-based care being a cornerstone of quality cancer care, studies that simultaneously assessed care delivery and outcomes for cancer and comorbidities were largely absent. Improving care coordination will be key to addressing disparities and promoting health equity for cancer survivors with comorbidities.
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Affiliation(s)
- Michelle Doose
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Dana Verhoeven
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Janeth I. Sanchez
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alicia A. Livinski
- National Institutes of Health Library, Office of Research Services, OD, National Institutes of Health, Bethesda, MD, USA
| | - Michelle Mollica
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Veronica Chollette
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sallie J. Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Haviland C, Green J, Dzara K, Hardiman WO, Petrusa ER, Park YS, Frey-Vogel AS. Psychological safety between pediatric residents and nurses and the impact of an interdisciplinary simulation curriculum. BMC MEDICAL EDUCATION 2022; 22:649. [PMID: 36038868 PMCID: PMC9426229 DOI: 10.1186/s12909-022-03709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Effective teamwork in interdisciplinary healthcare teams is necessary for patient safety. Psychological safety is a key component of effective teamwork. The baseline psychological safety on pediatric inpatient healthcare teams is unknown. The purpose of this study is to determine the baseline psychological safety between pediatric nurses and residents and examine the impact of an interdisciplinary nighttime simulation curriculum. METHODS A convergent, multistage mixed methods approach was used. An interprofessional simulation curriculum was implemented fall 2020 to spring 2021. Qualitative focus group data and quantitative survey data on team psychological safety were collected and compared, both pre- and post-intervention and across nurses and residents. Thematic analysis of the qualitative data was conducted, and themes integrated with survey findings. RESULTS Data were collected from 30 nurses and 37 residents pre-intervention and 32 and 38 post-intervention, respectively. Residents and nurses negatively rated psychological safety (pre-intervention mean = 3.40 [SD = 0.72]; post-intervention mean = 3.35 [SD = 0.81]). At both times psychological safety was rated significantly lower for residents (pre-intervention mean = 3.11 [SD = 0.76], post-intervention mean = 2.98 [SD = 0.84]) than nurses (pre-intervention mean = 3.76 [SD = 0.45], post-intervention mean = 3.79 [SD = 0.50]), all P < .001. Qualitative analysis identified six integrated themes: (1) influence of existing relationships on future interactions, (2) unsatisfactory manner and frequency of communication, (3) unsatisfactory resolution of disagreements (4) overwhelming resident workload impairs collaboration, (5) interpersonal disrespect disrupts teamwork, and (6) interprofessional simulation was useful but not sufficient for culture improvement. CONCLUSION Resident-nurse team psychological safety ratings were not positive. While interprofessional simulation curriculum shows promise, additional efforts are needed to improve psychological safety among residents and nurses.
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Affiliation(s)
- Courtney Haviland
- Department of Pediatric Emergency Medicine, Hasbro Children's Hospital, 593 Eddy St., Providence, RI, 02903, USA
| | - Janet Green
- Department of Nursing, Mass General for Children, 55 Fruit St., Ellison 17, Boston, MA, 02114, USA
| | - Kristina Dzara
- Department of Biomedical Informatics and Medical Education and Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Wendy O Hardiman
- Mass General for Children, Department of Nursing, 55 Fruit St., Ellison 17, Boston, MA, 02114 , USA
| | - Emil R Petrusa
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Bartlett Hall Second Floor, 55 Fruit St., Boston, MA, 02114, USA
| | - Yoon Soo Park
- Department of Emergency Medicine, Harvard Medical School and Massachusetts General Hospital, Bartlett Hall Second Floor, 55 Fruit St., Boston, MA, 02114, USA
| | - Ariel S Frey-Vogel
- Harvard Medical School and Mass General for Children, Department of Pediatrics, 175 Cambridge St, Fifth Floor, Room 587, Boston, MA, 02114 , USA.
