National Clinician Scholar, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
BMJ Qual Saf. 2020 Jun;29(6):499-508. doi: 10.1136/bmjqs-2019-009716. Epub 2019 Nov 27.
Little is known about how team processes impact providers' abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams' organised understanding of individual member's roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients.
This mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams' teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs.
The sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation.
Examining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.
对于团队流程如何影响提供者为患者安全出院做准备的能力知之甚少。团队共享心智模型（teamwork-SMMs）是团队对执行任务（如出院）所需的各个成员的角色、互动和行为的组织理解。团队-SMMs 与其他领域的团队有效性相关，但在医疗保健领域尚未得到广泛研究。本研究通过考察团队-SMMs 来了解多专业团队在为患者出院时如何协调护理工作。
本混合方法研究考察了一家医院的住院跨专业出院团队的团队-SMMs。对于每个出院事件，我们使用访谈和问卷从患者及其出院团队（护士、医生和协调员）收集数据。我们使用共享心智模型量表定量确定了出院团队的团队-SMM 质量和收敛组件，然后探讨了它们与患者报告的出院后护理准备情况之间的关系。我们使用叙述性案例的定性主题分析来考察具有较高和较低团队-SMMs 的出院团队之间的背景差异。
样本包括总共 106 次结构化患者访谈、192 次提供者出院日问卷调查和 430 个观察小时，以考察 64 次出院事件。我们发现，具有更好的团队-SMMs（即，更高的团队工作质量或更大的收敛性）的住院团队更能有效地为患者出院后的护理做好准备。此外，具有高和低团队-SMMs 的团队在团队凝聚力、沟通开放性以及对患者情况的一致性方面有不同的体验。
考察团队之间团队-SMMs 的质量和一致性可以更好地了解团队如何协调护理工作，并可能有助于开发特定的基于团队的干预措施，以改善患者在出院时的护理。
