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- Title
Self-Organization of Interprofessional Staff to Improve Mobility of Hospitalized Patients with STRIDE: a Complexity Science-Informed Qualitative Study.
- Authors
Bruening, Rebecca A.; Sperber, Nina; Wang, Virginia; Mahanna, Elizabeth; Choate, Ashley; Tucker, Matthew; Zullig, Leah L.; Van Houtven, Courtney Harold; Allen, Kelli D.; Hastings, Susan N.
- Abstract
Background: Inpatient mobility programs can help older adults maintain function during hospitalization. Changing hospital practice can be complex and require engagement of various staff levels and disciplines; however, we know little about how interprofessional teams organize around implementing such interventions. Complexity science can inform approaches to understanding and improving multidisciplinary collaboration to implement clinical programs. Objective: To examine, through a complexity science lens, how clinical staff's understanding about roles in promoting inpatient mobility evolved during implementation of the STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) hospital mobility program. Design: Qualitative study using semi-structured interviews. Participants: Ninety-two clinical staff at eight Veterans Affairs hospitals. Interventions: STRIDE is a supervised walking program for hospitalized older adults designed to maintain patients' mobility and function. Approach: We interviewed key staff involved in inpatient mobility efforts at each STRIDE site in pre- and post-implementation periods. Interviews elicited staff's perception of complexity-science aspects of inpatient mobility teams (e.g., roles over time, team composition). We analyzed data using complexity science-informed qualitative content analysis. Key Results: We identified three key themes related to patterns of self-organization: (1) individuals outside of the "core" STRIDE team voluntarily assumed roles as STRIDE advocates, (2) leader-champions adapted their engagement level to match local implementation team needs during implementation, and (3) continued leadership support and physical therapy involvement were key factors for sustainment. Conclusions: Staff self-organized around implementation of a new clinical program in ways that were responsive to changing program and contextual needs. These findings demonstrate the importance of effective self-organization for clinical program implementation. Researchers and practitioners implementing clinical programs should allow for, and encourage, flexibility in staff roles in planning for implementation of a new clinical program, encourage the development of advocates, and engage leaders in program planning and sustainment efforts.
- Publication
JGIM: Journal of General Internal Medicine, 2022, Vol 37, Issue 16, p4216
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-022-07482-9