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Iattoni M, Ormazabal M, Luvini G, Uccella L. Effect of Structured Briefing Prior to Patient Arrival on Interprofessional Communication and Collaboration in the Trauma Team. Open Access Emerg Med 2022; 14:385-393. [PMID: 35936514 PMCID: PMC9348573 DOI: 10.2147/oaem.s373044] [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: 05/01/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Treating a multiple trauma patient is multidisciplinary team work. The performance of the trauma team is crucial to treating the patients safely and effectively. The fundamentals of the performance are the quality of interprofessional collaboration and the communication inside the team and its efficacy for patients' safety and team's well being. This is a prospective interventional study. The aim of this paper was to assess interprofessional collaboration and perceived efficacy inside the trauma team and to evaluate the effects of the implementation of a trauma team briefing tool before the arrival of the patient on perceived teamwork performance. Participants and Methods The study took place in the emergency department. Participants were members of the trauma team (emergency physicians and nurses). Two validated scales were selected that address interprofessional collaboration and team perceived efficacy: the TEAM survey (revised version) and the Mayo High Performance Teamwork Scale. A detailed and structured team briefing was used. The trauma team filled in the two scales (46 participants). Prior to every multiple trauma patient arrival, the briefing was then implemented for 3 months. At the end of the third month, the two scales were re-administered and the results analysed (31 participants). The main outcome was the variation of proportion of desirable answers. We considered significant only clearly separated confidence intervals (95% CI). Results All items in the questionnaires had better responses in the second round. In 16 items, the differences found were statistically significant with a 95% confidence interval and p<0.05. The perceived communication and collaboration by healthcare professionals of the trauma team improved with the introduction of the tool. Conclusion A team briefing prior to the arrival of a multiple trauma patient enhances providers' self perception of interprofessional collaboration in the management of multiple trauma patients.
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Affiliation(s)
- Martina Iattoni
- Emergency Department, EOC - Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Matias Ormazabal
- Emergency Department, EOC - Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Giorgia Luvini
- Emergency Department, EOC - Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Laura Uccella
- Emergency Department, EOC - Ospedale Regionale di Lugano, Lugano, Switzerland
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House S, Crandell J, Miller M, Stucky C. The impact of professional role and demographic characteristics on job satisfaction and retention among healthcare professionals in a military hospital. Nurs Forum 2022; 57:1034-1043. [PMID: 35809050 PMCID: PMC10083962 DOI: 10.1111/nuf.12777] [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: 12/27/2021] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Sherita House
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Jaime Crandell
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Melissa Miller
- Center for Nursing Science and Clinical Inquiry (CNSCI), Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Christopher Stucky
- Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl, Germany
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Kerrissey M. Commentary on "Integrating network theory into the study of integrated healthcare". Soc Sci Med 2022; 305:115035. [PMID: 35654681 DOI: 10.1016/j.socscimed.2022.115035] [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: 04/08/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
As medicine continues to advance, fragmentation problems in care delivery - and the promise of care integration to solve them - will remain central. But focused research over the past thirty years has yet to uncover the key factors that enable integrated care. In their paper, Burns and colleagues offer a path to new discovery in this well-trodden area: drawing on network theory to better understand the social processes through which integrated care is produced. Social processes are a vital and understudied aspect of integration, and applying network theory may help to refocus integration in a more comprehensive way. However, to transform our understanding of integrated care - and to enable impact in practice - will require expansion beyond the usual network approaches to also capture the communication and work processes that occur among entities. This is no small endeavor. It will take considerable humility, open-mindedness, and focus.
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Affiliation(s)
- Michaela Kerrissey
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02116, USA.
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Gittell JH, Ali HN. Strengthening networks for healthcare integration: A commentary. Soc Sci Med 2022; 305:115036. [PMID: 35618600 DOI: 10.1016/j.socscimed.2022.115036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/12/2022] [Indexed: 01/02/2023]
Abstract
In their paper "Integrating Network Theory into the Study of Integrated Healthcare," Burns, Nembhard and Shortell set out to change how we think about healthcare, and ultimately how we design and deliver healthcare. They aim to do this by focusing attention on the networks through which care is delivered, with particular attention to the relational dimensions of those networks. Inspired by social network, care integration, and relational coordination theories, Burns et al. (2022) offer recommendations for moving the healthcare sector toward a fresh approach to care integration that reflects the realities of relationships and networks. In this commentary, we analyze the main recommendations by Burns et al. and present our view of the field's current standing with regards to each of them. We then suggest potential research questions, contexts and designs to move this proposed work forward, drawing upon insights from a conversation with the authors in addition to their original article. We end by recommending the formation of a research collaborative to carry out the work.
