Guidelines in Practice: Team Communication.

The perioperative setting is a complex environment requiring interdisciplinary team collaboration to avoid adverse events. To protect the safety of patients and perioperative team members, communication among personnel should be clear and effective. The recently updated AORN "Guideline for team communication" provides perioperative nurses with recommendations on the topic. To promote effective communication in perioperative areas, all personnel should value and commit to a culture of safety. This article discusses recommendations for supporting a culture of safety, developing and implementing an effective hand-off process and surgical safety checklist, and developing education strategies for team communication. It also includes a scenario describing the implementation of a standardized, electronic surgical safety checklist in the OR. Perioperative nurses should review the guideline in its entirety and apply the recommendations for team communication in their working environments.

Patient care in complex Sociotechnological ecosystems and learning health systems.

The learning health system (LHS) model was proposed to provide real-time, bi-directional flow of learning using data captured in health information technology systems to deliver rapid learning in healthcare delivery. As highlighted by the landmark National Academy of Medicine report "Crossing the Quality Chasm," the U.S. healthcare delivery industry represents complex adaptive systems, and there is an urgent need to develop innovative methods to identify efficient team structures by harnessing real-world care delivery data found in the electronic health record (EHR). We offer a discussion surrounding the complexities of team communication and how solutions may be guided by theories such as the Multiteam System (MTS) framework and the Multitheoretical Multilevel Framework of Communication Networks. To advance healthcare delivery science and promote LHSs, our team has been building a new line of research using EHR data to study MTS in the complex real world of cancer care delivery. We are developing new network metrics to study MTSs and will be analyzing the impact of EHR communication network structures on patient outcomes. As this research leads to patient care delivery interventions/tools, healthcare leaders and healthcare professionals can effectively use health IT data to implement the most evidence-based collaboration approaches in order to achieve the optimal LHS and patient outcomes.

Inpatient Corridor Visibility and Care Team Communication.

OBJECTIVE: This article aims to investigate the impact of fine-grained differences in unit layout on care staff corridor communication. BACKGROUND: Corridor design can be undertaken with greater emphasis on space and cost efficiency or with greater emphasis on affording quality knowledge workspace. Building on prior research on care team communication and inpatient unit design, this study aims to gain a better understanding of how corridor layout properties affect care team communication. METHOD: This study used space syntax analysis to characterize inpatient unit design, specifically floor-plan layout. Two approaches were used to capture care team communication: behavior mapping with recording of care team member locations and whether they were communicating and the HDR CARE Scale, Inpatient Version. The two units were part of a vertical tower expansion project, and, though constructed at separate times, they maintain the same organizational culture, floor plate, and location of key vertical elements. RESULTS: The newer unit was found to be more visually open using three measures from space syntax. More nursing staff verbal communication was observed on this unit. Across both units, nursing staff were more likely to be observed verbally communicating in locations that were more visually connected (i.e., at locations with larger viewsheds). There were no significant differences between nursing staff self-report on work using the HDR CARE Scale, Inpatient Version. CONCLUSION: We conclude that care team communication may tend to be encouraged by visual connectivity that can be promoted through floor-plan layout.

Evaluation of an Interprofessional Blended Learning Course Focusing on Communication within Veterinary Teams.

Based on the importance of communication and teamwork in veterinary practice, we explored the impact of a blended learning course designed to enhance interprofessional communication skills among veterinary students and apprentice assistants. The blended learning course design included online modules, synchronous (online) seminars, and simulation training sessions. The asynchronous online elements should complement the varied schedules of different professions and meet the individual needs of participants, especially considering the challenges posed by the COVID-19 pandemic. The course structure, evaluations, and outcomes were documented, showing a positive impact on knowledge gain concerning communication and self-assessment in communication skills. In the pretest, the participants scored 43.18% correct answers to a knowledge test, whereas 71.50% correct answers were given in the posttest. Some participants indicated an improvement in the self-assessment of their skills. For example, before the training only 13.64% answered the question "How prepared do you feel regarding your communication skills for entering the profession?" with "Very good" or "Good", versus 50.00% in the posttest. There were also only 22.73% of participants who agreed to having sufficient understanding of the roles of other professional groups, while in the posttest, 81.82% agreed. The evaluations highlighted positive feedback on the organization, learning environment, and overall course structure. However, challenges such as limited resources, especially time and financial constraints, influenced the implementation and ongoing development of the course. Subsequent runs of the course could gather more data to further improve the teaching of veterinary interprofessional communication. This ongoing data collection would allow continuous insights into and adjustments to the teaching methods, ensuring maximum benefit for veterinary students and apprentice assistants.

