How and why might interprofessional patient- and family-centered rounds improve outcomes among healthcare teams and hospitalized patients? A conceptual framework informed by scoping and narrative literature review methods.

Poor communication within healthcare contributes to inefficiencies, medical errors, conflict, and other adverse outcomes. A promising model to improve outcomes resulting from poor communication in the inpatient hospital setting is Interprofessional Patient- and Family-Centered rounds (IPFCR). IPFCR brings two or more health professions together with hospitalized patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. A growing body of literature focuses on implementation and outcomes of IPFCR to improve healthcare quality and team and patient outcomes. Most studies report positive changes following IPFCR implementation. However, conceptual frameworks and theoretical models are lacking in the IPFCR literature and represent a major gap that needs to be addressed to move this field forward. The purpose of this two-part review is to propose a conceptual framework of how IPFCR works. The goal is to articulate a framework that can be tested in subsequent research studies. Published IPFCR literature and relevant theories and frameworks were examined and synthesized to explore how IPFCR works, to situate IPFCR in relation to existing models and frameworks, and to postulate core components and underlying causal mechanisms. A preliminary, context-specific, conceptual framework is proposed illustrating interrelationships between four core components of IPFCR (interprofessional approach, intentional patient and family engagement, rounding structure, shared development of a daily care plan), improvements in communication, and better outcomes.

Early outcomes from a national Train-the-Trainer Interprofessional Team Development Program.

The imperative need to train health professions faculty (educators and clinicians) to lead interprofessional education efforts and promote interprofessional team-based care is widely recognized. This need stems from a growing body of research that suggests collaboration improves patient safety and health outcomes. This short report provides an overview of a Train-the-Trainer Interprofessional Team Development Program (T3 Program) that equips faculty leaders with the skills to lead interprofessional education and interprofessional collaborative practice across the learning continuum. We also describe the history, approach, and early outcomes of this innovative program.

Development and Usability Testing of a System to Detect Adverse Events and Medical Mistakes.

Many inpatient hospital visits result in adverse events, and a disproportionate number of adverse events are thought to occur among vulnerable populations. The personal and financial costs of these events are significant at the individual, care team, and system levels. Existing methods for identifying adverse events, such as the Institute for Healthcare Improvement Global Trigger Tool, typically involve retroactive chart review to identify risks or triggers and then detailed review to determine whether and what type of harm occurred. These methods are limited in scalability and ability to prospectively identify triggers to enable intervention before an adverse event occurs. The purpose of this study was to gather usability feedback on a prototype of an informatics intervention based on the IHI method. The prototype electronic Global Trigger Tool collects and presents risk factors for adverse events. Six health professionals identified as potential users in clinical, quality improvement, and research roles were interviewed. Interviewees universally described insufficiencies of current methods for tracking adverse events and offered important information on desired future user interface features. A key next step will be to refine and integrate an electronic Global Trigger Tool system into standards-compliant electronic health record systems as a patient safety module.

Using an academic-practice partnership to enhance ambulatory care nursing skills.

BACKGROUND: Ambulatory nursing services are essential to healthcare in communities, but nursing curricula often omit ambulatory care training. The purpose of this project was to enhance ambulatory care competencies among nursing students and provide ongoing education for practicing nurses through an academic-practice partnership. METHODS: A four-year externally funded project targeted enhancements to undergraduate nursing curricula and development activities. Students received didactic content and clinical experiences and were evaluated to assess critical ambulatory care nursing skills. Existing continuing education offerings were enhanced with team-based practice content. RESULTS: Despite pandemic-related clinical training changes, data from multiple quarters showed improvement in students' perceptions of self-efficacy (1.7-4.28-point increases) and actual performance (3.46-4.05-point increases) of core competencies on the 20-point evaluation scales. In addition, students rated simulations favorably, with scores ranging from 1.4 to 1.9 on the 2-point subscales. CONCLUSION: An academic-practice partnership provides mutually beneficial opportunities for enhancing the ambulatory care nursing workforce through undergraduate education and training and professional development for practicing nurses.

