Redesigning Systems to Improve Quality for Hospitalized Patients

Most adults requiring hospitalization are admitted for medical conditions, yet the optimal
model of care for these patients is yet to be established. Current care delivery models lack
the ability to optimally coordinate care on a daily basis and improve performance over time.
A growing body of research has tested interventions to redesign aspects of care delivery for
hospitalized medical patients. These interventions improve processes and culture, but the
evidence that patient outcomes have improved is equivocal. Importantly, most studies have
examined the effect of single interventions in isolation, yet these interventions are better
conceptualized as complementary and mutually reinforcing components of a redesigned clinical
microsystem. Clinical microsystems are the front line care giving units where patients,
families, and care teams meet. Our research team developed a set of complementary, mutually
reinforcing interventions based on available evidence and anchored in a clinical microsystem
framework. The 5 Advanced and Integrated MicroSystems (AIMS) interventions include: 1)
Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced
Interdisciplinary Rounds, 4) Unit-level Performance Reports, 5) Patient Engagement
Activities. Our long term goal is to discover and disseminate the optimal model of care to
improve outcomes for hospitalized patients. Our specific objective for this proposal is to
implement a set of evidence-based complementary interventions across a range of clinical
microsystems, identify factors and strategies associated with successful implementation, and
evaluate the impact on quality. Our research team will use mentored implementation, i.e.,
coaching by external professionals who are experts in the area of focus, to help facilitate
change. The research team has enrolled 4 hospitals in this quality improvement mentored
implementation study. Our hypothesis is that uptake of the complementary components of the
intervention set will result in improvements in teamwork climate and patient outcomes.

Specific Aims of the Redesigning Systems to Improve Quality for Hospitalized Patients (RESET)
study include:

1. Conduct a multi-site mentored implementation study in which each site adapts and
implements complementary interventions to improve care for medical patients.

2. Evaluate the effect of the intervention set on teamwork climate and patient outcomes
related to safety, patient experience, and efficiency.

3. Assess how site-specific contextual factors interact with the variation in the intensity
and fidelity of implementation to effect teamwork and patient outcomes.

The findings generated from this study will be directly applicable to hospitals throughout
the U.S. and our partnership with the Society of Hospital Medicine, the American Nurses
Association, and the Institute for Patient- and Family-Centered Care will ensure effective
dissemination and impact.

Inclusion Criteria:

- Adult patients admitted, under inpatient or observation status, to study units

Exclusion Criteria:

- Patients transferred from other hospitals and those initially admitted to other units.

- Patients admitted under non-medical services on the study units.