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Affiliation(s)
- Jody Hoffer Gittell
- The Heller School for Social Policy and Management, Brandeis University, USA.
| | - Hebatallah Naim Ali
- The Heller School for Social Policy and Management, Brandeis University, USA
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Rethinking Healthcare Teams’ Practices Using Network Science: Implications, Challenges, and Benefits. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Healthcare teams act in a very complex environment and present extremely peculiar features since they are multidisciplinary, work under quickly changing conditions, and often stay together for a short period with a dynamically fluctuating team membership. Thus, in the broad discussions about the future of healthcare, the strategy for improving providers’ collaboration and team dynamics is becoming a central topic. Within this context, this paper aims to discuss different viewpoints about the application of network science to teamworking. Our results highlight the potential benefits deriving from network science-enabled analysis, and also show some preliminary empirical evidence through a real case study. In so doing, we intend to stimulate discussions regarding the implications of network science in the investigation and improvement of healthcare teams. The intention is to pave the way for future research in this context by suggesting the potential advantages of healthcare teamwork analysis, as well as recognising its challenges and threats.
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Gottfredson RK, Wright SL, Heaphy ED. A critical review of relationship quality measures: Is a fresh start needed? An agenda to move forward. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2022. [DOI: 10.1111/joop.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ryan K. Gottfredson
- Department of Management, Mihaylo College of Business and Economics California State University – Fullerton Fullerton California USA
| | - Sarah L. Wright
- Department of Management, Marketing & Entrepreneurship University of Canterbury Christchurch New Zealand
| | - Emily D. Heaphy
- Department of Management, Isenberg School of Management University of Massachusetts Amherst Amherst Massachusetts USA
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41
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Managing a Team in the Operating Room: The Science of Teamwork and Non-Technical Skills for Surgeons. Curr Probl Surg 2022; 59:101172. [DOI: 10.1016/j.cpsurg.2022.101172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/19/2022]
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Warfield ME, Lorenz L, Ali HN, Gittell JH. Strengthening Community Participation by People With Disabilities in Community-Based Group Homes Through Innovative Action Research. Front Public Health 2022; 10:747919. [PMID: 35570906 PMCID: PMC9099021 DOI: 10.3389/fpubh.2022.747919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
In the US and beyond, a paradigm shift is underway toward community-based care, motivated by changes in policies, payment models and social norms. A significant aspect of this shift for disability activists and policy makers is ensuring participation in community life for individuals with disabilities living in residential homes. Despite a U.S. government ruling that encourages community participation and provides federal and state funding to realize it, little progress has been made. This study builds on and integrates the expanded model of value creation with relational coordination theory by investigating how the resources and relationships between care providers, adults with disabilities, family members, and community members can be leveraged to create value for residents through meaningful community participation. The purpose of our community case study was to assess and improve the quality of relationships between stakeholder groups, including direct care staff and managers, residents, family members, and the community through an action research intervention. This study took place in a residential group home in a Northeastern US community serving adults with disabilities from acquired brain injury. A pre-test post-test design was used and quantitative assessments of relational coordination were collected through electronic surveys, administered at baseline, and post-intervention. Direct care staff, supervisors, the house manager, and nursing staff completed the survey. Qualitative data were collected through focus groups, change team meetings, and key informant interviews. Direct care staff formed a change team to reflect on their baseline relational coordination data and identified the weak ties between direct care staff, family members, and the community as an area of concern. Staff chose to hold a community-wide open house to provide an opportunity to foster greater understanding among staff, residents, family, and community members. The change team and other staff members coordinated with local schools, business owners, town officials, churches, and neighbors. The event was attended by 50 people, about two-thirds from the community. Following the intervention, there was an increase in staff relational coordination with the community. While statistical significance could not be assessed, the change in staff RC with the community was considered qualitatively significant in that real connections were made with members of the community both directly and afterwards. Despite a small sample size, a residential setting where management was favorable to initiating staff-led interventions, and no comparison or control group, our small pilot study provides tentative evidence that engaging direct care staff in efforts to improve relational coordination with community members may succeed in building relationships that are essential to realizing the goal of greater participation in community life.
