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2019 HSR&D/QUERI National Conference Abstract

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1087 — Achieving resident-centered care through teamwork in high-performing VA nursing homes

Lead/Presenter: Rendelle Bolton,  COIN - Bedford/Boston
All Authors: Bolton RE ((Center for Healthcare Organization and Implementation Research; Brandeis University Heller School for Social Policy and Management)), Houston, AR (Center for Healthcare Organization and Implementation Research; Northeastern University), Clark, V (Center for Healthcare Organization and Implementation Research) Nash, P (Tuscaloosa VA Medical Center; University of Alabama) Hartmann, C (Center for Healthcare Organization and Implementation Research; Boston University) Snow, AL (Tuscaloosa VA Medical Center; University of Alabama)

Objectives:
VA promotes resident-centered care (RCC) practices to achieve high quality care in its Community Living Centers (CLCs). RCC involves partnering with CLC residents and their families to support resident choice, dignity, and purpose. Teamwork achieved through staff communication and relationships (e.g., relational coordination) can facilitate delivery of high-quality care tailored to individual preferences. Using a positive deviance design, we examined RCC delivery through the lens of relational coordination theory among high-performing CLCs to better understand RCC in daily practice.

Methods:
Eight high-performing sites were selected based on quality metrics and RCC indices. At these sites, we conducted semi-structured interviews with 89 purposively selected direct care, support, and management staff. Interview questions probed for RCC implementation in daily practice. Inductive codes captured content related to RCC, teamwork, formalized coordination structures, resident-staff relationships, and leadership. Using constant comparison, within and across sites, we mapped emergent findings to relational coordination theoretical constructs.

Results:
We identified 4 overarching themes explaining how teamwork contributed to RCC delivery. (1) RELATIONAL COORDINATION: Interdisciplinary relationships characterized by shared knowledge, shared goals, and mutual respect enabled staff to meet resident needs. Frequent, timely, and accurate communication promoted sharing resident preferences and care plans. (2) ORGANIZATIONAL STRUCTURES: Formalized structures/processes (huddles, meetings, communication books/boards) fostered teamwork. Cross-role training increased shared knowledge of roles. Hiring for teamwork promoted coordination. (3) RELATIONAL LEADERSHIP: CLC managers emphasized relationships and teamwork, engaged with residents and staff to enhance communication, and recognized staff successes. Some introduced infrastructure to promote teamwork. (4) RELATIONAL COPRODUCTION: Staff developed close relationships with residents and families to coproduce treatment plans tailored to individual preferences, needs, and goals.

Implications:
RCC was achieved through interdisciplinary teamwork characterized by strong relationships and communication, enabled by supportive management and infrastructure that formalized coordination practices. This teamwork facilitated relational coproduction with residents and families, promoting delivery of personalized care.

Impacts:
As Veterans continue to age, delivering consistent high-quality RCC is necessary for supporting CLC residents' quality of life and care. Adopting high-performance work and strategic human resource management practices to sustain a culture of relational coordination, relational leadership, and relational coproduction can help CLCs achieve RCC in daily practice.