Interpersonal And Organizational Dynamics Are Key Drivers Of Failure To Rescue

Health Aff (Millwood). 2018 Nov;37(11):1870-1876. doi: 10.1377/hlthaff.2018.0704.

Abstract

Failure to rescue-mortality following a major surgical complication-is a key driver of variation in postoperative mortality. However, little is known about the impact of interpersonal and organizational dynamics, or microsystem factors, on failure to rescue. In a qualitative study of providers from hospitals with high and low rescue rates, we identified five key factors that providers believe influence the successful rescue of surgical patients: teamwork, action taking, psychological safety, recognition of complications, and communication. Near-uniform agreement existed on two targets for improvement: delayed recognition of developing complications and poor interprofessional communication and inability to express clinical concerns. To improve perioperative outcomes, hospitals and payers should shift their attention to improving early detection and effective communication of major complications.

Keywords: Failure to Rescue; Interpersonal and Organizational Factors; Mortality; Patient Safety; Surgery.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Failure to Rescue, Health Care*
  • Hospital Mortality*
  • Humans
  • Interdisciplinary Communication*
  • Interviews as Topic
  • Patient Care Team / organization & administration*
  • Postoperative Complications / mortality*
  • Qualitative Research