Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems

Autor:	Jongmin Lee, Milisa Manojlovich, Jenna Goldstein, Mark V. Williams, Kevin J. O'Leary, Julie K. Johnson
Jazyk:	angličtina
Rok vydání:	2019
Předmět:	Quality Assurance Health Care media_common.quotation_subject Psychological intervention Interpersonal relations Health informatics Patient care team Health administration Clinical microsystems Study Protocol 03 medical and health sciences 0302 clinical medicine Mentorship Nursing Surveys and Questionnaires Health care Humans Medicine Medical errors 030212 general & internal medicine Quality of Health Care Retrospective Studies media_common Protocol (science) Teamwork business.industry 030503 health policy & services Health Policy Nursing research lcsh:Public aspects of medicine Mentors lcsh:RA1-1270 Organizational Culture Organizational Innovation 3. Good health Hospitalization Leadership Models Organizational Interdisciplinary communication 0305 other medical science business Delivery of Health Care
Zdroj:	BMC Health Services Research, Vol 19, Iss 1, Pp 1-11 (2019) BMC Health Services Research
ISSN:	1472-6963
DOI:	10.1186/s12913-019-4116-z
Popis:	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. Electronic supplementary material The online version of this article (10.1186/s12913-019-4116-z) contains supplementary material, which is available to authorized users.
Databáze:	OpenAIRE
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