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Affiliation(s)
- Marji Erickson Warfield
- Center for Youth and Communities, Lurie Institute on Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Laura Lorenz
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Hebatallah Naim Ali
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Jody Hoffer Gittell
- Institute for Health Systems, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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House S, Crandell J, Stucky C, Wilmoth M. Relational Coordination Among Military and Civilian Nurses and Physicians in an Army Hospital: Do Demographic Characteristics and Professional Roles Matter? J Nurs Adm 2022; 52:293-300. [PMID: 35467595 DOI: 10.1097/nna.0000000000001150] [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: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to explore whether demographic characteristics and professional roles are associated with relational coordination (RC) among nurses and physicians. BACKGROUND The increased race, age, and gender diversity in the nursing and medical workforce raises questions regarding how well nurses and physicians communicate and interact. Relational coordination is a unique framework to enhance teamwork and care coordination among healthcare professionals. METHODS An exploratory cross-sectional study was conducted in a military hospital. The study variables were examined using multiple regression. RESULTS Two-hundred eighty-nine participants completed the survey. Professional role, race, age, gender, and experience were not associated with RC. Rank and education were significantly associated with RC. Enlisted service members reported higher RC between roles, and participants with graduate degrees reported lower RC within roles. CONCLUSION Hospital leaders can implement RC to foster inclusivity and teamwork among healthcare professionals despite demographic characteristics and professional roles.
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Affiliation(s)
- Sherita House
- Author Affiliations: Postdoctoral Fellow (Dr House), Indiana University School of Nursing, Indianapolis; Biostatistician (Dr Crandell) and Executive Vice Dean/Associate Dean, Academic Affairs (Dr Wilmoth), University of North Carolina at Chapel Hill School of Nursing; and Deputy Chief, Center for Nursing Science and Clinical Inquiry (Dr Stucky), Fort Bragg, North Carolina
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van Duin TS, de Carvalho Filho MA, Pype PF, Borgmann S, Olovsson MH, Jaarsma ADC, Versluis MAC. Junior doctors' experiences with interprofessional collaboration: Wandering the landscape. MEDICAL EDUCATION 2022; 56:418-431. [PMID: 34890487 PMCID: PMC9305225 DOI: 10.1111/medu.14711] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 05/17/2023]
Abstract
CONTEXT The transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice that form the Landscape of Practice (LoP). This study aims to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice. METHODS In this multicentre qualitative study, 13 junior doctors individually drew two rich pictures of IPC experiences, one positive and one negative. A rich picture is a visual representation, a drawing of a particular situation intended to capture the complex and non-verbal elements of an experience. We used semi-structured interviews to deepen the understanding of junior doctors' depicted IPC experiences. We analysed both visual materials and interview transcripts iteratively, for which we adopted an inductive constructivist thematic analysis. RESULTS While transitioning into a doctor, junior doctors become foremost members of the physician CoP and shape their professional identity based on perceived values in their physician community. Interprofessional learning occurs implicitly, without input from the interprofessional team. As a result, junior doctors struggle to bridge the gap between themselves and the interprofessional team, preventing IPC learning from developing into an integrative process. This professional isolation leaves junior doctors wandering the landscape of practice without understanding roles, attitudes and expectations of others. CONCLUSIONS Learning IPC needs to become a collective endeavour and an explicit learning goal, based on multisource feedback to take advantage of the expertise already present in the LoP. Furthermore, junior doctors need a safe environment to embrace and reflect on the emotions aroused by interprofessional interactions, under the guidance of experienced facilitators.