Association of parent demographic and psychophysical characteristics and pediatric hospital falls: A pilot and feasibility study.

PURPOSE: This pilot project evaluated the feasibility of conducting a study describing parental characteristics associated with pediatric hospital falls. DESIGN AND METHODS: This observational case-control study enrolled parent-child dyads of children who fell in the hospital and age-matched controls. Parents completed demographic, anxiety, depression, fatigue, sleep disturbance and stress questionnaires. RESULTS: Four of 14 (28.6%) eligible faller dyads were recruited. Stress scores were correlated with anxiety and depression scores. Power calculations indicated a need for 392 fallers for a future study to identify associations of parent characteristics and pediatric hospital falls. CONCLUSIONS: Parents should be informed the ultimate goal of the research is to understand additional ways to prevent pediatric hospital falls. To decrease parental distraction during recruitment, researchers should engage volunteers or child life specialists to entertain younger children. Future studies should consider inclusion of non-English speaking subjects and children discharged within the post-fall eligibility time frame. To decrease multicollinearity concerns, the parent stress tool should be omitted. Due to the large number of fallers needed for an adequately powered sample, a multi-site study will be needed. PRACTICE IMPLICATIONS: A parent is often present when their child falls in the hospital. Fall risk assessment focuses on patient characteristics, neglecting parental psychophysical characteristics which may be associated with risk of falling in the hospital. Associations of parent psychophysical characteristics and pediatric hospital falls needs to be studied further. This pilot study supports the feasibility of and provides recommendations for conducting a study to describe parent characteristics associated with pediatric hospital falls.

Measuring the Impact of the National Train-the-Trainer Interprofessional Team Development Program (T3-ITDP) on the Implementation of Interprofessional Education and Interprofessional Collaborative Practice.

BACKGROUND: In order to prepare current and future educators and clinicians to lead interprofessional education (IPE) and interprofessional collaborative practice (IPCP), faculty and staff need training in collaborative approaches to developing, implementing, assessing, and sustaining high quality IPE across the interprofessional learning continuum. The Train-the-Trainer Interprofessional Team Development Program (T3-ITDP) is a 3.5-day program designed to develop expert IPE teams through interactive workshops, coaching, and the development and implementation of an IPE or IPCP (IPECP) project for their home institutions. PURPOSE: The purpose of this research was to assess the impact of the T3-ITDP on the development and implementation of IPECP projects by participating teams. METHODS: The T3-ITDP impact survey was created and administered to collect data on the scope and impact of participant teams' projects, including learner and project outcomes, training methods, dissemination plans, assessment strategies, and teams' intentions to continue working together beyond the initial project. With human subject's approval, we invited 55 T3-ITDP participant teams to complete the impact survey. These teams were at least one year post-completion of the in-person portion of the program and thus had time to initiate their IPECP projects. RESULTS: Forty-one (74.5%) teams responded to the survey. Of those teams, 31 (76%) used T3-ITDP content and/or approaches to develop their IPECP projects that targeted learners across the interprofessional learning continuum. Sustainability of IPECP projects was supported through several mechanisms, including institutional support or incorporating IPECP activities into existing courses. Almost half of the teams worked together on new projects, and 74% of teams planned to repeat a newly developed activity. DISCUSSION & CONCLUSIONS: Results of the T3-ITDP impact survey demonstrated that team-based, project-focused professional development catalyzed the development, implementation, and sustainment of new IPECP projects at academic and community institutions throughout the U.S.

A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals.

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.

Implementation and evaluation of team science training for interdisciplinary teams in an engineering design program.

