From the November/December Issue...
Ensuring effective and safe patient care coordination is among the hardest challenges that healthcare managers deal with on a day-in, day-out basis. The gold standard for care coordination holds effective teamwork as the central tenet for success. To that end, the Agency for Healthcare Research and Quality (AHRQ) freely distributes its TeamSTEPPS strategy (www.ahrq.gov/teamstepps) to promote effective communication in health systems.
Many hospitals and health systems struggle to create consistent staffing schedules, which complicates their intention to form teams and leverage those dynamics to improve care. As a result, patient experiences are a series of care processes that rely on providers exchanging information in a one-off, one-way transactional format. Those care transactions often occur through the electronic health record (EHR), further removing human affect and discourse that are crucial for teamwork.
The transactional care coordination model is unlikely to go away any time soon. Recognizing this fact and acknowledging the challenges it creates are the first steps to improving care coordination and, ultimately, safety. From a system's perspective, the main challenge with a transactional model is that it relies on a feed-forward design with very limited feedback mechanisms, particularly when they run through an EHR system. Pure feed-forward designs are sometimes called “ballistic” because once a signal is sent, it can be altered only by another signal from the original source. Feed-forward designs are best used when the outcome anticipated is highly predictable and stable. Such is rarely the case for the average patient on a medical–surgical unit.
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