Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Health Care Sciences & Services, Health Policy & Services, Public, Environmental & Occupational Health, care pathways, interprofessional teamwork, organization of care, risk of burnout, cluster randomized controlled trial, QUALITY-OF-CARE, EVALUATING COMPLEX INTERVENTIONS, RELATIONAL COORDINATION, IMPROVING TEAMWORK, CLINICAL PATHWAYS, IMPACT, MANAGEMENT, SAFETY, IMPLEMENTATION, EXACERBATION, Adult, Aged, Belgium, Burnout, Professional, Clinical Competence, Critical Pathways, Emotions, Environment, Female, Femoral Fractures, Hospital Administration, Humans, Interprofessional Relations, Male, Middle Aged, Organizational Innovation, Outcome and Process Assessment, Health Care, Patient Care Team, Pulmonary Disease, Chronic Obstructive, Quality of Health Care, 1117 Public Health and Health Services, 1402 Applied Economics, 3801 Applied economics, 4203 Health services and systems, 4407 Policy and administration

Abstract:

Background. Effective interprofessional teamwork is an essential component for the delivery of high-quality patient care in an increasingly complex medical environment. The objective is to evaluate whether the implementation of care pathways improves teamwork in an acute hospital setting. Design and measures. A post-test-only cluster randomized controlled trial was performed in Belgian acute hospitals. Teams caring for patients hospitalized with a proximal femur fracture and patients hospitalized with an exacerbation of chronic obstructive pulmonary disease were randomized into intervention and control groups. The intervention group implemented a care pathway. The control group provided usual care. A set of team input, process, and output indicators was used as effect measures. To analyze results, we performed multilevel statistical analysis. Results. Thirty teams and a total of 581 individual team members participated. The intervention teams scored significantly better on conflict management (β=0.30 (0.11), 95% CI 0.08 to 0.53); team climate for innovation (β=0.29 (0.10), 95% CI 0.09 to 0.49); and level of organized care (β=5.56 (2.05), 95% CI 1.35 to 9.76). They also showed lower risk of burnout as they scored significantly lower on emotional exhaustion (β= -0.57 (0.21), 95% CI -1.00 to -0.14) and higher on level of competence (β=0.39, 95% CI 0.15 to 0.64). No significant effect was found on relational coordination. Conclusions. Care pathways are effective interventions for improving teamwork, increasing the organizational level of care processes, and decreasing risk of burnout for healthcare teams in an acute hospital setting. Through this, high-performance teams can be built.