The importance of relational coordination for integrated care delivery to older patients in the hospital

J.M. Hartgerink, J.M. Cramm, T.J.E.M. Bakker, R.A.M. van Eijsden, J.P. Mackenbach, A.P. Nieboer

Background I

• 34-50% functional decline

• Fragmented, duplicated and directed at acute disease

• Integrated care delivery– coordinated response – horizontal work processes– complementary role

Background II

• Theory of relational coordination

“mutually reinforcing process of interaction between communication and relationships carried out for the purpose of task integration”

Setting and design

• Cross-sectional study

• Vlietland hospital, The Netherlands

• Data collected in 2010

• 192 professionals (44% response rate)

Questionnaires I

• Relational coordination survey

– Communication • frequency/timeliness, accuracy and problem solving

– Relationships • shared goals, shared knowledge and mutual respect

– 4-point scale

– Cronbach’s alpha 0.96

Questionnaires II

• Assessment of chronic illness care (ACIC)

– Self-management support – Delivery system design – Decision support – Clinical information systems

– 11-point scale

– Cronbach’s alpha 0.87

Results I - descriptives

Relational coordination M = 2.57 (SD 0.95)

Integrated care delivery M = 5.58 (SD 1.79)

Characteristic %

Sex Female 76

Profession Medical specialist 27

  Nurse 64

  Paramedic 9

Years working in the organization >1 year 96

Results II – differences in disciplines

• Geriatric unit compared to other hospital units:– Higher integrated care delivery– Higher relational coordination

• Nurses compared to medical specialists:– Higher relational coordination

• Same discipline compared to different disciplines:– Higher relational coordination

Results III – multiple regression analysis

  

B SE

Background characteristics      

Nurse -0.03 -0.12 0.40

Paramedic -0.13 -0.85 0.62

Gender 0.02 0.07 0.39

Number of years working in the current organization -0.07 -0.61 0.75

Relational coordination      

Overall relational coordination 0.20* 0.44 0.22

Adjusted R² for equation 0.11    

F 3.071    

* P < 0.001

Conclusion

• Relations, communication and coordination to improve integrated care

• Value of geriatric unit

• Less attraction to the unfamiliar discipline

Discussion

• Cross-sectional design

• Confounders

• Patient experiences and outcomes

Practical implications

• Expand geriatric awareness

• Improve attraction to the unfamiliar discipline

• Introduce training programmes

• Redefine goals and objectives of teamwork

The importance of relational coordination for integrated care delivery to older patients in the hospital

J.M. Hartgerink, J.M. Cramm, T.J.E.M. Bakker, R.A.M. van Eijsden, J.P. Mackenbach, A.P. Nieboer