Communication Strategies in Human-Autonomy Teams During Technological Failures.

OBJECTIVE: This study examines low-, medium-, and high-performing Human-Autonomy Teams' (HATs') communication strategies during various technological failures that impact routine communication strategies to adapt to the task environment. BACKGROUND: Teams must adapt their communication strategies during dynamic tasks, where more successful teams make more substantial adaptations. Adaptations in communication strategies may explain how successful HATs overcome technological failures. Further, technological failures of variable severity may alter communication strategies of HATs at different performance levels in their attempts to overcome each failure. METHOD: HATs in a Remotely Piloted Aircraft System-Synthetic Task Environment (RPAS-STE), involving three team members, were tasked with photographing targets. Each triad had two randomly assigned participants in navigator and photographer roles, teaming with an experimenter who simulated an AI pilot in a Wizard of Oz paradigm. Teams encountered two different technological failures, automation and autonomy, where autonomy failures were more challenging to overcome. RESULTS: High-performing HATs calibrated their communication strategy to the complexity of the different failures better than medium- and low-performing teams. Further, HATs adjusted their communication strategies over time. Finally, only the most severe failures required teams to increase the efficiency of their communication. CONCLUSION: HAT effectiveness under degraded conditions depends on the type of communication strategies enacted by the team. Previous findings from studies of all-human teams apply here; however, novel results suggest information requests are particularly important to HAT success during failures. APPLICATION: Understanding the communication strategies of HATs under degraded conditions can inform training protocols to help HATs overcome failures.

The interplay of financial toxicity, health care team communication, and psychosocial well-being among rural cancer patients and survivors.

BACKGROUND: Financial toxicity contributes to psychosocial distress among cancer patients and survivors. Yet, contextual factors unique to rural settings affect patient experiences, and a deeper understanding is needed of the interplay between financial toxicity and health care team communication and its association with psychosocial well-being among rural oncology patients. PURPOSE: We examined associations between financial toxicity and psychosocial well-being among rural cancer patients, exploring variability in these linkages by health care team communication. METHODS: Using data from 273 rural cancer patients who participated in Cancer Support Community's Cancer Experience Registry, we estimated multivariable regression models predicting depression, anxiety, and social function by financial toxicity, health care team communication, and the interplay between them. RESULTS: We demonstrate robust associations between financial toxicity and psychosocial outcomes among our sample of rural cancer patients and survivors. As financial toxicity increased, symptoms of depression and anxiety increased. Further, financial toxicity was linked with decreasing social function. Having health care team conversations about treatment costs and distress-related care reduced the negative impact of financial toxicity on depressive symptoms and social function, respectively, in rural cancer patients at greatest risk for financial burden. CONCLUSIONS: Financial toxicity and psychosocial well-being are strongly linked, and these associations were confirmed in a rural sample. A theorized buffer to the detrimental impacts of financial toxicity-health care team communication-played a role in moderating these associations. Our findings suggest that health care providers in rural oncology settings may benefit from tools and resources to bolster communication with patients about costs, financial distress, and coordination of care.

Parent communication with care teams and preparation for family meetings in the paediatric cardiac ICU: a qualitative study.

