Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Quality Improvement and Implementation Science
Jane Holl, MD, MPH
Professor of Pediatrics and Preventive Medicine; Director, Center for Healthcare Studies and Center for Education in Health Sciences
Feinberg School of Medicine, Northwestern University
Over the last 25 years a growing body of evidence shows that patient outcomes improve with organizational and process interventions targeting rehabilitation team functioning and interdisciplinary coordination. Key components for successful interventions include the active participation of hands- on clinicians, physician engagement, administrative and leadership “buy in”, a mechanism for information feedback, and the use of conceptual model of team effectiveness to frame discussions and actions. This workshop aims to provide participants with the skills and knowledge to address problematic areas in team functioning (TF) and interdisciplinary coordination (IC) relevant to their current needs.
The team approach is not only well-established in rehabilitation, it is codified into credentialing and regulatory guidelines. Ironically, the implementation of these same administrative mandates inhibit effective interdisciplinary team work. For example, a comprehensive progress note, which is template-driven, time consuming, and mind-numbing, distracts from vital interpersonal communication and interprofessional coordination. Likewise, the need for specific number of hands on therapy units per day may limit direct provider participation at team conferences where collaborative discussions and team dynamics could be leveraged to enhance patient outcomes These factors create a paradox where a rehabilitation unit which does its’ work strictly by the book, may have a less well functioning team.
This conference focuses on the interdisciplinary team utilizing a conceptual model of rehabilitation treatment effectiveness where the team acts as a key transformational variable between Inputs (hospital, staff – treatments, patient – family) and Outcomes (functional improvement, discharge destination, and resource utilization). This model proposes that team functioning can be understood and measured in domains of actions(leadership and managerial practices) and relationships (social climate and professional networks). The framework proved useful in a series of investigations on the relationship of team functioning to stroke patient outcomes, including a series of VA funded research projects on stroke rehabilitation (VA Merit Review B2367R; 03225R).
Insights gleamed from a successful cluster, randomized clinical trial on team training to improve patient outcomes are reviewed. In this trial involving 31 VA inpatient teams (464 staff; 467 stroke patients), patients treated by teams in the experimental arm showed greater motor FIM gain than patients in the comparison arm. Each experimental team developed site specific action plans as part of a skills training workshop. Insights from this research along with newer research and clinical experiences provide the basis for this workshop.
Woven into the presentations and discussions are relevant concepts from organization theory including Tacit Knowledge (TK) and Knowledge in Practice (KIP). Tacit Knowledge represents knowledge and skills developed from experience. TK is sometimes referred to as “know – how” which contrast to Explicit Knowledge or “know – what”. Knowledge in Practice refers to structured approach to learn about and categorize TK in a manner to promote sustainability and eventual incorporation into Explicit Knowledge.
Through selected clinical vignettes, participants will examine how TF and IC impact patient outcomes in a variety of circumstances and develop both diagnostic skills and interventional strategies to optimize team work and staff coordination. We address day to day practices which are integral to the smooth and efficient delivery of treatment in a systematic manner based on the successful intervention of a cluster, randomized clinical trial. Participants may submit clinical scenarios beforehand (to Dale Strasser – firstname.lastname@example.org) for evaluation and will have the opportunity to critique other proposed interventions.