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Geographic Wards

In January 2019 we re-designed our ward structures at University Hospital around a geographic ward model that co-locates providers on a single unit to achieve the following goals:

Instead of… …Imagine if

Little or no connection between team members

Personal connections between team members

Lack of interprofessional teamwork

Daily interprofessional team huddles/meetings

Waste in travel time between units

Economy of movement on one unit

Constant multitasking


Lack of defined leadership presence

Effective and well-known unit-based leadership

Lack of improvement infrastructure

Improvement work included in daily flow

Lack of team specific data

Unit-based data to drive team performance

Idiosyncratic rounding strategies

Structured interdisciplinary bedside rounding

Uncoordinated scheduling

Coordinating scheduling

Emphasis on process

Emphasis on outcomes

We saw early successes with geographic wards.  Teams had new opportunities to get to know nurses better and have in person discussions with consultants on rounds.  We developed standardized interdisciplinary communication and workflow including daily interprofessional team huddles.

And as expected, we also experienced significant challenges in work, including an increased amount of patient handoffs.

However, we are not afraid to tackle difficult problems.  Changes like this are considered complex service interventions requiring continuous improvement science to get it right.

If you are interested in more detail in how we improve, watch the videos below, parts of a grand rounds given by our Geographic Wards leader and associate program director Danielle Weber:

You will be encouraged to join our improvement groups to learn and contribute teams and system science. 

The opportunities are endless but here are some goals for the future:

  • Improve interdisciplinary communication related to patients not on our geographic wards (“rover patients”)
  • Develop a system for residents to receive data related to ongoing quality improvement projects
  • Participate in the Acute Care Pathway for residents that includes education related to specific inpatient systems-based care topics
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University of Cincinnati
Department of Internal Medicine

231 Albert Sabin Way
Medical Sciences Building Room 6058
PO Box 670557
Cincinnati, OH 45267-0557

Fax: 513-558-3878