Collaboration through clinical integration.

Rising healthcare costs and the nursing shortage have affected the ability of healthcare organizations to provide a collaborative environment for high-quality care. Recent studies show that the nursing shortage has resulted in increased work loads, fewer support resources, and nurse dissatisfaction, resulting in difficulty providing quality care. Henneman cited a lack of collaboration as a contributing factor to the fragmentation of care and poor outcomes which plague our healthcare system. Knaus et al found that hospitals where collaboration was present reported 41% lower mortality than predicted number of deaths. Hospitals where there was a little collaboration exceeded predicted mortality by 58%. Positive collaborative relations have also been tied to a decrease in negative patient outcomes, increased organizational commitment, and nurse satisfaction as well as reduced cost and greater responsiveness for healthcare providers. The aim of this discussion is to introduce the participant to the concept of collaboration and use of the Donabedian structure-process-outcome model to provide a framework for embedding best practice components necessary for multidisciplinary collaboration in an acute care setting. The National Joint Practice Commission recommendations and the work of Schmalenberg et al were utilized to establish structural and process components necessary for a collaborative practice environment. Trinity Regional Health System utilized this information in conjunction with the Center for Case Management to develop a care model and improve patient outcomes. The average length of stay (LOS) decreased from 4.24 to 3.37 days and cost per admission from $6723 to $5919 in just over 1 year.