Teamwork in primary health care. 1. Perspectives from organisational psychology

West, Michael; Field, Rosemary

doi:10.3109/13561829509047845

Cited by 27 publications

(16 citation statements)

References 5 publications

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“…Stott sounded a note of caution about the growth of the primary care organisation and argued in favour of a 'core' team, sensing an emerging lack of continuity and fragmentation [19]. West [20], and Ovretveit [21] described the inherent barriers to teamwork in primary care, such as the lack of shared records, accommodation and accountability systems, and suggested changes that could reduce or remove these obstacles. Investments were made in team development initiatives [22] and instruments developed to measure team climate and levels of interprofessional collaboration [23].…”

Section: Resultsmentioning

confidence: 99%

Organisational development in general practice: lessons from practice and professional development plans (PPDPs)

Elwyn¹,

Hocking²

2000

BMC Fam Pract

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BackgroundImproving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care.ResultsPractice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change.It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external facilitation were clear: evaluations of internal group processes were possible, strategic issues could be raised and explored and financial probity ensured. These areas are much more difficult to examine when only internal stakeholders are engaged in a planning process.ConclusionsIt is not possible to introduce practice and professional development plans (organisational development and organisational learning projects) in a publicly funded health care system without first addressing existing educational and management structures. Existing systems are based on educational credits for attendance and emerging accountability frameworks (criteria checklists) for clinical governance. Moving to systems that are less summative and more formative, and based on the philosophies of continual quality improvement, require changes to be made in the relevant support systems in order achieve policy proposals.

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Section: Resultsmentioning

confidence: 99%

Organisational development in general practice: lessons from practice and professional development plans (PPDPs)

Elwyn¹,

Hocking²

2000

BMC Fam Pract

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“…Analogous to a tennis serve, HCPs are able to give detailed accounts of the preparation, aim, timing and execution of discharge from their respective settings, but cannot "see" the final ball drop (outcome) in the current unilateral system for transferring patients. A process for a formal feedback loop between care settings would facilitate transitional care in which HCPs can learn from outcomes (Piquette, Reeves, & Leblanc, 2009;West & Field, 1995). HCPs need basic knowledge about what occurs generally in other health care settings.…”

Section: Discussionmentioning

confidence: 99%

Examining “success” in post-hip fracture care transitions: A strengths-based approach

Sims‐Gould

Byrne

Hicks

et al. 2012

Journal of Interprofessional Care

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Transitions between health care settings are a high-risk period for care quality and patient safety (Coleman, 2003; Picker Institute, 1999), particularly for older patients - such as those with hip fracture - who have complex needs and may undergo multiple care transitions. We sought to understand the key elements of "success" in care transition. Using a strengths-based perspective (Rapp, 1998; Saleebey, 2006), we focused on interprofessional health care providers' perspectives of what constitutes a "good" care transition for elderly hip fracture patients. As part of a larger ethnographic field study, semi-structured interviews were conducted with 17 health providers across a number of disciplines employed across the continuum of post-hip fracture management in British Columbia, Canada. We found two hallmarks of "success" in care transitions: a focus on process - information gathering and communication, and a focus on outcomes - autonomy and care pathways. Strategies for promoting and improving success, such as using practitioner-driven ground-up solutions to address challenges in care transitions, are highlighted.

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“…• Participative safety: how participative the team is in its decision-making procedures and how psychologically safe team members feel it is to propose new and improved ways of doing things • Support for innovation: the degree of practical support for innovation attempts contrasted against the rhetoric of professed support by senior management • Vision: how clearly defined, shared, attainable and valued are the team's objectives and vision • Task orientation: the commitment of the team to achieve the highest possible standards of task performance, including the use of constructive progress monitoring procedures Several studies have subsequently demonstrated the utility of the TCI as a way of examining health care teams' support for innovation. 1,10,11,[13][14][15] Results have shown that effective teams, as judged by external raters, have higher TCI scores than poorly functioning teams. TCI scores are also related to an increased level of innovative practice and improved quality of care.…”

Section: Team Climate For Innovationmentioning

confidence: 99%

Clinical Team Functioning and IT Innovation: A Study of the Diffusion of a Point-of-care Online Evidence System

Gosling

2003

Journal of the American Medical Informatics Association

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Team functioning had the greatest impact on the fourth stage of innovation diffusion, the effective use of online evidence for clinical care. This supports Rogers' diffusion of innovation theory, to the effect that different types of communication about an innovation are important at different stages in the diffusion process. Members of small teams were more aware of the system than members of large teams. Team functioning is amenable to improvement through interventions. The findings suggest that the role of team climate in the diffusion of information systems is a promising area for future research.

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Teamwork in primary health care. 1. Perspectives from organisational psychology

Cited by 27 publications

References 5 publications

Organisational development in general practice: lessons from practice and professional development plans (PPDPs)

Organisational development in general practice: lessons from practice and professional development plans (PPDPs)

Examining “success” in post-hip fracture care transitions: A strengths-based approach

Clinical Team Functioning and IT Innovation: A Study of the Diffusion of a Point-of-care Online Evidence System

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