Providing a Structure for Collaboration: A Leadership Challenge

Purpose:
The aim of this discussion is to introduce the learner to the key structures and processes necessary for collaboration in the healthcare environment. We will explore one systems experience with implementation of a collaborative process and impact on patient outcomes.

Significance:
Increased work loads, less support and nurse dissatisfaction results in decreased quality(Aiken, et al. 2002). Henneman(1995)sited a lack of collaboration as a factor. Knaus, et al.(1986) found hospitals with collaboration had a 41% lower mortality rate than hospitals without collaboration.

Strategy and Implementation:
In response to rising costs and increasing Length of stay a Health System in coordination with Karen Zander and the Center for Case Management (CCM) developed a care process where essential collaborative structures are woven into daily care and coined it the “Clinical Integration Model”. the The nurse caring for the patient fills out the CareGraph daily and meets with the entire care team three times a week to discuss problem foci. These meetings are completed on all units. If the patient is stalled in progression they are referred to the Complex Care. Complex Care meetings are comprehensive and multidisciplinary with the common goals of problem recognition, management, and resolution. Criteria have been set for patient referral. Problem management for the individual patient based on Complex Care discussions are carried out by each discipline. A patient is discussed at Complex Care thereafter until discharge or significant clinical progression is made.

Evaluation:
Positive results after one year of implementation: average length of stay went from 4.24 to 3.37 days. The cost per admission decreased from $6723.00 to $5919.00 The staff and patients were satisfied with the care process.

Implications for Practice:
Results provide a picture of the essential structure, process and outcomes of collaboration. It provides initial steps toward validation of a successful collaborative model for the acute care setting with key components essential for successful implementation.