Protocol for a mixed methods study of hospital readmissions: Sensemaking in Veterans Health Administration healthcare system in the USA

Lauren S. Penney, Luci K Leykum, Polly H Noel, Erin Finley Garcia, Holly L Lanham, Jacqueline A Pugh

Research output: Contribution to journalArticle

Abstract

Introduction Effective delivery of healthcare in complex systems requires managing interdependencies between professions and organisational units. Reducing 30-day hospital readmissions may be one of the most complex tasks that a healthcare system can undertake. We propose that these less than optimal outcomes are related to difficulties managing the complex interdependencies among organisational units and to a lack of effective sensemaking among individuals and organisational units regarding how best to coordinate patient needs. Methods and analysis This is a mixed method, multistepped study. We will conduct in-depth qualitative organisational case studies in 10 Veterans Health Administration facilities (6 with improving and 4 with worsening readmission rates), focusing on relationships, sensemaking and improvisation around care transition processes intended to reduce early readmissions. Data will be gathered through multiple methods (eg, chart reviews, surveys, interviews, observations) and analysed using analytic memos, qualitative coding and statistical analyses. We will construct an agent-based model based on those results to explore the influence of sensemaking and specific care transition processes on early readmissions. Ethics and dissemination Ethical approval has been obtained through the Institutional Review Board of the University of Texas Health Science Center at San Antonio (approval number: 14-258 hour). We will disseminate our findings in manuscripts in peer-reviewed journals, professional conferences and through short reports back to participating entities and stakeholders.

Original languageEnglish (US)
Article numbere020169
JournalBMJ Open
Volume8
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Veterans Health
Patient Readmission
United States Department of Veterans Affairs
Patient Transfer
Delivery of Health Care
Organizational Case Studies
Manuscripts
Research Ethics Committees
Health Facilities
Ethics
Interviews
Health

Keywords

  • complexity science
  • hospital readmissions
  • sensemaking
  • transitions of care
  • veterans

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Protocol for a mixed methods study of hospital readmissions : Sensemaking in Veterans Health Administration healthcare system in the USA. / Penney, Lauren S.; Leykum, Luci K; Noel, Polly H; Finley Garcia, Erin; Lanham, Holly L; Pugh, Jacqueline A.

In: BMJ Open, Vol. 8, No. 4, e020169, 01.04.2018.

Research output: Contribution to journalArticle

Penney, Lauren S. ; Leykum, Luci K ; Noel, Polly H ; Finley Garcia, Erin ; Lanham, Holly L ; Pugh, Jacqueline A. / Protocol for a mixed methods study of hospital readmissions : Sensemaking in Veterans Health Administration healthcare system in the USA. In: BMJ Open. 2018 ; Vol. 8, No. 4.
@article{6b1065ebe35246beb6697e52ce256852,
title = "Protocol for a mixed methods study of hospital readmissions: Sensemaking in Veterans Health Administration healthcare system in the USA",
abstract = "Introduction Effective delivery of healthcare in complex systems requires managing interdependencies between professions and organisational units. Reducing 30-day hospital readmissions may be one of the most complex tasks that a healthcare system can undertake. We propose that these less than optimal outcomes are related to difficulties managing the complex interdependencies among organisational units and to a lack of effective sensemaking among individuals and organisational units regarding how best to coordinate patient needs. Methods and analysis This is a mixed method, multistepped study. We will conduct in-depth qualitative organisational case studies in 10 Veterans Health Administration facilities (6 with improving and 4 with worsening readmission rates), focusing on relationships, sensemaking and improvisation around care transition processes intended to reduce early readmissions. Data will be gathered through multiple methods (eg, chart reviews, surveys, interviews, observations) and analysed using analytic memos, qualitative coding and statistical analyses. We will construct an agent-based model based on those results to explore the influence of sensemaking and specific care transition processes on early readmissions. Ethics and dissemination Ethical approval has been obtained through the Institutional Review Board of the University of Texas Health Science Center at San Antonio (approval number: 14-258 hour). We will disseminate our findings in manuscripts in peer-reviewed journals, professional conferences and through short reports back to participating entities and stakeholders.",
keywords = "complexity science, hospital readmissions, sensemaking, transitions of care, veterans",
author = "Penney, {Lauren S.} and Leykum, {Luci K} and Noel, {Polly H} and {Finley Garcia}, Erin and Lanham, {Holly L} and Pugh, {Jacqueline A}",
year = "2018",
month = "4",
day = "1",
doi = "10.1136/bmjopen-2017-020169",
language = "English (US)",
volume = "8",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "4",

}

TY - JOUR

T1 - Protocol for a mixed methods study of hospital readmissions

T2 - Sensemaking in Veterans Health Administration healthcare system in the USA

AU - Penney, Lauren S.

AU - Leykum, Luci K

AU - Noel, Polly H

AU - Finley Garcia, Erin

AU - Lanham, Holly L

AU - Pugh, Jacqueline A

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Introduction Effective delivery of healthcare in complex systems requires managing interdependencies between professions and organisational units. Reducing 30-day hospital readmissions may be one of the most complex tasks that a healthcare system can undertake. We propose that these less than optimal outcomes are related to difficulties managing the complex interdependencies among organisational units and to a lack of effective sensemaking among individuals and organisational units regarding how best to coordinate patient needs. Methods and analysis This is a mixed method, multistepped study. We will conduct in-depth qualitative organisational case studies in 10 Veterans Health Administration facilities (6 with improving and 4 with worsening readmission rates), focusing on relationships, sensemaking and improvisation around care transition processes intended to reduce early readmissions. Data will be gathered through multiple methods (eg, chart reviews, surveys, interviews, observations) and analysed using analytic memos, qualitative coding and statistical analyses. We will construct an agent-based model based on those results to explore the influence of sensemaking and specific care transition processes on early readmissions. Ethics and dissemination Ethical approval has been obtained through the Institutional Review Board of the University of Texas Health Science Center at San Antonio (approval number: 14-258 hour). We will disseminate our findings in manuscripts in peer-reviewed journals, professional conferences and through short reports back to participating entities and stakeholders.

AB - Introduction Effective delivery of healthcare in complex systems requires managing interdependencies between professions and organisational units. Reducing 30-day hospital readmissions may be one of the most complex tasks that a healthcare system can undertake. We propose that these less than optimal outcomes are related to difficulties managing the complex interdependencies among organisational units and to a lack of effective sensemaking among individuals and organisational units regarding how best to coordinate patient needs. Methods and analysis This is a mixed method, multistepped study. We will conduct in-depth qualitative organisational case studies in 10 Veterans Health Administration facilities (6 with improving and 4 with worsening readmission rates), focusing on relationships, sensemaking and improvisation around care transition processes intended to reduce early readmissions. Data will be gathered through multiple methods (eg, chart reviews, surveys, interviews, observations) and analysed using analytic memos, qualitative coding and statistical analyses. We will construct an agent-based model based on those results to explore the influence of sensemaking and specific care transition processes on early readmissions. Ethics and dissemination Ethical approval has been obtained through the Institutional Review Board of the University of Texas Health Science Center at San Antonio (approval number: 14-258 hour). We will disseminate our findings in manuscripts in peer-reviewed journals, professional conferences and through short reports back to participating entities and stakeholders.

KW - complexity science

KW - hospital readmissions

KW - sensemaking

KW - transitions of care

KW - veterans

UR - http://www.scopus.com/inward/record.url?scp=85057259158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057259158&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2017-020169

DO - 10.1136/bmjopen-2017-020169

M3 - Article

C2 - 29627815

AN - SCOPUS:85057259158

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 4

M1 - e020169

ER -