INTRODUCTION: Interdisciplinary academic teams perform better when competent in teamwork; however, there is a lack of best practices of how to introduce and facilitate the development of effective learning and functioning within these teams in academic environments. METHODS: To close this gap, we tailored, implemented, and evaluated team science training in the year-long Engineering Innovation in Health (EIH) program at the University of Washington (UW), a project-based course in which engineering students across several disciplines partner with health professionals to develop technical solutions to clinical and translational health challenges. EIH faculty from the UW College of Engineering and the Institute of Translational Health Sciences' (ITHS) Team Science Core codeveloped and delivered team science training sessions and evaluated their impact with biannual surveys. A student cohort was surveyed prior to the implementation of the team science trainings, which served as a baseline. RESULTS: Survey responses were compared within and between both cohorts (approximately 55 students each Fall Quarter and 30 students each Spring Quarter). Statistically significant improvements in measures of self-efficacy and interpersonal team climate (i.e., psychological safety) were observed within and between teams. CONCLUSIONS: Tailored team science training provided to student-professional teams resulted in measurable improvements in self-efficacy and interpersonal climate both of which are crucial for teamwork and intellectual risk taking. Future research is needed to determine long-term impacts of course participation on individual and team outcomes (e.g., patents, start-ups). Additionally, adaptability of this model to clinical and translational research teams in alternate formats and settings should be tested.

An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice.

INTRODUCTION/OBJECTIVES: Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. METHODS: This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. RESULTS: The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach's alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach's expertise with the team's needs. CONCLUSIONS: While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.

Sustaining improvements in relational coordination following team training and practice change: A longitudinal analysis.

BACKGROUND: Poor communication is a leading cause of errors in health care. Structured interprofessional bedside rounds are a promising model to improve communication. PURPOSE: The aim of the study was to test if an intervention to improve communication and coordination in an inpatient heart failure care unit would result in lasting change. METHODOLOGY/APPROACH: The relational coordination (RC) survey was administered to seven workgroups (i.e., nurses, physicians) at baseline (2015) and three subsequent years following the intervention (team training, leadership development workshops, and structured interprofessional bedside round implementation). Descriptive analysis and mixed-effects models were used to assess the impact of the intervention on improving RC. RESULTS: During the study period (2015-2018), 344 participants completed the survey for an overall response rate of 53.5% (n = 643). Postintervention, the RC index significantly increased from 3.79 to 4.08 (p < .001) and remained significantly higher over 2 years, with an RC index of 4.12 and 4.04, respectively (p < .001). The range of RC scores between and within workgroups narrowed over time, with nonrotating workgroups showing the most improvements. CONCLUSION: Findings indicate that positive changes as a result of the intervention have been sustained, despite high rates of turnover among all workgroups. Notably, positive change in RC was found to be more pronounced for nonrotating workgroups compared to team members who rotate within the hospital (i.e., pharmacists who rotate to other units every month). PRACTICE IMPLICATIONS: This intervention holds promise for teams seeking best practice models of "high-reliability" care organization and delivery. Sustained changes from this intervention represent an important area of future practice-based research.

Relationships Between the Great Recession and Widening Maternal and Child Health Disparities: Findings From Washington and Florida.

The purpose of this study was to explore relationships between the Great Recession in the United States and maternal and child health (MCH) disparities in prenatal care, birth weight, gestational age, and infant mortality. Using annual, 2005-2011 individual-level Washington (WA) and Florida (FL) birth certificate data, we analyzed MCH outcome rates and disparities among subpopulation component groups (e.g., subpopulation 'maternal ethnicity' divided into component groups such as non-Hispanic White, non-Hispanic Black). We focused on whether disparities widened during two recession periods: Period 1 (December 2007-June 2009-official dates of Great Recession) and Period 2 (January 2010-December 2011) and compared these to a Baseline Period 0 (January 2005-March 2007). Subpopulations (n=14) and component groups (n=47) were identified a priori. Results indicate that disparities widened on at least one MCH outcome for 22 component groups in WA during Period 1 and 37 component groups during Period 2, compared to baseline. In FL, disparities widened for 25 component groups during Period 1 and 31 during Period 2. Disparities increased in both periods on the same outcomes for 11 WA component groups and 7 component groups in FL. Disparity increases tended to cluster among those with young age, low education, and among members of minority race/ethnicity groups-particularly Black mothers. Findings support hypothesized relationships between expected increases in need during the Great Recession, and worsening MCH outcomes and disparities. Compared to baseline, there were more disparity increases in Period 2 than 1. Additional research regarding specific factors influencing changes in disparities are needed.

