Some interventions designed to improve healthcare worker collaboration may not result in improved patient outcomes, according to a recent trial published in the Annals of Internal Medicine.
While it’s widely accepted that increased healthcare worker teamwork is essential for safe and high-quality medical care, research aimed at understanding how collaborative interventions impact patients has been inconclusive.
Building off previous research that indicated changes to the healthcare delivery system can improve teamwork between nurses and physicians, Kevin O’Leary, MD, ’09 MS, ’00 GME, the John T. Clarke Professor and Chief of Hospital Medicine in the Department of Medicine, who was first author of the study, designed the trial to incorporate five different interventions aimed at increasing healthcare worker cooperation.
“Our research group has been investigating interprofessional teamwork for years. We have done some interventions here at Northwestern Memorial Hospital that were successful in improving interprofessional teamwork and lowering the rate of adverse events,” O’Leary said. “This trial was a way to deliberately combine interventions that could be complementary, mutually reinforcing and transformative. Because this area is not well researched, this was designed to be a major contribution to the literature and knowledge around this.”
In the current study, healthcare professionals in two general medicine units at four different U.S. hospitals assigned physicians to specific units and installed nurse-physician leadership teams who were jointly responsible for the quality of care on their respective units.
The participating units then established interprofessional rounds, which were redesigned with input from frontline healthcare professionals to optimize collaboration and patient engagement. Frequent unit-level reports were then given to unit leaders to provide them with relevant and actionable data on their unit’s performance.
Among healthcare workers who completed pre- and post-intervention surveys, nurses indicated that the teamwork climate improved, but physicians reported no change, according to the study.
“This was not too surprising, because it’s usually nurses who are most aware of teamwork deficiencies,” O’Leary said.
There was no reduction in the number of patients who experienced adverse events after the intervention than before, according to the trial, and the length of stay, rate of readmission and overall patient experience all remained unchanged.
“We had a really rigorous model, but we just didn’t see any association with improvement in patient outcomes,” O’Leary said. “This might be explained by the fact that there was perhaps not a lot of room for improvement. The rate of adverse events before the intervention was already low and in line with national trends, following campaigns and new policies, that have led to improvements over time for hospital adverse events.”
The findings underscore the need for more research around healthcare worker collaboration and how it relates to patient safety and outcomes, O’Leary said.
Despite the negative results, O’Leary and his collaborators will continue to use the trial model to pilot other changes to healthcare delivery in hopes of identifying which interventions do lead to better patient results, he said.
“Because we have unit-based physician teams and really highly functioning unit co-leadership at Northwestern Memorial Hospital, when we are trying to address a challenge, we always leverage that model and pilot new initiatives on a few units so we can compare their improvement to other units,” O’Leary said. “If it works, we’ve already got the structure to implement it at scale. This model is a foundation for further quality improvement initiatives and is conducive to testing new strategies.”
The study was funded by the Agency for Healthcare Research and Quality.
