Better hospital context increases success of care pathway implementation on achieving greater teamwork: a multicenter study on STEMI care

Abstract

AbstractObjectiveTo evaluate whether hospital context influences the effect of care pathway implementation on teamwork processes and output in STEMI care.DesignA multicenter pre–post intervention study.SettingEleven acute hospitals.ParticipantsCardiologists-in-chief, nurse managers, quality staff, quality managers and program managers reported on hospital context. Teamwork was rated by professional groups (medical doctors, nurses, allied health professionals, other) in the following departments: emergency room, catheterization lab, coronary care unit, cardiology ward and rehabilitation.InterventionCare pathway covering in-hospital care from emergency services to rehabilitation.Main outcome measuresHospital context was measured by the five dimensions of the Model for Understanding Success in Quality: microsystem, quality improvement team, quality improvement support, high-level organization, external environment. Teamwork process measures reflected teamwork between professional groups within departments and teamwork between departments. Teamwork output was measured through the level of organized care. Two-level regression analysis accounted for clustering of respondents within hospitals and assessed the influence of hospital context on the impact of care pathway implementation on teamwork.ResultsCare pathway implementation significantly improved teamwork processes both between professional groups (P < 0.001) and between departments (P < 0.001). Teamwork output also improved (P < 0.001). The effect of care pathway implementation on teamwork was more pronounced when the quality improvement team and quality improvement support and capacity were more positively reported on.ConclusionsHospitals can leverage the effect of quality improvement interventions such as care pathways by evaluating and improving aspects of hospital context.