Managing intergroup silos to improve patient flow

Kreindler, Sara A.; Hastings, Stephanie E.; Mallinson, Sara; Brierley, Meaghan; Birney, Arden; Tarraf, Rima C.; Winters, Shannon; Johnson, Keir

doi:10.1097/hmr.0000000000000310

Cited by 6 publications

(7 citation statements)

References 35 publications

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“…These results made it impossible for us to complete a mixed-methods comparison as planned. However, qualitative data corroborated the quantitative findings of inter-regional similarity (Kreindler et al 2020(Kreindler et al , 2021a(Kreindler et al , 2021b. Across the sample, participants reported that service offerings remained badly misaligned with population needs, resulting in pervasive inefficiency, inappropriateness and, in many acute facilities, a perpetual state of overcapacity.…”

Section: Discussionsupporting

confidence: 53%

“…The aim was not to produce a complete inventory of strategies, but rather to explore explanations for perceived success or failure and to identify broader organizational factors that might underpin performance. The qualitative findings were too extensive to be reported in a single article and have instead been developed into separate articles on common strategies and challenges (Anwar et al 2021;Kreindler et al 2020Kreindler et al , 2021aKreindler et al , 2021bKreindler et al , 2021c.…”

Section: Introductionmentioning

confidence: 99%

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Despite Interventions, Emergency Flow Stagnates in Urban Western Canada

Kreindler

Schull

Rowe

et al. 2021

hcpol

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Despite Interventions, Emergency Flow Stagnates in Urban Western Canada

Kreindler

Schull

Rowe

et al. 2021

hcpol

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“…Whereas hospital executives strive to achieve timely, efficient, and high‐quality patient care throughout the entire institution, nurses promote care within their own department, section, or assignment. Although effective patient flow management requires a systemic approach, 2 interprofessional “siloing” between administration and staff has impeded patient flow improvement 20 . The ability to articulate patient flow management as a uniting concept relevant to hospital administrators, managers, and all nurses has powerful implications for breaking down silos, engaging and empowering hospital staff, and harnessing nursing knowledge and expertise.…”

Section: Discussionmentioning

confidence: 99%

“…Although effective patient flow management requires a systemic approach, 2 interprofessional "siloing" between administration and staff has impeded patient flow improvement. 20 The ability to articulate patient flow management as a uniting concept relevant to hospital administrators, managers, and all nurses has powerful implications for breaking down silos, engaging and…”

Section: Implications For Hospital Managementmentioning

confidence: 99%

“ Nurses are every bit of the flow:” Emergency department nurses' conceptualization of patient flow management

Benjamin

Wolf

2022

Nursing Forum

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Aim To validate and refine Benjamin and Jacelon's 2021 definition of patient flow management using the experience and knowledge of practicing emergency department nurses. Background Patient flow requires complex, real‐time decision‐making to match patients to limited resources and facilitate their movement through care processes. A literature‐based concept analysis of patient flow management was first performed in 2021, but the voice of nurses is largely absent from existing patient flow research. Design This study employed an expanded concept analysis methodology, as articulated by Kathleen Cowles. Data source Focus groups of nine emergency nurses were conducted. Results Emergency nurses' conceptualization of patient flow management differs from the definition as it has emerged through patient flow literature. Patient flow management is a nurse‐driven process that relies on nursing knowledge and the work of all emergency nurses, including bedside nurses. Emergency nurses perceive the ultimate goal of patient flow management to be the collective safety of patients, and they work to promote patient safety within their own scope of responsibility. Conclusion Understanding patient flow management as a nurse‐driven process emphasizes the importance of nurse training and capacity to effective patient flow. Future research should explore the role of emergency nurses as active directors, rather than passive components, of patient flow. More work is needed to investigate this complex nursing task.

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“…These challenges strongly relate to the fact that the current health care system is still based on a single-disease paradigm that focuses on and subspecializes in single conditions, whereas complex patients have multiple conditions and require an integrated approach involving multiple specialties [6,8,9]. Earlier research stressed that for an integrated approach, structural reorganization is not sufficient [10]. Instead, research suggests that an integrated approach can be supported through relational coordination [11].…”

Section: Introductionmentioning

confidence: 99%

Clinical leaders crossing boundaries: A study on the role of clinical leadership in crossing boundaries between specialties

Braam,

van Wijngaarden,

Vollmann

et al. 2023

PLoS ONE

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Background Due to the growing number of complex (multimorbid) patients, integrating and coordinating care across medical specialties around patient needs is an urgent theme in current health care. Clinical leadership plays an important role in stimulating coordination both within and between specialty groups, which results in better outcomes in terms of job satisfaction and quality of care. Purpose In this light, this study aims to understand the relation between physicians’ clinical leadership and outcomes, focusing on the sequential mediation of relationships and coordination with physicians within their own medical specialty group and from other specialties. Methodology A cross-sectional self-administered survey among physicians in a Dutch hospital (n = 107) was conducted to measure clinical leadership, relational coordination at two levels (medical specialty group and between different specialties), quality of care, and job satisfaction. Results Clinical leadership was related to better quality of care through more relational coordination within the medical specialty group. Clinical leadership was related to more job satisfaction through more relational coordination within the medical specialty group, through more relational coordination between specialties, and sequentially through both kinds of relational coordination. Conclusion Physicians who act as clinical leaders are important for crossing specialist boundaries and increasing care outcomes. Practical implications To improve multidisciplinary collaboration, managers should encourage clinical leadership and pay attention to the strong relationships between physicians from the same specialty.

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Managing intergroup silos to improve patient flow

Abstract: Supplemental digital content is available in the text.

Cited by 6 publications

References 35 publications

Despite Interventions, Emergency Flow Stagnates in Urban Western Canada

Despite Interventions, Emergency Flow Stagnates in Urban Western Canada

“ Nurses are every bit of the flow:” Emergency department nurses' conceptualization of patient flow management

Clinical leaders crossing boundaries: A study on the role of clinical leadership in crossing boundaries between specialties

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