The effect of women, infant, and children (WIC) services on birth weight before and during the 2007-2009 great recession in Washington state and Florida: a pooled cross-sectional time series analysis.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to have positive effects in promoting healthy birth outcomes in the United States. We explored whether such effects held prior to and during the most recent Great Recession to improve birth outcomes and reduce differences among key socio-demographic groups. METHODS: We used a pooled cross-sectional time series design to study pregnant women and their infants with birth certificate data. We included Medicaid and uninsured births from Washington State and Florida (n = 226,835) before (01/2005-03/2007) and during (12/2007-06/2009) the Great Recession. Interactions between WIC enrollment and key socio-demographic groupings were analyzed for binary and continuous birth weight outcomes. RESULTS: Our study found beneficial WIC interaction effects on birth weight. For race, prenatal care, and maternal age we found significantly better birth weight outcomes in the presence of WIC compared to those without WIC. For example, being Black with WIC was associated with an increase in infant birth weight of 53.5 g (baseline) (95% CI = 32.4, 74.5) and 58.0 g (recession) (95% CI = 27.8, 88.3). For most groups this beneficial relationship was stable over time. CONCLUSIONS: This paper supports previous research linking maternal utilization of WIC services during pregnancy to improved birth weight (both reducing LBW and increasing infant birth weight in grams) among some high-disadvantage groups. WIC appears to have been beneficial at decreasing disparity gaps in infant birth weight among the very young, Black, and late/no prenatal care enrollees in this high-need population, both before and during the Great Recession. Gaps are still present among other social and demographic characteristic groups (e.g., for unmarried mothers) for whom we did not find WIC to be associated with any detectable value in promoting better birth weight outcomes. Future research needs to examine how WIC (and/or other maternal and child health programs) could be made to work better and reach farther to address persistent disparities in birth weight outcomes. Additionally, in preparation for future economic downturns it will be important to determine how to preserve and, if possible, expand WIC services during times of increased need. TRIAL REGISTRATION: Not applicable, this article reports only on secondary retrospective data (no health interventions with human participants were carried out).

Impact of leadership development workshops in facilitating team-based practice transformation.

The development of interprofessional collaborative practice (IPCP) environments requires a systematic, multi-pronged approach. Despite recognition of the need for IPCP, interventions that support its development are not well described in the literature. Leadership training is necessary for individuals and teams to build IPCP-supportive environments. This study describes the impact of a longitudinal series of leadership development workshops to strengthen IPCP and facilitate practice transformation. Semi-structured interviews were conducted with 16 healthcare professionals who described ways in which the workshops influenced the team-based practice transformation. Thematic analysis indicated that the workshops were instrumental in providing structure and opportunity for participants to learn skills, expand perspectives, and change behavior to improve team outcomes. Findings highlight the importance of supporting individual and team development over time and suggest that intentional, targeted coaching focused on relationship building and meeting the evolving needs of the team is critical to the implementation and sustainment of practice change.

Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010.

BACKGROUND: Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007-June 2009). METHODS: Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects' research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual predictors into three scenarios representing low, average, and high degrees of social disadvantage. RESULTS: Individual and community indicators of need (e.g., maternal Medicaid enrollment, unemployment rate) increased during the Recession. Associations between late/no prenatal care utilization and individual-level characteristics (including disparate associations among race/ethnicity groups) did not shift greatly with young maternal age and having less than a high school education remaining the largest contributors to late/no prenatal care utilization. In contrast, individual maternal enrollment in a supplemental nutrition program for women, infants, and children (WIC) exhibited a protective association against late/no prenatal care utilization. The magnitude of association between community-level partisan voting patterns and expenditures on some maternal child health programs increased in non-beneficial directions. Simulated scenarios show a high combined impact on prenatal care utilization among women who have multiple disadvantages. CONCLUSIONS: Our findings provide a compelling picture of the important roles that individual characteristics-particularly low education and young age-play in late/no prenatal care utilization among pregnant women. Targeted outreach to individuals with high disadvantage characteristics, particularly those with multiple disadvantages, may help to increase first trimester entry to utilization of prenatal care. Finally, WIC may have played a valuable role in reducing late/no prenatal care utilization, and its effectiveness during the Great Recession as a policy-based approach to reducing late/no prenatal care utilization should be further explored.

