Developing and validating a comprehensive measure of coordination in patient aligned care teams.

BACKGROUND/OBJECTIVE: Despite numerous extant measures assessing context-specific elements of care coordination, we are unaware of any comprehensive, team-based instrument that measures the requisite mechanisms and conditions required to coordinate successfully. In this study we develop and validate the psychometric properties of the Coordination Practices Survey, a context-agnostic measure of coordination for primary care teams. METHODS: Coordination items were developed based on a systematic literature review; items from previously developed scales were adapted and new items were created as needed; all items were refined after subject matter expert review and feedback. We collected data from Primary Care teams drawn from 1200 Veterans Health Administration (VHA) medical centers and outpatient clinics nationwide. 1645 primary care team members from 512 patient aligned care teams in the Veterans Health Administration completed the survey from 2015 to 2016. Psychometric properties were assessed after data collection using Cronbach's alpha, intraclass correlations and multilevel confirmatory factor analysis to assess the factor structure. RESULTS: Our findings confirmed the psychometric properties of two distinguishable subscales of coordination: (a) Accountability and (b) Common Understanding. The within- and between-team latent structure of each subscale exhibited adequate fit to the data, as well as appropriately high Cronbach's alpha and intraclass correlations. There was insufficient variability in responses to the predictability subscale to properly assess its psychometric properties. CONCLUSION: With context-specific validation, our subscales of accountability and common understanding may be used to assess coordination processes in other contexts for both research and operational applications.

Linking ICT Availability Demands to Burnout and Work-Family Conflict: The Roles of Workplace Telepressure and Dispositional Self-Regulation.

The advancement of technology has led to an increasingly permeable boundary between work and off-work time. As such, employees may face pressure to immediately respond to work-related information and communication technology (ICT) messages during off-work time. This study examines the mediating role of workplace telepressure on the relationships between ICT availability demands with burnout and work-family conflict, as well as the moderating effects of self-regulation on these relationships. Data were collected from 185 full-time employees at two time points. Results indicated full support for the moderated mediation model, demonstrating that workplace telepressure mediated the relationships between ICT availability demands and burnout and work-family conflict. Moreover, dispositional self-regulation strengthened the direct effect of ICT availability demands on workplace telepressure and the indirect effects of ICT availability demands on burnout and work-family conflict. Theoretical and practical implications are discussed.

When work-family conflict hits home: Parental work-family conflict and child health.

Work-family conflict affects employee performance and well-being. However, despite the underlying focus of work-family research on family health and well-being, we have limited knowledge about the impact of role-based stressors, such as work-family conflict, on child health. In this study, we propose and test the stressor-self-regulatory resources-crossover framework. In the spirit of extension of existing work-family research to other cultural settings, we report on two multisource studies conducted in Nigeria to explain whether, how, why, and when parental work-family conflict relates to child health. In Study 1, we collected multisource data from parent-child pairs in low-income families to test whether parental self-regulatory resources explain why work- family conflict relates to child health, resulting in findings that support the stressor-self-regulatory resources-crossover framework. In order to identify possible targets for future organizational-based interventions, we collected Study 2 data from parents and their children (who were enrolled at private schools) to test whether job autonomy and job demands altered the relationship between parental self-regulatory resources and child health. Moderator analyses of the multisource data reveal that self-regulatory resources matter for child health only when job demands are high or when job autonomy is low, pointing to potential intervention and policy levers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Identifying job characteristics related to employed women's breastfeeding behaviors.

For employed mothers of infants, reconciliation of work demands and breastfeeding constitutes a significant challenge. The discontinuation of breastfeeding has the potential to result in negative outcomes for the mother (e.g., higher likelihood of obesity), her employer (e.g., increased absenteeism), and her infant (e.g., increased risk of infection). Given previous research findings identifying return to work as a major risk factor for breastfeeding cessation, we investigate what types of job characteristics relate to women's intentions to breastfeed shortly after giving birth and women's actual breastfeeding initiation and duration. Using job titles and job descriptors contained in a large Australian longitudinal cohort data set (N = 809), we coded job titles using the U.S. Department of Labor (DOL)'s Occupational Information Network (O*NET) database and extracted job characteristics. Hazardous working conditions and job autonomy were identified as significant determinants of women's breastfeeding intentions, their initiation of breastfeeding, and ultimately their breastfeeding continuation. Hence, we recommend that human resource professionals, managers, and public health initiatives provide breastfeeding-supportive resources to women who, based on their job characteristics, are at high risk to prematurely discontinue breastfeeding to ensure these mothers have equal opportunity to reap the benefits of breastfeeding. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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.