Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems

Kevin J O'Leary, Julie K Johnson, Milisa Manojlovich, Jenna D Goldstein, Jungwha Lee, Mark V Williams, Kevin J O'Leary, Julie K Johnson, Milisa Manojlovich, Jenna D Goldstein, Jungwha Lee, Mark V Williams

Abstract

Background: A number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective for this study is to implement a set of evidence-based complementary interventions across a range of clinical microsystems, identify factors and strategies associated with successful implementation, and evaluate the impact on quality.

Methods: The RESET project uses the Advanced and Integrated MicroSystems (AIMS) interventions. The AIMS interventions consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Four hospital sites were chosen to receive guidance and resources as they implement the AIMS interventions. Each study site has assembled a local leadership team, consisting of a physician and nurse, and receives mentorship from a physician and nurse with experience in leading similar interventions. Primary outcomes include teamwork climate, assessed using the Safety Attitudes Questionnaire, and adverse events using the Medicare Patient Safety Monitoring System (MPSMS). RESET uses a parallel group study design and two group pretest-posttest analyses for primary outcomes. We use a multi-method approach to collect and triangulate qualitative data collected during 3 visits to study sites. We will use cross-case comparisons to consider how site-specific contextual factors interact with the variation in the intensity and fidelity of implementation to affect teamwork and patient outcomes.

Discussion: The RESET study provides mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. Our findings will be of interest and directly applicable to all hospitals providing care to patients with medical conditions.

Trial registration: NCT03745677 . Retrospectively registered on November 19, 2018.

Keywords: Clinical microsystems; Hospitalization; Interdisciplinary communication; Interpersonal relations; Medical errors; Patient care team.

Conflict of interest statement

Ethics approval and consent to participate

The Northwestern University Institutional Review Board approved this study. The need for consent was waived by the Northwestern University Institutional Review Board. Each study site has also received approval from the appropriate local entities.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overview of Implementation Approach using EPIS Framework
Fig. 2
Fig. 2
Overview of RESET Study Design and Data Collection
Fig. 3
Fig. 3
RESET Study Timeline (SPIRIT diagram of trial stages of enrollment, intervention, assessment, and evaluation)

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