A Systematic Literature Review of Instruments to Measure Coordination.

EXECUTIVE SUMMARY: Organizing patient care and improving team coordination have been identified by the Institute of Medicine and the Agency for Healthcare Research and Quality as essential components of high-quality care. Research is lacking, however, on the measurement of care team coordination and its mechanisms. Using an organizational psychology framework developed by Okhuysen and Bechky (O&B) as a guide, the authors identify strengths and gaps in the existing literature related to the measurement of coordination and its associated constructs. The authors conducted a review of peer-reviewed articles in healthcare, management, and psychology journals that contain survey items that could be used to measure the domains in the O&B framework. An initial search yielded 468 articles published from 1978 to 2014, 37 of which came from healthcare journals. From this set, 1,401 candidate survey items were extracted from 74 articles. Of these, 279 items were categorized into at least one O&B domain. Retained items were drawn from scales representing 51 constructs related to teamwork, roles, trust, coordination broadly, and ancillary constructs. Two constructs, physical proximity and plans and rules, were directly represented both in the O&B framework and as standalone constructs in the literature. The remaining constructs contributed items that indirectly assess components of the O&B framework domains. Despite decades of research on coordination, valid survey items for measuring the mechanisms and integrating conditions described by the O&B framework as leading to successful team coordination are scarce, and virtually nonexistent in healthcare, as measures of care team coordination.

Linking clinician interaction and coordination to clinical performance in Patient-Aligned Care Teams.

BACKGROUND: Team coordination within clinical care settings is a critical component of effective patient care. Less is known about the extent, effectiveness, and impact of coordination activities among professionals within VA Patient-Aligned Care Teams (PACTs). This study will address these gaps by describing the specific, fundamental tasks and practices involved in PACT coordination, their impact on performance measures, and the role of coordination task complexity. METHODS/DESIGN: First, we will use a web-based survey of coordination practices among 1600 PACTs in the national VHA. Survey findings will characterize PACT coordination practices and assess their association with clinical performance measures. Functional job analysis, using 6-8 subject matter experts who are 3rd and 4th year residents in VA Primary Care rotations, will be utilized to identify the tasks involved in completing clinical performance measures to standard. From this, expert ratings of coordination complexity will be used to determine the level of coordinative complexity required for each of the clinical performance measures drawn from the VA External Peer Review Program (EPRP). For objective 3, data collected from the first two methods will evaluate the effect of clinical complexity on the relationships between measures of PACT coordination and their ratings on the clinical performance measures. DISCUSSION: Results from this study will support successful implementation of coordinated team-based work in clinical settings by providing knowledge regarding which aspects of care require the most complex levels of coordination and how specific coordination practices impact clinical performance.

Electronic alerts and clinician turnover: the influence of user acceptance.

OBJECTIVES: Use of certain components of electronic health records (EHRs), such as EHR-based alerting systems (EASs), might reduce provider satisfaction, a strong precursor to turnover. We examined the impact of factors likely to influence providers' acceptance of an alerting system, designed to facilitate electronic communication in outpatient settings, on provider satisfaction, intentions to quit, and turnover. STUDY DESIGN AND METHODS: We conducted a cross-sectional Web-based survey of EAS-related practices from a nationwide sample of primary care providers (PCPs) practicing at Department of Veterans Affairs (VA) medical facilities. Of 5001 invited VA PCPs, 2590 completed the survey. We relied on Venkatesh's Unified Theory of Acceptance and Use of Technology to create survey measures of 4 factors likely to impact user acceptance of EAS: supportive norms, monitoring/ feedback, training, and providers' perceptions of the value (PPOV) of EASs to provider effectiveness. Facility-level PCP turnover was measured via the VA's Service Support Center Human Resources Cube. Hypotheses were tested using structural equation modeling. RESULTS: After accounting for intercorrelations among predictors, monitoring/feedback regarding EASs significantly predicted intention to quit (b = 0.30, P < .01), and PPOV of EASs predicted both overall provider satisfaction (b = 0.58, P < .01) and facility-level provider turnover levels (b = -0.19, P < .05), all without relying on any intervening mechanisms. CONCLUSIONS: Design, implementation, and use of EASs might impact provider satisfaction and retention. Institutions should consider strategies to help providers perceive greater value in these clinical tools.

Euthanasia-related strain and coping strategies in animal shelter employees.

OBJECTIVE: To identify and evaluate coping strategies advocated by experienced animal shelter workers who directly engaged in euthanizing animals. DESIGN: Cross-sectional study. SAMPLE POPULATION: Animal shelters across the United States in which euthanasia was conducted (5 to 100 employees/shelter). PROCEDURES: With the assistance of experts associated with the Humane Society of the United States, the authors identified 88 animal shelters throughout the United States in which animal euthanasia was actively conducted and for which contact information regarding the shelter director was available. Staff at 62 animal shelters agreed to participate in the survey. Survey packets were mailed to the 62 shelter directors, who then distributed them to employees. The survey included questions regarding respondent age, level of education, and role and asked those directly involved in the euthanasia of animals to provide advice on strategies for new euthanasia technicians to deal with the related stress. Employees completed the survey and returned it by mail. Content analysis techniques were used to summarize survey responses. RESULTS: Coping strategies suggested by 242 euthanasia technicians were summarized into 26 distinct coping recommendations in 8 categories: competence or skills strategies, euthanasia behavioral strategies, cognitive or self-talk strategies, emotional regulation strategies, separation strategies, get-help strategies, seek long-term solution strategies, and withdrawal strategies. CONCLUSIONS AND CLINICAL RELEVANCE: Euthanizing animals is a major stressor for many animal shelter workers. Information regarding the coping strategies identified in this study may be useful for training new euthanasia technicians.

