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