Team structure, team climate and the quality of care in primary care: an observational study

Bower, Peter; Campbell, Stephen; Bojke, Chris; Sibbald, Bonnie

doi:10.1136/qhc.12.4.273

Cited by 208 publications

(198 citation statements)

References 24 publications

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“…This study did not examine the impact of state certification of CHWs on the patient care or health outcomes, and assessed only one factor, team climate, in the complex system of interdisciplinary team based health care delivery. Previous research on team climate has shown it is affected by a variety of internal and external factors not assessed in this study including: leadership, electronic health record capability, organizational culture, organizational tenure, support from new roles, and professional role conflicts [31][32]. In addition, the survey questions did not address potential mediating and moderating variables including: payment options available for CHW services [26], team training, and organizational resources available for innovation and adoption of new models of health care delivery.…”

Section: Limitationsmentioning

confidence: 87%

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

Siemon

2014

J Community Health

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This is an author-produced, peer-reviewed version of this article. The final, definitive version of this document can be found online at Journal of Community Health, published by Springer. The final publication is available at link.springer.com. Copyright restrictions may apply. doi: 10.1007/ s10900-014-9919-6 AbstractA number of states have adopted certification programs for community health workers (CHWs) to improve recognition of CHWs as members of health care teams, increase oversight, and to provide sustainable funding. There has been little research into the impact of state CHW certification on the diffusion and adoption of CHWs into existing health care systems. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. The study recruited RNs using a purposeful sampling method and used an online survey, which included the Team Climate Inventory (TCI), and compared the perceptions of team climate between the two groups. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n = 81) and those who work in states without CHW certification programs (n = 115). There was a statistically significant difference on one survey question regarding whether RNs believe state certification of CHWs improved the ability of their health care team to deliver quality care. More research is needed to assess impact of state certification of CHWs and other factors that influence the diffusion and adoption of CHWs into the current health care system.

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Section: Limitationsmentioning

confidence: 87%

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

Siemon

2014

J Community Health

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“…The TCI has four subscales: vision, participative safety, task orientation, and support for innovation. 190 A study by Bower et al found that ratings on the Team Climate Inventory (TCI) were associated with better diabetes care, 172 while another study showed no relationship between the TCI and diabetes management. 173 The Intensity of Interprofessional Collaboration Questionnaire is an instrument that measures the nurse-physician collaboration in the inpatient setting.…”

Section: Teamwork Tools Associated With Patient Outcomesmentioning

confidence: 99%

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

et al. 2013

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OBJECTIVE: Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. DATA SOURCES: We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. STUDY ELIGIBILITY: Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. STUDY APPRAISAL AND SYNTHESIS METHODS:Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. RESULTS: Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. LIMITATIONS: Review is limited to quantitative assessments of teamwork in internal medicine. CONCLUSIONS:There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes. 3,4 Recognizing this, the Institute of Medicine, the Joint Commission, the Agency for Healthcare Research and Quality (AHRQ), and others have made teamwork a top priority in their recommendations for improving healthcare. [5][6][7][8][9] Teamwork is also prominently positioned within the American Board of Internal Medicine (ABIM) requirements for maintenance of certification for internists, 10 as well as the Accreditation Council for Graduate Medical Education's core competencies, 11 milestones, 12 and medical student competencies. 13 As such, every physician at the undergraduate, graduate, and continuing professional level must demonstrate competency in teamwork.While there is broad agreement on the imperative to improve teamwork, there is littl...

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“…Two articles were separate publications of one study, 15,16 three articles were separate publications of a second study, [17][18][19] and another two articles were separate publications of a third study. 20,21 Nine studies were conducted in the UK, [15][16][17][18][19][20][21][22][23][24][25][26][27] two in the US, 28,29 one in Canada, 30 and one in the Netherlands.…”

Section: How This Fits Inmentioning

confidence: 99%

Does practice size matter? Review of effects on quality of care in primary care

Ng¹,

Ng²

2013

Br J Gen Pract

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BackgroundThere is a trend towards consolidating smaller primary care practices into larger practices worldwide. However, the effects of practice size on quality of care remain unclear. AimThis review aims to systematically appraise the effects of practice size on the quality of care in primary care. Design and settingA systematic review and narrative synthesis of studies examining the relationship between practice size and quality of care in primary care. MethodQuantitative studies that focused on primary care practices or practitioners were identified through PubMed, CINAHL, Embase, Cochrane Library, CRD databases, ProQuest dissertations and theses, conference proceedings, and MedNar databases, as well as the reference lists of included studies. Independent variables were team or list size; outcome variables were measures of clinical processes, clinical outcomes, or patient-reported outcomes. A narrative synthesis of the results was conducted. ResultsThe database search yielded 371 articles, of which 34 underwent quality assessment, and 17 articles (13 cross-sectional studies) were included. Ten studies examined the association of practice size and clinical processes, but only five found associations of larger practices with selected process measures such as higher specialist referral rates, better adherence to guidelines, higher mammography rates, and better monitoring of haemoglobin A1c. There were mixed results for cytology and pneumococcal coverage. Only one of two studies on clinical outcomes found an effect of larger practices on lower random haemoglobin A1 value. Of the three studies on patient-reported outcomes, smaller practices were consistently found to be associated with satisfaction with access, but evidence was inconsistent for other patient-reported outcomes evaluated. ConclusionThere is limited evidence to support an association between practice size and quality of care in primary care. Keywordshealth facility size; primary care; quality of health care.

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Team structure, team climate and the quality of care in primary care: an observational study

Cited by 208 publications

References 24 publications

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

Does practice size matter? Review of effects on quality of care in primary care

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