title: Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in the Netherlands: a comparison between hospitals.
abstract: BACKGROUND
  It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components 'relational coordination' and 'situational awareness' of integrated care delivery and the role of team and organizational context in integrated care delivery; and (ii) compare situational awareness, relational coordination, and integrated care delivery of different hospitals in the Netherlands.
  
  
  METHODS
  This cross-sectional study took place in 2012 among professionals from three different hospitals involved in the delivery of care to older patients. A total of 215 professionals filled in the questionnaire (42% response rate).Descriptive statistics and paired-sample t-tests were used to investigate the level of situational awareness, relational coordination, and integrated care delivery in the three different hospitals. Correlation and multilevel analyses were used to investigate the relationship between background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery.
  
  
  RESULTS
  No differences in background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery were found among the three hospitals. Correlational analysis revealed that situational awareness (r = 0.30; p < 0.01), relational coordination (r = 0.17; p < 0.05), team climate (r = 0.29; p < 0.01), formal internal communication (r = 0.46; p < 0.01), and informal internal communication (r = 0.36; p < 0.01) were positively associated with integrated care delivery. Stepwise multilevel analyses showed that formal internal communication (p < 0.001) and situational awareness (p < 0.01) were associated with integrated care delivery. Team climate was not significantly associated with integrated care delivery when situational awareness and relational coordination were included in the equation. Thus situational awareness acted as mediator between team climate and integrated care delivery among professionals delivering care to older hospitalized patients.
  
  
  CONCLUSIONS
  The results of this study show the importance of formal internal communication and situational awareness for quality of care delivery to hospitalized older patients.
authors.affiliation: Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P,O, Box 1738, Rotterdam, DR 3000, The Netherlands. hartgerink@bmg.eur.nl.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Hartgerink
authors.forename: Jane M
authors.initials: JM
authors.lastname: Cramm
authors.forename: Annemarie J B M
authors.initials: AJ
authors.lastname: de Vos
authors.forename: Ton Jem
authors.initials: TJ
authors.lastname: Bakker
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.forename: Anna P
authors.initials: AP
authors.lastname: Nieboer
mesh_terms: D000368:Aged; D001364:Awareness; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000592:standards; D005260:Female; D006282:Health Personnel / Q000592:standards; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D009426:Netherlands; D010348:Patient Care Team / Q000592:standards; D011795:Surveys and Questionnaires / Q000592:standards