Problem: Teaching hospital multidisciplinary work rounds are often inefficient, delaying the completion of patient care tasks and detracting from teaching. Participants often act as working groups rather than interdependent teams. Athletic principles were used to train multidisciplinary rounding teams to adopt the systems used by manufacturing to improve the efficiency and quality of patient care, as well as teamwork and didactic teaching.
Approach: Experimental groups of general medical rounding teams—faculty member, house staff, medical students, bedside nurses, pharmacists, and a case manager—were introduced to individual job descriptions (playbooks), key customer–supplier relation ships, and efficient communication protocols, accompanied by weekly feed back (game films). A two-phase pilot 11-month prospective trial (February to July 2009 and September 2011 to January 2012) compared the experimental and control rounding teams on the basis of length of stay, 30-day readmission rates, and physician, student, and patient satisfaction.
Outcomes: These interventions resulted in a 30% reduction in 30-day readmissions and, in the 2011–2012 phase, an 18% shorter length of stay. Anonymous surveys documented greater satisfaction of faculty, residents, and medical students, and student ratings of teaching were markedly improved. Patient satisfaction did not change.
Next Steps: The new rounding system has the potential to reduce waste and improve the quality of patient care while improving caregiver satisfaction and medical student teaching. Adaptive leadership skills will be required to overcome resistance to change. The use of athletic analogies can improve teamwork and facilitate the adoption of a systems approach to the delivery of patient care.
Dr. Southwick is professor of medicine, Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida.
Ms. Lewis is case manager, UF Health Shands Hospital, Gainesville, Florida.
Dr. Treloar is associate professor of nursing, College of Medicine, University of Florida, Gainesville, Florida.
Dr. Cherabuddi is assistant professor of medicine, Division of Infectious Diseases, College of Medicine, University of Florida, Gainesville, Florida.
Dr. Radhakrinshan is assistant professor of medicine, Division of Hospitalist Medicine, College of Medicine, University of Florida, Gainesville, Florida.
Dr. Leverence is vice chairman of medicine for clinical affairs, professor of medicine, and chief, Division of Hospital Medicine, College of Medicine, University of Florida, Gainesville, Florida.
Ms. Han is an undergraduate student, Department of Statistics, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida.
Dr. Cottler is dean’s professor and chair, Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida.
Funding/Support: None reported.
Other disclosures: None reported.
Ethical approval: University of Florida IRB approval as exempt, no. 129-2009.
Previous presentations: November 2013, University Hospital Consortium, Atlanta, Georgia.
Correspondence should be addressed to Dr. Southwick, Box 100277, Department of Medicine/Division of Infectious Diseases, 1600 Archer Rd., Gainesville, FL 32610; telephone: (352) 246-8465; e-mail: southf@EPI.ufl.edu.