Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems
Abstract 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 fam...
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4116-z |
| _version_ | 1818033988288118784 |
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| author | Kevin J. O’Leary Julie K. Johnson Milisa Manojlovich Jenna D. Goldstein Jungwha Lee Mark V. Williams |
| author_facet | Kevin J. O’Leary Julie K. Johnson Milisa Manojlovich Jenna D. Goldstein Jungwha Lee Mark V. Williams |
| author_sort | Kevin J. O’Leary |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-10T06:32:00Z |
| format | Article |
| id | doaj.art-98b7b15c381d487ab9f36ffeca554c87 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-10T06:32:00Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-98b7b15c381d487ab9f36ffeca554c872022-12-22T01:59:04ZengBMCBMC Health Services Research1472-69632019-05-0119111110.1186/s12913-019-4116-zRedesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystemsKevin J. O’Leary0Julie K. Johnson1Milisa Manojlovich2Jenna D. Goldstein3Jungwha Lee4Mark V. Williams5Division of Hospital Medicine, Northwestern University Feinberg School of MedicineDepartment of Surgery and the Center for Healthcare Studies, Northwestern University Feinberg School of MedicineDepartment of Systems, Populations, and Leadership, University of Michigan School of NursingCenter for Hospital Innovation and Improvement, Society of Hospital MedicineDepartment of Preventative Medicine, Northwestern University Feinberg School of MedicineCenter for Health Services Research, University of Kentucky College of MedicineAbstract 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.http://link.springer.com/article/10.1186/s12913-019-4116-zInterdisciplinary communicationPatient care teamInterpersonal relationsMedical errorsHospitalizationClinical microsystems |
| spellingShingle | Kevin J. O’Leary Julie K. Johnson Milisa Manojlovich Jenna D. Goldstein Jungwha Lee Mark V. Williams Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems BMC Health Services Research Interdisciplinary communication Patient care team Interpersonal relations Medical errors Hospitalization Clinical microsystems |
| title | Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems |
| title_full | Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems |
| title_fullStr | Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems |
| title_full_unstemmed | Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems |
| title_short | Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems |
| title_sort | redesigning systems to improve teamwork and quality for hospitalized patients reset study protocol evaluating the effect of mentored implementation to redesign clinical microsystems |
| topic | Interdisciplinary communication Patient care team Interpersonal relations Medical errors Hospitalization Clinical microsystems |
| url | http://link.springer.com/article/10.1186/s12913-019-4116-z |
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