A human factors systems approach to understanding team-based primary care: a qualitative analysis

Abstract

Our qualitative data support the SEIPS model as a promising conceptual framework for creating and evaluating primary care teams. Future studies of team-based care may benefit from using the SEIPS model to shift clinical practice to high functioning team-based primary care.

A Systems Framework for Understanding the Environment’s Relation to Clinical Teamwork: A Systematic Literature Review of Empirical Studies

“…This systems-based review makes advances over earlier work by (a) increasing the number of empirical articles on teamwork and the built environment by nearly threefold ( n = 12 vs. n = 34; Gharaveis et al, 2017); (b) using a systems model (Carayon et al, 2006) to understand the underlying structure that impacts teamwork processes and health care outcomes; (c) using a validated teamwork framework (i.e., “Big Five”) linked to systems components (Mundt & Swedlund, 2016; Salas et al, 2005); (d) following widely accepted PRISMA quality guidelines in documenting search strategy, including exclusively empirical studies, using two independent reviewers to assess quality (Moher et al, 2009); (e) using of a validated mixed-methods study quality assessment (i.e., MMAT) as part of screening and assessment; (f) discussing theory, methods, and analysis of past studies in the light of currently available tools.…”

“…Leadership support, in the form of extra flexibility and encouragement to collaborate across professions, allowed staff to more effectively advance patient care (Price et al, 2009). Mundt and Swedlund (2016) found that having an organizational climate that welcomed feedback and conversation about changing protocols was important in giving the staff the feeling that they are “part of a team” (p. 724). Organizational support, physician buy-in, staff participation in process changes and a common philosophy toward teamwork were found to be critical to fostering teamwork, especially in interprofessional teams (Al Sayah et al, 2014; Brown et al, 2015; Mundt & Swedlund, 2016; Price et al, 2009).…”

“…Mundt and Swedlund (2016) found that having an organizational climate that welcomed feedback and conversation about changing protocols was important in giving the staff the feeling that they are “part of a team” (p. 724). Organizational support, physician buy-in, staff participation in process changes and a common philosophy toward teamwork were found to be critical to fostering teamwork, especially in interprofessional teams (Al Sayah et al, 2014; Brown et al, 2015; Mundt & Swedlund, 2016; Price et al, 2009). Organizational cultures that supported the one profession’s dominance over other others (e.g., medical dominance over nursing professionals) showed hampered interprofessional teamwork (Dean, Gill, & Barbour, 2016; Lewin & Reeves, 2011; Liu, Manias, & Gerdtz, 2012, 2014).…”

“…More than two thirds of included studies ( n = 27) reported the importance of face-to-face interaction over other forms of communication. Informal communication was an important part of building trust, respect and social capital within teams to create communities of practice (Al Sayah et al, 2014; Mundt & Swedlund, 2016; Real et al, 2016), and was linked to nurse reports of being able to find or offer assistance from peers (e.g., back-up behavior; Hua, Becker, Wurmser, Bliss-Holtz, & Hedges, 2012). Furthermore, social communications were reported as an important factor in relieving staff stress and building team comradery (e.g., team orientation; Rajkomar & Blandford, 2012).…”

“…These theories recognize an interdependent network of factors that interact to influence system outcomes such as care quality, patient safety, or effective teamwork. The SEIPS model was adopted as the foundation for this systems-based review because it is widely cited in the health care improvement and safety literature and has been validated as an effective conceptual framework for evaluating clinical care teams to support processes of clinical teamwork and quality care outcomes (Carayon et al, 2006; Mundt & Swedlund, 2016). This model posits five interdependent factors—physical environment, organization (e.g., culture), tasks (e.g., processes, activities), person (e.g., staff), and technology and tools—that, when working in synergy, can foster high-performing clinical teams; but, when in conflict or when synergy is missing, can create low-performing team environments.…”