Repeated, Close Physician Coronary Artery Bypass Grafting Teams Associated with Greater Teamwork

Everson, Jordan; Funk, Russell J.; Kaufman, Samuel R.; Owen‐Smith, Jason; Nallamothu, Brahmajee K.; Pagani, Francis D.; Hollingsworth, John M.

doi:10.1111/1475-6773.12703

Cited by 22 publications

(18 citation statements)

References 39 publications

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“…Ironically, what allowed the team to work flexibly was the stability provided by a core group of experienced ED doctors and nurses. These findings are in line with studies in other healthcare settings where there is a growing recognition of a positive relationship between team experience, team member familiarity, and the team's ability to efficiently coordinate their tasks to deliver safe patient care [45][46][47].…”

Section: Discussionsupporting

confidence: 87%

Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team

et al. 2020

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Background: The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly. Methods: The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically. Results: The roles were occupationally specialized: "Assessment and Diagnosis" tasks consumed the largest proportion of doctors' (51.1%) and NPs' (38.1%) time, and "Organization of Care" tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients' needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses. Conclusion: Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to "be flexible" (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients' needs within its organizational context. The study's findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work.

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Section: Discussionsupporting

confidence: 87%

Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team

et al. 2020

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“…after another organization or provider participated in providing health services to the same patient" (CMS, 2016b). This type of relationship has been previously used to measure collaborative relationships between hospitals (Mascia & Di Vincenzo, 2013) and physicians (Barnett, Landon, O'Malley, Keating, & Christakis, 2011;Everson et al, 2017). We merged this data with the American Hospital Association (AHA) Annual Survey to identify hospital organizations and their characteristics within the patient-sharing file.…”

Section: Data Sourcementioning

confidence: 99%

Hospitals Strengthened Relationships With Close Partners After Joining Accountable Care Organizations

et al. 2018

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The strategies that hospitals participating in Medicare Accountable Care Organizations (ACOs) use to achieve quality and cost containment goals are poorly understood. One possibility is that participating hospitals could try to influence where their patients receive care. To test this hypothesis, we examined whether a hospital’s participation in a Medicare ACO was associated with changes in its patterns of patient sharing with other hospitals. Between 2010 and 2014, patient sharing across hospitals increased 23.3%. After controlling for hospital and regional factors, patient sharing increased 4.4% more at ACO hospitals than non-ACO hospitals ( p = .001 for difference). This increase occurred disproportionately among hospitals with which ACO hospitals already shared a high proportion of their patients prior to participation, and among hospitals in ACOs characterized as physician–hospital collaborations. The increased sharing of patients among closely affiliated hospitals may serve to achieve ACO quality and cost containment goals through increased interorganizational coordination.

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“…Second, our study is based on claims, not clinical, data. While using claims data to study provider networks has been validated, 21,22 it excludes providers not paid by Medicare, including ancillary services providers such as social work, financial counseling, and pastoral care. Therefore, our study may underestimate coordination complexity, especially when viewed from a holistic perspective.…”

Section: Limitationsmentioning

confidence: 99%

Coordination of Care Around Surgery for Colon Cancer: Insights From National Patterns of Physician Encounters With Medicare Beneficiaries

Lin

Regenbogen

Hollingsworth

et al. 2019

JOP

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PURPOSE: To improve care coordination for complex cancers, it is critical to establish a more nuanced understanding of the types of providers involved. As the number of provider types increases, strategies to support cancer care coordination must adapt to a greater variety of information needs, communication styles, and treatment strategies. METHODS: We categorized providers into 11 types, using National Provider Identifier specialties. Using Medicare claims, we counted the number of unique combinations of provider types billed during preoperative, operative, and postdischarge care for colon cancer surgery and assessed how this count varies across hospitals. The study included 70,567 beneficiaries in fee-for-service Medicare A and B for 6 months before and 60 days after an admission for colectomy for colon cancer between 2008 and 2011. RESULTS: We observed 1,554 preoperative provider-type combinations, 975 operative combinations, and 1,571 postdischarge combinations. The three most common combinations in the preoperative phase were general medicine only, other medical specialists only, and general medicine and other medical specialists. In the operative phase, the three most common combinations were primary surgery, anesthesiology, and pathology; general medicine, other medical specialists, radiology, primary surgery, anesthesiology, and pathology; and other medical specialists, radiology, primary surgery, anesthesiology, and pathology. In the postdischarge phase, the three most common combinations were general medicine, general medicine and other medical specialists, and general medicine and oncology. On average, each hospital had 15 preoperative, 11 operative, and 15 postoperative combinations. High-volume, larger, teaching, urban, and noncritical access hospitals had more combinations in all phases. CONCLUSION: Many provider-type combinations are involved in colon cancer surgery care. Substantial variation exists across hospitals types, suggesting that certain hospitals need additional resources and more flexible infrastructure to coordinate care.

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Repeated, Close Physician Coronary Artery Bypass Grafting Teams Associated with Greater Teamwork

Cited by 22 publications

References 39 publications

Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team

Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team

Hospitals Strengthened Relationships With Close Partners After Joining Accountable Care Organizations

Coordination of Care Around Surgery for Colon Cancer: Insights From National Patterns of Physician Encounters With Medicare Beneficiaries

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