{"id":{"repo_id":"sask","oai_identifier":"oai:harvest.usask.ca:10388/18272"},"canonical_url":"https://search.dev.ndltd.org/etd/sask/oai:harvest.usask.ca:10388/18272","repository":{"repo_id":"sask","name":"University of Saskatchewan","base_url":"https://harvest.usask.ca/server/oai/request"},"display":{"title":"The Patient's Care Experiences in a Team-Based Clinical Microsystem Model of Care: Accountable Care Unit","abstract":"Hospitals are reorganizing inpatient care into interprofessional clinical microsystems such as the Accountable Care Unit. However, findings on healthcare outcomes are mixed, and studies that explain how patients experience care within this team-based care model remain limited. This dissertation responds by synthesizing evidence on a team-based clinical microsystem model similar to the Accountable Care Unit’s components as a clinical microsystem, developing a constructivist grounded theory of how patients experience care within this interprofessional collaborative care setting, and translating those findings into policy recommendations aligned with the Quintuple Aim to make meaningful engagement a designed feature of similar models. Guided by Charmaz’s constructivist methodology, the grounded theory study used purposive and theoretical sampling in three established Accountable Care Units within a mid-sized Canadian hospital. Data were generated from 24 interviews with 14 discharged adult patients, and the data were analyzed using constant comparative analysis. The substantive theory of Patients Navigating Engagement explains how patients experience and navigate their care in these interprofessional collaborative care settings. Patients Navigating Engagement emerged as a core social process, a dynamic movement between lower and higher engagement, shaped by interprofessional interactions across five subprocesses. These subprocesses include communication and information sharing, quality of care and relational interactions, emotional and psychological support, autonomy and empowerment, and education and discharge planning, which are influenced by interprofessional, systemic, and environmental contexts. Strengthening team-based care models is critical through high-fidelity structured rounds, active invitation and response to patient questions, consistently updated bedside whiteboards, empathic microbehaviors, proactive check-ins, support for autonomy and shared decision making, promotion of equity through proactive communication, reliable privacy and call bell response, and protection of clinician wellbeing through clear roles and appropriate staffing. Policy recommendations were generated using the Quintuple Aim framework and provide actionable steps for health systems to potentially improve patient experience, enhance population health, reduce costs, advance health equity, and boost clinician well-being, so that consistent and meaningful engagement is reliably embedded in team-based care models.","abstract_html":"Hospitals are reorganizing inpatient care into interprofessional clinical microsystems such as the Accountable Care Unit. However, findings on healthcare outcomes are mixed, and studies that explain how patients experience care within this team-based care model remain limited. This dissertation responds by synthesizing evidence on a team-based clinical microsystem model similar to the Accountable Care Unit’s components as a clinical microsystem, developing a constructivist grounded theory of how patients experience care within this interprofessional collaborative care setting, and translating those findings into policy recommendations aligned with the Quintuple Aim to make meaningful engagement a designed feature of similar models. Guided by Charmaz’s constructivist methodology, the grounded theory study used purposive and theoretical sampling in three established Accountable Care Units within a mid-sized Canadian hospital. Data were generated from 24 interviews with 14 discharged adult patients, and the data were analyzed using constant comparative analysis. The substantive theory of Patients Navigating Engagement explains how patients experience and navigate their care in these interprofessional collaborative care settings. Patients Navigating Engagement emerged as a core social process, a dynamic movement between lower and higher engagement, shaped by interprofessional interactions across five subprocesses. These subprocesses include communication and information sharing, quality of care and relational interactions, emotional and psychological support, autonomy and empowerment, and education and discharge planning, which are influenced by interprofessional, systemic, and environmental contexts. Strengthening team-based care models is critical through high-fidelity structured rounds, active invitation and