AHRQ-Funded Guide Helps Hospitals Redesign Systems To Improve Patient Care

An AHRQ-funded implementation guide is now available to help hospitals make changes to establish the structure and shared accountability needed to coordinate high-quality care and improve performance over time. The guide was developed by the RESET project, an initiative led by researchers at Northwestern University Feinberg School of Medicine. It is designed to address challenges such as managing large teams with evolving membership and ensuring collaboration between clinicians in distant hospital locations. Strategies also are aimed at ensuring patients and family members receive the information needed to engage in decision-making and care planning. Access the toolkit’s implementation guide.

Redesigning Systems To Improve Teamwork and Quality for Hospitalized Patients (RESET Project)

A number of challenges impede hospitals’ ability to provide high-quality care to patients on medical services. Teams are large, membership changes over time, and members are often physically scattered, working across multiple units and floors. Nurse and physician leaders commonly operate in silos, limiting their ability to address challenges collaboratively. Patients and family members may not receive all the information they need to engage in decision making and care planning. Therefore, medical services may lack the structure and shared accountability needed to optimally coordinate care on a daily basis and improve performance over time.

A growing number of hospitals have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients. Research suggests that these interventions can improve patient outcomes when implemented as a set of complementary and mutually reinforcing components. However, these interventions need to be adapted to account for hospital-specific contextual factors. To assist these efforts, a team led by Northwestern, with funding from the Agency for Healthcare Research and Quality and in collaboration with the Society of Hospital Medicine and the American Nurses Association, began the Redesigning Systems To Improve Teamwork and Quality for Hospitalized Patients (RESET project) in 2018.

The RESET project provided mentorship and resources for four hospitals to adapt and implement a set of complementary interventions based on a clinical microsystems framework called Advanced and Integrated MicroSystems (AIMS). The AIMS model consists of five interventions:

Unit-Based Physician Teams.
Unit Nurse-Physician Co-Leadership.
Enhanced Interprofessional Rounds.
Unit-Level Performance Reports.
Patient Engagement Activities.

The RESET project is administered through three phases: Preparation, Implementation, and Sustainment.

The project is ongoing, with results expected in 2022. Because many hospitals are already working on similar interventions, the project team decided to share the RESET Implementation Guide and its accompanying resources to assist hospitals in adapting and implementing the AIMS interventions to meet their local needs. This guide provides detailed information about the RESET project, the AIMS interventions, and useful strategies for leading changes.