<p>Moving on from CUSP to CUP: empowering multidisciplinary teams and integrating them in the management structure of hospital organization</p>

Abstract

Background: The functional role of Comprehensive Unit-based Safety Program (CUSP) teams was extended to empower them and make them a part of the organizational management. Purpose: These improvements in the functional roles of CUSP were made with the objective of solving two structural issues, namely, departmentalization and compartmentalization present in health care organizations. Methods: The following were three improved functional roles: 1) instead of just being a reactive mechanism to implement improvements based on real safety issues, they also carried out risk analysis and implemented preventive actions proactively; 2) instead of focusing only on safety, they controlled all results such as safety, quality, treatment effectiveness and timeliness of their respective process units, using a series of Key Performance Indicators; and 3) instead of being a supplementary multidisciplinary team parallel to the organization´s departmentalized management structure, they were made to participate in the decision-making structure, representing their respective process units. These teams represented different process units and were named as Comprehensive Unit-based Process (CUP) teams. Results: The CUP structural design changed the dynamics of the organization: 1) it integrated members of different disciplines, especially physicians and nurses, and integrated them into a team with a shared goal, making internal communication and teamwork a “systemic” requirement; 2) it disabled the middle-level managers to represent the interests of specific knowledge-based groups such as physician departments or nursing areas while making decisions; and 3) it reassigned middle-level managers the task of representing different CUPs, making each manager responsible for a process unit, thus ensuring control over the results of multidisciplinary activities. Conclusion: The new organizational structure put burden on the system, not on its people, as it made multidisciplinary communication and teamwork to be the rule of the game, allowing patient-centered health care.

La centralización y descentralización en los procesos de departamentalización: una revisión de la literatura

“…La departamentalización es beneficiosa para una óptima organización en las empresas; por ejemplo, en una encuesta realizada a un grupo de docentes escolares, la gran mayoría respondió que preferían organizarse por departamentos, puesto que les daba más tiempo para preparar sus lecciones (Parker et al, 2017). Asimismo, la mayoría de las organizaciones médicas están estructuradas en departamentos unidisciplinarios según Govindarajan (2019), los cuales se dividen con tal de controlar el conocimiento que pueda ser necesario para llevar a cabo una determinada tarea, pero no para controlar la calidad y eficacia de la tarea en sí.…”