Support for Healthy Work Environments and
Collaborative Clinical Cultures
To Improve Quality of Care and Trust in Health Care Organizations
In a research project, each of 72 hospitals’ ICUs formed a multidisciplinary team that underwent teamwork and communication training, and employed joint rounds and an inclusive communication protocol. This formed the foundation for adopting new practices that, in less than one year, dropped bloodstream infections to less than the 10th percentile nationally—it actually eradicated them in 22 ICUs—and produced similar results for ventilator-associated pneumonia.
Pronovost, P. and Goeschel, C., Improving ICU Care: It Takes a Team, Healthcare Executive, Mar./Apr. 2005: 15
By promoting better information exchange and mutuality among treatment providers, interdisciplinary practice has been shown to reduce from ¼ to 1/3 the amount of time patients need to be on ventilators.
Henneman, E., Liberating Patients from Mechanical Ventilation: A Team Approach, Critical Care Nurse, June 2001:25
A cardiac surgery unit instituted interdisciplinary rounds and a communication protocol to ensure universal input and topic coverage, focus on patient strengths, and capture potential patient safety pitfalls. During the three years measured, there were half as many deaths as expected based on previous and regional experience, and morbidity showed similar gains.
Uhlig, P., Collaborative Communication Cycle: A System Innovation for Improved Patient Safety, Remarks at the Risk Management and Patient Safety Institute
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Accurate diagnosis requires that patients give intimate confidences to health workers, creating personal relationships on which continuing mutual responsibility can and should be built. We have good evidence that the quality of these continuing relationships profoundly affects compliance, drop out rates, investigation rates, and willingness to “wait and see,” hospital emergency admission rates, and average length of stay.
Hart, J.T., Two Paths for Medical Practice. Lancet, 1992; 340:772-75
Improved communication, collaboration, and conflict resolution between nurses and physicians can improve clinical outcomes for patients.
Sovie, M.D., Jawad, A.F., Hospital Restructuring and Its Impact on Outcomes: Nursing Staff Regulations Are Premature, J Nsg Adm, 2001;31:588-600
The likelihood that caring relationships will develop between caregivers and their patients depends on administrative and organizational features of the settings in which medicine is practiced. Humane care derives largely from the structure of human relationships and collegial arrangements, and if humane norms are widely shared and supported by everyday attitudes and routines, we have a great opportunity to improve the quality of the care environment and, in the long run, to reduce healthcare costs by encouraging physicians and patients to work together in a mutually rewarding relationship.
Scott, R., Aiken, L., Mechanic, D., and Moravcsik, J., Organizational Aspects of Caring. The Milbank Quarterly, 1995, 73:1;77-95
In general, teamwork results in enhanced effectiveness (Risser et al, 1999), fewer and shorter delays, improved morale and job satisfaction, increased efficiency, lower stress and improved patient satisfaction (Firth-Cozens, 2001; Majzun, 1998; Sexton, Thomas, and Helmreich, 2000)
Kaissi, Johnson, and Kirschbaum, Nurs Econ, 2003;21(5):211-218
“Sustained physician-patient partnerships with bonds of trust and knowledge of patients were leading correlates of three outcomes of care: adherence, satisfaction, and improved health status.”
Safran, D., Taira, D., Rogers, W., Kosinski, M., Ware, J., Tarlov, A. Linking Primary Care Performance to Outcomes of Care, J Fam Pract, 1998;47:213-20
Communicating clearly, listening and responding carefully to feedback, and demonstrating concern about regimens’ fit with patient needs are components of a basic humanizing process.
Although caring is manifested in physician’s attitudes, feelings and actions, the organizational and administrative (not to mention cultural) contexts in which the doctors and patients interact crucially affect the ability of each to act toward the other in a caring fashion.
Poor communication between physicians and nurses, strained by lack of mutual respect and feelings of antagonism that generally arise in segregated training experiences, sometimes throws up additional barriers to humane medical care.
Scott, R., Aiken, L., Mechanic, D., and Moravcsik, J.,
Organizational Aspects of Caring. The Milbank Quarterly, 1995, 73:1;77-95