Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care

Eve Isabelle Purdy, Darren McLean, Charlotte Alexander, Matthew Scott, Andrew Donohue, Don Campbell, Martin Wullschleger, Gary Berkowitz, James Winearls, Doug Henry, Victoria Brazil

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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.

Original languageEnglish
Article numbere000749
Number of pages11
JournalBMJ Open Quality
Volume9
Issue number1
DOIs
Publication statusPublished - Feb 2020

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    Purdy, E. I., McLean, D., Alexander, C., Scott, M., Donohue, A., Campbell, D., ... Brazil, V. (2020). Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care. BMJ Open Quality, 9(1), [e000749]. https://doi.org/10.1136/bmjoq-2019-000749