Introduction

Hospital leaders should be aware that implementing successful and sustainable Interdisciplinary Rounds (IDRs) of any type, including Structured Interdisciplinary Bedside Rounds (SIBR), requires careful planning, dedicated resources, and ongoing support. Simply trying to spread existing practices to other units without providing the necessary expertise and resources may not yield the desired outcomes and may even lead to the dilution of the initial program's effectiveness.

Spreading IDR success without key resources and expertise: The dilution effect

The authors of a study on the impact of an Accountable Care Unit (ACU) model with SIBR on inpatient mortality noted that, despite enthusiasm for the model, coordinated models like it require effort, and without this effort there can be uncertain return on investment. The authors specifically cited the challenges they encountered when asked to expand their model:

"In fact, early success on the [Accountable Care Unit with SIBR Rounds] ACU led hospital executives to request our help in spreading the model, diluting our focus on the original unit and making study challenging by modifying workflows on what would have been a natural comparator unit".

The study authors, serving as unit medical co-directors, hypothesized that "gains achieved through a strong culture of collaboration and innovation are highly sensitive to local leadership and maintained enthusiasm". This suggests that successfully implementing an IDR program, like SIBR, in one unit may not easily translate to success in other units, especially if you are relying on leadership from within that already has a focus and limited availability. The specific contextual factors, leadership engagement, and team dynamics within each unit are crucial for its success.

Key Takeaways for Hospital Leaders

1. Dedicated Expertise: Ensure dedicated resources and expertise are available to support the implementation and ongoing refinement of IDR practices in new units - leverage outside expertise and technology supports where possible to lighten the internal load. Implementing IDRs, like SIBR rounds, requires "preparatory work, continued surveillance, and participant orientation" from a variety of hospital staff, including administrators, nurses, hospitalists, pharmacists and care managers.

2. Maintain Focus: Avoid diluting the focus and resources of successful programs by attempting to spread them too quickly or without proper support. The researchers themselves pointed out that "hospital-wide efforts... inevitably compete for the limited resource of innovation energy among both leaders and caregivers".

3. Sustainable Improvement: Recognize that achieving and sustaining improvements from IDRs requires continuous effort, leadership engagement, and a commitment to adapting the model based on ongoing evaluation and feedback, and as staff churn impacts consistency. For example, the unit described in the study made a variety of changes to its workflows throughout the study period that competed for energy and elevated the quantum of change on the unit, such as shifting from weekly leadership rounding to monthly leadership rounding, introducing a "Team to Bedside" protocol, and participating in hospital-wide initiatives like High Reliability Organization training.