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Meterko M, Restuccia JD, Anand K, Kaboli PJ, Charns M, Burgess JF. Organizational Predictors of Coordination in Inpatient Medicine. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD.
Research Objective: As the care of hospitalized patients becomes more complex, intraprofessional coordination among nurses and among physicians, and interprofessional coordination between these groups is likely to play an increasingly important role in the provision of hospital care. The purpose of this study was to identify the independent effects of organizational factors on provider ratings of overall coordination in inpatient medicine. Study Design: This was a cross-sectional, descriptive study. Primary data were collected between June 2010 and September 2011 through surveys of inpatient medicine nurse managers, physicians, and chiefs of medicine at 36 Veterans Health Administration (VHA) medical centers. Secondary data from the 2011 VHA national survey of nurses were also used. Individual-level data were aggregated and analyzed at the facility level. Multivariate linear regression models were used to assess the relationship between organizational factors and provider ratings of overall coordination in inpatient medicine. Population Studied: Inpatient medicine nurses, nurse managers, attending physicians, and chiefs of medicine at 36 VHA medical centers. Principal Findings: Organizational factors that were common across models and associated with better provider ratings of overall coordination in inpatient medicine included: provider perceptions that the goals of senior leadership are aligned with those of the inpatient service and that the facility is committed to the highest patient care; having resources and staff that enable clinicians to do their jobs; and use of strategies that enhance interactions and communication among and between nurses and physicians. Conclusions: Alignment of the goals of senior leadership with those of the inpatient service, facility committment to the highest patient care, having adequate resources and staff enabling clinicians to do their jobs, and the use of strategies that enhance intra- and interprofessional interactions and communication are associated with higher provider perceptions of overall coordination. Implications for Policy, Delivery, or Practice: To improve intra- and interprofessional coordination, and consequently patient care, facilities should consider: making patient care quality a more important strategic organizational priority; ensuring that providers have the staffing, training, supplies and other resources they need to do their jobs; and implementing strategies that improve interprofessional communication and working relationships, such as multidisciplinary rounding.
