The importance of relational coordination for integrated care delivery to older patients in the...
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![Page 1: 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,](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b83d9550346d6338b5832/html5/thumbnails/1.jpg)
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
![Page 2: 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,](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b83d9550346d6338b5832/html5/thumbnails/2.jpg)
Background I
• 34-50% functional decline
• Fragmented, duplicated and directed at acute disease
• Integrated care delivery– coordinated response – horizontal work processes– complementary role
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Background II
• Theory of relational coordination
“mutually reinforcing process of interaction between communication and relationships carried out for the purpose of task integration”
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Setting and design
• Cross-sectional study
• Vlietland hospital, The Netherlands
• Data collected in 2010
• 192 professionals (44% response rate)
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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
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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
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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
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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
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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
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Conclusion
• Relations, communication and coordination to improve integrated care
• Value of geriatric unit
• Less attraction to the unfamiliar discipline
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Discussion
• Cross-sectional design
• Confounders
• Patient experiences and outcomes
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Practical implications
• Expand geriatric awareness
• Improve attraction to the unfamiliar discipline
• Introduce training programmes
• Redefine goals and objectives of teamwork
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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