OBJECTIVE: The paediatric cardiac ICU presents unique challenges to optimal communication practices, which may impact participation in medical decision-making and long-term psychosocial outcomes for families. This study characterised parent perceptions of (1) team practices that impeded or facilitated communication and (2) preparation for family meetings with interprofessional care teams during extended cardiac ICU admissions. METHODS: A purposive sample of parents of children admitted to the cardiac ICU was selected to participate in interviews about their communication experiences. Data were analysed using a grounded theory approach. RESULTS: Twenty-three parents of 18 patients participated with an average length of stay of 55 days at the time of interview. Team practices that impeded communication included inaccurate/incomplete communication, inconsistent within team communication/coordination, and feeling overwhelmed by too many team members/questions. Team practices that facilitated communication included valuing parent preferences, provider continuity, explaining jargon, and eliciting questions. Preparation for family meetings included team practices, parental preferences, and experiences when learning about family meetings (including apprehension about meetings). Family meetings were described as valued opportunities to improve communication. CONCLUSION: Communication with medical teams represents a modifiable determinant of long-term outcomes for families of children in the cardiac ICU. When parents are included as valued members of their child's care team, they are more likely to feel a sense of control over their child's outcomes, even in the face of prognostic uncertainty. Family meetings represent an important opportunity to repair fractures in trust between families and care teams and overcome barriers to communication between parties.

Team communication patterns during real and simulated trauma resuscitation-a social network analysis.

In trauma teams, coordination can be established through a centralised leader. The team can also use a decentralised strategy. In this descriptive study of video-recorded trauma resuscitations, using quantification of qualitative data, Social Network analysis of all real-time communications of eight in-real-life (IRL) and simulated trauma teams explained team social structure. The communication network structures in the simulated scenarios were more centralised using individually directed speech and had a high proportion of communication to update all team members. Such a structure might be the result of work performed in a complexity-stripped simulation environment where simplified task-executions required less interactions, or from work revolving around a deteriorating patient, imposing high demands on rapid decision-making and taskwork. Communication IRL was mostly decentralised, with more variability between cases, possibly due to unpredictability of the IRL case. The flexibility to act in a decentralised manner potentiates adaptability and seems beneficial in rapidly changing situations.Practitioner summary: Efficient collaboration in trauma teams is essential. Communication in in-real-life and simulated trauma teams was analysed using social network analysis. The simulation teams were overall more centralised compared to the IRL teams. The flexibility to act decentralised seems beneficial for emergency teams as it enables adaptability in unpredictable situations.

Optimizing infection control and antimicrobial stewardship bedside discussion: a scoping review of existing evidence on effective healthcare communication in hospitals.

BACKGROUND: The link between healthcare worker (HCW) communication, teamwork and patient safety is well-established. Infection prevention and control (IPC) and antimicrobial stewardship (AMS) require multidisciplinary teamwork and communication. OBJECTIVES: We conducted a scoping review of published evidence on effective mechanisms of HCW team communication in hospitals with the intention of transferring and tailoring learning to IPC and AMS team communication. METHODS: PubMed, Scopus, Web of Science, and CINAHL were searched for studies that investigated HCW team communication across in-hospital patient pathways. Studies published between 2000 and 2021 that provided evidence on/or described the effect of communication on team and patient outcomes in hospital were included. Through a process of inductive qualitative content analysis, key themes in the included studies were identified. RESULTS: Of 537 studies identified, 53 (from high-income countries) were included in the data extraction. Fifty one percent (27/53) of studies were conducted in high acuity settings e.g., intensive care units. Standardizing or structuring the content and/or process of team communication was the most common goal of interventions (34/53, 64%). The key outcome measures were either team communication focused (25/34,74%) or patient and process outcome focused (8/34, 24%), such as reduced length of mechanical ventilation days, length of hospital stay, and shorter empiric antibiotic duration. Four studies (4/53, 8%) associated improved communication with positive IPC and AMS outcome measures. Mixed method intervention studies primarily facilitated collaborative input from HCWs and applied structures to standardize the content of patient care discussions, whereas observational studies describe component of team communication. CONCLUSIONS: A communication strategy that formalizes input from multidisciplinary team members can lead to optimized and consistent clinical discussion including in IPC and AMS-related care. Although we were unable to assess the effectiveness of interventions, the existing evidence suggests that optimizing team communication can have a positive effect on infection-related patient outcomes.