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Affiliation(s)
- Titia S. van Duin
- Center for Education Development and Research in Health Professions (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Centre GroningenUniversity of GroningenGroningenNetherlands
| | - Marco A. de Carvalho Filho
- Center for Education Development and Research in Health Professions (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Centre GroningenUniversity of GroningenGroningenNetherlands
- Faculty of Veterinary MedicineUtrecht UniversityUtrechtNetherlands
| | - Peter F. Pype
- Department of Family Medicine and Primary Health CareGhent UniversityGhentBelgium
| | - Susanne Borgmann
- Student Deanery of the Faculty of MedicineUniversity Medical Center GöttingenGöttingenGermany
| | - Matts H. Olovsson
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - A. Debbie C. Jaarsma
- Center for Education Development and Research in Health Professions (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Centre GroningenUniversity of GroningenGroningenNetherlands
- Faculty of Veterinary MedicineUtrecht UniversityUtrechtNetherlands
| | - Marco A. C. Versluis
- Department of Obstetrics and GynaecologyUniversity Medical Centre GroningenGroningenNetherlands
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45
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What Can Canada Learn From Accountable Care Organizations: A Comparative Policy Analysis. Int J Integr Care 2022; 22:1. [PMID: 35480852 PMCID: PMC8992768 DOI: 10.5334/ijic.5677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models to integrate care, though comparative studies assessing the applicability and transferability of ACOs in Canada are lacking. In this comparative study, we performed a narrative literature review to examine how Canadian health systems could support ACO models. Methods: We reviewed empirical studies (published 2011–2020) that evaluated ACO impacts in the US. Thematic analysis and critical appraisal were performed to identify factors associated with positive ACO impacts. These factors were compared with the Canadian context to assess the applicability and transferability of ACO models within Canada. Findings: Physician-led models, global budgets and financial incentives, and focus on collaborative care may optimize ACO impacts. While reforms towards alternative payments and team-based care are not unprecedented in Canada, significant further reforms to physician remuneration, intersectoral collaboration, and accountability for performance are required to support ACO-like models. Conclusion: This comparative study uncovered several insights on the applicability and transferability of ACOs to the Canadian context. Further comparative research outside the US is needed to infer the essential components of successful ACO models.
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46
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Ianni L, Camden C, Anaby D. How can we evaluate collaborative practices in inclusive schools? Challenges and proposed solutions. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2022. [DOI: 10.1080/19411243.2022.2054486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lina Ianni
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Chantal Camden
- École de réadapation, Université de Sherbrooke Sherbrooke, Quebec, Canada
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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47
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Bonavia T, Julián M. Effective Behaviors in Work Teams: Spanish Adaptation of the Individual Behavior Analysis Scale. Front Psychol 2022; 13:809731. [PMID: 35356347 PMCID: PMC8959135 DOI: 10.3389/fpsyg.2022.809731] [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: 11/05/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
There are hardly any instruments to measure teamwork behaviors from an individual approach. This applies both in interprofessional teams or not, and in teams involved in health, social care, and other areas. The Individual Behavior Analysis (IBA) scale measures efficacious behavior in work teams. It is one of the few instruments proposed in the literature to measure personal skills necessary for teamwork. Only a previous exploratory analysis of the scale was informed in another study. This article analyzes its internal structure using different confirmatory factor analyses and its internal consistency, with a sample of 815 employees working for Spanish social organizations in the geriatric field, both private and public. The results of the definitive version adapted to Spanish, referred to as Individual Behavior Analysis -25, indicate a good fit of the model to the data and good reliability. Factor analysis confirmed the existence of two factors: Communication skills and Acceptance, with good internal consistency coefficients. This scale is a useful instrument for assessing, based on the reviewed literature, two of the most important individual skills an efficacious team should have.
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Affiliation(s)
- Tomas Bonavia
- Department of Social Psychology, Universitat de València, Valencia, Spain
| | - Martín Julián
- Department of Psychology, Faculty of Health Sciences, Universidad Europea de Valencia, Valencia, Spain
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Roberts APJ, Webster LV, Salmon PM, Flin R, Salas E, Cooke NJ, Read GJM, Stanton NA. State of science: models and methods for understanding and enhancing teams and teamwork in complex sociotechnical systems. ERGONOMICS 2022; 65:161-187. [PMID: 34865613 DOI: 10.1080/00140139.2021.2000043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
This state of the science review brings together the disparate literature of effective strategies for enhancing and accelerating team performance. The review evaluates and synthesises models and proposes recommended avenues for future research. The two major models of the Input-Mediator-Output-Input (IMOI) framework and the Big Five dimensions of teamwork were reviewed and both will need significant development for application to future teams comprising non-human agents. Research suggests that a multi-method approach is appropriate for team measurements, such as the integration of methods from self-report, observer ratings, event-based measurement and automated recordings. Simulations are recommended as the most effective team-based training interventions. The impact of new technology and autonomous agents is discussed with respect to the changing nature of teamwork. In particular, whether existing teamwork models and measures are suitable to support the design, operation and evaluation of human-nonhuman teams of the future. Practitioner summary: This review recommends a multi-method approach to the measurement and evaluation of teamwork. Team models will need to be adapted to describe interaction with non-human agents, which is what the future is most likely to hold. The most effective team training interventions use simulation-based approaches.
