Relational coordination in value-based health care.

BACKGROUND: An important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched. PURPOSE: The aim of this study was to examine relational coordination (RC) in VBHC and its antecedents. APPROACH: A questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell's Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints). RESULTS: The number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC. CONCLUSIONS: In IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships. PRACTICE IMPLICATIONS: Hospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs.

Differing Professional Perspectives on the Interprofessional Collaboration in IPUs: A Mixed-methods Study.

Introduction: An important aspect of Value-Based Healthcare (VBHC) is providing the full cycle of care for a specific medical condition through interprofessional collaboration. This requires employees from diverse professional backgrounds to interact, but there is limited knowledge on how professionals perceive such interprofessional collaboration. We aimed to provide insight into how different professionals perceive Integrated Practice Unit (IPU) composition and what factors influence the quality of interprofessional collaboration within IPUs. Methods: A survey was administered to employees from different professional backgrounds (medical specialists, nurses, allied health professionals, administrative employees) working in IPUs to assess their perception of the composition of their IPU and the quality of the interactions. Subsequently, semi-structured interviews were conducted to gain a deeper understanding of the findings of the survey. Results: Medical specialists and nurses were most frequently considered to be part of an IPU and indicated that they have high quality interactions. Allied health professionals were less often considered part of the team by all other professional groups and all report low quality interaction with this group. The extent to which a professional group is perceived as a team member depends on their visibility, involvement in the treatment of the patient, and shared interest. Differences in the quality of interprofessional collaboration are influenced by organizational structures, knowledge of each other's expertise, and by ways of communication. Conclusions: In VBHC, there seems to be a lack of common perception of an IPU's composition and a failure to always achieve high quality interprofessional collaboration. Given the importance of interprofessional collaboration in VBHC, effort should be invested in achieving a shared understanding and improved collaboration.

Why do nurses intend to leave their organization? A large-scale analysis in long-term care.

AIM: To analyse the impact of six job characteristics on the intention of nurses to leave their organization, specifically focusing on long-term care settings: nursing homes, care homes and home care. BACKGROUND: When nurses leave their organization, this can negatively affect organizational performance. Organizations have to recruit new nurses and tacit knowledge is lost. Furthermore, organizational turnover could contribute to the nursing shortage, which will increasingly become a problem given the ageing population. This article adds to the literature, given: (a) its focus on long-term care; and (b) by explicating the differences between nursing and care homes (intramural) on one hand and home care (extramural) on the other. DESIGN: Survey. METHOD: Survey of 9982 nurses in 156 Dutch organizations in 2010-2011, 6321 nurses in nursing and care homes and 3661 nurses working in home care, based on the ActiZ Benchmark in Healthcare. RESULTS: First, the most important reason for nurses' intention to leave is insufficient development and career opportunities. Secondly, a negative working atmosphere strongly influenced intention to leave. The impact of the working atmosphere is not often examined in the literature. However, this research shows that it is an important reason. Thirdly, intention to leave is partly context dependent. More specifically, when nurses in home care felt that their autonomy was reduced, this strongly influenced their intention to leave, although this was not the case for nurses working in nursing and care homes. CONCLUSION: This article provides guidelines for organizations on how to retain their nurses.