Sustaining improvements in relational coordination following team training and practice change: A longitudinal analysis

Abstract

Background Poor communication is a leading cause of errors in health care. Structured interprofessional bedside rounds are a promising model to improve communication. Purpose The aim of the study was to test if an intervention to improve communication and coordination in an inpatient heart failure care unit would result in lasting change. Methodology/Approach The relational coordination (RC) survey was administered to seven workgroups (i.e., nurses, physicians) at baseline (2015) and three subsequent years following the intervention (team training, leadership development workshops, and structured interprofessional bedside round implementation). Descriptive analysis and mixed-effects models were used to assess the impact of the intervention on improving RC. Results During the study period (2015–2018), 344 participants completed the survey for an overall response rate of 53.5% (n = 643). Postintervention, the RC index significantly increased from 3.79 to 4.08 (p < .001) and remained significantly higher over 2 years, with an RC index of 4.12 and 4.04, respectively (p < .001). The range of RC scores between and within workgroups narrowed over time, with nonrotating workgroups showing the most improvements. Conclusion Findings indicate that positive changes as a result of the intervention have been sustained, despite high rates of turnover among all workgroups. Notably, positive change in RC was found to be more pronounced for nonrotating workgroups compared to team members who rotate within the hospital (i.e., pharmacists who rotate to other units every month). Practice Implications This intervention holds promise for teams seeking best practice models of “high-reliability” care organization and delivery. Sustained changes from this intervention represent an important area of future practice-based research.

Interventions Into Reliability-Seeking Health Care Organizations: A Systematic Review of Their Goals and Measuring Methods

“…Confronted with methodological standards regarding not only reliability but also validity, we cannot negate that almost all the studies reviewed lack a control group 24,29,39 and rely on small sample sizes 33,66,67 or—as in the case of qualitative research designs—only single-case studies, 45 potentially limiting their generalizability across organizations. Nevertheless, qualitative or mixed-method research in and of reliability-seeking healthcare organizations has particular value because it captures the processual, highly contextual journey of an organization toward greater reliability.…”

“…31 Regarding the goal of timeliness, we find measures such as discharge delays 32 and the length of stay. 32 With regard to the goal of efficiency, we find operationalizations such as the frequency, timeliness, and accuracy of communication and coordination, 33 financial growth rate, 34 and turnaround times. 35 The number of variables that studies use to measure the more reliable achievement of a goal differs.…”