Effects of provider characteristics on care coordination under comanagement

Abstract

BACKGROUND:Care coordination is critical in settings characterized by high levels of uncertainty, time constraints, and interdependent work processes. The effects of provider characteristics on coordination in comanaged teams has never been examined.OBJECTIVE:To characterize individual providers based on their contribution to team coordination.PARTICIPANTS:Hospitalists, nonphysician providers, hepatologists, and fellows on a comanaged liver service of an academic hospital.DESIGN:Between April 2008 and October 2008, participants were surveyed at baseline and repeatedly at the completion of physician rotations to assess their preferred and actual comanagement structures. In addition, they repeatedly rated their comanagers' contributions to overall coordination using an instrument that assessed relational coordination (RC). Providers were categorized into tertiles of RC. Their management preferences and the frequency of a “composite bad outcome” (intensive care unit [ICU] transfer or inpatient death) in each tertile were evaluated.RESULTS:All (100%) Baseline Surveys and 177/224 (79%) Repeated Surveys were completed by 32 providers. RC was shown to be a stable attribute of providers and not of adverse patient outcomes. Higher coordinators were characterized by their “ownership of patients” (higher 86% vs. lowest 20%, P < 0.01). High compared to low coordinator hepatologists demonstrated leadership through a broader delegation of tasks as well as self‐assignment of responsibilities. A trend toward more frequent “composite bad outcomes” was seen for low tertile physicians: hospitalists (low 8.6% vs. high 1.1%, P < 0.01), hepatologists (low 5.2% vs. high 2.0%, P = 0.22), fellows (low 5.8% vs. high 1.8%, P = 0.08).CONCLUSION:Individual provider's teamwork‐related disposition affects perceived coordination on comanaged team and may influence patient outcomes. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

Factors associated with relational coordination between health professionals involved in insulin initiation in the general practice setting for people with type 2 diabetes

“…This instrument can be adapted for use in different health settings and for different groups of health professionals. Previous studies have indicated that higher RC scores are associated with improved patient outcomes and quality of care in hospital settings (Gittell et al 2000, Havens et al 2010, Hinami et al 2010.…”

Impact of Provider Coordination on Nurse and Physician Perceptions of Patient Care Quality

“…Coordination is defined as the management of task interdependencies, 4 that is, the conscious activity to assemble and synchronize differentiated work efforts so that they function harmoniously in attaining an organizational goal. 5 It is a central component of teamwork 6 and has verbal and nonverbal communication at its core.…”

Provider expectations and experiences of comanagement

“…Based on the fact that no hepatologists wanted more influence over decision‐making, we assume that hepatologists were the physician leaders for most of the studied comanaged teams. Under situations characterized by high levels of complexity and interdependence, a team governed by a single leader may often be more effective than one governed by shared authority 8. However, even under hierarchical models, a more participatory than supervisory leadership can help avoid alienating partners through a pattern of “we decide, you carry it out” that is often associated with ineffective leadership styles 13–14.…”

“…Floor nurses received in‐servicing at the commencement of the service. Additional details about the service are described elsewhere 8…”