Kelly Thomson

Resident Experiences With Implementation of the I-PASS Handoff Bundle

BACKGROUND The I-PASS Handoff Study found that introduction of a handoff bundle (handoff and teamwork training for residents, a mnemonic, a handoff tool, a faculty development program, and a sustainability campaign) at 9 pediatrics residency programs was associated with improved communication and patient safety. OBJECTIVE This parallel qualitative study aimed to understand resident experiences with I-PASS and to inform future implementation and sustainability strategies. METHODS Resident experiences with I-PASS were explored in focus groups (N = 50 residents) at 8 hospitals throughout 2012-2013. A content analysis of transcripts was conducted following the principles of grounded theory. RESULTS Residents generally accepted I-PASS as an ideal format for handoffs, and valued learning a structured approach. Across all sites, residents reported full adherence to I-PASS when observed, but selective adherence in usual practice. Residents adhered more closely when patients were complex, teams were unfamiliar, and during evening handoff. Residents reported using elements of the I-PASS mnemonic variably, with Illness Severity and Action Items most consistently used, but Synthesis by Receiver least used, except when observed. Most residents were receptive to the electronic handoff tool, but perceptions about usability varied across sites. Experiences with observation and feedback were mixed. Concern about efficiency commonly influenced attitudes about I-PASS. CONCLUSIONS Residents generally supported I-PASS implementation, but adherence was influenced by patient type, context, and individual and team factors. Our findings could inform future implementation, particularly around the areas of resident engagement in change, sensitivity to resident level, perceived efficiency, and faculty observation.

Multimarket Contact, Strategic Alliances, and Firm Performance

Research on multimarket contact and firm performance has produced mixed results. To reconcile this discrepancy, we theorize how varying levels of multimarket contact may generate mutual forbearance that influences firm performance. We also examine how strategic alliances moderate the relationship between levels of multimarket contact and firm performance. Our analysis of 233 semiconductor firms across 52 markets reveals that multimarket contact has an inverted U-shaped relationship with a multimarket firm’s market share. The number of strategic alliances that a firm has helps to further extend the positive effect of multimarket contact and mitigate its negative effect on the firm’s market share. Accordingly, our study contributes to the literature on multimarket competition by shedding light on the conditions under which multimarket contact may increase/decrease firm performance.

Maneuvering multimarket competition: The effects of multimarket contact and strategic alliances on performance of single-market firms

Research on multimarket competition has focused on how multimarket contact shapes competitive behavior of firms that face each other in multiple markets. To date, there has been little attention to how multimarket contact affects single-market firms nor how single-market firms cope with multimarket competition. In this study, we examine the effects of multimarket competition and strategic alliances on single-market firms’ market share. Our analysis shows that the degree of multimarket contact firms had outside of a single-market firm’s market negatively affected the single-market firm’s market share. Yet, the number of strategic alliances a single-market firm had and having alliances with multimarket firms helped the single-market firm to cope with competitive pressure derived from multimarket contact and enhance its market share.