Unpacking the Dynamics of Cross-Unit Coordination: A Multi-Level Quasi-Experimental Investigation of Patient Handoffs

Coordination is a temporally unfolding process of work integration enacted by individuals in context. Despite a well-established literature on coordination there has been very limited consideration of the individuals enacting the process. To address this critical void, I draw from both micro- and macro-organizational literatures to advance and test a contextualized meso-theory concerning how coordination occurs across entities and how to improve it. Notably, I examine contextual features of both the setting and the situation. The setting of cross-unit coordination during a sequentially interdependent task (i.e., patient handoffs) creates knowledge and motivational asymmetries between units, which places a premium on certain individual and situational features. Specifically, I consider the influence of: 1) ability (i.e., job competence) and non-ability (i.e., personality, efficacy) individual characteristics; 2) alignment between individuals (i.e., goal congruence); and 3) situational context (i.e., workload pressure, situational strength), on the coordination process. In turn, I explore the impact of the coordination process on proximal (e.g., handoff quality) and distal outcomes (e.g., patient outcomes). In addition, I reify the coordination construct in the study context and advance a methodology to index it as a multi-dimensional and temporally unfolding process. Finally, I use a multi-source, multi-level, interrupted time series design in which situational strength is manipulated via a work process intervention. Observational data were collected on 382 patients (146 pre-intervention, 236 post-intervention) and from the 27 individuals engaged in patient handoffs from the operating room to the post-anesthesia care unit, at a large community hospital in the southwest United States. Select comparative data were collected on all 2,357 individuals transferred between those two units during the 16 week study period. Although many of the hypothesized results were not supported, there were important differences between the effects of the individuals in the sender and receiver roles. Notably, those effects varied across the pre-intervention and post-intervention periods as the situational strength intervention successfully reduced the variance attributable to individuals in both roles. Furthermore, as anticipated, the intervention strongly positively influenced coordination, which in turn enhanced proximal outcomes and distal patient outcomes. Implications for both the advancement and application of coordination theory are discussed