Using a Sociogram to Assess a Resident-led Team Huddle on an Inpatient Medicine Unit: A Novel Way to Evaluate Interprofessional Communication
The complexity of modern medicine requires high performance teamwork to ensure quality care. Inpatient medicine floors in the U.S. are organized around the point of care and are fluid with members moving in and out of patient care teams. Teams rely on communication patterns that are replicable and efficient. The aim of this study was to (a) assess communication within structured huddles on an inpatient medicine unit by evaluating who talked and to whom and what types of communication took place during each interaction throughout the huddle and (b) explore participants’ perceptions of the huddles. The dynamics of these huddles were studied using sociograms. Themes emerging from sociogram data were triangulated using focus groups. This project presents a novel method for evaluating teamwork dynamics in interprofessional huddles and characterizes what actually happens during information exchange at the point of care. The project also serves as task analysis for how well-designed technology can help support huddling behavior while reducing logistical challenges.
With guidance from my mentor, Dr. Kimberly Hoffman, we developed the research design and obtained IRB approval. Next, I observed three team huddles for two days to create and refine the sociogram. Then, using the sociogram, I observed three team huddles each day for 16 days yielding 48 completed sociograms. I completed reflective field notes at the end of each observation with the purpose of identifying patterns and points of clarification. Data from completed sociograms was used to analyze the most frequent types of interactions among team members. To triangulate observation data, we conducted two focus groups with huddle participants–one with residents and one with nurses. I drafted the focus group protocols and transcribed the group interviews in real time. I used transcripts to conduct a content analysis and identify themes. I serve as lead author of the manuscript.
Peer-Reviewed National Presentations
Royse, L., Nolan, N. (2014). Exploring the Value of a Resident-led Team Huddle on an Inpatient Medicine Unit. Oral abstract presented at Academy for Healthcare Improvement. Baltimore, MD (May 29, 2014). Artifact: Oral Presentation
Royse, L., Deane, K., Schlaudecker, J. (2013). Identifying the Essential Elements of Effective Interprofessional Communication. Presentation and workshop presented at Reynolds Grantee Annual Meeting. San Diego, CA (October 22, 2013).
Peer-Reviewed Regional Poster Presentations
Royse, L., Hoffman, K., Nolan, N. (2014). Exploring the Value of a Resident-led Team Huddle on an Inpatient Medicine Unit. Poster presented at Association of American Medical Colleges Central Group on Educational Affairs (CGEA) Spring Conference. Cleveland, OH (March 29, 2014). Artifact: Poster Presentation
Royse, L., Hoffman, K., Nolan, N. (2014) Exploring the Value of a Resident-led Team Huddle on an Inpatient Medicine Unit. Poster presented at University of Missouri School of Medicine Education Day. Columbia, MO (April 14, 2014). Artifact: Poster Presentation
Manuscript in final stages–submitting to the Journal of Graduate Medical Education soon.
Evaluating Usability of a Re-evaluation Request Web Application at the University of Missouri School of Medicine
University of Missouri School of Medicine recently launched a re-evaluation request system that moved an idiosyncratic paper process to a streamlined online system. I used a situated action approach to design and actively participated in the re-evaluation request process for one year to identify the “embodied actions” of the actors facilitating the process. The purpose of the usability study was to: 1) evaluate the usability of the most complex interface of the web application—the administrative interface and 2) pilot faculty and student satisfaction surveys. Five potential users participated in the usability study and faculty (n = 5) and student (n = 3) stakeholders completed pilot surveys. Usability study results were categorized as content to include in a training tutorial and/or program enhancements. Survey analysis indicates faculty users are satisfied with the application and student users have confusion regarding the re-evaluation process.
As principal investigator for this usability study, I drafted the IRB application, drafted testing protocols, recruited and scheduled usability testing participants, observed usability testing sessions, drafted and created surveys in SurveyMonkey, sent survey invitations to faculty and student participants, and compiled and categorized results.
