The Effect of a Redesigned Nurse-Led Care Coordination Model on Patient Length of Stay Mona Kahil, DNP, MSN, ACM- RN, IQCI, CCRN Alumnus Background • The US healthcare system is shifting from volume-based fee for service reimbursement to value-based patientcentered care delivery (Gordon, Leiman, Deland & Pardes, 2014) with its ultimate goal to improve population health, improve patients' experience, and decrease the spiraling health care cost (Berwick, Nolan & Wittington, 2008) • In response to the Institute of Medicine (IOM) report of 2001, healthcare organizations are proactively identifying gaps in their systems, planning and implementing redesigned strategies to ensure that health care services are rendered in the safest, most effective, patient-centered, timely, efficient, and equitable manner.
Research Purpose • To examine whether role ambiguity and role conflict exist among practicing nurse Care Coordinators in the inpatient acute care hospital settings • To evaluate whether the implementation of a redesigned nurse-led care coordination model that outlines clearly defined Care Coordinator's role, functions and organizational expectations affect the Care Coordinators levels of role ambiguity, role conflict, and patient length of stay.
This is an exploratory, correlational, descriptive study, that uses a purposive sample of nurse Care Coordinators n= 23 , and an anonymous survey consisting of two questionnaires: 1. A short demographic questionnaire and 2. The Role Ambiguity Scale (RAS) [(Rizzo, House & Lirtzman, 1970)]. This instrument contains 15 role conflict items and 15 role ambiguity items and utilizes a 5 point Likert-type (Strongly disagree =1, disagree = 2, Neither = 3, Agree = 4, Strongly agree = 5).
Research Results n
Percentage %
2 21
8.6 91.30
2 5 14 1
8.6 21.73 60.86 4.34
Education level Bachelor-nursing Bachelor-non nursing Master’s-nursing Master’s-non nursing
12 1 4 6
52.17 4.34 17.39 26.08
Number of years of experience in nursing 11–15 16–20 21–25 >25
1 4 3 15
4.34 17.39 13.04 65.21
Number of years of experience in care coordination <2 2–5 6–10 11–15 16–20 21–25 >25
1 4 6 3 5 2 1
4.34 17.39 17.39 13.04 21.75 8.6 4.34
Number of years of experience in current position <2 2–5 6–10 11–15 16–20 21–25
4 7 6 4 1 1
17.39 30.43 17.39 17.39 4.34 4.34
Unit based Team based
18 5
78.2 21.75
Years of Employment at institution <2 2–5 6–10 11–15 16–20 21–25 >25
1 6 6 5 2 3 3
4.34 17.39 17.39 21.75 21.75 13.04 13.04
Certification in case management Yes No
9 14
39.13 60.86
Male Female Age 35–44 45–54 55–64 65 or older
RAS Four Factors Grouping
I - Internal department standard conflicts; a person-role conflict or intra-role conflict.
Ambiguity Conflict Valid N (list wise)
22 18- 49 37.0455
2.84
1.78 - 3.65
III- Conflict between several roles for same person
3.34
2.95 - 3.73.
2.88
2.52–3.21
43-65 54.2609
22
Descriptive Statistics
The results will be used as a baseline of information to assist the organization in modifying the redesigned nurse-led care coordination model and developing interventions such as clearly defined workflow, practice guidelines and policies to decrease nurse care coordinator's role ambiguity and role conflict and to decrease patient length of stay.
References
Role Ambiguity Four Factor Grouping
M Cardiac MS
6.51
Pediatric/PostPartum
Med Surg
6.95 5.98
6.01
5.85
4.03
4.08
6.14
5.71 3.92
SD 8.72586 0.73 0.65
23
Implications For Practice
II- Conflict in time, resources & capabilities
4.06
Mean
• Nurse care coordinators need clearly defined role and skill sets to effectively manage patient care delivery and improve patient outcomes. • This study identified areas where significant role ambiguity and role conflict exist among practicing nurse care coordinators • Nurse care coordinators self- reported areas of role conflict were related to inter and intradepartmental standards, conflict in time to perform their job, inadequate resources, role overload, and role conflict as a member of the multidisciplinary team.
Note. Based upon responses from 23 completed surveys. Reprinted with permission from “Role Conflict and Ambiguity in Complex Organizations” by John R. Rizzo, Robert J. House, Sidney I. Lirtzman, June 1970, The Administrative Science Quarterly, 15, pp. 150–163, © Johnson Graduate School of Management, Cornell University.
Theoretical Framework: Range
Range
2.34 – 3.56
IV- Conflicting expectations and organizational demands associated with incompatible policies and conflicting requests from others.
6.71
N
Mean
3.06
Nurse Care Coordinators Demographic and Professional Characteristics
Role theory (RT) is the theoretical framework for this study (Banton,1965; Thomas & Biddle,1966). It provides a roadmap to explore the attitudes and perceptions of nurse care coordinators who interact within a health care organization to deliver high quality coordinated patient care.
Conclusion
Research Design and Method
Variables Gender
Saint Peter’s University The Jesuit University of New Jersey
6.37622 Mean LOS
M ELOS 1st Qtr 2014
0.81
0.15
M Variance
Mean LOS
M ELOS
0.3 0.15
M Variance
3rd Qtr 2014
LOS before and after implementation of Redesigned Nurse-Led Care coordination Model
Banton, M. (1965). Roles: An introduction to the study of social relations. Tavistock London. Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs (Project Hope), 27(3), 759-769. Gordon, J. E., Leiman, J. M., Deland, E. L., & Pardes, H. (2014). Delivering Value: Provider Efforts to Improve the Quality and Reduce the Cost of Health Care. Annual review of medicine, 65, 447-458. Institute of Medicine (US). Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century . National Academies Press. Rizzo, J. R., House, R. J., & Lirtzman, S. I. (1970). Role conflict and ambiguity in complex organizations. Administrative Science Quarterly, 150-163. Thomas, E. J., & Biddle, B. J. (1966). Basic concepts for classifying the phenomena of role. Role Theory: Concepts and Research, 23-45.