response to patient questions, consistently updated bedside whiteboards, empathic microbehaviors, proactive check-ins, support for autonomy and shared decision making, promotion of equity through proactive communication, reliable privacy and call bell response, and protection of clinician wellbeing through clear roles and appropriate staffing. Policy recommendations were generated using the Quintuple Aim framework and provide actionable steps for health systems to potentially improve patient experience, enhance population health, reduce costs, advance health equity, and boost clinician well-being, so that consistent and meaningful engagement is reliably embedded in team-based care models.","abstract_has_math":false,"creators":["Urcia, Ivan Aldrich Pastrana"],"institution":"University of Saskatchewan","degree_name":"Doctor of Philosophy (Ph.D.)","degree_level":"Doctoral","degree_discipline":"Nursing","degree_department":null,"school":null,"contributors":[],"advisors":["Penz, Kelly"],"committee_chairs":[],"committee_members":["Martin, Wanda","Groot, Gary","Vandenberg, Helen","Benzies, Karen"],"year":2026,"date_issued":"2026-04-23","date_published":"2026-04-23","updated_at":"2026-07-24T04:27:18Z","subjects":["Accountable Care Unit","Clinical Microsystem Model","Constructivist Grounded Theory","Geographic Cohorting","Interprofessional Collaborative Care","Interprofessional Collaborative Practice","Patient Engagement","Patient Experience","Patient Navigating Engagement","Physician-Nurse Co-Leadership","Quintuple Aim","Structured Interdisciplinary Bedside Rounds","Team-Based Care","Unit-Level Performance Reporting"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/10388/18272","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Penz, Kelly"]},{"key":"dc:contributor.committeemember","label":"Committee Member","values":["Martin, Wanda","Groot, Gary","Vandenberg, Helen","Benzies, Karen"]},{"key":"dc:creator","label":"Author","values":["Urcia, Ivan Aldrich Pastrana"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2026-04-23T17:04:51Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2026-04-23T17:04:51Z"]},{"key":"dc:date.issued","label":"Date","values":["2026-04-23"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Nursing"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Doctoral"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Philosophy (Ph.D.)"]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["University of Saskatchewan"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Accountable Care Unit","Clinical Microsystem Model","Constructivist Grounded Theory","Geographic Cohorting","Interprofessional Collaborative Care","Interprofessional Collaborative Practice","Patient Engagement","Patient Experience","Patient Navigating Engagement","Physician-Nurse Co-Leadership","Quintuple Aim","Structured Interdisciplinary Bedside Rounds","Team-Based Care","Unit-Level Performance Reporting"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/10388/18272"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Hospitals are reorganizing inpatient care into interprofessional clinical microsystems such as the Accountable Care Unit. However, findings on healthcare outcomes are mixed, and studies that explain how patients experience care within this team-based care model remain limited. This dissertation responds by synthesizing evidence on a team-based clinical microsystem model similar to the Accountable Care Unit’s components as a clinical microsystem, developing a constructivist grounded theory of how patients experience care within this interprofessional collaborative care setting, and translating those findings into policy recommendations aligned with the Quintuple Aim to make meaningful engagement a designed feature of similar models. Guided by Charmaz’s constructivist methodology, the grounded theory study used purposive and theoretical sampling in three established Accountable Care Units within a mid-sized Canadian hospital. Data were generated from 24 interviews with 14 discharged adult patients, and the data were analyzed using constant comparative analysis. The substantive theory of Patients Navigating Engagement explains how patients experience and navigate their care in these interprofessional collaborative care settings. Patients Navigating Engagement emerged as a core social process, a dynamic movement between lower and higher engagement, shaped by interprofessional interactions across five subprocesses. These subprocesses include communication and information sharing, quality of care and relational interactions, emotional and psychological support, autonomy and empowerment, and education and discharge planning, which are influenced by interprofessional, systemic, and environmental contexts. Strengthening team-based care