Bringing a Multiteam Systems Perspective to the Perioperative Context: Considerations for Future Research of Perioperative Handoffs.

BACKGROUND: Perioperative handoffs entail transferring responsibility for surgical patients from one specialized group or team to another. Multiteam system (MTS) theory has not yet been considered within perioperative handoff literature, even though multiple teams must work within and across the preoperative, intraoperative, and postoperative settings to care for shared patients. METHODS: Using a case study from gynecological oncology, the authors demonstrate the applicability of an MTS taxonomy to the perioperative context. Compositional, linkage, and developmental MTS attributes are defined, along with the concept of boundary spanning, using examples from the case study to illustrate their relevance to the perioperative environment. Key research issues invoked through the application of the MTS taxonomy are discussed alongside overarching recommendations regarding approaches and methods to study these issues. RESULTS: This discussion of perioperative handoffs considers team functional diversity and motivation, between-team interdependence and communication patterns, changes in MTS composition and structure, and boundary spanning. The authors make overarching recommendations for future research that specify mapping perioperative MTSs, identifying weaknesses in MTS functioning and possible handoff design countermeasures, and evaluating handoffs designs' impact on patient care and MTS outcomes using several study designs. CONCLUSION: An MTS perspective can uniquely inform key research questions to advance the practice of perioperative handoffs. Processes that affect complex patient safety and care quality outcomes demand consideration of between-team collaboration quality during perioperative periods. The application of MTS theory in intervention research addressing perioperative handoffs can support MTS functioning for the benefit of safe, high-quality care.

Making Every Meeting Count: A Qualitative Investigation of Multiteam Meeting Events and Their Role in Supporting Coordinated Cancer Care Delivery.

PURPOSE: This research considers how cross-disciplinary cancer care meetings can facilitate coordination within the multiteam systems (MTSs) that provide inpatient hospital care. We conducted a series of interviews and observations with members of a single cancer care MTS to address the following research questions: (1) what are the key characteristics of MTS cancer care meetings (with regard to composition, focus, and structure)? and (2) how is cross-team coordination acknowledged and addressed during these meetings? METHODS: In this single-site case study of a MTS operating to provide gynecologic oncology care within a teaching hospital, two types of meetings, called rounds and huddles, were held consistently. We used qualitative methods, including interviews with health care professional subject matter experts and 30 hours of observations of cancer care meetings, and analyzed the data in three stages of qualitative coding. RESULTS: Our analyses resulted in a thematic framework detailing key processes, and subprocesses, identified as central to the activities of observed cancer care meetings. Key processes include information sharing, gaining clarity, strategizing, and pedagogy. Discussions and explanations of this framework showcase the ways in which MTS meetings can bolster cross-team coordination and facilitate MTS activities. CONCLUSION: Inpatient cancer care meetings provide opportunities to facilitate MTS coordination in several ways, yet doing so does not come without challenges. Considering these results together with insights from meeting science and MTS research, this article concludes by putting forward practical recommendations for leveraging opportunities and overcoming challenges to use cancer care meetings as tools to support cross-team coordination.

Enhancing the practice of medicine with embedded multi-disciplinary researchers in a model of change.

Successfully embedding researchers in a health care setting brings unique challenges and opportunities. Through a joint clinical and academic partnership, we have developed a novel approach to problem-solving in the health care context, by employing a model for leading through change to embed researchers in transformative initiatives. Using the model, we have been able to leverage our local environment and resources to engage multi-disciplinary researchers in solving complex issues. An example is our initiative, Enhancing the Practice of Medicine, to address burnout among health care providers. Through this work, we have identified 3 primary factors critical to the successful deployment of embedded researchers. First and foremost, a multi-disciplinary team with diverse expertise is necessary to truly understand the root causes and potential solutions for complex issues. Second, this diverse team of embedded researchers must be involved from the initial stages of project design and have a voice throughout all phases of planning and assessing the initiative. Finally, embedded researchers will be most successful when they are supported to build relationships, navigate the system, and conduct research as part of an integrated and comprehensive effort that aligns with health system priorities.

To Address Burnout in Oncology, We Must Look to Teams: Reflections on an Organizational Science Approach.

PURPOSE: Despite decades of effort, burnout among physicians remains elevated compared with that of other working populations, and it yields catastrophic consequences, including medical errors and physician suicide. Burnout leaves oncologists feeling like they are alone, but this is not the case-it affects everyone. To effectively address burnout, it is not enough to look only at oncologists; instead, we must include all those involved in the delivery of cancer care. With this aim, we present an overview of the organizational science strategies and initial evidence for the value of a comprehensive, team-focused approach to addressing oncology provider burnout. METHODS: We describe the development of a team-focused burnout intervention approach, implemented for oncology providers, which focuses on the importance of encouraging communication and psychological safety to reduce feelings of isolation and fragmentation. We discuss the initial findings from 1 such team-based initiative currently underway within an academic medical center, presenting data from 409 cancer care providers embedded in 30 oncology units participating in this intervention approach. RESULTS: Preliminary results demonstrate that units that integrated a team-focused intervention for burnout reported significantly higher levels of teamwork and lower levels of burnout. We also describe lessons learned and recommendations for implementing this type of intervention on the basis of best practices from organizational science. CONCLUSION: This approach can positively affect the delivery of cancer care, interprofessional relationships among oncology staff, and the well-being of both patients and providers. Treating physician burnout alone will treat 1 symptom of the overall issue of burnout in oncology. As burnout pulls oncology clinicians apart, our solution must be to bring them together.

A multicenter study to determine motivating factors for residents pursuing obstetrics and gynecology.

OBJECTIVE: This study was undertaken to determine why residents choose obstetrics and gynecology. STUDY DESIGN: Applicants to obstetrics and gynecology residency programs were surveyed; a 5-point scale (5 = most important) was used to rate various aspects of the specialty. Univariate statistics were performed. Bivariate analysis comparing results that were based on gender and timing of decisions was completed with Student t test, chi2, and Kruskal-Wallis tests. RESULTS: A total of 153 applicants (42% response rate) from 10 programs participated; 85.3% of respondents were female. Surgical opportunities, variety of clinical experience, and fast-paced/high-acuity experiences attract applicants to obstetrics and gynecology. When considering programs, resident camaraderie, gynecologic experience, and commitment to education were most important. Over 70% of residents decided to pursue obstetrics and gynecology during or after their third-year clerkship. CONCLUSION: Surgical opportunities and clinical variety appeal to applicants. The majority choose obstetrics and gynecology during or after their core clerkship. In addition, program dynamics are important when choosing a residency.