Meaningful Communication but not Superficial Anthropomorphism Facilitates Human-Automation Trust Calibration: The Human-Automation Trust Expectation Model (HATEM).

OBJECTIVE: The objective was to demonstrate anthropomorphism needs to communicate contextually useful information to increase user confidence and accurately calibrate human trust in automation. BACKGROUND: Anthropomorphism is believed to improve human-automation trust but supporting evidence remains equivocal. We test the Human-Automation Trust Expectation Model (HATEM) that predicts improvements to trust calibration and confidence in accepted advice arising from anthropomorphism will be weak unless it aids naturalistic communication of contextually useful information to facilitate prediction of automation failures. METHOD: Ninety-eight undergraduates used a submarine periscope simulator to classify ships, aided by the Ship Automated Modelling (SAM) system that was 50% reliable. A between-subjects 2 × 3 design compared SAM appearance (anthropomorphic avatar vs. camera eye) and voice inflection (monotone vs. meaningless vs. meaningful), with the meaningful inflections communicating contextually useful information about automated advice regarding certainty and uncertainty. RESULTS: Avatar SAM appearance was rated as more anthropomorphic than camera eye, and meaningless and meaningful inflections were both rated more anthropomorphic than monotone. However, for subjective trust, trust calibration, and confidence in accepting SAM advice, there was no evidence of anthropomorphic appearance having any impact, while there was decisive evidence that meaningful inflections yielded better outcomes on these trust measures than monotone and meaningless inflections. CONCLUSION: Anthropomorphism had negligible impact on human-automation trust unless its execution enhanced communication of relevant information that allowed participants to better calibrate expectations of automation performance. APPLICATION: Designers using anthropomorphism to calibrate trust need to consider what contextually useful information will be communicated via anthropomorphic features.

Impact of the COVID-19 pandemic on emergency department team dynamics and workforce sustainability in Australia. A qualitative study.

INTRODUCTION: The COVID-19 pandemic has challenged health care professionals and changed our approach to care delivery. The aim in this study was to explore nurses' experiences providing care in the ED during the COVID-19 pandemic in Australia and the impact of this on ED team functioning. METHODS: A qualitative explorative descriptive study was conducted using thematic analysis strategies. Participants comprised: Registered Nurses (n = 18) working in clinical roles in the Emergency Department and Leadership Registered Nurses (n = 6) within the organisation. One on one interviews (n = 21) and one focus group interview were conducted utilising semi-structured, conversational style, in-depth interviews between January 2022 and April 2022. RESULTS: Two major themes were identified that described the impact on ED team dynamics and longer-term impacts on the ED nursing workforce. The first major theme was: 'Changed Emergency Department team identity and dynamics' and included four sub-themes: i) PPE is a barrier to team camaraderie; ii) outsiders versus insiders - ambivalence to PPE spotter role; iii) personal safety comes first in a pandemic; and iv) using PPE depersonalises the whole patient experience. The second major theme was: 'This pandemic caught everyone off guard' and had three sub-themes. The associated sub-themes were: i) People outside ED have no understanding of what it has been like; ii) COVID-19 is here to stay - Permanent changes to care delivery and nursing practice; and iii) tenacity of a true profession. CONCLUSIONS: Study findings illuminated the dynamics and functionality of ED nursing, encompassing the unique qualities of camaraderie, autonomy, resilience and tenacity.

Assessing the Value of Huddle Implementation in the Perioperative Setting.

Communication is essential for safe, effective patient care. In perioperative services, where interdisciplinary teamwork is crucial, communication breakdowns may lead to increased errors, decreased staff member satisfaction, and poor team performance. This process improvement project focused on instituting perioperative huddles for two months and measuring the effect that they had on staff members' satisfaction, engagement, and communication effectiveness. We used validated, Likert-style survey tools to gauge participants' satisfaction, level of engagement, communication practices, and opinions about the value of huddles before and after implementation, in addition to an open-ended descriptive question in the postsurvey. Sixty-one participants completed the presurvey and 24 participants completed the postsurvey. Scores across all categories increased post huddle implementation. Benefits of the huddles noted by participants included timely and consistent messaging, sharing essential information, and increased feelings of connection between perioperative leaders and staff members.

