Hospital Culture of Transitions in Care

McClelland, Mark; Lazar, Danielle; Wolfe, Lindsay; Goldberg, Debora Goetz; Zocchi, Mark S.; Twesten, Jenny; Pines, Jesse M.

doi:10.1097/ncq.0000000000000132

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…A final insight is the recognition that ED and hospital culture can also contribute to poor flow. Crowding is a result of staff, space, and processes but it is also a result of how well teams work together within and across units [ 19 ]. For example, hospitals with a silo mentality that only consider their own flow and do not recognize crowding as a hospital-wide issue can perpetuate dysfunction in other units while protecting their own staff.…”

Section: Solutions To Improve Ed Flowmentioning

confidence: 99%

Solving the worldwide emergency department crowding problem – what can we learn from an Israeli ED?

Pines

Bernstein

2015

Isr J Health Policy Res

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ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED crowding, including management, process, environmental, human factors, and resource issues. Several solutions exist to reduce ED crowding, which involve addressing several of the issues identified by Bashkin et al. This includes reducing the demand for and variation in care, and better matching the supply of resources to demands in care in real time. However, what is needed to reduce crowding is an institutional imperative from senior leadership, implemented by engaged ED and hospital leadership with multi-disciplinary cross-unit collaboration, sufficient resources to implement effective interventions, access to data, and a sustained commitment over time. This may move the culture of a hospital to facilitate improved flow within and across units and ultimately improve quality and safety over the long-term.

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Section: Solutions To Improve Ed Flowmentioning

confidence: 99%

Solving the worldwide emergency department crowding problem – what can we learn from an Israeli ED?

Pines

Bernstein

2015

Isr J Health Policy Res

Self Cite

View full text Add to dashboard Cite

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Psychometric Evaluation of the Hospital Culture of Transitions Survey

McClelland¹,

Bena²,

Albert

et al. 2017

The Joint Commission Journal on Quality and Patient Safety

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A New Tool to Assess Clinician Experience With Patient Care Transitions

Fekieta

Rosenberg

Jenq

et al. 2021

Quality Management in Health Care

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Background and Objectives: Clinician experience of intrahospital patient care transfers can drive transfer success and safe patient care. Measuring clinician experience can provide insights into opportunities to improve transfer processes that impact patient care. As part of a quality improvement project, we developed a brief survey to gauge clinician experience with patient care transfers that occur within a hospital. Methods: The survey framework was built upon a previously identified taxonomy of intrahospital transfers that includes categories of transfer activities: disposition, notification, preparation, communication, and coordination. The survey tool was administered twice to physicians, nurses, and other health professionals across a single hospital. Data were analyzed comparing providers sending patients, and those receiving patients. Results: The survey response rate was 33% to 34% across both years. While helpful in demonstrating improving trends in provider experience and engagement with transfer processes, the survey also allowed for differences between the experiences of sending and receiving providers to be revealed. Nurses reported improved preparedness to receive patients and receivers overall reported improved teamwork. Senders' perceptions showed improved trends in all transfer categories. Preliminary data also suggest acceptable reliability across respondent type, item category, and time. Specifically, reliability across sending and receiving clinicians was demonstrated in the categories of timeliness (α = 0.85) and culture (α = 0.72). Responses of sending clinicians were internally consistent within culture (α = 0.82), while responses of receiving clinicians were internally consistent within culture (α = 0.86), timeliness (α = 0.76), notification (α = 0.77), communication (α = 0.73), and teamwork (α = 0.73). Conclusions: Overall, the survey was feasible to implement and built to optimize content, construct, and response process validity. Survey results drove practical improvement work, such as informing a verbal transfer protocol to improve nursing preparedness to receive patients on general medicine units. As a practical tool, the survey and its results can help hospital administrators to focus on categories of transfer activities that are most problematic for clinicians and to track trends for quality improvement.

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Hospital Culture of Transitions in Care

Cited by 3 publications

References 12 publications

Solving the worldwide emergency department crowding problem – what can we learn from an Israeli ED?

Solving the worldwide emergency department crowding problem – what can we learn from an Israeli ED?

Psychometric Evaluation of the Hospital Culture of Transitions Survey

A New Tool to Assess Clinician Experience With Patient Care Transitions

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