Development and Validation of the Primary Care Team Dynamics Survey

Abstract

Objective. To develop and validate a survey instrument designed to measure team dynamics in primary care. Data Sources/Study Setting. We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. Study Design. We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. Data Collection. We administered the survey between September 2012 and March 2013. Principal Findings. Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71-0.91), and discriminant validity (average factor correlations: 0.49). Conclusions. It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes). Key Words. Survey, primary care, team dynamics, team effectiveness There is increasing recognition that team-based approaches to delivering care in ambulatory settings may be critical for improving health care services and outcomes for patients. When patients require services of nurses, social workers, pharmacists, case managers, receptionists, or schedulers in addition to their primary care providers (e.g., physicians, nurse practitioners, and physi-

A Comprehensive Theory of Integration

“…Instruments for measuring types of integration could leverage existing tools and may also require novel construct development. For instance, interpersonal integration might be assessed using validated instruments that measure interprofessional teamwork (Song et al, 2015; Valentine, Nembhard, & Edmondson, 2015) while also requiring new constructs that include patients and caregivers, as their inclusion is critical to our definition of interpersonal integration. Given the emerging state of theory and empirical research on integration, a mix of close-ended questions to generate comparable answers and open-ended questions to record nuanced impressions and rich descriptions of context might best enable such surveys to provide a comprehensive assessment of types of integration.…”

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

“…Survey Data. Data on team dynamics and clinical work satisfaction came from annual administration of the Primary Care Team Dynamics Survey and a rating of clinical work satisfaction (Song et al, 2015) to all patient-facing staff at each practice site. The 26-item survey covers five domains of teamwork, including questions about skill sets of teams, communication within teams, shared goals and understanding of each other's roles, and perceptions of mutual respect and trust, plus one satisfaction measure.…”

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

“…There are at least 192 instruments available for assessment of team-based primary care (22). Although even more measures are being developed (23,24), the need to single out the most theoretically relevant assessment tools is urgent if we want to shift clinical practice and raise quality of care. The SEIPS model could help to crystalize what evaluation instruments are most suitable for the assessment of teambased care elements as well as guide the development of measures for SEIPS team-care components overlooked in the literature.…”