Royse, L., Myers, D. (2015). Evaluating a Re-evaluation Request Web Application at the University of Missouri School of Medicine. In Proceedings of E-Learn: World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education 2015 (pp. 903-908). Chesapeake, VA: Association for the Advancement of Computing in Education (AACE). Artifact: Conference proceedings
Peer-Reviewed International Poster Presentation
Royse, L., Myers, D. (2015). Evaluating a Re-evaluation Request Web Application at the University of Missouri School of Medicine. Poster presented at Association for the Advancement of Computing in Education (AACE) E-Learn 2015 Conference. Kona, HI (October 21, 2015). Artifact: Poster Presentation
Slowing Down the Revolving Door: Retaining Chronically Ill Patients in Resident Practice with a Transition of Care Note
Transitions of care from different care settings have been a focus of recent research due to concern for errors from the increased number of handoffs as well as other factors. However, there is little research about the transition that occurs in the primary care ambulatory clinic when residents graduate. The purpose of this project was to implement a transition of care process and evaluate a checklist created to guide family medicine residents when writing a transition of care note in the patient’s medical record. We developed a transition of care process in which residents and their nurse partners utilize a transition checklist to write a transition of care note in a patient’s medical record. We piloted the process and used participant feedback to revise the checklist. Next, we created a 9-member physician expert panel from varying specialties to evaluate the checklist and sample notes from the pilot. Focus groups were conducted with the expert panelists and qualitative analysis of focus group transcripts was used to identify the most salient elements of both the checklist and sample notes and identify any missing content. Results were used to improve the transition of care checklist. This project also serves as task analysis for potential implementation of the transition of care template in the patient’s electronic medical record.
I worked with the principal investigator, Dr. Kristen Deane, to formalize the research design and draft the IRB. I drafted the focus group protocols, co-facilitated focus groups, and oversaw qualitative analysis of focus group transcripts by a research assistant. I drafted the methods and results section of the manuscript.
Manuscript in progress–submitting to the Journal of Graduate Medical Education soon.
Other Peer-Reviewed Presentations
Dyer, C., Royse, L., Craig, K., Deane, K., Parker, R. (2014). Taking your Institution’s IPE to the Next Level: Using IPEC Competencies to Develop and Improve Interprofessional Education. Presentation and workshop presented at Reynolds Grantee Annual Meeting. Las Vegas, NV (October 6-7, 2014).
Craig, K., Royse, L., Gray, P. (2012). Developing Longitudinal Geriatrics Programs for Medical Students: IPEC Competency-Driven Planning Workshop. Presentation and workshop presented at Reynolds Grantee Annual Meeting. St. Louis, MO (October 22, 2012).
Hoffman, K., Hosokawa, M., Royse, L., Dyer, C., Higbee, D. (2012). Will our students be able to care for granny? Developing geriatric cases as objective structured clinical exam (OSCE’S) to assess third-year students’ knowledge and skills in delivering patient centered geriatric care. Presented at the Central Group on Educational Affairs Regional Group of the American Association of American Medical Colleges. St. Louis, MO (March 29-31, 2012).
Hoffman, K., Hosokawa, M., Royse, L., Dyer, C., Moylan, K. (2011). Developing Geriatric Cases as Patient-Centered Care Objective Structured Clinical Exams (PCC-OSCEs). Presentation and workshop presented at Reynolds Grantee Annual Meeting. St. Louis, MO (October 24, 2011).
Royse, L., Warne-Griggs, M. (2016). Writing Learning Objectives and Identifying Results. Presentation and workshop presented at T3 Train the Trainer: Faculty Development in Interprofessional Team-Based Care Series. Sponsored by the Josiah Macy Foundation. Columbia, MO (September 12-13, 2016).
Hoffman, K., Royse, L., Warne-Griggs, M. (2016). Writing Learning Objectives and Identifying Results. Presentation and workshop presented at T3 Train the Trainer: Faculty Development in Interprofessional Team-Based Care Series. Sponsored by the Josiah Macy Foundation. Columbia, MO (January 25-26, 2016).
Grant and Research Awards
Agency: MU-Patient Centered Outcomes Research-Small Grant
Title: The Unfulfilled PROMIS of Pain Intensity
Total Costs: $20,000
Time Period: 9/2015 to 5/2017
Role: Research staff. Facilitated focus groups and conducted qualitative analysis to assess patient’s perception of clinical tools to evaluate pain intensity. Erin Dannecker, PhD, Principal Investigator
Agency: Donald W. Reynolds Foundation
Title: Learning to Provide Better Care in Teams: The Next Steps in Strengthening Geriatrics Medical Education at the University of Missouri School of Medicine
Total Costs: $999,288
Time Period: 1/2011 to 12/2014
Role: Collaborator (20% effort). Served as an instructional design specialist on the evaluation team. I actively engaged seven curriculum improvement teams to provide a framework for competency-driven discussion and planning and identified multiple forms of assessment. Our team developed a comprehensive and integrated assessment strategy to determine the effectiveness of the project. Steven C. Zweig, MD, Principal Investigator