Creating Space for Care: Enhancing Patient-Centered Performance Outcomes Through Organizational Change
Dinh, Julie Vy
Doctor of Philosophy
Hospitals present serious challenges to the development of patient-provider relationships, particularly in the pediatric intensive care unit (PICU), where stakes, stress, and entropy are high. However, episodic change, particularly at the environmental and structural levels, can create space for more positive interpersonal dynamics. This series of studies triangulates mixed-methods data, collected in the field, to identify how one such intervention influenced patient-centered performance (PCP) outcomes, including patient trust and satisfaction. Overall, this research seeks to answer the question: how do the supportive design and departmentalization of hospital units impact PCP outcomes? Accordingly, this dissertation draws upon organizational change, supportive design, and classical organization theories, centering them around an intervention. A PICU (a) developed a new, larger, and improved physical space and (b) implemented departmentalization, geographically grouping patients and provider teams by subspecialty disease groups. Study 1 uses qualitative data to describe the psychologically supportive design aspects of the intervention. Study 2 quantitatively examines how this design-based intervention ultimately enhanced PCP outcomes, including patient trust and satisfaction. Study 3 uses numeric indices derived from archival data to investigate the effects of departmentalization on health care team volume and outcomes. This research also involves the validation of a parent satisfaction scale and the development of a novel, quantitative, group-level volume index. Theoretical contributions and practical implications are discussed.
health care; interventions; patient satisfaction; patient trust; psychological safety