Entropy for team communication pattern recognition.

This work aims to demonstrate entropy as a method that can be used to analyze team coordination using naturalistic team communication content. Much of team coordination happens through communication; understanding team communication is vital to better formulate and train teams for successful performance outcomes. Several decades of team communication research have led to various methods for analyzing team communication patterns. Many existing methods for team communication analysis have not been tested with naturalistic communication or only consider the frequency or flow of communication. Sliding-window entropy is used to analyze team coordination dynamics with team communication as a proxy. The resulting time series are evaluated using nonlinear dynamical systems analysis and clustering. Various team coordination patterns are identified using communication entropy at the team level. Entropy can be used to identify team communication patterns and their relation to team performance. While team coordination happens at the team level, a posteriori analysis indicates members' individual characteristics affect the overall team coordination patterns. In teams where the contribution is unequal, some members disproportionately affect the overall team coordination, which may undermine the team impact and affect team performance.

A 3D mixed reality visualization of network topology and activity results in better dyadic cyber team communication and cyber situational awareness.

Background: Cyber defense decision-making during cyber threat situations is based on human-to-human communication aiming to establish a shared cyber situational awareness. Previous studies suggested that communication inefficiencies were among the biggest problems facing security operation center teams. There is a need for tools that allow for more efficient communication of cyber threat information between individuals both in education and during cyber threat situations. Methods: In the present study, we compared how the visual representation of network topology and traffic in 3D mixed reality vs. 2D affected team performance in a sample of cyber cadets (N = 22) cooperating in dyads. Performance outcomes included network topology recognition, cyber situational awareness, confidence in judgements, experienced communication demands, observed verbal communication, and forced choice decision-making. The study utilized network data from the NATO CCDCOE 2022 Locked Shields cyber defense exercise. Results: We found that participants using the 3D mixed reality visualization had better cyber situational awareness than participants in the 2D group. The 3D mixed reality group was generally more confident in their judgments except when performing worse than the 2D group on the topology recognition task (which favored the 2D condition). Participants in the 3D mixed reality group experienced less communication demands, and performed more verbal communication aimed at establishing a shared mental model and less communications discussing task resolution. Better communication was associated with better cyber situational awareness. There were no differences in decision-making between the groups. This could be due to cohort effects such as formal training or the modest sample size. Conclusion: This is the first study comparing the effect of 3D mixed reality and 2D visualizations of network topology on dyadic cyber team communication and cyber situational awareness. Using 3D mixed reality visualizations resulted in better cyber situational awareness and team communication. The experiment should be repeated in a larger and more diverse sample to determine its potential effect on decision-making.

Continuity of care (COC) and amyloid-ß PET scan: the CARE-IDEAS study.

BACKGROUND: High continuity of care (COC) is associated with better clinical outcomes among older adults. The impact of amyloid-ß PET scan on COC among adults with mild cognitive impairment (MCI) or dementia of uncertain etiology is unknown. METHODS: We linked data from the CARE-IDEAS study, which assessed the impact of amyloid-ß PET scans on outcomes in Medicare beneficiaries with MCI or dementia of uncertain etiology and their care partners, to Medicare claims (2015-2018). We calculated a participant-level COC index using the Bice-Boxerman formula and claims from all ambulatory evaluation and management visits during the year prior to and following the amyloid-ß PET scan. We compared baseline characteristics by scan result (elevated or non-elevated) using standardized differences. To evaluate changes in COC, we used multiple regression models adjusting for sociodemographics, cognitive function, general health status, and the Charlson Comorbidity Index. RESULTS: Among the 1171 cohort members included in our analytic population, the mean age (SD) was 75.2 (5.4) years, 61.5% were male and 93.9% were non-Hispanic white. Over two-thirds (68.1%) had an elevated amyloid-ß PET scan. Mean COC for all patients was 0.154 (SD = 0.102; range = 0-0.73) prior to the scan and 0.158 (SD = 0.105; range = 0-1.0) in the year following the scan. Following the scan, the mean COC index score increased (95% CI) by 0.005 (-0.008, 0.019) points more for elevated relative to not elevated scan recipients, but this change was not statistically significant. There was no association between scan result (elevated vs. not elevated) or any other patient covariates and changes in COC score after the scan. CONCLUSION: COC did not meaningfully change following receipt of amyloid-ß PET scan in a population of Medicare beneficiaries with MCI or dementia of uncertain etiology. Future work examining how care continuity varies across marginalized populations with cognitive impairment is needed.

