The importance of relational coordination for integrated care delivery to older patients in the hospital J.M. Hartgerink, J.M. Cramm, T.J.E.M. Bakker, R.A.M. van Eijsden, J.P. Mackenbach, A.P. Nieboer

Background I 34-50% functional decline Fragmented, duplicated and directed at acute disease Integrated care delivery –coordinated response –horizontal work processes –complementary role

Background II Theory of relational coordination “mutually reinforcing process of interaction between communication and relationships carried out for the purpose of task integration”

Setting and design Cross-sectional study Vlietland hospital, The Netherlands Data collected in professionals (44% response rate)

Questionnaires I Relational coordination survey –Communication frequency/timeliness, accuracy and problem solving –Relationships shared goals, shared knowledge and mutual respect –4-point scale –Cronbach’s alpha 0.96

Questionnaires II Assessment of chronic illness care (ACIC) –Self-management support –Delivery system design –Decision support –Clinical information systems –11-point scale –Cronbach’s alpha 0.87

Results I - descriptives Relational coordination M = 2.57 (SD 0.95) Integrated care delivery M = 5.58 (SD 1.79) Characteristic% SexFemale76 ProfessionMedical specialist27 Nurse64 Paramedic9 Years working in the organization>1 year96

Results II – differences in disciplines Geriatric unit compared to other hospital units: –Higher integrated care delivery –Higher relational coordination Nurses compared to medical specialists: –Higher relational coordination Same discipline compared to different disciplines: –Higher relational coordination

Results III – multiple regression analysis  BSE Background characteristics Nurse Paramedic Gender Number of years working in the current organization Relational coordination Overall relational coordination 0.20* Adjusted R² for equation 0.11 F * P < 0.001

Conclusion Relations, communication and coordination to improve integrated care Value of geriatric unit Less attraction to the unfamiliar discipline

Discussion Cross-sectional design Confounders Patient experiences and outcomes

Practical implications Expand geriatric awareness Improve attraction to the unfamiliar discipline Introduce training programmes Redefine goals and objectives of teamwork

The importance of relational coordination for integrated care delivery to older patients in the hospital J.M. Hartgerink, J.M. Cramm, T.J.E.M. Bakker, R.A.M. van Eijsden, J.P. Mackenbach, A.P. Nieboer