Deirdre Mylod, PhD, Executive Director, Institute for Innovation
| Apr 13, 2015
Care Coordination is an often used term. With so much focus from so many sources, it’s not surprising that it can be defined in many different ways. Care coordination is described as an element of efficiency, the process of hand offs, the support of a navigator or the role of multi-disciplinary teams. But from the patient point of view, the definition may be the most basic, simply: the perception of staff working together as a team to provide care. When care runs smoothly, events occur as expected, care providers provide consistent information and seem to support and respect one another, patients feel reassured that they are in good hands. Conversely, when elements of care break down and feel fragmented, patients are left to wonder if they may slip through the cracks. Dr. Tom Lee often notes that while patients have always experienced some level of fear and anxiety about their disease and treatment, they are increasingly afraid that care is not as well coordinated as it needs to be to keep them safe.
One of the Institute projects is to better understand patient perceptions of coordination and teamwork. An interactive set of findings regarding patient perception of care coordination demonstrates how patient-level characteristics create risk or resiliency in patient perceptions of staff working together as a team. For example, within the inpatient setting, maternity patients and surgical patients perceive more teamwork than medically treated patients. Regardless of service line, inpatients admitted through the emergency department are less likely to feel that staff worked together as a team. In both inpatient and medical practice settings, patients’ own health influences their perception of teamwork with patients in poorer health perceiving less optimal teamwork among caregivers. Importantly, we also see that the perception of teamwork is vital for more global evaluations of hospital care such as overall rating of a hospital experience or intent to recommend the hospital to others. Patients that give an optimal response (i.e., top box rating) to a measure regarding staff working well together are dramatically more likely to both rate the hospital as a 9 or a 10 and to indicate that they are certain they would recommend the hospital.
Also available as a resource is a curated annotated bibliography on Care Coordination which highlights recent studies addressing improvements in processes as well as communication. The impact of teamwork is also emphasized with evidence showing how perceived teamwork in the Emergency Department setting is associated with overall perceptions of care and the confidence patients have in their care providers (Kipnis, A., Rhodes, K. V., Burchill, C. N., & Datner, E. (2013). The relationship between patients' perceptions of team effectiveness and their care experience in the emergency department. The Journal of Emergency Medicine, 45(5), 731-738.)
Improving patient perceptions of staff working well together will rely on the process improvements that are the focus of many care coordination efforts. That is, patients will certainly benefit from programs to prepare them for transitions, smooth hand offs and streamlined processes. It is equally as important to acknowledge, however, the way personal interactions among staff convey a sense of teamwork to patients and influence their perception of care and safety. To fully tackle coordination of care from the patient’s point of view, cultural issues of respect, mutual support and shared purpose will need to be addressed. Process improvements will get us part of the way there, however, to truly deliver on patient needs and reduce suffering, we must build culture that embeds teamwork within practices.