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Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care
  1. Eve Isabelle Purdy1,2,
  2. Darren McLean3,
  3. Charlotte Alexander2,
  4. Matthew Scott4,
  5. Andrew Donohue5,
  6. Don Campbell6,
  7. Martin Wullschleger7,
  8. Gary Berkowitz8,
  9. James Winearls9,
  10. Doug Henry10,
  11. Victoria Brazil2,11
  1. 1Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
  2. 2Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
  3. 3Centre for Health Innovation, Gold Coast University Hospital, Southport, Queensland, Australia
  4. 4Trauma Service, Gold Coast University Hospital, Southport, Queensland, Australia
  5. 5Anaesthetics, Gold Coast University Hospital, Southport, Queensland, Australia
  6. 6Trauma Service/Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
  7. 7Trauma Service/General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
  8. 8High Acuity Response Unit, Queensland Ambulance Service, Southport, Queensland, Australia
  9. 9Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia
  10. 10Department of Anthropology, University of North Texas, Denton, Texas, USA
  11. 11Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
  1. Correspondence to Dr Eve Isabelle Purdy; epurdy{at}qmed.ca

Abstract

Background Trauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across diverse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital.

Methods We conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance.

Findings We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers.

Conclusions Through engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.

  • qualitative research
  • teamwork
  • organizational theory
  • resuscitation
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @purdy_eve

  • Presented at Gold Coast Hospital Research Day, Queensland Trauma Symposium.

  • Contributors EIP was involved in project design, participant observation, informal interviews, interviews, focus groups, survey design, data analysis and initial draft of the manuscript. DM was involved in project design, survey design, data management and analysis, and review of the manuscript. CA was involved with data management and analysis and critical review of the manuscript. MS was involved with project design, survey distribution, data analysis and critical review of the manuscript. AD was involved with project design, survey distribution, data analysis and critical review of the manuscript. DC was involved with project design, survey distribution, data analysis and critical review of the manuscript. MW was involved with project design, survey distribution, data analysis and critical review of the manuscript. GB was involved with project design, survey distribution, data analysis and critical review of the manuscript. DH was involved with project design, data analysis, drafting of the manuscript and critical review of the manuscript. VB was involved with project design, distribution of surveys, data analysis, drafting the manuscript and critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the GCUH Human Ethics Research Committee (HREC/18/QGC/13).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data are not available in total as some of them are identifiable. Quantitative data and de-identified qualitative data are available on request (epurdy@qmed.ca).

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