TY - JOUR
T1 - Redesigning systems to improve teamwork and quality for hospitalized patients (RESET)
T2 - Study protocol evaluating the effect of mentored implementation to redesign clinical microsystems
AU - O'Leary, Kevin J.
AU - Johnson, Julie K.
AU - Manojlovich, Milisa
AU - Goldstein, Jenna D.
AU - Lee, Jungwha
AU - Williams, Mark V.
N1 - Funding Information:
Each study site has assembled a local leadership team, including a physician leader, a nurse leader, and a research nurse. Site physician and nurse leaders dedicate sufficient time for the study with support from their hospital. The research nurse receives funding from the grant to support effort for data collection and local project management activities. Mentors coach sites during monthly calls with site leadership teams. The research team hosts monthly calls with all mentors, during which each mentor team provides updates on sites’ progress. Each site also received guidance from their mentor team through an initial two-day site visit to assess relationships with key stakeholders, site infrastructure, and readiness for change. Mentor teams provided a written report with observations from site visits and recommendation to site leaders.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/5/8
Y1 - 2019/5/8
N2 - Background: A number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective for this study is to implement a set of evidence-based complementary interventions across a range of clinical microsystems, identify factors and strategies associated with successful implementation, and evaluate the impact on quality. Methods: The RESET project uses the Advanced and Integrated MicroSystems (AIMS) interventions. The AIMS interventions consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Four hospital sites were chosen to receive guidance and resources as they implement the AIMS interventions. Each study site has assembled a local leadership team, consisting of a physician and nurse, and receives mentorship from a physician and nurse with experience in leading similar interventions. Primary outcomes include teamwork climate, assessed using the Safety Attitudes Questionnaire, and adverse events using the Medicare Patient Safety Monitoring System (MPSMS). RESET uses a parallel group study design and two group pretest-posttest analyses for primary outcomes. We use a multi-method approach to collect and triangulate qualitative data collected during 3 visits to study sites. We will use cross-case comparisons to consider how site-specific contextual factors interact with the variation in the intensity and fidelity of implementation to affect teamwork and patient outcomes. Discussion: The RESET study provides mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. Our findings will be of interest and directly applicable to all hospitals providing care to patients with medical conditions. Trial registration: NCT03745677. Retrospectively registered on November 19, 2018.
AB - Background: A number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective for this study is to implement a set of evidence-based complementary interventions across a range of clinical microsystems, identify factors and strategies associated with successful implementation, and evaluate the impact on quality. Methods: The RESET project uses the Advanced and Integrated MicroSystems (AIMS) interventions. The AIMS interventions consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Four hospital sites were chosen to receive guidance and resources as they implement the AIMS interventions. Each study site has assembled a local leadership team, consisting of a physician and nurse, and receives mentorship from a physician and nurse with experience in leading similar interventions. Primary outcomes include teamwork climate, assessed using the Safety Attitudes Questionnaire, and adverse events using the Medicare Patient Safety Monitoring System (MPSMS). RESET uses a parallel group study design and two group pretest-posttest analyses for primary outcomes. We use a multi-method approach to collect and triangulate qualitative data collected during 3 visits to study sites. We will use cross-case comparisons to consider how site-specific contextual factors interact with the variation in the intensity and fidelity of implementation to affect teamwork and patient outcomes. Discussion: The RESET study provides mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. Our findings will be of interest and directly applicable to all hospitals providing care to patients with medical conditions. Trial registration: NCT03745677. Retrospectively registered on November 19, 2018.
KW - Clinical microsystems
KW - Hospitalization
KW - Interdisciplinary communication
KW - Interpersonal relations
KW - Medical errors
KW - Patient care team
UR - http://www.scopus.com/inward/record.url?scp=85065486102&partnerID=8YFLogxK
U2 - 10.1186/s12913-019-4116-z
DO - 10.1186/s12913-019-4116-z
M3 - Article
C2 - 31068161
AN - SCOPUS:85065486102
VL - 19
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 293
ER -