Optimizing virtually-based communication among tribal primary care facility team members to improve patient care

Abstract

Background: Effective communication among healthcare providers is linked to patient safety and improved patient outcomes but requires leadership accountability, team engagement, and organizational structure. Improving communication exchange at a tribal primary care facility among staff during group meetings may positively impact patient care and outcomes for American Indian and Alaska Native people who already experience disproportionate chronic health issues. Objective: The aim of this Doctor of Nursing Practice (DNP)/quality improvement project is to improve effective communication among tribal healthcare staff during weekly staff meetings by incorporating TeamSTEPPS framework in the form of structured technology platform etiquette, using targeted agendas, and utilizing leadership follow-up and feedback to enhance the care provided. Methods: Descriptive statistics and qualitative findings were used. Five weekly meetings that included a blend of multidiscipline and multicultural staff were observed for baseline assessment of perceived satisfaction among health care providers and review of the frequency of interruptions with non-agenda items, etiquette interruptions, and the number of missed opportunities for leadership to provide timely follow-up/feedback. The literature review was conducted to identify evidence-based or informed communication interventions. Intervention: Based on the literature review, Team Strategies and Tools to Enhance Performance and Patient Safety was used to guide the intervention. The three interventions included improved structure through agenda sharing, enhanced expectations in the form of chat/emoji use for discussion to discourage interruption, and enhanced leadership through well-planned follow-up. Results: Outcomes included improved communication exchange regarding an increased number of staff who participated in agenda sharing, a decrease in frequency of "hi-jacked" agenda items, an increase in frequency of staff who used chat/emoji features, and a decrease in frequency of interruptions. The frequency of missed opportunities for leadership to follow-up with staff on agenda items increased. Improvement in communication elements was observed in all but follow-up and resolution. Conclusions: The insights gained from this quality improvement project may further the understanding of optimizing communication in the tribal healthcare setting. Further studies related to how tribal culture influences the exchange of communication are needed in order to continue improving upon healthcare team communication in an effort to improve patient health outcomes.