Competencies for improving diagnosis: an interprofessional framework for education and training in health care.

Background Given an unacceptably high incidence of diagnostic errors, we sought to identify the key competencies that should be considered for inclusion in health professions education programs to improve the quality and safety of diagnosis in clinical practice. Methods An interprofessional group reviewed existing competency expectations for multiple health professions, and conducted a search that explored quality, safety, and competency in diagnosis. An iterative series of group discussions and concept prioritization was used to derive a final set of competencies. Results Twelve competencies were identified: Six of these are individual competencies: The first four (#1-#4) focus on acquiring the key information needed for diagnosis and formulating an appropriate, prioritized differential diagnosis; individual competency #5 is taking advantage of second opinions, decision support, and checklists; and #6 is using reflection and critical thinking to improve diagnostic performance. Three competencies focus on teamwork: Involving the patient and family (#1) and all relevant health professionals (#2) in the diagnostic process; and (#3) ensuring safe transitions of care and handoffs, and "closing the loop" on test result communication. The final three competencies emphasize system-related aspects of care: (#1) Understanding how human-factor elements influence the diagnostic process; (#2) developing a supportive culture; and (#3) reporting and disclosing diagnostic errors that are recognized, and learning from both successful diagnosis and from diagnostic errors. Conclusions These newly defined competencies are relevant to all health professions education programs and should be incorporated into educational programs.

Distance to HIV and Antenatal Care: A Geospatial Analysis in Siaya County, Kenya.

As maternal child health (MCH) programs expand in the setting of HIV, health systems are challenged to reach those most vulnerable and at the greatest need. Cross-sectional surveys of MCH clinics and recent mothers in the Siaya Health Demographic Surveillance System were conducted to assess correlates of accessing antenatal care and facility delivery. Of 376 recent mothers, 93.4% accessed antenatal care and 41.2% accessed facility delivery. Per-kilometer distance between maternal residence and the nearest facility offering delivery services was associated with 7% decreased probability of uptake of facility delivery. Compared with a reference of less than 1 km between home and clinic, a distance of more than 3 km to the nearest facility was associated with 25% decreased probability of uptake of facility delivery. Distance to care was a factor in accessing facility delivery services. Decentralization or transportation considerations may be useful to optimize MCH and HIV service impact in high-prevalence regions.

Purposeful interprofessional team intervention improves relational coordination among advanced heart failure care teams.

Effective delivery of healthcare is highly interdependent within and between interprofessional (IP) care teams and the patients they serve. This is particularly true for complex health conditions such as advanced heart failure (AHF). Our Academic Practice Partnership received funding to carry out IP workforce development with inpatient AHF care teams. Our objectives were to (a) identify challenges in team functioning that affected communication and relationships among the AHF care teams, (b) collaboratively identify a focal work process in need of improvement, and (c) test whether facilitated the implementation of team training and work process changes would lead to improvements in team communication, relationships, and process outcomes. The health-care team identified implementation of structured IP bedside rounds (SIBR) as the preferred approach to improving collaborative care. Utilizing a cross-sectional pre/post design, changes in team communication and relationships before and after a team intervention that included TeamSTEPPS training and SIBR implementation, were assessed using a validated Relational Coordination (RC) survey. The study population included AHF care team members (n ~ 100) representing seven workgroups (e.g., nurses, pharmacists) from two inpatient cardiology units at a 450-bed academic medical center in the Pacific Northwest during 2015-2016. Improvements in RC scores were demonstrated across all seven RC dimensions from baseline (Year 1) to follow-up (Year 2). Percent change on each of the seven dimensions ranged from 3.57% to 9.85%. Changes were statistically significant for improvements between baseline and follow-up on all but one of the seven RC dimensions (shared knowledge). The IP team intervention was associated with improvements in RC from baseline to follow-up. Additional research is needed to assess patient perspectives and outcomes of the IP team intervention. Findings of this study are consistent with the growing body of RC and SIBR research and provide a useful model of an IP team-based intervention in clinical practice.

