Better Interprofessional Teamwork, Higher Level of Organized Care, and Lower Risk of Burnout in Acute Health Care Teams Using Care Pathways: A Cluster Randomized Controlled Trial

Med Care. 2013 Jan;51(1):99-107. doi: 10.1097/MLR.0b013e3182763312.

Abstract

Background: Effective interprofessional teamwork is an essential component for the delivery of high-quality patient care in an increasingly complex medical environment. The objective is to evaluate whether the implementation of care pathways (CPs) improves teamwork in an acute hospital setting.

Design and measures: A posttest-only cluster randomized controlled trial was performed in Belgian acute hospitals. Teams caring for patients hospitalized with a proximal femur fracture and those hospitalized with an exacerbation of chronic obstructive pulmonary disease, were randomized into intervention and control groups. The intervention group implemented a CP. The control group provided usual care. A set of team input, process, and output indicators were used as effect measures. To analyze the results, we performed multilevel statistical analysis.

Results: Thirty teams and a total of 581 individual team members participated. The intervention teams scored significantly better in conflict management [β=0.30 (0.11); 95% confidence interval (CI), 0.08 to 0.53]; team climate for innovation [β=0.29 (0.10); 95% CI, 0.09 to 0.49]; and level of organized care [β=5.56 (2.05); 95% CI, 1.35 to 9.76]. They also showed lower risk of burnout as they scored significantly lower in emotional exhaustion [β=-0.57 (0.21); 95% CI, -1.00 to -0.14] and higher in the level of competence (β=0.39; 95% CI, 0.15 to 0.64). No significant effect was found on relational coordination.

Conclusions: CPs are effective interventions for improving teamwork, increasing the organizational level of care processes, and decreasing risk of burnout for health care teams in an acute hospital setting. Through this, high-performance teams can be built.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Belgium
  • Burnout, Professional / prevention & control
  • Clinical Competence
  • Critical Pathways / organization & administration*
  • Emotions
  • Environment
  • Female
  • Femoral Fractures / therapy
  • Hospital Administration
  • Humans
  • Interprofessional Relations*
  • Male
  • Middle Aged
  • Organizational Innovation
  • Outcome and Process Assessment, Health Care
  • Patient Care Team / organization & administration*
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Quality of Health Care / organization & administration*