Interdisciplinary Rounding and Associations with Team Collaboration and Practitioner and Patient Experiences: Does Design Matter?

Abstract
The first two decades of the 21st century brought a surge in popularity for interdisciplinary rounding practices on hospital units as a means to promote collaboration and patient-centered care. However, there are still challenges to full-scale implementation rooted in the historical dominance of physicians over rounding practices as well as increasing complexity of hospital care. This dissertation includes four manuscripts addressing the topic of interdisciplinary rounding. The first, a literature review, concluded that while there is a growing body of evidence to support that implementing interdisciplinary rounding may increase practitioner collaboration and satisfaction there is limited understanding on how the practice affects patients. Additionally, there is limited evidence on how the design (i.e., location, use of script, and leader role) of interdisciplinary rounding associates with elements of collaboration, team effectiveness, and patient experiences. In the next manuscript, a historical analysis revealed that nurses often served in support roles to physicians during rounds during the early 20th century. In response to decreased hospital staff during World War II and nurses’ burgeoning professionalism following the war, some nurses strayed away from participating in rounds with physicians, perhaps leading to struggles seen today in implementing a truly interdisciplinary practice. Using a conceptual framework as guidance, the primary research study presented in this paper sought to explore how different interdisciplinary rounding designs associated with practitioners’ perceptions of collaboration, team effectiveness and patients’ experiences of seeing the team working together and being included in decision making. A total of 174 practitioners from fifteen general care inpatient units across two academic health centers completed a survey measuring elements of collaboration (partnership and cooperation) and team effectiveness. Patient experience data was collected the unit-level using two questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Additionally, open-ended questions were asked of practitioners regarding their experiences with interdisciplinary rounding practices. The quantitative data were analyzed with multilevel modeling for the individual level data and general descriptive statistics and comparisons for the unit-level data. The role of the leader had a significant impact on cooperation. Units with nurse-led and shared-led rounds demonstrated higher levels of cooperation than those with physician-led rounds after controlling for age and hospital. The role of leader remained significant when included in a model controlling for age, hospital, location and script. In this model, use of a script also had a significant positive association with cooperation. Cooperation moderated the relationship between location and team effectiveness and leader role and team effectiveness as well. Script was also associated with higher levels of team effectiveness after controlling for age, hospital and the interaction with cooperation. There was a significant inverse relationship between cooperation and patient inclusion, but no association between design features and patient experiences. Lastly, a content analysis was conducted with the responses from the open-ended questions. Three themes emerged from the analysis: 1) setting the stage, 2) work of the team, and 3) benefits to patient care. The results of this study point to new areas for future inquiry as well as important implications for hospital leadership when planning and implementing or restructuring interdisciplinary rounding practices.