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A mixed methods study examining teamwork shared mental models of interprofessional teams during hospital discharge
  1. Kirstin Manges1,2,
  2. Patricia S Groves3,
  3. Amany Farag3,
  4. Ryan Peterson4,
  5. Joanna Harton5,
  6. S Ryan Greysen2
  1. 1National Clinician Scholar, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  3. 3College of Nursing, University of Iowa, Iowa City, Iowa, USA
  4. 4Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
  5. 5Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Kirstin Manges, National Clinician Scholar, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; kirstin.manges{at}


Background Little is known about how team processes impact providers’ abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams’ organised understanding of individual member’s roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients.

Methods This mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams’ teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs.

Results The sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation.

Conclusions Examining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.

  • teamwork
  • transitions in care
  • organizational theory
  • decision making
  • teams

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  • Contributors Study concept and design (KM, PSG, AF, RP), data collection (KM), analysis and interpretation of data (KM, PSG, AF, RP, JH, SRG) and preparation and critical revision of the manuscript (KM, PSG, AF, RP, JH, SRG).

  • Funding KM is supported by the National Institute of Health Agency for Healthcare Research and Quality under award number T32HS026116-02.

  • Disclaimer The manuscript reflects the views of the authors, and not necessarily that of affiliated academic institutions or BMJ Quality and Safety.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The local institutional review board approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.