A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-Based Care

Abstract

Team-based care is considered central to achieving value in primary care, yet results of large-scale primary care transformation initiatives have been mixed. We explore how underlying change processes influence the effectiveness of transition to teambased care. We studied 12 academically affiliated primary care practices participating in a learning collaborative, using longitudinal staff survey data to measure progress toward team-based care and qualitative interviews with practice staff to understand practice transformation. Transformation efforts focused on team formation and capacity building for quality improvement. Using thematic analysis, we explored types of change processes undertaken and the relationship between change processes and effective team-based care. We identified three prototypical approaches to change: pursuing functional and cultural change processes, functional only, and cultural only. Practice sites prioritizing both change processes formed the most effective teams: simultaneous functional and cultural change spurred a mutually reinforcing virtuous cycle. We describe implications for research, practice, and policy.

Optimizing patient partnership in primary care improvement: A qualitative study

“…Patients in stronger partnerships were sufficiently confident in an unfamiliar clinical setting to speak up. Among AIC practices, the preexisting quality of “teamness” varied (as described in Kyle, Aveling, & Singer, 2018 ). However, our data suggest these were not immutable properties that teams and individuals either possessed or lacked: Both provider buy-in and patients’ confidence in their team role evolved over time, and greater initial skepticism did not always lead to weaker partnerships.…”

“…Thus, behaviors and strategies that enhanced team functioning generally also enhanced patient participation. The experiences of these sites suggest there may be mutually reinforcing benefits of team-based care and patient engagement, because both entail disruption to established norms and engage participants in cultural change processes oriented to redistributing authority and flattening hierarchies ( Kyle et al, 2018 ; Sheridan et al, 2018 ).…”

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

“…23 , 44 The effectiveness of the care teams, and the quality of care delivered, is impacted by environmental and contextual factors related to implementation, culture of the primary care teams, and perceived team dynamics. 10 , 54 - 56 As we are unable to control for these factors, there may be residual confounding. Lastly, our sample includes academically affiliated primary care practices in the Boston area, which, although a diverse group including hospital-based, community-based and federally qualified health centers, may not be generalizable to other practices.…”

Puerto Rican healthcare workers' perspectives on the impact of COVID‐19 pandemic on their role, patient care, and mental health

“…Demonstrating empathy, appreciation, providing mental health resources, and including frontline workers in decision‐making were all recommendations identified as elements for building resilient organizations (Benham et al, 2022; Shanafelt et al, 2020). Moreover, high‐performing teams place an emphasis on team communication, tracking performance, and devising better processes as a group (Kyle et al, 2021; Singer et al, 2021). Supervisors and other administrative leadership were likely stressed and overwhelmed themselves.…”