models is critical through high-fidelity structured rounds, active invitation and response to patient questions, consistently updated bedside whiteboards, empathic microbehaviors, proactive check-ins, support for autonomy and shared decision making, promotion of equity through proactive communication, reliable privacy and call bell response, and protection of clinician wellbeing through clear roles and appropriate staffing. Policy recommendations were generated using the Quintuple Aim framework and provide actionable steps for health systems to potentially improve patient experience, enhance population health, reduce costs, advance health equity, and boost clinician well-being, so that consistent and meaningful engagement is reliably embedded in team-based care models."]},{"key":"dc:format.mimetype","label":"Dc Format Mimetype","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["The Patient's Care Experiences in a Team-Based Clinical Microsystem Model of Care: Accountable Care Unit"]}]}],"canonical_facts":{"dc:contributor.advisor":["Penz, Kelly"],"dc:contributor.committeemember":["Martin, Wanda","Groot, Gary","Vandenberg, Helen","Benzies, Karen"],"dc:creator":["Urcia, Ivan Aldrich Pastrana"],"dc:date.accessioned":["2026-04-23T17:04:51Z"],"dc:date.available":["2026-04-23T17:04:51Z"],"dc:date.issued":["2026-04-23"],"dc:description.abstract":["Hospitals are reorganizing inpatient care into interprofessional clinical microsystems such as the Accountable Care Unit. However, findings on healthcare outcomes are mixed, and studies that explain how patients experience care within this team-based care model remain limited. This dissertation responds by synthesizing evidence on a team-based clinical microsystem model similar to the Accountable Care Unit’s components as a clinical microsystem, developing a constructivist grounded theory of how patients experience care within this interprofessional collaborative care setting, and translating those findings into policy recommendations aligned with the Quintuple Aim to make meaningful engagement a designed feature of similar models. Guided by Charmaz’s constructivist methodology, the grounded theory study used purposive and theoretical sampling in three established Accountable Care Units within a mid-sized Canadian hospital. Data were generated from 24 interviews with 14 discharged adult patients, and the data were analyzed using constant comparative analysis. The substantive theory of Patients Navigating Engagement explains how patients experience and navigate their care in these interprofessional collaborative care settings. Patients Navigating Engagement emerged as a core social process, a dynamic movement between lower and higher engagement, shaped by interprofessional interactions across five subprocesses. These subprocesses include communication and information sharing, quality of care and relational interactions, emotional and psychological support, autonomy and empowerment, and education and discharge planning, which are influenced by interprofessional, systemic, and environmental contexts. Strengthening team-based care models is critical through high-fidelity structured rounds, active invitation and response to patient questions, consistently updated bedside whiteboards, empathic microbehaviors, proactive check-ins, support for autonomy and shared decision making, promotion of equity through proactive communication, reliable privacy and call bell response, and protection of clinician wellbeing through clear roles and appropriate staffing. Policy recommendations were generated using the Quintuple Aim framework and provide actionable steps for health systems to potentially improve patient experience, enhance population health, reduce costs, advance health equity, and boost clinician well-being, so that consistent and meaningful engagement is reliably embedded in team-based care models."],"dc:format.mimetype":["application/pdf"],"dc:identifier.uri":["https://hdl.handle.net/10388/18272"],"dc:language.iso":["en"],"dc:subject":["Accountable Care Unit","Clinical Microsystem Model","Constructivist Grounded Theory","Geographic Cohorting","Interprofessional Collaborative Care","Interprofessional Collaborative Practice","Patient Engagement","Patient Experience","Patient Navigating Engagement","Physician-Nurse Co-Leadership","Quintuple Aim","Structured Interdisciplinary Bedside Rounds","Team-Based Care","Unit-Level Performance Reporting"],"dc:title":["The Patient's Care Experiences in a Team-Based Clinical Microsystem Model of Care: Accountable Care Unit"],"dc:type":["Thesis"],"thesis:degree_discipline":["Nursing"],"thesis:degree_level":["Doctoral"],"thesis:degree_name":["Doctor of Philosophy (Ph.D.)"],"thesis:institution_name":["University of Saskatchewan"]},"updated_at":"2026-07-24T04:27:18Z"}