Weinberg Dana Beth, Lusenhop R William, Gittell Jody Hoffer, Kautz Cori M
Department of Sociology, Queens College, CUNY, Flushing, NY, USA.
Health Care Manage Rev. 2007 Apr-Jun;32(2):140-9. doi: 10.1097/01.HMR.0000267790.24933.4c.
The increased "outsourcing" of care-related tasks to patients and their informal caregivers is part of a broader trend in service industries toward engaging customers as "coproducers" of service outcomes. As both quasi-patients and quasi-providers, caregivers may play a critical role in successful coproduction, but they require coordination with care providers to play this role effectively. When tasks are highly interdependent, uncertain, and time constrained, as they often are in health care, relational forms of coordination are expected to be most effective.
This study explores the effects of coordination between formal providers and informal caregivers on caregiver preparation to provide care at home and the effect of caregiver preparation on patient outcomes. Gittell's theory of relational coordination posits that effective coordination occurs through frequent, high-quality communication that is supported by relationships of shared goals, shared knowledge, and mutual respect. We extend the relational coordination model, previously used to examine coordination between formal providers, to encompass coordination of care between formal providers and informal caregivers.
We surveyed patients before and 12 weeks after knee replacement surgery to assess outcomes. At 6 weeks postsurgery, we surveyed their caregivers regarding coordination with providers and preparation to provide care.
We found that relational coordination between formal providers and caregivers improves caregiver preparation to provide care, which, in turn, is positively associated with patients' freedom from pain, functional status, and mental health.
Providers should be encouraged to attend to the interpersonal aspects of their interactions with caregivers to promote relational coordination, which may ultimately benefit the patient's health. It is not enough, however, to urge providers to build shared goals, shared knowledge, and mutual respect with patients and caregivers. Dedicated resources and support are needed, given the context of constrained resources and brief encounters in which providers deliver care.
将与护理相关的任务更多地“外包”给患者及其非正式护理人员，是服务行业更广泛的一种趋势的一部分，即让客户成为服务成果的“共同生产者”。作为准患者和准提供者，护理人员可能在成功的共同生产中发挥关键作用，但他们需要与护理提供者协调，才能有效地发挥这一作用。当任务高度相互依存、不确定且时间紧迫时（医疗保健中常常如此），关系型协调形式预计最为有效。
本研究探讨正式护理提供者与非正式护理人员之间的协调对护理人员在家提供护理准备情况的影响，以及护理人员准备情况对患者治疗结果的影响。吉特尔的关系型协调理论认为，有效的协调通过频繁、高质量的沟通实现，这种沟通得到共同目标、共享知识和相互尊重关系的支持。我们扩展了先前用于研究正式护理提供者之间协调的关系型协调模型，以涵盖正式护理提供者与非正式护理人员之间的护理协调。
我们在膝关节置换手术前和术后12周对患者进行了调查，以评估治疗结果。在术后6周，我们就护理人员与提供者的协调情况以及提供护理的准备情况对他们进行了调查。
我们发现，正式护理提供者与护理人员之间的关系型协调改善了护理人员提供护理的准备情况，而这又与患者的无痛状态、功能状况和心理健康呈正相关。
应鼓励护理提供者关注他们与护理人员互动中的人际方面，以促进关系型协调，这最终可能有益于患者的健康。然而，仅仅敦促护理提供者与患者和护理人员建立共同目标、共享知识和相互尊重是不够的。鉴于护理提供者提供护理时资源有限且接触时间短暂的情况，还需要专门的资源和支持。
