: Our main objective is to better understand how hospitalists interact with nurses, particularly as this interaction affects perceptions of teamwork and the frequency of medical errors. Hospitalists represent the most rapidly growing group of physicians in the U.S., and are poised to play a seminal role in creating systems to improve patient safety in the hospital. Focused on the care of hospitalized patients, hospitalists are changing care delivery in hospitals across the U.S. We believe a careful, theoretically based understanding of hospitalists' contribution to teamwork and patient safety is necessary in order to develop the most appropriate interventions to address weaknesses in teamwork within the hospital. In this study, we will use a theoretical framework from High Reliability Organization theory to explore the impact of hospitalists on the nurse-physician relationship in two hospitals in Atlanta: Emory University Hospital, a large academic medical center, and Emory Eastside Medical Center, a small community hospital. Using qualitative methods (in-depth interviews with 20-25 nurses from each hospital, and with 12 hospitalists and 12 internists or specialists who are not hospitalists at these two hospitals), we will assess perceptions of relationships between nurses, hospitalists and other physicians, and how these relationships affect safety in the hospitals.
Our specific aims are to: 1) Use qualitative techniques to determine the degree of """"""""heedful interrelating"""""""" between physicians and nurses at two different hospitals: community and academic. 2) Determine how hospitalists, compared to other physicians, interact with nurses. 3) Determine potential effects of the degree of heedful interrelating between nurses and physicians on patient safety. 4) Based on the data from the interviews, identify areas most immediately in need of improvement in the hospitalist-nurse relationship and develop an intervention to address these areas. We envision this exploratory analysis as the first phase in a larger research agenda, which will focus on improving nurse-physician interactions and their effect on patient safety. Our broad, long-term objective is to understand how hospitalists impact the dynamics of medical systems (i.e., interrelations and teamwork among staff), particularly as these systems contribute to medical errors.
