SHM Converge Scientific Abstract ePoster Gallery-Contextual Factors Influencing the Implementation of a Multifaceted Intervention to Redesign Systems to Improve Teamwork and Quality for Hospitalized Patients

Contextual Factors Influencing the Implementation of a Multifaceted Intervention to Redesign Systems to Improve Teamwork and Quality for Hospitalized Patients

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This document summarizes findings from the RESET (REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients) study, which tested a multifaceted intervention in four hospitals to improve teamwork and quality of inpatient care. The intervention included five components: unit-based physician teams, unit nurse-physician co-leadership, enhanced interprofessional rounds, unit-level performance reports, and patient engagement activities.<br /><br />The purpose of this analysis was to identify contextual factors that influenced implementation success. Data came from semi-structured interviews with 40 healthcare professionals and 8 site mentors, plus observations from six site visits. The researchers analyzed transcripts, field notes, and recordings to understand what supported or hindered adoption of the intervention.<br /><br />Four major contextual factors emerged. First, consistent system support and engaged senior leadership were essential, especially when implementation challenges arose. Second, the intervention needed to align with broader hospital, system, and professional priorities; competing goals often created barriers and silos. Third, active site leadership strongly affected implementation, with physician leader engagement being especially important. Fourth, interprofessional buy-in varied by profession: nurses generally saw the intervention as beneficial, while physicians were more skeptical and often focused on workflow disruption.<br /><br />The main conclusion is that these contextual factors should be in place before launching a clinical microsystem redesign effort. Leaders and researchers can use these insights to better prepare for implementation and reduce the impact of contextual barriers.

Asset Subtitle

Iva Terwilliger

Meta Tag

Author List Gopi J. Astik, Iva Terwilliger, Jane S. Kim, Julie K. Johnson, Kevin J. O'Leary, Mark v. Williams, Milisa Manojlovich

Category Research

Concept Intervention

Concept Teamwork

Concept Quality

Concept Clinical Microsystem Redesign

Concept Contextual Considerations

Distinguished Non-Finalist

Presenter Organization Northwestern University

Presenting Author Iva Terwilliger

Track Quality Improvement

Keywords

RESET study

hospital teamwork

inpatient care quality

implementation context

senior leadership support

interprofessional rounds

physician nurse co-leadership

clinical microsystem redesign

healthcare intervention

staff buy-in

Intervention

Teamwork

Quality

Clinical Microsystem Redesign

Contextual Considerations