142nd APHA Annual Meeting and Exposition

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311576
Developing effective primary care teams at an urban safety-net system: Predictors of operating as a real team and implications for PCMH development

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Adriana Bearse, MS , Institute for Community Health, Cambridge, MA
Jeffrey Desmarais, MA , Institute for Community Health, Cambridge, MA
Sami Hamdan, BA , Boston University School of Public Health, Boston, MA
Lisa Arsenault, PhD , Institute for Community Health, Cambridge Health Alliance, Cambridge, MA
Karen Hacker, MD, MPH , Allegheny County Health Department, Pittsburg, PA
Somava Stout, MD , Cambridge Health Alliance, Cambridge, MA
Background: Since the 2010 Patient Protection and Affordable Care Act, health systems face unique opportunities and challenges in moving toward patient-centered, team-based care delivery models. Central to patient-centered medical homes (PCMHs) is developing effective primary care teams, which better coordinate care, improve quality, and reduce costs – particularly important in safety-net settings facing limited resources and higher-risk patient populations.

According to management literature on teams in other industries, having a “real team” is an important condition for team effectiveness. However, this knowledge has rarely been applied to team development in safety-net healthcare settings.

Objective: Identify predictors of perceived “real teams” at ambulatory clinic practices within a safety-net hospital system.

Methods: An online workforce survey was administered in 2012 across 10 primary care sites at an urban, safety-net hospital system undergoing PCMH transformation. 428 providers/staff completed the survey (70% response rate); 297 indicated working on a care team and were included in the final sample.

Our primary outcome was measured using agreement (five-point likert scale) with “People in the practice operate as a real team.” Responses were dichotomized into “high” (strongly agree/agree) verses “low” (neither agree nor disagree/disagree/strongly disagree) agreement. Bivariate analyses using Chi-square tests and independent sample t-tests explored associations with operating as a real team and other measures of workforce perception/behavior. Multivariate logistic regression determined factors most highly associated with higher perceptions of being a real team.

Results: 55% of respondents (n=163) reported high perceptions of operating as a real team. Significant bivariate associations included: facilitative leadership (p<0.0001), job satisfaction (p=0.0002), care team behaviors (regular huddles, meetings) (p=0.0008), care team perception (communication, goals) (p=0.002), and lower burnout (0.039). Multivariate results revealed facilitative leadership as the primary factor associated with operating as a real team; those with higher ratings of leadership were 10 times as likely to have higher perceptions of being a real team (OR 10.0; 95% CI 5.10-19.60). Other independent variables were significant only with leadership removed from the model: care team behaviors (OR 3.69; 95% CI 1.39-9.80), care team perception (OR 2.61; 95% CI 1.11-6.14), and job satisfaction (OR 2.03; 95% CI 1.02-4.03).

Conclusion: Understanding contributing factors to effective primary care team development is critical as healthcare undergoes transformation to more patient-centered care. This study demonstrates the importance of facilitative leadership in developing teams where members perceive they operate as a “real team,” and suggests the importance of care team behaviors (e.g. huddling), job satisfaction and burnout.

Learning Areas:

Administration, management, leadership
Public health or related organizational policy, standards, or other guidelines
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Discuss national imperatives for high-functioning, effective primary care team development in safety-net healthcare settings. Articulate survey and analytic methods used to assess team perceptions and predictors of operating as ôreal team". List key predictors of high perceptions of operating as a real team in primary care settings. Identify ways in which ambulatory primary care leadership and staff can help facilitate more effective care teams.

Keyword(s): Patient-Centered Care, Health Systems Transformation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the project manager on the evaluation and data team overseeing and conducting analysis and reporting for the patient-centered medical home primary care team development workforce survey results to be presented here.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.