Developing and implementing a heart failure data mart for research and quality improvement.

OBJECTIVE: The purpose of this project was to build and formatively evaluate a near-real time heart failure (HF) data mart. Heart Failure (HF) is a leading cause of hospital readmissions. Increased efforts to use data meaningfully may enable healthcare organizations to better evaluate effectiveness of care pathways and quality improvements, and to prospectively identify risk among HF patients. METHODS AND PROCEDURES: We followed a modified version of the Systems Development Life Cycle: 1) Conceptualization, 2) Requirements Analysis, 3) Iterative Development, and 4) Application Release. This foundational work reflects the first of a two-phase project. Phase two (in process) involves the implementation and evaluation of predictive analytics for clinical decision support. RESULTS: We engaged stakeholders to build working definitions and established automated processes for creating an HF data mart containing actionable information for diverse audiences. As of December 2017, the data mart contains information from over 175,000 distinct patients and >100 variables from each of their nearly 300,000 visits. CONCLUSION: The HF data mart will be used to enhance care, assist in clinical decision-making, and improve overall quality of care. This model holds the potential to be scaled and generalized beyond the initial focus and setting.

RN Job Satisfaction and Retention After an Interprofessional Team Intervention.

Despite continuing interest in interprofessional teamwork to improve nurse outcomes and quality of care, there is little research that focuses on nurse job satisfaction and retention after an interprofessional team intervention. This study explored registered nurse (RN) job satisfaction and retention after a purposeful interprofessional team training and structured interprofessional bedside rounds were implemented. As part of a larger study, in this comparative cross-sectional study, pre- and post-intervention data on RN job satisfaction and turnover rate were collected and analyzed. It was found that RNs had significantly higher job satisfaction after the interprofessional team intervention. The 6-month period turnover rate in the post-intervention period was slightly lower than the 6-month period turnover rate in pre-intervention period; however, the rate was too low to provide statistical evidence. Ongoing coaching and supportive work environments to improve RN outcomes should be considered to enhance quality of care and patient safety in healthcare.

Clinical nurses' experiences and perceptions after the implementation of an interprofessional team intervention: A qualitative study.

AIMS AND OBJECTIVES: To explore clinical nurses' experiences and perceptions following a purposeful interprofessional (IP) team intervention in practice. BACKGROUND: Despite increasing interest in IP collaborative practice to improve teamwork, nursing outcomes and quality of care, there has been little research that focused on nurses' perspectives of IP collaboration after a purposeful IP team intervention. DESIGN: A qualitative descriptive study using focus group interviews of registered nurses who care for patients with advanced heart failure. METHODS: This study is part of a larger study that conducted and evaluated a purposeful IP team intervention. Registered nurses (n = 10) were invited to participate in three focus groups following the IP team intervention. Data were audio-recorded, transcribed and analysed using a conventional content analysis approach and constant comparative method. RESULTS: We identified six interrelated themes: (a) IP team building, (b) psychological safety and cultural change, (c) efficiency in delivery of care, (d) quality of patient care, (e) job outcomes and (f) team challenges. Notably, participants reported that they could better understand the patient's care plan of the day because every team member was "on the same page at the same time." Registered nurses perceived that they were more satisfied with their job through improved IP team performance, enhanced psychological safety and cultural change, efficient workflow and better quality of patient care. CONCLUSIONS: The IP team intervention contributed to enhancing IP team functioning as well as improving registered nurse job satisfaction. To sustain the improved perceptional and behavioural changes, team strategies to improve workflow and communication should be considered. RELEVANCE TO CLINICAL PRACTICE: Effective teamwork and communication between multiple healthcare professionals including nurses are the cornerstones to improve care delivery, nursing outcomes and quality of patient care in clinical settings.