Quality healthcare in the United States continues to lag despite being a major focus over the last twenty years (Conn, Kenaszchuk, Dainty, Zwarenstein, & Reeves, 2014; Nembhard, Alexander, Hoff, & Ramanujam, 2009; O’Leary et al., 2010). Achieving high quality care demands effective interdisciplinary team collaboration and improved patient experiences. Hierarchical relationships between physicians and other healthcare practitioners as well as the traditional power structure between practitioners and patients act as barriers to achieving high quality care (MacMillan & Reeves, 2014). To help mitigate these barriers in the inpatient setting, healthcare leaders advocate for micro-system level solutions such as interdisciplinary rounding (IDR), a team-based model of care, where healthcare team members from multiple disciplines gather daily to discuss patient plans of care (Institute for Healthcare Improvement, 2015). Interdisciplinary rounding aims to foster a team collaboration process consisting of communication, coordination of care and patient-centered shared decision making (Gonzalo, Himes, McGillen, Shifflet, & Lehman, 2016). However, despite IDR’s ability to bring team members from different disciplines together in one place, IDR’s effectiveness at supporting team collaboration and improving practitioner and patient experiences is uncertain (Pannick et al., 2015; Paradis, Leslie, & Gropper, 2015; Zwarenstein, Rice, Gotlib-Conn, Kenaszchuk, & Reeves, 2013). Design features such as where the rounds occur, who leads the discussion, use of a script, and whether the patient is present may influence IDR’s effectiveness. More information is needed on how these design features associate with team collaboration and healthcare practitioner and patient experiences.
The proposed study draws on Donabedian’s structure, process, outcomes model for examining health services and evaluating quality of care (1966, 1978, 1980) and Gittell’s relational coordination theory (2003, 2009). Interdisciplinary rounding is a structural intervention that serves as a coordinating mechanism between practitioners (Gittell, 2002). Having an IDR structure provides an opportunity for team collaboration to take place. Team collaboration is an interpersonal process built on partnerships, coordination, cooperation and shared decision making (Orchard, Curran, & Kabene, 2005). Effective team collaboration leads to improved outcomes for both patients and practitioners (Zwarenstein, Goldman, & Reeves, 2009). Team collaboration serves as a moderator between the IDR structure and the outcomes: experiences of practitioners and patients. It is thought that as team collaboration increases, the relationship between IDR practices and outcomes strengthens. Previous research supports that practitioners engaged in high levels of team collaboration perceive themselves as a highly effective team. Additionally, patients recognize the effectiveness of their practitioners as a team and whether they were included in decisions about their treatment (Song et al., 2015).
Literature on IDR practices neither provides consensus on whether they directly improve outcomes, nor does it provide guidance on best design for the practice (O’Leary, Johnson, & Auerbach, 2016). Findings suggest uncertainty that by having an IDR practice in place means team collaboration becomes salient to the team members (Paradis et al., 2015; Zwarenstein et al., 2013). A systematic review found evidence that IDR practices have a positive association with decreased length of stay and improved staff satisfaction, but failed to provide support for an association with patient satisfaction (Bhamidipati et al., 2016). A different systematic review concluded that interdisciplinary care interventions like IDR practices did not consistently reduce risk of early readmission, early mortality or a reduction in length of stay (Pannick et al., 2015). It is difficult to tie improved patient experiences directly to IDR practices due to the multiple confounding factors influencing patient care (O’Leary et al., 2016). However, it is generally accepted that effective team collaboration processes lead to improved outcomes. Therefore, a potential reason for the mixed findings is that not all IDR practices foster effective team collaboration equally (O’Leary et al., 2016). This study explores design features as potential factors in the mixed findings.
Multiple different variations of IDR designs can be found across hospital units. Currently, healthcare leadership has little evidence of best practices for designing IDR practices. A thorough understanding of how IDR designs are associated with effective team collaboration and their contribution to practitioner and patient experiences can inform hospital leadership about ways to design their services to improve outcomes and further engage patients in the co-production of their own healthcare (Batalden et al., 2016).
The study uses a cross-sectional, mixed method design describing IDR practices on sixteen adult inpatient hospital units in two academic medical centers. Practitioners were surveyed on their perceptions partnership and coordination (two components of team collaboration) as well as their perceived team effectiveness. Two questions from the standard Press-Ganey patient satisfaction survey were used as well to examine the relationship between IDR features, practitioner experiences and patient experiences.
Multilevel modeling using the RStudio software program will be used to explore the quantitative data collected and directed content analysis will be used to explore the qualitative data. The results from both the quantitative and qualitative findings will be looked at together to confirm findings and potential areas for future research as well as implications for practice.