Leveraging the Science of Teamwork to Sustain Handoff Improvements in Cardiovascular Surgery.
Publication/Presentation Date
8-1-2023
Abstract
BACKGROUND: Improving the reliability of handoffs and care transitions is an important goal for many health care organizations. Increasing evidence shows that human-centered design and improved teamwork can lead to sustainable care transition improvements and better patient outcomes. This study was conducted within a cardiovascular service line at an academic medical center that performs more than 600 surgical procedures annually. A handoff process previously implemented at the center was poorly adopted. This work aimed to improve cardiovascular handoffs by applying human factors and the science of teamwork.
METHODS: The study's quality improvement method used Plan-Do-Study-Act cycles and participatory design and ergonomics to develop, implement, and assess a new handoff process and bundle. Trained observers analyzed video-recorded and live handoffs to assess teamwork, leadership, communication, coordination, cooperation, and sustainability of unit-defined handoff best practices. The intervention included a teamwork-focused redesign process and handoff bundle with supporting cognitive aids and assessment metrics.
RESULTS: The study assessed 153 handoffs in multiple phases over 3 years (2016-2019). Quantitative and qualitative assessments of clinician (teamwork) and implementation outcomes were performed. Compared with the baseline, the observed handoffs demonstrated improved team leadership (p < 0.0001), communication (p < 0.0001), coordination (p = 0.0018), and cooperation (p = 0.007) following the deployment of the handoff bundle. Sustained improvements in fidelity to unit-defined handoff best practices continued 2.3 years post-deployment of the handoff bundle.
CONCLUSION: Participatory design and ergonomics, combined with implementation and safety science principles, can provide an evidence-based approach for sustaining complex sociotechnical change and making handoffs more reliable.
Volume
49
Issue
8
First Page
373
Last Page
383
ISSN
1938-131X
Published In/Presented At
Keebler, J. R., Lynch, I., Ngo, F., Phelps, E., Huang, N., Guttman, O., Preble, R., Minhajuddin, A. T., Gamez, N., Wanat-Hawthorne, A., Landgraf, K., Minnis, E., Gisick, L., McBroom, M., Ambardekar, A., Olson, D., Greilich, P. E., & ECHO ICU Collaborative (2023). Leveraging the Science of Teamwork to Sustain Handoff Improvements in Cardiovascular Surgery. Joint Commission journal on quality and patient safety, 49(8), 373–383. https://doi.org/10.1016/j.jcjq.2023.05.006
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
37357132
Department(s)
Administration and Leadership
Document Type
Article