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Affiliation(s)
- Aaron P J Roberts
- Human Factors Engineering, Transportation Research Group, Faculty of Engineering and the Environment, University of Southampton - Boldrewood Innovation Campus, Southampton, UK
| | - Leonie V Webster
- Human Factors Engineering, Transportation Research Group, Faculty of Engineering and the Environment, University of Southampton - Boldrewood Innovation Campus, Southampton, UK
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sippy Downs, Australia
| | - Rhona Flin
- Aberdeen Business School, Robert Gordon University, Aberdeen, UK
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, USA
| | - Nancy J Cooke
- Human Systems Engineering, Arizona State University, Phoenix, AZ, USA
| | - Gemma J M Read
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sippy Downs, Australia
| | - Neville A Stanton
- Human Factors Engineering, Transportation Research Group, Faculty of Engineering and the Environment, University of Southampton - Boldrewood Innovation Campus, Southampton, UK
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sippy Downs, Australia
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House S, Wilmoth M, Stucky C. Relational coordination as a merger and acquisition framework for healthcare organizations. Nurs Manag (Harrow) 2022; 53:36-42. [PMID: 35105844 DOI: 10.1097/01.numa.0000816256.13974.1b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sherita House
- Sherita House is a postdoctoral fellow at Indiana University School of Nursing in Indianapolis, Ind. Margaret Wilmoth is the executive vice dean of academic affairs at the University of North Carolina at Chapel Hill School of Nursing in Chapel Hill, N.C. Christopher Stucky is the deputy chief of the Center for Nursing Science and Clinical Inquiry at Landstuhl Regional Medical Center in Landstuhl, Germany
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Golling M, Behringer W, Schwarzkopf D. Assessing the quality of patient handovers between ambulance services and emergency department – development and validation of the emergency department human factors in handover tool. BMC Emerg Med 2022; 22:10. [PMID: 35045828 PMCID: PMC8772155 DOI: 10.1186/s12873-022-00567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patient handover between prehospital care and the emergency department plays a key role in patient safety. Therefore, we aimed to create a validated tool for measuring quality of communication and interprofessional relations during handover in this specific setting.
Methods
Based on a theoretical framework a comprehensive item pool on information transfer and human factors in emergency department handovers was created and refined in a modified Delphi survey involving clinical experts. Based on a pre-test, items were again revised. The resulting Emergency Department Human Factors in Handover tool (ED-HFH) was validated in a field test at the emergency department of a German university hospital from July to December 2017. The ED-HFH was completed by emergency department and ambulance service staff participating in handovers and by an external observer. Description of item characteristics, exploratory factor analysis, analyses on internal consistency and interrater reliability by intraclass-correlation. Construct validity was analysed by correlation with an overall rating on quality of the handover.
Results
The draft of the ED-HFH contained 24 items, 90 of 102 eligible staff members participated in the field test completing 133 questionnaires on 38 observed handovers. Four items were deleted after analysis of item characteristics. Factor analysis supported a single factor explaining 39% of variance in the items. Therefore, a sum-score was calculated with a possible range between 14 and 70. The median value of the sum-score in the sample was 61.5, Cronbach’s α was 0.83, intraclass-correlation was 0.52, the correlation with the overall rating of hand-over quality was ρ = 0.83 (p ≤ 0.001).
Conclusions
The ED-HFH showed its feasibility, reliability and validity as a measure of quality of information transfer and human factors in handovers between ambulance services and the emergency department. It promises to be a useful tool for quality assurance and staff training.
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