Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care

Abstract

BackgroundTrauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across diverse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital.MethodsWe conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance.FindingsWe engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers.ConclusionsThrough engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.

Revisiting Relational Coordination: A Systematic Review

“…While studies of relational interventions are in their infancy compared with studies of structural interventions, nearly all reported findings have been positive. Relational interventions have been associated with increased relational coordination (e.g., Abu-Rish Blakeney et al, 2019;Brazil et al, 2019;Cramm & Nieboer, 2014b;Purdy et al, 2020;Ross, 2015), as well as increased efficiency (Bitter, 2017), and improved quality (Goldstein et al, 2014) in the health care sector. Often these relational interventions have been implemented in tandem with structural interventions such as cross-functional training programs (Ross, 2015) and cross-functional meeting structures (Abu-Rish Blakeney et al, 2019).…”

“…How can change agents help organizations learn how to coordinate? As shown above, change agents can engage in relational interventions such as humble inquiry and empathetic connection to establish a safe space to reflect on interdependencies and transform fragmented relationshps into more connected ones (Abu-Rish Blakeney et al, 2019;Gittell, 2016;Purdy et al, 2020). As relational coordination begins to gain strength, change agents are able to implement structural interventions with relational intent, thus further reinforcing relational coordination.…”

The team briefing: setting up relational coordination for your resuscitation

“…Recently, we undertook a study of relational coordination and the culture of trauma care at Gold Coast University Hospital, a large tertiary care and trauma centre in Australia. 10 Data was collected using a quantitative relational coordination survey in conjunction with an ethnography-participant observation, interviews, and working groups-with the trauma service. The study was approved by the Gold Coast University Hospital ethics review board (HREC/18/QGC/13).…”

Translational simulation for rapid transformation of health services, using the example of the COVID-19 pandemic preparation

“…Given our existing relationships with clinical services, our focus was on team and system challenges. We felt that our specific expertise in building relationships and shaping culture through simulation [7,8] was likely to be more important than ever as we undertook rapid and urgent high stakes change. Our strategy was aligned with the Queensland Health Pandemic Influenza Plan [9] and guided by the local Health Emergency Operations Centre (HEOC), to whom we provided biweekly reports.…”