Too stressed out to participate? Examining the relation between stressors and survey response behavior.

Despite the use of survey-based organizational data in many studies of organizational behavior, survey response behavior and nonresponse are rarely studied phenomena. This study expands on previously proposed survey response and nonresponse frameworks by integrating the job stress literature. The authors investigated whether overload, role ambiguity, and role conflict experienced by individuals relate to survey response behavior. Using organizational citizenship behavior theory and social exchange theory as theoretical frameworks, the authors proposed that nonrespondents experience higher levels of stressors than respondents. Data collected in a longitudinal field study partially supported the hypotheses. As hypothesized, overload increased the likelihood of nonresponse. Contrary to hypotheses, role ambiguity decreased the likelihood of nonresponse. Role conflict was not significantly related to nonresponse.

What shelters can do about euthanasia-related stress: an examination of recommendations from those on the front line.

Shelter employees with euthanasia responsibilities are an at-risk population for a variety of psychological and emotional ailments. This study surveyed 305 employees from 62 shelters throughout the United States to gather first-hand perspectives on what should be done to assist shelter workers in dealing with euthanasia-related stress. Researchers conducted a qualitative analysis of 359 improvement suggestions to identify broad common themes and sorted the suggestions into 26 thematic categories. The most common participant suggestion concerned management supportive-ness (13.17% of participants). Some other issues raised involved providing counseling, job rotation, assistance or more help, breaks and time off, support groups and meetings, better communication, skills-based training, stress and coping seminars, and employee appreciation and morale-boosting initiatives.

Impact of euthanasia rates, euthanasia practices, and human resource practices on employee turnover in animal shelters.

OBJECTIVE: To examine the effects of euthanasia rates, euthanasia practices, and human resource practices on the turnover rate among employees with euthanasia responsibilities at animal shelters. DESIGN: Cross-sectional original study. SAMPLE POPULATION: 36 shelters across the United States that employed at least 5 full-time employees and performed euthanasia on site. PROCEDURES: By mail, 1 survey was sent to each shelter. Surveys were completed by a senior member of management and were returned by mail. Questions assessed characteristics (eg, euthanasia rates) and practices of the animal shelter, along with employee turnover rates. By use of correlation coefficients and stepwise regression analyses, key predictors of turnover rates among employees with euthanasia responsibilities were investigated. RESULTS: Employee turnover rates were positively related to euthanasia rate. Practices that were associated with decreased turnover rates included provision of a designated euthanasia room, exclusion of other live animals from vicinity during euthanasia, and removal of euthanized animals from a room prior to entry of another animal to be euthanized. Making decisions regarding euthanasia of animals on the basis of factors other than behavior and health reasons was related to increased personnel turnover. With regard to human resources practices, shelters that used a systematic personnel selection procedure (eg, standardized testing) had comparatively lower employee turnover. CONCLUSIONS AND CLINICAL RELEVANCE: Data obtained may suggest several specific avenues that can be pursued to mitigate turnover among employees with euthanasia responsibilities at animal shelters and animal control or veterinary medical organizations.

Employee reactions and adjustment to euthanasia-related work: identifying turning-point events through retrospective narratives.

This study used a retrospective narrative procedure to examine the critical events that influence reactions and adjustment to euthanasia-related work of 35 employees who have stayed in the animal care and welfare field for at least 2 years. The study analyzed adjustment trajectory graphs and interview notes to identify turning-point events that spurred either a positive or negative change in shelter workers' psychological well-being. Analysis of the identified turning-point events revealed 10 common event themes that have implications for a range of work, personnel, and organizational practices. The article discusses implications for shelter, employee, and animal welfare.

A lengthy look at the daily grind: time series analysis of events, mood, stress, and satisfaction.

The present study investigated processes by which job stress and satisfaction unfold over time by examining the relations between daily stressful events, mood, and these variables. Using a Web-based daily survey of stressor events, perceived strain, mood, and job satisfaction completed by 14 university workers, 1,060 occasions of data were collected. Transfer function analysis, a multivariate version of time series analysis, was used to examine the data for relationships among the measured variables after factoring out the contaminating influences of serial dependency. Results revealed a contrast effect in which a stressful event associated positively with higher strain on the same day and associated negatively with strain on the following day. Perceived strain increased over the course of a semester for a majority of participants, suggesting that effects of stress build over time. Finally, the data were consistent with the notion that job satisfaction is a distal outcome that is mediated by perceived strain.

Profiling active and passive nonrespondents to an organizational survey.

In this field study (N = 405) population profiling was introduced to examine general and specific classes of nonresponse (active vs. passive) to a satisfaction survey. The active nonrespondent group (i.e., purposeful nonresponders) was relatively small (approximately 15%). Active nonrespondents, in comparison with respondents, were less satisfied with the entity sponsoring the survey and were less conscientious. Passive nonrespondents (e.g., forgot), who represented the majority of nonrespondents, were attitudinally similar to respondents but differed with regard to personality. Nonresponse bias does not appear to be a substantive concern for satisfaction type variables--the typical core of an organizational survey. If the survey concerns topics strongly related to Conscientiousness and Agreeableness, the respondent sample may not be representative of the population.