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Caregiver crisis: How to confront challenges to coordinated care

This is the fifth blog in a five-part series on the state of the healthcare workforce.  

Blog #1: 4 Immediate interventions every leader should consider; Blog #2: Tackling workplace violence and compassion fatigue in healthcare; Blog #3: How to reduce nurse turnover in first-year nurses; Blog #4: 3 steps to avert physician and nurse suicide

Although teamwork has been central to healthcare organizations' ability to deliver safe, quality care for years, COVID-19 has amplified the need for coordinating care across teams, care settings, and clinical specialties. As caregivers strive to keep up with high volumes, staffing shortages, continually evolving clinical knowledge, and the potential for long-term COVID co-morbidities (long COVID), they will need to collaborate even more to ensure optimal care across the continuum during the pandemic.  

The past 20 months, however, have exposed vulnerabilities in care models as caregivers have balanced complex needs and surges in patient volume. Institutions everywhere have confronted workforce shortages due to employee burnout and leaders have been forced to shift staff member roles as a result. 

As the pandemic continues to strain healthcare systems and new variants appear on the horizon, it’s never been more vital to address challenges to coordinated care and optimize teamwork.   

Challenges to working across roles and settings

Numerous factors make care coordination complex across teams and settings, both every day and during crisis: 

  • Hierarchy and power distance – Power distance is a dynamic measure of power differences between superiors and subordinates. High power distances may inhibit team members from asking questions, clarifying information, or relaying important on-the-ground feedback to other teams and leaders. Rigid hierarchies that discourage cross-departmental dialogue hinder caregivers from collaborating effectively.  

  • Role changes – Healthcare professionals often inhabit new roles or have different responsibilities during crises. For instance, outpatient nurses are sometimes called upon to assist hospital team members, or physicians may be asked to join trauma teams. Unless adequate onboarding, role delineation, and expectations around communication best practices are established, coordination can suffer.  

  • Lack of effective handoffs – Patients are commonly moved to other areas and different care teams. During these transitions, information critical to patient recovery can get lost if teams don’t have standard handoff processes and technology for accessing complete medical records. Effective handoff procedures can include: providing unambiguous transfers of responsibility, promoting shared doctrines, soliciting repeated key points, transmitting contingency plans and precautions, articulating up-to-date and accurate information, and reviewing patient family input. The effects on patients due to missed communication and failed handoffs can be potentially devastating.  

  • Job stress and overload – The sheer number and acuity of patients admitted and treated during COVID-19 has posed a slew of problems for hospitals, such as bed shortages and increased safety events. As individual caregivers are strained to accommodate these conditions, they may have less time for communicating across teams.  

  • Workforce shortages – Burnout and frontline trauma have contributed to record workforce shortages in healthcare. As talent leaves the sector, employees experience heavier burdens: caring for more patients, taking on more responsibilities, and assuming more accountability. These stressors can inhibit the ability of teams to function well together. 

Team-based approaches for coordinating care

At its core, coordinating care starts at the team level. A collaborative culture is necessary for healthcare institutions to sustain continued interdisciplinary practices. Employing team-based strategies can help mitigate or prevent care coordination challenges during crisis:   

  • Create psychological safety and belonging – Ensuring caregivers have the psychological safety to speak up and relay patient needs, clinical observations, progress, and concerns across the entire patient journey is essential. Staff must be comfortable with asking questions, challenging opinions, and presenting concerns to ensure patient safety and quality when working across settings and groups. Daily huddles, leadership rounding, and interdisciplinary team meetings are strategies that institutions can implement to nurture that psychological safety.  

  • Clear accountability – Ensure teams clearly define who is responsible for which components of the follow-up and treatment plan so there are robust handoffs with no care gaps or missed information. Effectively delegating steps throughout the care journey helps teams collectively understand their undertakings and address issues before they become larger problems. 

  • Align with patients and families on care plans – Patients and their families provide intimate insights absent from medical charts. This information can affect care plans and how treatment is applied. Caregivers should engage patients and families in collaborative dialogue, communicate key concepts related to care and treatment plans to patients throughout their experiences, and ask them to repeat this information to ensure understanding. Partnering with patients and families leads to better care coordination, and improved safety and patient experience. 

By carefully addressing areas of opportunity at team levels, caregivers can take care coordination from an ideal to reality.  

System-based approaches for coordinating care

Team-based strategies alone can’t effectively overcome coordination difficulties affecting organizations at large. Systems also need to change rigid structures to be more supportive and interactive with their workforce. To address challenges to coordinated care, institutions must carefully implement larger reforms:  

  • Break down silos – Care can’t be approached in isolation. To properly treat patients with complex and interacting health issues, organizations must put systems in place to facilitate sharing of critical information and expertise both within and across teams. Establishing cross-departmental huddles and supporting teams with the right technology can go a long way in reinforcing interdisciplinary practices.  

  • Draw on data to reinforce teams – By leveraging employee feedback with tools such as Press Ganey’s Pulse Surveys for engagement and safety culture, you can better understand psychological safety, gaps or breakdowns in processes, training opportunities, and how to support workers quickly jumping into new roles.  

  • Foster communication – Training teams to communicate is key for effectively coordinating care. Organizations need robust processes related to verbal and written handoffs, communication expectations, and best practices to reinforce consistency and support collaboration across teams. Apart from skills labs and other clinical development opportunities, team members should engage in trainings on communication, planning, working with others, and problem-solving. Other vital learning concepts include reliability skills, or evidence-based and non-technical abilities that can minimize communication and reasoning errors, and relationship skills–strategies that help to reduce power distance and open up communication channels. Focusing on these core abilities and establishing them as integral components to any existing team technical simulation helps to elevate the entire team and ensure everyone’s on the same page. Team-based care further requires intentionally developing cross-departmental relations. Recognizing and celebrating instances of teamwork between distinct groups reinforces coordinated care as a success point. 

Understanding challenges to team-based care and how to confront them make all the difference during stressful times. Considering the difficulties individuals and teams face during crisis can help teams and systems better implement coordinated care across roles and settings. Treating patients and families as allies streamlines the care process, nurtures trust, and improves treatment outcomes. It’s vital that teams empower workers to voice patient needs and observations with other groups while institutions implement system-based approaches to support cross-departmental communication and nurture relationships across units.   

To assess your employee wellbeing and identify gaps, get started with a 15-minute Flight Risk assessment or speak with one of Press Ganey’s .experienced consultants.

About the author

As Chief Safety and Transformation Officer, Dr. Gandhi, MPH, CPPS is responsible for improving patient and workforce safety, and developing innovative healthcare transformation strategies. She leads the Zero Harm movement and helps healthcare organizations recognize inequity as a type of harm for both patients and the workforce. Dr. Gandhi also leads the Press Ganey Equity Partnership, a collaborative initiative dedicated to addressing healthcare disparities and the impact of racial inequities on patients and caregivers. Before joining Press Ganey, Dr. Gandhi served as Chief Clinical and Safety Officer at the Institute for Healthcare Improvement (IHI), where she led IHI programs focused on improving patient and workforce safety.

Profile Photo of Dr. Tejal Gandhi, MPH, CPPS