Highlights
- •Pediatric clinicians' experiences with primary care redesign implementation have not been well described.
- •In this pilot, teamwork improvements helped mitigate unpredictability in newborn needs and arrival times.
- •RNs and physicians valued teamwork but were concered that sharing visit taks could compromise patient relationships.
- •Resolving ambivalence about task sharing between RNs and physicians may support dissemination of redesign efforts.
Abstract
Purpose
Pediatric primary care redesign includes changes to clinical teams and clinical workflows.
This study described the perspectives of pediatric clinicians on their experience
with redesign.
Design and methods
This qualitative study explored clinician perspectives on a newborn care redesign
pilot at a pediatric primary care site. Newborn Hallway (NBH), implemented in 2019,
clustered morning newborn visits with a single physician, increased RN staffing, and
provided newborn-specific training for RNs. NBH also revised visit documentation templates
to promote communication between RNs and physicians and shared completion of history
taking and education. We conducted semi-structured qualitative interviews with clinicians.
The interview guide was developed using the Consolidated Framework for Implementation
Research. Interviews were recorded and transcribed, and coded using an integrated
approach.
Results
We interviewed 17 staff (8 physicians, 8 RNs, 1 nurse practitioner) from 3/2020 to
1/2021. Clinicians reported that NBH implementation was facilitated by widespread
agreement on baseline challenges to newborn care, and interest in optimizing roles
for RNs. Clinicians believed NBH facilitated teamwork, which mitigated unpredictability
in newborn needs and arrival times, and improved staff satisfaction. Perceived barriers
to NBH included staffing constraints and ambivalence about whether sharing tasks with
RNs would negatively influence patient relationships and continuity.
Conclusions
Pediatric primary care redesign focused on sharing tasks between RNs and physicians
can promote teamwork and address unpredictability in clinical settings.
Practice implications
Resolving questions about how redesign influences patient continuity and trust, and
clarifying optimal staffing may help facilitate adoption of clinical team and workflow
innovations.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric Nursing: Nursing Care of Children and FamiliesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Periodic Survey #56.
- Checklists for improving rigour in qualitative research: A case of the tail wagging the dog?.BMJ [British Medical Journal]. 2001; 322: 1115
- Qualitative data analysis for health services research: Developing taxonomy, themes, and theory.Health Services Research. 2007; 42: 1758-1772
- Top-of-license nursing practice: Describing common nursing activities and nurses’ experiences that hinder top-of-license practice, part 1.Journal of Nursing Administration. 2018; 48: 266-271
- TeamSTEPPS: Assuring optimal teamwork in clinical settings.American Journal of Medical Quality. 2007; 22: 214-217
- A TeamSTEPPS® implementation plan for recently assigned interns and nurses.Journal of Interprofessional Care. 2019; 33: 823-827
- A parent coach model for well-child care among low-income children: A randomized controlled trial.Pediatrics. 2016; 137e20153013
- Does well-child care have a future in pediatrics?.Pediatrics. 2013; 131
- Feasibility of implementing group well baby/well woman dyad care at federally qualified health centers.Academic Pediatrics. 2018; 18: 510-515
- Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science.Implementation Science. 2009; 4: 50
- A texting intervention in Latino families to reduce ED use: A randomized trial.Pediatrics. 2020; 145
- Registered nurses in primary care: Emerging new roles and contributions to team-based care in high-performing practices.The Journal of Ambulatory Care Management. 2017; 40: 287-296
- A systematic review of the use of the consolidated framework for implementation research.Implementation Science. 2015; 11: 72
- The association between organizational cultural competence and teamwork climate in a network of primary care practices.Health Care Management Review. 2020; 45: 106-116
- Do nurses play a role in perpetuating racial/ethnic disparities in outcomes in maternal/child health? MCN.The American Journal of Maternal Child Nursing. 2009; 34: 78-79
- The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes.Pediatric Research. 2016; 79: 141-147
- The impact of health equity coaching on patient’s perceptions of cultural competency and communication in a pediatric emergency department: An intervention design.Journal of Patient Experience. 2019; 6: 257-264
- Well-child care clinical practice redesign at a community health center: Provider and staff perspectives.Journal of Primary Care and Community Health. 2014; 5: 19-23
- Challenges to implementation of developmental screening in urban primary care: A mixed methods study.BMC Pediatrics. 2014; 14
- Utilization of registered nurses in primary care teams: A systematic review.International Journal of Nursing Studies. 2017; 74: 15-23
- Intercoder reliability in qualitative research: Debates and practical guidelines.International Journal of Qualitative Methods. 2020; 19
- Estimating the staffing infrastructure for a patient-centered medical home.The American Journal of Managed Care. 2013; 19: 509-516
- Healthy steps: A systematic review of a preventive practice-based model of pediatric care.Journal of Developmental and Behavioral Pediatrics. 2009; 30: 91-103
- NVivo (12 Plus).
- Parental perceptions of culturally sensitive care and well-child visit quality.Academic Pediatrics. 2020; 20: 234-240
- Roles of registered nurses in pediatric preventive care delivery: A pilot study on between-office variation and within-office role overlap.Journal of Pediatric Nursing. 2020; 52: 5-9
- Saturation in qualitative research: Exploring its conceptualization and operationalization.Quality and Quantity. 2018; 52: 1893-1907
- Implementing a patient centered medical home in the veterans health administration: Perspectives of primary care providers.Healthcare. 2014; 2: 245-250
- Non-value-added time: The million dollar nursing opportunity.The Journal of Nursing Administration. 2009; 39: 38-45
- Nursing role in well-child care: Systematic review of the literature - PubMed.Canadian Family Physician. 2018; 64: e169-e180
- Organizing care for patients with chronic illness revisited.Milbank Quarterly. 2019; 97: 659-664
- Interprofessional team member communication patterns, teamwork, and collaboration in pre–family meeting huddles in a pediatric cardiac intensive care unit.Journal of Pain and Symptom Management. 2019; 58: 11-18
- Improving team-based care for children: Shared well child care involving family practice nurses.Primary Health Care Research & Development. 2017; 18: 507-514
- Walk-in model for ill care in an urban academic pediatric clinic.Academic Pediatrics. 2018; 18: 281-288
Article info
Publication history
Published online: April 07, 2022
Accepted:
March 26,
2022
Received in revised form:
March 23,
2022
Received:
October 15,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