Meeting the Challenge of Transmission Delay: Communication Protocols for Space Operations.

OBJECTIVE: Several studies were conducted to assess media-specific communication protocols as a countermeasure to challenges of asynchronous space-ground communication. BACKGROUND: Previous research demonstrated that transmission delay can negatively impact space-ground communication, collaboration, and task performance. We created media-specific protocols designed to mitigate identified problems associated with asynchronous communication and examined their effects on team communication and task performance. METHODS: The lab study included 24 teams of three who collaborated remotely via voice or text on computer-based tasks simulating failures in a spacecraft's life support system. Training and availability of communication protocols was the between-groups variable. Perceived usability, criticality, and effectiveness of the communication protocols were also assessed in space-analog simulations. RESULTS: Lab study data revealed that communication protocols facilitated some aspects of team communication; specifically, they reduced threats to common ground and information splitting but not instances of miscommunication. Analog data indicated that protocol compliance was high, participants evaluated most elements as highly important, and protocols maintained perceived communication effectiveness between space crews and mission control during time delay comparably to no-time-delay conditions. CONCLUSION: Converging data attest to the feasibility, usability, and effectiveness of empirically derived communication protocols as a countermeasure to the negative impacts of transmission delay and also point to technological solutions. APPLICATION: The communication protocols have been adopted for training in NASA analog simulations involving time-delayed communication. They could also support communication among remote team members in medical operations, command-and-control teams, or disaster response under asynchronous conditions or when time is limited and precise communication is critical.

Psychological Care of Children and Families with Variations or Differences in Sex Development.

The paediatric clinical psychology literature provides applicable evidence for use in specialist healthcare settings and services. The general approach of psychological care of children and families with paediatric conditions is recognizable as preventative and destigmatizing, aimed to maximize personal agency with shared responsibility for achieving best outcomes via multi-professional teamwork. Recent commentaries regarding healthcare for children with differences in sex development (DSD) have noted service-level pitfalls, including poor teamwork and underuse of early and integrated psychological intervention. Psychological research regarding the variously termed DSD, variations in sex development, variation in sex characteristics, or intersex has historically centred around the assessment of sex differences, gender identity, and the impact of including hormone influences on brain and behaviour. Psychological research in this specialist area has not focussed on the evaluation of specific clinical interventions or psychotherapeutic models but has investigated psychological aspects of multi-professional healthcare provision. There are new goals for psychological care of children with variations or differences in sex development (V/DSD). These require a framework of good communication to enable those receiving care to come to know and articulate their own hopes for treatment and support. Paediatric psychological intervention studies involving larger clinical groups such as diabetes provide evidence applicable to DSD populations. A risk of stigma is recognized as inherent to some physical interventions within routine paediatric care of people with V/DSD. Psychological care and intervention should be aimed at minimizing these risks via questioning and examining their assumed need. Psychological approaches can provide a foundation for ethical and rights-based multi-professional care of children with V/DSD.

A Lexical Approach to Assessing Stress: Development and Proof-of-Concept.

