Suppr超能文献

关系协调与基于团队的护理:学习型健康系统中的变革举措过载及其他挑战

Relational coordination and team-based care: Change initiative overload and other challenges in a learning health system.

作者信息

Hajjar Lauren, Olaleye Olawale, Yang Julius, McGirr Susan, Sullivan Erin E

机构信息

Department of Public Service and Healthcare Administration Suffolk University Boston Massachusetts USA.

Institute on Healthcare Systems Brandeis University Waltham Massachusetts USA.

出版信息

Learn Health Syst. 2025 Jan 8;9(3):e10455. doi: 10.1002/lrh2.10455. eCollection 2025 Jul.

Abstract

INTRODUCTION

Most change interventions to address quality of care and lower costs focus on technical aspects of the work through process improvements, which have not consistently delivered the anticipated impact for healthcare organizations. This study aims to (1) understand how relational interventions including shared huddles and cross-role shadowing opportunities, impact team dynamics and functioning and (2) describe the challenges and opportunities associated with implementing relational interventions at an Academic Medical Center in a large metropolitan city in the United States.

METHODS

This paper is a mixed method, pre-post-intervention study in which data were collected using a validated survey, observations, interviews, and one focus group. Relational coordination survey data were analyzed within and across eight interdependent workgroups on three inpatient medical units at baseline and 16 months post-intervention. Qualitative data were coded and analyzed for themes.

RESULTS

While there were some improvements in overall relational coordination between baseline and post-intervention measures, the findings were not statistically significant. Qualitative data reveal four themes, highlighting the strengths and barriers to the intervention: (1) incomplete fidelity to the relational coordination framework, (2) leadership, (3) meeting structure and participation, and (4) stakeholder engagement.

CONCLUSIONS

Within the healthcare context, this study contributes to our learning about implementing and measuring relational interventions. We offer insights for future research and practice on change initiative overload and operational constraints, socializing relational interventions, and balancing core and non-core roles in the intervention strategy.

摘要

引言

大多数旨在提高医疗质量和降低成本的变革干预措施都侧重于通过流程改进来关注工作的技术层面,但这些措施并未始终如一地为医疗组织带来预期的影响。本研究旨在:(1)了解包括共享碰头会和跨角色跟班学习机会在内的关系干预措施如何影响团队动态和运作;(2)描述在美国一个大城市的学术医疗中心实施关系干预措施所面临的挑战和机遇。

方法

本文是一项干预前后的混合方法研究,使用经过验证的调查问卷、观察、访谈和一个焦点小组收集数据。在基线和干预后16个月,对三个住院医疗单元的八个相互依存的工作组内部和之间的关系协调调查数据进行了分析。对定性数据进行编码并分析主题。

结果

虽然基线和干预后措施之间的整体关系协调有一些改善,但结果在统计学上并不显著。定性数据揭示了四个主题,突出了干预措施的优势和障碍:(1)对关系协调框架的不完全忠实;(2)领导力;(3)会议结构和参与度;(4)利益相关者参与。

结论

在医疗背景下,本研究有助于我们了解关系干预措施的实施和衡量。我们为未来关于变革倡议过载和运营限制、关系干预措施的推广以及在干预策略中平衡核心和非核心角色的研究和实践提供了见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a2c7/12264371/2b7627c47779/LRH2-9-e10455-g001.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验