A mixed methods study examining teamwork shared mental models of interprofessional teams during hospital discharge

2019 ◽  
Vol 29 (6) ◽  
pp. 499-508 ◽  
Author(s):  
Kirstin Manges ◽  
Patricia S Groves ◽  
Amany Farag ◽  
Ryan Peterson ◽  
Joanna Harton ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mental Models ◽  
Hospital Discharge ◽  
Improve Patient Care ◽  
Shared Mental Models ◽  
Mixed Methods Study ◽  
Interprofessional Teams ◽  
Patient Interviews ◽  
Qualitative Thematic Analysis ◽  
Patient Reported

BackgroundLittle is known about how team processes impact providers’ abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams’ organised understanding of individual member’s roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients.MethodsThis mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams’ teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs.ResultsThe sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation.ConclusionsExamining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.

scholarly journals An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Patricia A. Carney ◽  
W. Perry Dickinson ◽  
Jay Fetter ◽  
Eric J. Warm ◽  
Brenda Zierler ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Local Context ◽  
Primary Care Residency ◽  
Interprofessional Teams ◽  
Coaching Relationship ◽  
Team Coaching ◽  
Primary Care Education ◽  
Health Coaches

Introduction/Objectives: Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. Methods: This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. Results: The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach’s alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach’s expertise with the team’s needs. Conclusions: While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.

scholarly journals Identifying positive deviants in healthcare quality and safety: a mixed methods study

2018 ◽  
Vol 111 (8) ◽  
pp. 276-291 ◽  
Author(s):  
Jane K O’Hara ◽  
Katja Grasic ◽  
Nils Gutacker ◽  
Andrew Street ◽  
Robbie Foy ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Statistical Modelling ◽  
Service Level ◽  
Knee Surgery ◽  
Mixed Methods Study ◽  
Quality And Safety ◽  
Hospital Data ◽  
Local Improvement ◽  
Patient Reported ◽  
Hip And Knee Surgery

Objective Solutions to quality and safety problems exist within healthcare organisations, but to maximise the learning from these positive deviants, we first need to identify them. This study explores using routinely collected, publicly available data in England to identify positively deviant services in one region of the country. Design A mixed methods study undertaken July 2014 to February 2015, employing expert discussion, consensus and statistical modelling to identify indicators of quality and safety, establish a set of criteria to inform decisions about which indicators were robust and useful measures, and whether these could be used to identify positive deviants. Setting Yorkshire and Humber, England. Participants None - analysis based on routinely collected, administrative English hospital data. Main outcome measures We identified 49 indicators of quality and safety from acute care settings across eight data sources. Twenty-six indicators did not allow comparison of quality at the sub-hospital level. Of the 23 remaining indicators, 12 met all criteria and were possible candidates for identifying positive deviants. Results Four indicators (readmission and patient reported outcomes for hip and knee surgery) offered indicators of the same service. These were selected by an expert group as the basis for statistical modelling, which supported identification of one service in Yorkshire and Humber showing a 50% positive deviation from the national average. Conclusion Relatively few indicators of quality and safety relate to a service level, making meaningful comparisons and local improvement based on the measures difficult. It was possible, however, to identify a set of indicators that provided robust measurement of the quality and safety of services providing hip and knee surgery.

scholarly journals Investigating the causes of patient anxiety at induction of anaesthesia: A mixed methods study

2020 ◽  
pp. 175045892093693
Author(s):  
Andrew B Lumb ◽  
Gary J Latchford ◽  
Hilary L Bekker ◽  
Anna R Hetmanski ◽  
Caroline R Thomas ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Biological Response ◽  
Mixed Methods Study ◽  
Qualitative Assessment ◽  
Patient Anxiety ◽  
Anaesthetic Induction ◽  
Cardiovascular Changes ◽  
Patient Reported ◽  
Theatre Staff ◽  
Induction Of Anaesthesia

Aim To investigate patient anxiety at anaesthetic induction and whether this is affected by anaesthetic room interventions. Methods A mixed methods study was carried out: pre-induction interventions were directly observed. Patient anxiety was assessed quantitatively with cardiovascular changes, the visual analogue scale and the state-trait anxiety inventory. Interviews allowed qualitative assessment. Results Patient-reported anxiety did not correlate with cardiovascular changes. Anaesthetic room interventions were not predictive of anxiety. Postoperative interviews identified five sources of anxiety, mostly related to preparation for surgery. Staff responses to anxiety were also highlighted. Discussion Patient-reported anxiety and its biological response are not correlated. Pre-induction interventions do not contribute to anxiety. Anxiety levels at induction are similar to or lower than earlier in the preoperative period. Conclusions On induction of anaesthesia, patients have little control over their situation but are actively reassured and distracted by theatre staff. Our data suggest staff are good at this. More could still be done to reduce preoperative sources of anxiety.

scholarly journals Which Reasons Do Doctors, Nurses, and Patients Have for Hospital Discharge? A Mixed-Methods Study

PLoS ONE ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. e91333 ◽  
Author(s):  
Dirk T. Ubbink ◽  
Evelien Tump ◽  
Josje A. Koenders ◽  
Sieta Kleiterp ◽  
J. Carel Goslings ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hospital Discharge ◽  
Mixed Methods Study

Primary care physician’s (PCP) perceived value of patient-reported outcomes (PROs) in clinical practice: a mixed methods study

2021 ◽  
pp. bmjqs-2020-012206
Author(s):  
Danny Mou ◽  
Daniel M Horn ◽  
Marilyn Heng ◽  
Manuel Castillo-Angeles ◽  
Keren Ladin ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Mixed Methods ◽  
Clinical Setting ◽  
Patient Reported Outcomes ◽  
Mixed Methods Study ◽  
Clinic Efficiency ◽  
Wide Range ◽  
Patient Reported ◽  
Semistructured Interviews

BackgroundPatient-reported outcomes (PROs) can promote patient engagement, shared-decision making and improve the overall experience of care. However, PRO integration in the primary care clinical setting is limited. Exploring the perspectives of primary care physicians (PCPs) on PROs is key to understanding how they are being used in the clinical setting. We sought to elucidate this clinical perspective at one of the largest US health systems that has integrated a wide range of PROs into routine primary care.MethodsMixed methods study with both anonymous online surveys and in-person qualitative semistructured interviews conducted with PCPs to understand their clinical perspectives on the applications of the existing PROs. PCPs from the 19 affiliated clinics were prompted to complete the survey. Interviewed PCPs were selected via a combination of random and purposive selection from the PCP directory.ResultsOf 172 PCPs, 117 (68%) completed the online survey and 28 completed semistructured interviews. Most PCPs (77%) reviewed PRO responses with their patients. PCPs endorsed that PROs improve clinic efficiency and clinical management. However, PCPs have heterogeneous perspectives on the relevance of PROs in clinical practice, likely due to variations in clinic practice. For specific PRO instruments, PCPs reported anxiety and depression screening PROs to be most helpful. PCPs felt that PROs assisted with completing screening questions that are required by regulatory bodies. Barriers to using PROs include poor user-interface for both clinicians and patients and inadequate training.ConclusionsMost PCPs regularly use PRO data though there are mixed opinions about their clinical relevance. An adaptable, user-friendly PRO system has the potential to have meaningful clinical applications in primary care.

scholarly journals Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study

2017 ◽  
Vol 16 (4) ◽  
pp. 883 ◽  
Author(s):  
Lacey English ◽  
Elias Kumbakumba ◽  
Charles P Larson ◽  
Jerome Kabakyenga ◽  
Joel Singer ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hospital Discharge ◽  
Mixed Methods Study ◽  
Hospital Deaths
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