OBJECTIVE: We describe a methodology that provides a nonobtrusive means of detecting stress and related deficits through the assessment of spontaneous verbal output in ongoing communications. BACKGROUND: In high-demand environments, operational personnel are exposed to an array of environmental, task, and interpersonal stressors that can negatively impact performance as well as jeopardize safety and well-being. In these settings, the requirement exists to assess cognitive and emotional state "at a distance" and without interfering with ongoing performance. METHOD: We describe a lexical approach to assessing stress effects from ongoing or spontaneous verbal output. This approach is examined in a spaceflight analog setting. RESULTS: We assess stress effects in terms of five core dimensions and develop lexical indicators of these core stress dimensions and relevant sub-facets. We establish the proof-of-concept of this approach by presenting representative data from a spaceflight analog. CONCLUSION: This approach provides an unobtrusive means to evaluate ongoing task communications at the individual and team level in order to assess cognitive/emotional states such as workload, negative affect, attentional focus, anxiety, and team orientation. APPLICATION: There are many high-demand settings in which it is valuable to monitor the potential negative effects of stress on operational personnel. These environments include spaceflight, the military, aviation, law enforcement, and medicine.

Engaging Chief Medical Officers to Improve Multidisciplinary Rounds.

Background: Multidisciplinary rounds (MDRs), a model of care in which multiple members of the care team, representing different disciplines, come together to discuss the care of a patient in real-time. MDRs are a valuable tool for clinical teams to improve patient length of stay (LOS), reduce healthcare-associated infections, and increase care coordination. HCA Healthcare's data science and performance improvement teams created a data visualization tool called Next-gen Analytics for Treatment and Efficiency (NATE) Tempo to support care teams in managing rounds and barriers. Methods: A pilot implementation of MDRs using the NATE Tempo tool was initiated in 10 hospitals, accompanied by a survey for Chief Medical Officers (CMOs) of each of the participating hospitals. Results: Implementation of MDRs using the NATE Tempo tool was associated with an average reduction in LOS ratio from 135% to 114% across the 10 hospitals. CMO survey feedback identified areas of improvement related to MDR participation, and incorporation of NATE Tempo. CMO leadership within each facility and the use of the interactive dashboard facilitated the identification of high performers and areas of opportunity for improvement. Conclusion: CMO engagement can help physicians take steps to decrease variation in practice, leading to compliance with best practice guidelines and decreasing the overall LOS in hospitals. The MDR process can support these efforts. Empowering CMOs through the use of the NATE Tempo tool improved engagement. Through the tool, the CMO promotes coordination of patient care throughout the hospital experience and during the post-discharge phase.

A mixed-methods program evaluation of the Alda Healthcare Experience- a program to improve healthcare team communication.

BACKGROUND: Communication among interprofessional healthcare worker teams is critical to ensure a thriving and resilient workforce. We will evaluate the implementation and effectiveness of the Alda Healthcare Experience (AHE), a novel medical improvisation (improv) workshop designed to improve interprofessional communication skills among healthcare professionals. The AHE workshop includes a two-hour experiential training workshop led by an improv specialist and a clinical co-facilitator. In July 2022 we began implementing the AHE workshop by training 18 clinical co-facilitators who will co-facilitate the workshops for 550 healthcare workers from five hospital departments at Stony Brook University Hospital over the course of a year and a half. Using mixed-methods, we will conduct an Effectiveness-Implementation Hybrid Design project that includes an outcome evaluation (effectiveness) and a process evaluation (implementation). METHODS: Our outcome evaluation will assess the impact of the AHE workshop on short- and long-term improvement in interprofessional communication, stress, and professional fulfillment. The process evaluation component will examine programmatic, organizational, and individual facilitators or barriers to effective implementation of the AHE workshop. Qualitative methods will include dimensional analysis employing individual interviews of 20-40 AHE Project Participants, 5-10 Selected Informants, and all the clinical co-facilitators. Quantitative methods will use a quasi-experimental longitudinal design with an intervention group and surveillance of a control group (wait-list) and repeated assessments using validated instruments measuring communications skills, professional fulfillment, stress, burnout, uncertainty tolerance, and teamwork. DISCUSSION: Effective and efficient communication within healthcare teams is fundamental to building team cohesion that, in turn, supports individual resilience and builds positive organizational culture. The AHE program is an innovative approach to improve interprofessional healthcare communication and reduce healthcare worker burnout. In addition to institutional buy-in, rigorous evaluations of medical improv programs are necessary as a critical step in making such programs scalable. TRIAL REGISTRATION: N/A.